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1
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Hamzah JL, Phua JKS, Chan WT, Teo SY, Tan VKM, Lim GH, Tan BKT, Lim SH, Tan PH, Allen JC, Leong LCH. Factors affecting mammogram breast cancer surveillance effectiveness in the ipsilateral and contralateral breast. Clin Imaging 2024; 116:110308. [PMID: 39423691 DOI: 10.1016/j.clinimag.2024.110308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/17/2024] [Accepted: 09/30/2024] [Indexed: 10/21/2024]
Abstract
AIM Mammography is the mainstay of imaging surveillance after breast cancer (BC) treatment, but false negatives can occur. The objective of the study was to determine the factors that can predict poorer second breast cancer (SBC) mammogram detection of the ipsilateral and contralateral breast separately. METHODS A multicentre retrospective review was performed on female patients with a previous history of treated BC who developed a second breast cancer (SBC) in the ipsilateral (ISBC) or contralateral breast (CSBC) within 10 years from the first BC. SBC cases that occurred between January 2006 and October 2017 were included from the institutional database. The ISBC and CSBC mammogram-occult (MO) rates were correlated with mammographic breast density as well as various clinical, radiological and histological characteristics of the first BC. RESULTS 274 cases of SBC were evaluated. 39.4 % (108/274) of cases were ISBC and 60.6 % (166/274) were CSBC. 35 (32.4 %) of the ISBCs and 42 (25.3 %) of the CSBCs were MO (p = 0.218). On multivariate analysis, symptomatic first BC (p = 0.041), prevailing dense breast tissue at the time of SBC diagnosis (p = 0.003) and trabecular thickening on surveillance mammograms (p = 0.017) were associated with MO ISBC. MO first BC (p < 0.001) was the only factor found to correlate with MO CSBC. CONCLUSION The study found various clinical, radiological and pathological factors associated with mammogram surveillance failure for the ipsilateral and contralateral breast. This information can provide additional guidance in the planning of a personalised surveillance program using adjunct imaging screening.
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Affiliation(s)
- Julie Liana Hamzah
- Department of Breast Surgery, Singapore General Hospital, Singapore; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Breast Centre, Singapore.
| | | | | | - Sze Yiun Teo
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Veronique Kiak-Mien Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - Geok Hoon Lim
- SingHealth Duke-NUS Breast Centre, Singapore; Breast Department, KK Women's and Children's Hospital, Singapore
| | - Benita Kiat Tee Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Breast Centre, Singapore; Department of General Surgery, Sengkang General Hospital, Singapore
| | - Swee Ho Lim
- SingHealth Duke-NUS Breast Centre, Singapore; Breast Department, KK Women's and Children's Hospital, Singapore
| | | | | | - Lester Chee Hao Leong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore; Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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2
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Louis M, Tapia R, Grabill N, Strom P. Dormancy Leading to Late Recurrence in Breast Cancer: A Case of Hormone Receptor-Positive Supraclavicular Metastasis 10 Years After the Initial Treatment. Cureus 2024; 16:e71586. [PMID: 39553033 PMCID: PMC11566324 DOI: 10.7759/cureus.71586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 10/15/2024] [Indexed: 11/19/2024] Open
Abstract
Breast cancer recurrence can occur many years after the initial treatment, particularly in hormone receptor-positive (HR+) cases, where the risk of late recurrence remains significant. Late recurrences are well documented, with research showing that they can happen even decades after the primary diagnosis, necessitating extended monitoring and personalized therapeutic approaches. A 65-year-old woman with a history of stage IIIC invasive ductal carcinoma, initially treated with neoadjuvant chemotherapy, bilateral mastectomies, adjuvant chemoradiation, and prolonged hormonal therapy, presented 10 years later with metastasis to the left supraclavicular lymph nodes. A biopsy confirmed recurrent ER+/PR+/HER2- (estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative) breast cancer. Her treatment was adjusted to include Faslodex (fulvestrant) and Verzenio (abemaciclib), followed by the surgical resection of the metastatic lymph node. Managing HR+ breast cancer involves significant challenges, mainly due to the potential for late recurrence. Even after aggressive treatment and years of remission, dormant tumor cells may become active again, leading to metastasis in less common sites, like the supraclavicular lymph nodes. This situation demands a tailored therapeutic approach, adjusting treatment strategies to address the specific characteristics of the recurrent tumor. In conclusion, late recurrence in HR+ breast cancer requires vigilant long-term follow-up and personalized treatments to effectively manage recurrence risk. Understanding dormancy and reactivation mechanisms is essential for guiding clinical decisions. Prioritizing individualized follow-up strategies and refining treatment protocols will be key to improving patient outcomes and maintaining quality of life.
