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We performed a retrospective review of 65 patients with nonmetastatic clinical inflammatory breast carcinoma treated with radical radiotherapy as the sole local treatment between 1968 and 1986. Chemotherapy was given to 47 patients (72%). The median total radiation dose to the target volume was 6,984 cGy. With a median follow-up in survivors of 41 months, the 5-year actuarial probability of relapse-free survival was 17% and the overall survival was 28%. Thirty patients experienced failure in the treated breast, skin, or draining lymph nodes, for a crude, uncensored local recurrence rate of 46%. Of the factors analyzed, only the response to initial chemotherapy was predictive of local recurrence. Local recurrence was noted in 0 of 3 patients with a complete response (CR) to initial chemotherapy, 5 of 17 patients with a partial response (PR), and 12 of 17 patients with less than a partial response (CR/PR versus less than PR, p = 0.009). We conclude that conventional radical radiotherapy in unselected patients is insufficient to manage the local tumor burden presented by inflammatory breast cancer, even when high doses are employed., Inflammatory carcinoma of the breast is an aggressive type of cancer, having a high risk of rapid spread and an extremely poor prognosis. This cancer usually has an acute onset with symptoms of redness, edema, and local heat of the breast. Treatment by mastectomy (breast removal) is almost always followed by local or regional cancer spread. Treatment with radiotherapy has been advocated to improve survival, but there are conflicting reports on the results. In nonrandomized studies, combination chemotherapy has been reported to improve survival. To reevaluate the effectiveness of this treatment, a retrospective review was undertaken of 65 women, with inflammatory breast cancer without metastasis (cancer spread), who were treated by radical radiotherapy. There were 18 women who received only radiotherapy (treated prior to 1974); 47 women (72 percent) received both radiotherapy and systemic chemotherapy. Radiotherapy was delivered to the breast, chest wall, and sometimes the breast lymph nodes; average total radiation dose was 6,984 units. At five years, the disease-free survival rate was 17 percent, and overall survival was 28 percent. There were 30 women who had local recurrence. The only factor predictive of local recurrence was initial response to chemotherapy. None of the three patients who had complete response to initial chemotherapy had local recurrence. Of the 17 women with partial response, five had local recurrence; and of the 17 women with less than partial response, 12 had local recurrence. It is concluded that even at high doses, radical radiotherapy alone does not control local tumor growth in patients with inflammatory breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

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