INflammatory breast cancer Surgery: Preserving versus Radical therapy – a rEgistry based study
Step one: Inflammatory Breast Cancer Surgery: Preserving versus
Radical Therapy – A Registry-Based Study (Step 1)
Step two: Inflammatory Breast Cancer Surgery: Preserving versus
Radical Therapy – A New International Registry (Step 2)
Principal Investigator
| Dr Jan Žatecký Breast Surgeon, Department of Surgery, Moravian-Silesian Hospital in Opava Researcher, Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Lecturer, The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian Czech Republic |
Sub-Principal Investigator
| Prof Dr Med Thorsten Kühn Die Filderklinik, Filderstadt-Bonlanden Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Ulm, Ulm Germany |
Steering Board
Assoc. prof. Oldřich Coufal, MD, PhD
Dr. Kerstin Pfister, Ulm University, Ulm, Germany
Prof. Jan Beneš, MD
Contact email:
Summary:
Background and rationale
Over the past decades, surgical de-escalation in breast cancer has increasingly been adopted across a broad range of patients. Unfortunately, patients with inflammatory breast cancer (IBC) have largely been excluded from many of the pivotal studies evaluating less invasive surgical approaches. As a result, mastectomy and axillary lymph node dissection (ALND) remain the standard surgical approach for patients with IBC, regardless of their response to neoadjuvant therapy (NAT).
Inflammatory breast cancer (IBC) represents one of the most aggressive subtypes of breast cancer and has traditionally been managed with multimodal therapy, including mastectomy and axillary lymph node dissection. Unlike patients with other breast cancer subtypes, those with IBC have been systematically excluded from key prospective trials investigating less invasive breast and axillary approaches, such as breast-conserving surgery with sentinel lymph node biopsy (SLNB), targeted lymph node biopsy (TLNB), or targeted axillary dissection (TAD).
Nevertheless, emerging evidence suggests that the therapeutic benefit of axillary dissection in IBC may be more limited than previously assumed. Analyses of large databases have shown no clear survival advantage associated with radical axillary surgery in patients with clinically node-negative IBC. Moreover, real-world series indicate that a substantial proportion of patients achieve a complete nodal response (ypN0) following NAT, particularly those with triple-negative or HER2-positive tumors.
These findings raise important concerns regarding potential axillary overtreatment in IBC and highlight the need to critically re-evaluate current surgical standards. Prospective studies, like INSPIRE, are therefore needed to determine whether selected patients with IBC who achieve an excellent response to NAT may safely benefit from less extensive axillary surgery.
Study Milestones:
Step 1: Registry-based data analysis (Baden-Württemberg Cancer Registry)
Step 2: Registry-based data analysis (Consortium of German Cancer Registries)
Step 3: Prospective IBC arm of the AXSANA study (from Fall 2026 onwards)
Prizes and Presentations:
1. European Society of Surgical Oncology (ESSO) 2026 – Poster
De-escalation of Axillary Surgery in Inflammatory Breast Cancer: A New Clinical Era
Authors: J. Žatecký, O. Coufal, T. Kühn, I. Surovtsova, K. Pfister, K. Burtscher, P. Morakis
2. Annual Congress of the German Society for Senology 2026 – Poster Award
Inflammatory Breast Cancer: Biology Matters More Than Phenotype – A Real-World Registry Study
Authors: I. Surovtsova, T. Kühn, J. Žatecký, K. Burtscher, K. Pfister, P. Morakis
3. Brno Oncology Days 2026 – Oral Presentation
Inflammatory Breast Cancer – Is It Time for Conservative Axillary Surgery?
Authors: J. Žatecký, O. Coufal, T. Kühn, I. Surovtsova, K. Pfister, K. Burtscher, P. Morakis