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Affiliation(s)
- Mena Louis
- General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Rafael Tapia
- General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Nathaniel Grabill
- Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Priscilla Strom
- General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
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3
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Almási S, Cserni G. The value of oestrogen receptor, progesterone receptor and keratins 5 and 14 immunohistochemistry in the evaluation of epithelial proliferations at cauterised margins in breast-conserving surgery specimens. Pathol Res Pract 2024; 257:155280. [PMID: 38608372 DOI: 10.1016/j.prp.2024.155280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Abstract
In breast conservative surgery, it is sometimes difficult to decide whether the cauterised tissue at the inked margin represents normal / hyperplastic or neoplastic tissue. We retrospectively assessed the value of ER, PR, CK5 and CK14 IHC in clarifying the nature of cauterised tissues at the margins concerning 34 lesions of 23 patients. 27 cases belonged to lesions that could not be adequately classified on the basis of the HE stains. Two thirds of them could be classified as non-neoplastic or neoplastic and two thirds of the remaining could be favourised as neoplastic or non-neoplastic, with 3/27 cases remaining uncertain. All 4 IHC reactions were helpful in classifying the lesions in almost half of the cases. However, 3 or 4 immunostains were supportive of the classification in 19/27. The most useful stains were the keratins, generally demonstrating a matching pattern of cell labelling with CK5 and CK14. ER and PR were somewhat less useful in classifying uncertain lesions. Considering all the 27 questionable lesions, IHC with ER, PR, CK5 and CK14 clarified the lesions at the cauterised margins in 23 cases. Taken all these considerations into account, CK5, CK14, PR and ER IHC may help in distinguishing between cautery damaged neoplastic and non-neoplastic tissues. All four IHC may yield the best support for decision making, but CK5 and/or CK14 may be sufficient in their own. The essential approach is that the results must be interpreted with caution, in the context of the given patient's disease, to avoid misinterpretations.
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Affiliation(s)
- Szintia Almási
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical Centre, Állomás u. 1, Szeged 6725, Hungary.
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical Centre, Állomás u. 1, Szeged 6725, Hungary; Department of Pathology, Bács-Kiskun County Teaching Hospital., Nyíri út 38, Kecskemét 6000, Hungary
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4
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Farah E, Carbonell C, Boyne DJ, Brenner DR, Henning JW, Moldaver D, Shokar S, Cheung WY. Treatment Patterns and Health Outcomes among Patients with HER2 IHC0/-Low Metastatic or Recurrent Breast Cancer. Cancers (Basel) 2024; 16:518. [PMID: 38339269 PMCID: PMC10854846 DOI: 10.3390/cancers16030518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Improved understanding of the biological heterogeneity of breast cancer (BC) has facilitated the development of more effective and personalized approaches to treatment. This study describes real-world evidence on treatment patterns and outcomes for a population-based cohort of patients with human epidermal growth factor receptor (HER2) IHC0 and -low BC with de novo or recurrent disease from Alberta, Canada. Patients 18+ years old diagnosed with HER2 IHC0/-low, de novo/recurrent BC from 2010 to 2019 were identified using Alberta's cancer registry. Analyses of these patients' existing electronic medical records and administrative claims data were conducted to examine patient characteristics, treatment patterns, and survival outcomes. A total of 3413 patients were included in the study, of which 72.10% initiated first line hormonal and non-hormonal systemic therapy. The 1-year overall survival (OS) was 81.09% [95% CI, 79.52-82.69]. Recurrent patients had a higher OS compared to de novo patients: 54.30 months [95% CI, 47.80-61.90] vs. 31.5 months [95% CI, 28.40-35.90], respectively. Median OS was 43.4 months [95% CI, 40.70-47.10] and 35.80 months [95% CI, 29.00-41.70] among patients with HER2-low and HER2 IHC0 cancer, respectively. The study results provide real-world evidence regarding the clinical outcomes of HER2 IHC0/-low and de novo/recurrent disease.
