Would presence of DIEP flap reconstruction impact your decision to proceed with a BID approach to PMRT for inflammatory breast cancer?

The short answer is no. I would first carefully review the history that led to an IBC patient having immediate reconstruction since immediate reconstruction is not recommended and it warrants a careful review. Ideally, the patient would have upfront photos of skin involvement, bilateral nodal evaluation (regardless of contralateral breast findings; the contralateral nodes can be positive in up to 10% of cases), and cross-sectional neck imaging (PET/CT or dedicated neck CT) as these are commonly ...

There are really two separate questions here. First, what is the experience with PMRT for patients undergoing immediate reconstruction after mastectomy for inflammatory breast cancer (IBC)? Second, what fractionation scheme(s) are appropriate for patients with IBC to achieve optimal local-regional control, leaving aside the impact on the reconstruction?

Very few IBC patients appear to have had immediate autologous reconstructions. For example, the M.D. Anderson Cancer Center treated 7 patients (5...

No. Inflammatory cancer is an aggressive form of breast cancer and the risk of LF is generally higher than most patients. So, skimping on local-regional therapy is not optimal. Now, are there some patients who can 'get away' with skipping PMRT? Almost certainly, so as our chemo gets better; but I do not know that we know well enough who those patients are (e.g. just "a little" [whatever that means] skin involvement, good response to induction chemo, etc.). I suspect that data-sets may become ava...