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Annals of Oncology Advance Access originally published online on November 15, 2007
Annals of Oncology 2008 19(3):473-480; doi:10.1093/annonc/mdm480
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© The Author 2007. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

breast cancer

Inflammatory breast cancer in Tunisia in the era of multimodality therapy

S. I. Labidi1,2,*, K. Mrad3, A. Mezlini1, M. Ayadi Ouarda1, J. D. Combes4, M. Ben Abdallah5, K. Ben Romdhane3, P. Viens6 and F. Ben Ayed1

1 Department of Medical Oncology, Salah Azaiz Institute, Tunis, Tunisia
2 Department of Medical Oncology, Centre Léon Berard, Lyon, France
3 Department of Pathology, Salah Azaiz Institute, Tunis, Tunisia
4 Department of Biostatistics, Centre Léon Berard, Lyon, France
5 Department of Epidemiology and Biostatistics, Salah Azaiz Institute, Tunis, Tunisia
6 Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France

* Correspondence to: Dr S. I. Labidi, Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon 69008, France. Tel: +33-4-78-78-28-28; Fax: +33-4-78-78-28-16; E-mail: labidi{at}lyon.fnclcc.fr

Background: This study aimed to identify prognostic factors for outcome in Tunisian patients with nonmetastatic inflammatory breast cancer (IBC) receiving multimodality therapy.

Patients and methods: From 1994 to 2000, 100 patients with nonmetastatic IBC were reviewed. Patients underwent neo-adjuvant chemotherapy including anthracyclines (99%), then mastectomy (93%) when feasible, radiotherapy (83%) and adjuvant chemotherapy (84%). Sixty patients (60%) had hormone therapy.

Results: Median age at diagnosis was 44 years (range 23–71). Seventy patients had premenopausal status (70%). Ten cases occurred during pregnancy (10%). Body mass index indicated overweight or obesity in 76 patients (76%). After neo-adjuvant chemotherapy, pathologic complete response (pCR) rate was 20%. Median time of follow-up for surviving patients was 44 months. Median progression-free survival (PFS) was 19 months and overall survival (OS) 30 months. Factors associated with improved survival were no pregnancy (P = 0.0095), estrogen receptor positivity (P = 0.028), tumor size <5 cm (P = 0.021), clinical complete response (cCR) (P = 0.022), pCR (P = 0.011), negative nodes (P = 0.053) and hormone therapy (P < 0.001). In multivariate analysis, cCR, negative nodes and hormone therapy were independently associated with better OS and PFS. Factors predictive to pCR were age >45 years, negative nodes and cCR.

Conclusions: Tunisian patients with IBC have particular epidemiologic characteristics, with earlier disease and context of overweight and obesity, but prognostic factors are similar to those reported in the literature. Hormone therapy seems to improve patient outcome.

Key words: hormone therapy, inflammatory breast cancer, multimodality therapy, pathologic complete response, prognostic factors, Tunisia

Received for publication May 15, 2007. Revision received September 10, 2007. Accepted for publication September 12, 2007.


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