INFLAMMATORY BREAST CANCER IN A TUNISIAN UNIVERSITY HOSPITAL FROM 2007 TO 2012 : HOW TO MANAGE INFLAMMATORY BREAST CANCER WITH LIMITED RESSOURCES

Ammar.N¹, Ezzaairi.F, Belaid.I, Khechine.W, Ben fredj.M, Zaghouani.H, Hochlaf.M, Chabchoub.I, Ben fatma.L, Mokni.M4, Bibi.M, Ben ahmed S

ABSTRACT

IBC is the most aggressive and deadly form of breast cancer and is frequently misdiagnosed and therefore considered as a rare entity. The typical clinical presentation of a quickly developing locally advanced disease shows the obvious limitations to the early diagnosis of the disease with radiological screening approaches. Management involves coordination of multidisciplinarymanagement. This multimodal therapeutic approach has significantly improved patient survival. Objectives: assess the clinical-pathological parameters and outcome of IBC at the center of Tunisia. Materials and Methods: We screened 1260 breast cancer cases registered from January 2007 to December 2012 and found100 cases of IBC. Patients who presented with IBC as a recurrence, or who had a neglected and advanced breast cancer that simulated an IBC were excluded from this study. Results: The median age was 51 years (range 29-85). The median duration of symptoms was 4 months. The American Joint Committee on Cancer stage (AJCC) distribution was Stage III- 57 and IV- 43 patients. Estrogen receptor (ER), progesterone receptor (PR) positivity and human epidermal growth factor receptor2 (HER2/neu) positivity were 57%, 46% and 36 %, respectively. Triple negativity was found in 35% of the cases. All the non metastatic IBC patients received anthracycline and/ or taxane based chemotherapy followed by modified radical mastectomy, radiotherapy and hormonal therapy as indicated. The pathological complete remission rate was 21 %. At a median follow-up of 149 months, the 3 year relapse free survival and overall survival were 15% and 28 % respectively. Median overall survival was 18 months, and its influencing factors according to our results were: estrogen receptor positivity, presence of extracapsular extension and M tumor stages, lymphovascular space invasion and adjuvant chemotherapy. Conclusion: IBC is an aggressive subtype of locally advanced breast cancer; it is heterogeneous with various factors influencing survival.

Keywords: Inflammatory breast cancer – Epidemiology- treatment - outcome –prognostic factors- Tunisia.