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Affiliation(s)
- Eliya Farah
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Chantelle Carbonell
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Devon J. Boyne
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Darren R. Brenner
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jan-Willem Henning
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Simran Shokar
- AstraZeneca Canada Inc., Mississauga, ON L4Y 1M4, Canada
| | - Winson Y. Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
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5
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepole AB. Computational mechanobiology model evaluating healing of postoperative cavities following breast-conserving surgery. Comput Biol Med 2023; 165:107342. [PMID: 37647782 PMCID: PMC10581740 DOI: 10.1016/j.compbiomed.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through Gaussian process surrogates. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA; Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepole
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA; Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA.
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6
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Zarean Shahraki S, Azizmohammad Looha M, Mohammadi kazaj P, Aria M, Akbari A, Emami H, Asadi F, Akbari ME. Time-related survival prediction in molecular subtypes of breast cancer using time-to-event deep-learning-based models. Front Oncol 2023; 13:1147604. [PMID: 37342184 PMCID: PMC10277681 DOI: 10.3389/fonc.2023.1147604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
Background Breast cancer (BC) survival prediction can be a helpful tool for identifying important factors selecting the effective treatment reducing mortality rates. This study aims to predict the time-related survival probability of BC patients in different molecular subtypes over 30 years of follow-up. Materials and methods This study retrospectively analyzed 3580 patients diagnosed with invasive breast cancer (BC) from 1991 to 2021 in the Cancer Research Center of Shahid Beheshti University of Medical Science. The dataset contained 18 predictor variables and two dependent variables, which referred to the survival status of patients and the time patients survived from diagnosis. Feature importance was performed using the random forest algorithm to identify significant prognostic factors. Time-to-event deep-learning-based models, including Nnet-survival, DeepHit, DeepSurve, NMLTR and Cox-time, were developed using a grid search approach with all variables initially and then with only the most important variables selected from feature importance. The performance metrics used to determine the best-performing model were C-index and IBS. Additionally, the dataset was clustered based on molecular receptor status (i.e., luminal A, luminal B, HER2-enriched, and triple-negative), and the best-performing prediction model was used to estimate survival probability for each molecular subtype. Results The random forest method identified tumor state, age at diagnosis, and lymph node status as the best subset of variables for predicting breast cancer (BC) survival probabilities. All models yielded very close performance, with Nnet-survival (C-index=0.77, IBS=0.13) slightly higher using all 18 variables or the three most important variables. The results showed that the Luminal A had the highest predicted BC survival probabilities, while triple-negative and HER2-enriched had the lowest predicted survival probabilities over time. Additionally, the luminal B subtype followed a similar trend as luminal A for the first five years, after which the predicted survival probability decreased steadily in 10- and 15-year intervals. Conclusion This study provides valuable insight into the survival probability of patients based on their molecular receptor status, particularly for HER2-positive patients. This information can be used by healthcare providers to make informed decisions regarding the appropriateness of medical interventions for high-risk patients. Future clinical trials should further explore the response of different molecular subtypes to treatment in order to optimize the efficacy of breast cancer treatments.
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Affiliation(s)
- Saba Zarean Shahraki
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooya Mohammadi kazaj
- Geographic Information Systems Department, Faculty of Geodesy and Geomatics Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Mehrad Aria
- Faculty of Information Technology and Computer Engineering, Azarbaijan Shahid Madani University, Tehran, Iran
| | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Emami
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Harbin Z, Sohutskay D, Vanderlaan E, Fontaine M, Mendenhall C, Fisher C, Voytik-Harbin S, Tepolea AB. Computational Mechanobiology Model Evaluating Healing of Postoperative Cavities Following Breast-Conserving Surgery. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.26.538467. [PMID: 37162899 PMCID: PMC10168325 DOI: 10.1101/2023.04.26.538467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through the Gaussian Process. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.
