Inflammatory Breast Cancer Treatment

Your cancer treatment should not be a "one-size-fits-all." At Penn Medicine’s Abramson Cancer Center, our multidisciplinary team will work with you to create a treatment plan that may include one or a combination of the following treatments.

Surgery for Inflammatory Breast Cancer (IBC)

Breast-conserving Surgery

Breast-conserving surgery removes only the affected part of the breast and a surrounding margin (region) of normal tissue. Because of the aggressive nature of IBC and because it is locally advanced in the breast at diagnosis, breast-conserving surgery is generally not recommended.

Mastectomy Surgery

Mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues. In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast.

A modified radical mastectomy is a simple mastectomy plus removal of axillary (underarm) lymph nodes. In IBC, an axillary lymph node dissection is almost always done (as opposed to sentinel lymph node).

For some women considering immediate breast reconstruction, a skin-sparing or nipple-sparing mastectomy can be done.

Reconstructive Surgery

Breast reconstruction is a surgical procedure performed to recreate the shape and appearance of a woman's breast following a mastectomy. At Penn, we believe that restoration of the breast following mastectomy is an integral part of the holistic treatment of breast cancer.

There are two types of breast reconstruction:
  • Tissue flap
  • Breast implant
Surgeons at Penn Medicine are pioneers in tissue flap reconstruction, which uses a woman’s own tissue to reconstruct the breast.


Radiation Therapy for Inflammatory Breast Cancer (IBC)

Radiation therapy stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Conformal Radiation Therapy

Modern radiation therapy is designed with 3-dimensional virtual reality computer programs. The imaging technology used by radiation oncologists shape the radiation treatment beams to the shape of the breast. Known as conformal radiation therapy, this technology gives doctors more control when treating breast cancer.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the breast and the normal organs to be avoided, like the lung and heart. The system permits delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the breast. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Deep Inspiration Breath Hold

This very specialized method for breast radiation is used for women with left-sided breast cancer.

The radiation is timed carefully to the respiration cycle of the woman — during a deep inspiration.

This method may cause the lung to expand and move the heart farther away from the left breast than without a breath hold. In this way, less radiation is given to the heart.

A woman is given special training on how to do this and works with her therapists to do this correctly every day of treatment.

Image-Guided Radiation Therapy (IGRT)

Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery of the radiation treatment. In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that take pictures of the tumor immediately before or even during the time radiation is delivered.

Specialized computer software compares these images of the tumor to the images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to the patient's position and/or the radiation beams to more precisely target the breast and avoid the healthy surrounding tissue.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy utilizing computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors.

Using 3-D computed tomography (CT) images of the patient in conjunction with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the breast tumor by controlling—or modulating—the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused to regions within the breast while minimizing the dose to surrounding normal critical structures.<

IMRT may be used in some cases of IBC instead of 3-D conformal planning when the greater computer-assisted planning will help shape the dose treating the breast or spare normal tissue better.

Prone Position

For many women with large or pendulous breasts, and left-sided breast cancer, radiation can be planned and delivered with the patient lying on her stomach instead of her back.

The breast hangs down with gravity into an opening in the treatment table. This method can reduce the dose of radiation to the heart.

There may also be less immediate skin reactions from radiation with prone position in common areas like the underside of the breast by reducing skin folds.

Proton Therapy

Proton therapy is an external method of partial breast radiation.

Unlike conventional radiation that can affect surrounding healthy tissue as it enters the body and targets the tumor, proton therapy's precise, high dose of radiation is extremely targeted. This targeted precision causes less damage to healthy, surrounding tissue.

When aimed at cancer tumors, protons pack impressive power. Protons release their energy completely once they enter a tumor, limiting the radiation dose beyond the tumor, causing less damage to the healthy surrounding tissues and resulting in fewer side effects.

Even if you've already had a course of conventional radiation and are unable to receive more, you may still be able to receive proton therapy.

More facts about proton therapy:
  • Proton therapy offers fewer reported side effects and complications
  • Normal, healthy, surrounding tissues receive 50% to 70% less radiation
  • Proton therapy offers an increased safe dose delivered to tumors
  • Cure rates may be increased with proton therapy
  • Proton therapy can re–treat tumors after recurrences.

Thanks to its marvelous precision, proton therapy is perhaps the most advanced treatment for cancer tumors located close to critical organs and highly sensitive areas, such as the spinal cord, heart and brain.


Proton therapy is also an important treatment option for cancers that cannot be completely removed by surgery.

Whole Breast Radiation Therapy

Radiation therapy stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all cancer cells. Radiation is generally given after surgery, but in some cases of inflammatory breast cancer, it may be given before surgery.

For more than 25 years, breast-conserving surgery and radiation therapy have been standard alternatives to mastectomy for women with early stage breast cancer. Radiation after a lumpectomy reduces the risk of a recurrence in the breast.

Historically, radiation therapy after lumpectomy has treated the whole breast — this may make sense as radiation was replacing another whole breast treatment (mastectomy). For many women, after radiation is given to the whole breast, an additional more focused dose of radiation is given to the lumpectomy cavity, called a cone down or boost.

