Surgery for Inflammatory Breast Cancer: How and Why
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Transcript of Surgery for Inflammatory Breast Cancer: How and Why
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Faina Nakhlis
Division of Surgical OncologyDana Farber Cancer Institute
1st Annual IBC Patient Forum
May 13, 2017
Surgery for Inflammatory Breast Cancer (IBC): How and Why
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Histologic Evaluation
Dermal lymphatic invasionGrade 3 invasive ductal carcinoma
Image-guided core needle biopsy +/- skin punch biopsy
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Initial Evaluation
Peau d’orange (dermal lymphatic invasion)
Unresectable disease
1. Neoadjuvant systemic therapy for cytoreduction
2. Modified radical mastectomy
3. Chest wall and regional nodal radiotherapy*
*Morris, Journal of Surgical Oncology 1983; Dawood et al. Annals of Oncology 2011
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What is the Role of Surgery in IBCSurvival in 28 patients with IBC (23 patients with stage III disease) with and without surgery, 1969-1980
Hagelberg, Jolly, Anderson, Am Journal of Surgery 1984
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What is the Role of Surgery in IBCRecurrence and survival in 107 patients with IBC with and without surgery, 1958-1985
Fields et al, Cancer 1989
Multivariate Analysis
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What is the Role of Surgery in IBCResponse to chemotherapy, receipt of surgery and outcomes in 178 IBC patients
1974-1993, median follow-up 89 months (22-223 months)
Fleming et al, Ann Surg Oncol 1989
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What is a Modified Radical Mastectomy
Mastectomy (total, simple) + Axillary lymph node dissection
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Why Mastectomy
The cancer is often present throughout the breast at the time of diagnosis
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Why Axillary Lymph Node Dissection?
Axillary lymph nodes are almost always involved at diagnosis and it may be unsafe to not to remove them
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Drains
Round Jackson-PrattRound Blake Flat Jackson-Pratt
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Why Should Immediate Reconstruction Not Be Done in IBC?
The amount of involved skin can go beyond what is clinically visible
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Patterns of Breast Reconstruction in Patients Diagnosed with Inflammatory Breast Cancer: the Dana Farber Cancer
Institute’s Inflammatory Breast Cancer Program Experience
F. Nakhlis, M.M. Regan, Y.S. Chun, L.S. Dominici, J.R. Bellon, L. Warren, E.D. Yeh, H.A. Jacene, K. Hirko, A. Hazra, J Hirshfield-
Bartek, T. A. King, B. Overmoyer
SABCS 2015 Poster
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Background
• Immediate reconstruction is not advised in IBC patients due to lack of safety data for skin-sparing mastectomy
• Data on breast reconstruction outcomes in IBC patients are scant
• Our experience with breast reconstruction in IBC patients was reviewed
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Methods
• Retrospective analysis of IRB-approved DFCI IBC database
• Patients included in the analysis• Stage III IBC
• Sufficient response to preoperative chemotherapy to achieve resectability
• No preoperative radiotherapy
• No loco-regional progression or distant metastasis during preoperative chemotherapy
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Results
Stage III IBC patients* (1997-2014), n=167
Immediate reconstruction,
n=12
Delayed reconstruction,
n=18
No reconstruction, n=135
*In two patients breast reconstruction took place but no information about reconstruction details and follow-up is available
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Immediate Reconstruction, n=12*
Reconstructive Option Number of Patients
Tissue expander 3
Single stage implant 3
DIEP flap 1
TRAM flap 4
Latissimus Dorsi flap 1
*Eleven out of 12 patients with immediate reconstruction underwent surgery outside of DFCI
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Delayed Reconstruction, n=18
Reconstructive Option Number of Patients
Tissue expander 1
TRAM flap 9
DIEP flap 5
Latissimus Dorsi and tissue expander 1
Latissimus Dorsi flap 2
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Complications After Delayed Reconstruction
ComplicationDelayed Reconstruction
(N=18)
Reoperation for flap donorsite wound dehiscence
1 (6%)
Reconstruction loss 1 (6%)
Total Complications 2 (12%)
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Future Direction
• Exploration of the role of local therapy (surgery and radiation) in stage IV IBC
•Axillary and extra-axillary lymphatic drainage in IBC and the potential for sentinel node mapping