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Affiliation(s)
- Zachary Harbin
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - David Sohutskay
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Vanderlaan
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muira Fontaine
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
| | - Carly Mendenhall
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
| | - Carla Fisher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sherry Voytik-Harbin
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
- Department of Basic Medical Sciences Purdue University, West Lafayette, IN, USA
| | - Adrian Buganza Tepolea
- School of Mechanical Engineering Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, IN, USA
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8
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Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns J, Kumar R. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:691-722. [PMID: 35714673 DOI: 10.6004/jnccn.2022.0030] [Citation(s) in RCA: 531] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. These NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.
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Affiliation(s)
| | | | - Jame Abraham
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | - Sara H Javid
- Fred Hutchinson Cancer Research Center/University of Washington
| | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - John H Ward
- Huntsman Cancer Institute at the University of Utah
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9
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Lowry KP, Callaway KA, Lee JM, Zhang F, Ross-Degnan D, Wharam JF, Kerlikowske K, Wernli KJ, Kurian AW, Henderson LM, Stout NK. Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016. J Natl Compr Canc Netw 2022; 20:379-386.e9. [PMID: 35390766 DOI: 10.6004/jnccn.2021.7081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. METHODS We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. RESULTS Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. CONCLUSIONS Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.
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Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Katherine A Callaway
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karla Kerlikowske
- Department of Medicine, and.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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10
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Mazumdar A, Jain S, Jain S, Bose SM. Management of Early Breast Cancer – Surgical Aspects. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Baek SY, Kim J, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH, Lee SB. Clinical Course and Predictors of Subsequent Recurrence and Survival of Patients With Ipsilateral Breast Tumor Recurrence. Cancer Control 2022; 29:10732748221089412. [PMID: 35414226 PMCID: PMC9016529 DOI: 10.1177/10732748221089412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the clinical course and long-term outcomes of patients with
ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery
(BCS) and identify independent prognostic factors for further
recurrence. Methods In this retrospective study, we reviewed the records of 327 patients who
experienced IBTR after undergoing BCS for breast cancer at Asan Medical
Center during 1990–2013. Overall survival (OS) after IBTR and cumulative
incidence rates of recurrences after IBTR were calculated. The association
of clinicopathological factors with survival and the development of further
recurrence after IBTR was determined in multivariate analysis. Results At a median follow-up of 127.7 months, 97 patients experienced recurrence
after IBTR. The 5-year and 10-year cumulative incidence rates of recurrence
after IBTR were 32% and 41%, respectively. The 5-year and 10-year OS rates
after IBTR were 86.6% and 70.3%, respectively. In multivariate analysis,
hormone receptor negativity was associated with decreases in OS after IBTR
(hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.18–6.78). Patients
with longer disease-free interval (DFI) had decreased risks of second
recurrence (HR .99, 95% CI .99–1.00), and second locoregional recurrence
(LRR) (HR .98, 95% CI .97–.99). Lymphovascular invasion (LVI) of IBTR was
associated with increased recurrence rates (second recurrence-free survival,
HR 3.58, 95% CI 2.16–5.94; second LRR free survival, HR 5.21, 95% CI
2.77–9.78; second distant metastasis-free survival, 2.11, 95% CI 1.04–4.30)
and lower survival rates (OS after IBTR, HR 4.64, 95% CI 2.23–9.67). Conclusions Despite subsequent recurrences during long-term follow-up, the survival rates
after IBTR remained high. Patients with hormone receptor-negative tumors,
shorter DFI, and tumors that present LVI of IBTR had higher risks for
recurrence and poor survival rates after IBTR. The study findings may help
in understanding the course and prognosis of IBTR patients and identifying
high-risk IBTR to establish management strategies.