Shorter Radiation Schedule

Conventional treatment schedules involve daily radiation Monday through Friday for five to six weeks.

Hypofractionation, however, uses fewer, larger dose radiation treatments (also called fractions) usually given over a shorter time period when compared to standard radiation fraction sizes.

This type of radiation therapy reduces the length of a course of treatment by two to three weeks compared to standard schedules. This reduced length of treatment reduces cost, reduces travel or lost days of work, and reduces the inconvenience of a course of radiation. In addition, studies show that there are no significant differences in cosmetic appearance of the breast or other negative side effects in women treated with a shorter course of radiation.

Chemotherapy and Other Biologic Therapies for Inflammatory Breast Cancer (IBC)

Chemotherapy

Penn medical oncologists have a great deal of experience in the use of chemotherapy as part of an overall breast cancer treatment program and in chemotherapy research. Chemotherapy uses drugs to kill cancer cells.

Chemotherapy drugs attack cancer cells, slowing or stopping their ability to grow and multiply. Chemotherapy is usually given in one of the following ways:
  • Orally. Taking pills or capsules by mouth
  • Intravenously (IV). Injecting medication into a vein
  • Intramuscularly (IM). Injecting medication into the muscle
  • Subcutaneously. Injecting medication into the skin
Chemotherapy is not a 'one-size-fits-all' breast cancer treatment. The wide range of cancer-fighting drugs attack different types of cancer cells at varying stages of cell development. The medical oncologists at Abramson Cancer Center are experts at determining which drug or combination of drugs are the most effective in treating breast cancer.

Depending upon the kind of cancer and its stage of development, chemotherapy can be used to:
  • Destroy cancer cells
  • Prevent the spread of cancer to other parts of the body
  • Kill cancer cells that have spread to other parts of the body
  • Decrease the size of a cancerous tumor
  • Relieve symptoms caused by cancer
For a comprehensive list of most commonly used chemotherapy agents, please visit OncoLink.

Anti-hormone Therapy

Estrogen or progesterone promote the growth of about two out of three breast cancers — those containing estrogen receptors (ER-positive cancers) and/or progesterone receptors (PR-positive cancers). Because of this, several approaches to blocking the effect of estrogen or lowering estrogen levels are used to treat ER-positive and PR-positive breast cancers. Hormone therapy does not help patients whose tumors are both ER- and PR-negative.

Anti-hormone therapy is used to help reduce the risk of breast cancer recurrence after surgery in cancers that are ER and/or PR positive. Anti-hormone therapy is NOT the same as hormone replacement therapy used after menopause. Certain types of hormone replacement therapy are associated with increasing risk for breast cancer. Anti-hormone therapy for breast cancer is anti-estrogen therapy and decreases the risk of cancer recurrence. Similar hormone therapies are used in DCIS to decrease the risk of developing a new cancer.

Immunotherapy

Immunotherapy is designed to repair, stimulate, or enhance the immune system's responses.

Your immune system helps prevent disease, but it can also play a role in preventing cancer from developing or spreading.

The goal of immunotherapy is to enhance the body's natural defenses and its ability to fight cancer.

Immunotherapy often has fewer side effects than conventional cancer treatments because it uses your own immune system to:
  • Target specific cancer cells, thereby potentially avoiding damage to normal cells
  • Make cancer cells easier for the immune system to recognize and destroy
  • Prevent or slow tumor growth and spread of cancer cells
The use of immunotherapy to treat breast cancer is still under investigation. There are a variety of trials open at the Abramson Cancer Center studying immunotherapy to treat various stages of breast cancer.

Clinical Trials at Penn Medicine for Inflammatory Breast Cancer (IBC)

Clinical trials benefit patients by offering access to breakthrough therapies and treatments.

Because more and more treatments for cancer are becoming available, it’s important to speak with your doctor about available clinical trials throughout your entire cancer treatment.

Advantages of Clinical Trials

Being in a clinical trial offers you the opportunity to be treated with treatments, medications or agents that are not otherwise available.

It also gives you the opportunity to be treated by, and have your case reviewed by experts who are directly involved with the design of the treatment.

Through clinical trials:

  • Diagnosing cancer has become more precise
  • Radiation and surgical techniques have advanced
  • Medications have been improving
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes
  • Strategies to address the late effects of cancer and its treatment have been developed to improve the quality of life

Learn more about clinical trials, frequently asked questions about clinical trials, and available clinical trials at the Abramson Cancer Center.

Complementary and Integrative Therapies for Inflammatory Breast Cancer (IBC)

In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy.

These therapies do not have curative intent, and are designed to complement standard treatments — not take their place.

Integrative Oncology Services

Our integrative oncology services can supplement traditional cancer treatments such as chemotherapy. We are knowledgeable of and support complementary cancer treatments.

While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you and your family ways to minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Our cancer teams work with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

Our integrative supportive services include: