What is the first-line treatment sequence for inflammatory breast cancer?

The first-line treatment for inflammatory breast cancer is indeed neoadjuvant chemotherapy, followed by mastectomy, and then radiation therapy. This treatment sequence is crucial due to the aggressive nature of inflammatory breast cancer, which often presents with locally advanced disease at diagnosis.

Starting with neoadjuvant chemotherapy helps in reducing the tumor size and converting a clinically advanced disease to a surgically resectable one. This approach not only helps to manage systemic disease but also improves surgical outcomes and allows for the assessment of the tumor's response to therapy, which can be valuable for prognostic information.

After chemotherapy, mastectomy is typically performed to remove the remaining cancerous tissues. Given the unique characteristics of inflammatory breast cancer, which often involves extensive skin and lymphatic system involvement, mastectomy is preferred over breast-conserving surgery.

Following surgery, radiation therapy is recommended to eliminate any residual microscopic disease and further reduce the risk of recurrence in the chest wall and regional lymph nodes.

This combined approach is supported by clinical guidelines and reflects the multidimensional treatment strategy required for this particularly aggressive subtype of breast cancer. Other treatment sequences, such as surgery first or relying solely on radiation, are not appropriate for inflammatory breast cancer due to its unique presentation and treatment challenges.