Vnetni rak dojk: priporočila za diagnostično obdelavo in zdravljenje

Inflammatory breast cancer (IBC) represents 1-5% of all breast cancer. Early and accurate diagnosis of this aggressive disease is of critical importance for the outcome. Diagnosis is made based upon its typical clinical appearance (breast erithema, edema and/or peau d’orange) and histopathological confirmation of invasive cancer. A multimodality approach is recommended for treatment. The initial treatment recommended in a localised disease is primary systemic chemotherapy with anthracyclines and taxanes for a duration of 4-6 months. The surgical treatment of choice is a modified radical mastectomy, followed by adjuvant radiation of the mammary region and ipsilateral supraclavicular region. According to predictive factors, adjuvant hormonal and/or trastuzumab therapy is indicated; the latter could be used in combination with taxanes even in the neoadjuvant setting. Despite the multimodality approach, the outcome of IBC is not optimal (median overall survival in localised disease patients is less than four years). Patients with IBC should be treated in experienced oncological centres with the possibility of cooperation in international randomised clinical studies.Vnetni rak dojke predstavlja 1 do 5 % raka dojke. Zaradi agresivne narave bolezni sta bistvenega pomena zgodnja diagnoza in začetek zdravljenja. Diagnoza se postavi na podlagi značilnega kliničnega videza (rdečina, edem in/ ali »pomarančna« koža dojke) in histopatološke potrditve diagnoze raka dojke. Zdravljenje je multimodalno. Začetno zdravljenje pri lokalizirani bolezni je sistemska neoadjuvantna kemoterapija z antraciklini in taksani, ki traja 4 do 6 mesecev, sledita modificirana radikalna mastektomija ter dopolnilno obsevanje mamarnega predela in ipsilateralne supraklavikularne lože. Glede na prediktivne dejavnike je indicirano še morebitno zdravljenje z dopolnilnim hormonskim ali biološkim zdravljenjem s trastuzumabom, ki se v kombinaciji s taksani lahko uporablja tudi že v neoadjuvantnem zdravljenju. Kljub multimodalnemu zdravljenju je izid vnetnega raka dojke še vedno slab (srednje preživetje manj kot 4 leta), zato priporočamo zdravljenje v specializiranem onkološkem centru, ki ima izkušnje s tem in kjer je možnost vključevanja v prospektivne mednarodne klinične raziskave