Fatoumata Diallo
Writing for the Sciences
Professor Zayas
Annotated Bibliography
March 26, 2025
Annotated Bibliography
Fattahi, S., Mullikin, T. C., Aziz, K. A., Afzal, A., Smith, N. L., Francis, L. N., Harmsen, W. S., Routman, D. M., Remmes, N. B., Ahmed, S. K., Shumway, D. A., Park, S. S., Mutter, R. W., & Corbin, K. S. (2022). Proton therapy for the treatment of inflammatory breast cancer. Radiotherapy and Oncology, 171, 77–83. https://doi.org/10.1016/j.radonc.2022.04.008
IBC is a rare and aggressive subtype of breast cancer. It accounts for less than 2% of breast cancer cases. The characteristic of IBC includes erythema and edema. Current treatment for IBC is surgery(mastectomy), neoadjuvant chemotherapy, and post-mastectomy radiology (PMRT). PMRT is often extremely aggressive due to high dosages and is often very toxic for IBC patients. Intensity modulated proton therapy (IMPT) is a developing treatment for inflammatory breast cancer. It is a form of radiotherapy that is meant to target and shrink the tumor while minimizing the exposure to other organs. IMPT reduces the toxicity of the radiation due to accuracy rapid dose fall-off. In this study (2016-2020) they test the possibility of IMPT. They treated 19 IBC patients with adjuvant IMPT, treatment planning started 4-7 weeks (about 1 and a half months) post-op. They used Ct scan to CTV coverage and dosage. The Radiation targeted the chest wall, lymph nodes, and skin. Results showed the IMPT can be a treatment for IBC with more patient observation, but more data needs to be collected on toxicity and survival rates.
This source explores a new treatment for IBC IMPT that has not been tested before, the study compares IMPT to the standard treatment for IBC(surgery, chemotherapy, and radiology). The study also addresses the cons of IBC treatment that aren’t talked about enough
“Intensity modulated proton therapy (IMPT) is an attractive emerging modality for breast cancer due to unique physical properties with rapid dose fall-off at the proton Bragg Peak [18,19]. Compared with photon-based techniques, IMPT may allow for more comprehensive CTV coverage and lower exposure to OARs [18,20]” (Fattahi et al., 2022)
“All patients were treated with multi-field optimized pencil-beam scanning IMPT on a Hitachi PROBEAT-V proton therapy system (Hitachi, Tokyo, Japan) with a range shifter to adequately cover the skin [19]” (Fattahi et al., 2022)
“Median follow-up was 24 months (IQR: 12–28 months). There have been no locoregional recurrences. Three have developed distant metastases – 1 to the brain and lung at 4 months, 1 to the cervical nodes and lung at 6 months, and 1 to the bone at 19 months. At 2 years, OS and DMFS were 89% and 82%, respectively (Figs. 2 and 3). OS and DMFS, stratified by RCB-0/I versus RCB-II/III, were 100% versus 83% and 100% versus 73%, respectively” (Fattahi et al., 2022)
“IMPT for IBC is well-tolerated with excellent dosimetry, low rates of AEs, and favorable early locoregional control outcomes. Follow-up for long-term outcomes is ongoing. Our findings suggest that IMPT is feasible and an attractive modality worthy of further investigation in patients with IBC” (Fattahi et al., 2022)
Robertson, F. M., Bondy, M., Yang, W., Yamauchi, H., Wiggins, S., Kamrudin, S., Krishnamurthy, S., Le-Petross, H., Bidaut, L., Player, A. N., Barsky, S. H., Woodward, W. A., Buchholz, T., Lucci, A., Ueno, N., & Cristofanilli, M. (2010). Inflammatory breast cancer: The disease, the biology, the treatment. CA: A Cancer Journal for Clinicians, 60(6), 351–375. https://doi.org/10.3322/caac.20082
Inflammattory Breast Cancer is a rare and aggressive form of breast cancer that only accounts for 2.5% of all breast Cancer cases. IBC has had a less than 5% survival rate beyond 5 years. IBC is often misdiagnosed with mastitis. The standard treatments for IBC are systemic therapy, radiation, and surgery. Treatments using surgery and radiation led to a survival rate of 15 months and in half the cases the cancer returns. Common signs of IBC include erythema(redness), edema(swelling), and orange peel appearance. IBC spreads fast so often redness can cover 1/3 of the breast, also within a few days the skin can change from pink to dark red/purple. Doctors diagnose IBC by finding dermal tumor emboli on the breasts, those emboli are found in the lymphphatic tissue which helps doctor differentiate IBC from other BC. IBC can be misdiagnosed with other conditions such as melanoma and other metastatic cancers. There are many risk factors of IBC such race, Obesity, and age. Black women and younger women have higher IBC rates and worse survival rates compared to white women. Studies have shown that the highest IBC rates are in Tunisia, and that rare male IBC patients were documented since 1953, in addition there has not been a genetic link for IBC. Imaging has a huge role in diagnosing and monitoring IBC. Mammographs are not effective, but ultrasound helps with finding the tumor and lymph nodes, MRI are great for tracking the tumor and PET/CT scans help with tracking tumor growth.
“African American women were found to have an incidence of IBC at least 50% higher than white women, to be diagnosed at younger ages, and to have decreased survival times” (Robertson et al., 2010).
“The frequency of involvement of axillary and supraclavicular lymph nodes in different studies of IBC patients has ranged from 60% to 85%.17” (Robertson et al., 2010).
“The presence of pertinent histopathological findings in the mammary parenchyma and overlying skin, however, in conjunction with the characteristic clinical history, can allow the pathologist to suggest a diagnosis of IBC” (Robertson et al., 2010).
“One of the most frequently described changes associated with IBC is erythema, where the skin overlying the breast shows a pink or mottled pink hue” (Robertson et al., 2010).
