I am writing in reference to your Oncology Rounds section
in the September 2000 issue of Oncology News International (page
18). In the first case, entitled What further therapy for this
woman postmastectomy? I noted that in the answer given by I.
Craig Henderson, MD, there was no specific mention of adjuvant
This patient had inflammatory breast cancer by definition with dermal
lymphatic involvement and, in addition, on mastectomy had positive
margins on the chest wall.
Although I would agree with Dr. Henderson that she should be treated
with aggressive systemic therapy, she is also at high risk for
locoregional recurrence and should be treated with post-mastectomy radiation.
I do agree with Dr. Hendersons comments that upfront
chemotherapy followed by local treatment (mastectomy and
then adjuvant radiation therapy) would have been the optimal
GABRIELA B. MASKO, MD
Radiation Oncology Associates, Inc.
Providence, Rhode Island
In the September ONI Oncology Rounds, a reader
asked about further treatment for a woman after mastectomy. Clearly,
this woman has inflammatory breast cancer, and while I would agree
with Dr. I. Craig Hendersons approach with chemotherapy
preoperatively, I do not understand his omission of the need for
radiation therapy after her chemotherapy and surgery is complete.
This patient has a positive margin and dermal lymphatic invasion, and
has a very high likelihood of local recurrence and requires
Please clarify this issue with Dr. Henderson. From a medical oncology
standpoint, I am afraid readers will assume that chemotherapy is the
only adjuvant treatment this patient will need. Without question, she
needs radiation therapy as well.
ANITA JOY HILLIARD, MD
Radiation Oncology Associates of Lynchburg, Inc.
Dr. Henderson Replies:
In my discussion of this case in Oncology Rounds, I
referred to local treatment, stating that many, if
not most, oncologists would have treated this patient with
chemotherapy before administering local treatment. Dr. Hilliard
assumed I meant mastectomy when referring to local
treatment. Dr. Masko assumed I meant both mastectomy and
adjuvant radiation therapy.
In actual practice, I always administer radiation therapy to a
patient with inflammatory breast cancer. I do not always
recommend mastectomy. This will depend on the completeness of the
patients response to chemotherapy and radiation therapy.
I have a few patients who were treated with chemotherapy and
radiation therapy only who are alive and free of disease for periods
in excess of 10 years.
I. CRAIG HENDERSON, MD
Adjunct Professor of Medicine
University of California
San Francisco, California