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Affiliation(s)
- Soo Yeon Baek
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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12
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Mo C, Ruan W, Lin J, Chen H, Chen X. Repeat Breast-Conserving Surgery Versus Salvage Mastectomy for Ipsilateral Breast Tumour Recurrence After Breast-Conserving Surgery in Breast Cancer Patients: A Meta-Analysis. Front Oncol 2021; 11:734719. [PMID: 34888233 PMCID: PMC8650120 DOI: 10.3389/fonc.2021.734719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background Salvage mastectomy (SM) is the standard surgery for ipsilateral breast tumour recurrence (IBTR). However, whether repeat breast-conserving surgery (RBCS) is an alternative method remains unclear. We performed a meta-analysis to compare the effects of RBCS and SM after IBTR for breast-conserving surgery (BCS). Methods We searched PubMed, Cochrane, Wiley Online and Embase for controlled studies comparing RBCS and SM after IBTR for BCS (published between 1993 and 2019, published in English). Our main endpoints were the secondary local recurrence rate (SLRR), distant metastasis rate (DMR) and overall survival (OS). We used a random-effects model or fixed-effects model for data pooling. Results Fifteen of the 424 eligible studies were ultimately included, and all studies were retrospective cohort studies (n=2532 participants). 1) SLRR: The SLRR of RBCS was higher than SM (pooled relative rate (pRR) = 1.87, 95% CI 1.22 - 2.86, P=0.004). Stratified analysis was performed according to whether radiotherapy was performed after salvage surgery (radiotherapy group: 2ndRT, no radiotherapy group: no-2ndRT), and the following results were revealed: pRR=0.43 (95% CI 0.20-0.95, P=0.04) for group 2ndRT; and pRR=2.30 (95% CI 1.72-3.06, P<0.00001) for group no-2ndRT. These results showed that the main cause of heterogeneity was salvage radiotherapy. 2) DMR: No significant difference in the DMR was observed between RBCS and SM (pRR = 0.61, 95% CI 0.37 - 1.01, P=0.05). 3) OS: No significant difference in OS was observed between RBCS and SM (pRR=0.65, 95% CI 0.39 - 1.08, P=0.10). Conclusions The SLRR of RBCS was higher than SM for ITBR after BCS, but survival was not affected. RBCS may be used as an alternative for IBTR patients after BCS with strict control for several indications, such as tumor size, recurrence interval and biological behavior, and attaching importance to subsequent salvage radiotherapy and systematic therapy.
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Affiliation(s)
- Caiqin Mo
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Weihong Ruan
- Department of General Surgery, Traditional Chinese Hospital of Xiamen, Fujian, China
| | - Junyu Lin
- The First Clinical Medical College, Fujian Medical University, Fujian, China
| | - Huaying Chen
- The First Clinical Medical College, Fujian Medical University, Fujian, China
| | - Xiangjin Chen
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, China
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13
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Goulding A, Asmar L, Wang Y, Tole S, Barke L, Widner J, Leonard C. Outcomes After Accelerated Partial Breast Irradiation in Women With Triple Negative Subtype and Other "High Risk" Variables Categorized as Cautionary in The ASTRO Guidelines. Front Oncol 2021; 11:617439. [PMID: 33777758 PMCID: PMC7993056 DOI: 10.3389/fonc.2021.617439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a primary objective clinical outcome of ipsilateral breast recurrence following accelerated partial breast irradiation (APBI) in women with triple negative and other high risk breast cancer (as described in 2017 ASTRO guidelines) (i.e., age 40-49, size 2.1-3.0 cm, estrogen receptor negative and invasive lobular breast cancer). Secondary objectives of axillary and regional failure as well as overall survival are also reported. METHODS AND MATERIAL Patients from two clinical trials (NCT01185145, NCT01185132) were treated with 38.5 Gy IMRT or 3D-CRT APBI w/3.85 Gy fraction/BID fractionation for 10 fractions. Triple negative and other high risk patients (n=269) were compared to a total of 478 low risk patients which ASTRO defined as "suitable" for APBI. High risk patients, for the purpose of this study, were defined as those who possess one or more high risk criteria: triple negative (n=30), tumor size >2 cm <3 cm (n=50), HER 2+ (n=54), age range 40-50 years (n=120), ER- (n=43), and ILC histology (n=52). RESULTS Median follow up was 4.0 years for all patients. No significant difference was found for this high-risk cohort at 5 years for ipsilateral breast, or regional recurrences. Axillary recurrence was significantly adversely impacted by triple negative and ER- statuses (p=0.01, p=0.04). There were significant correlations between triple negative type and axillary recurrence on multivariate analysis (p=0.03). Overall survival for all patients was unaffected by any of the high-risk categories. CONCLUSION The data from this study suggests that women possessing high risk features are at no more meaningful risk for recurrence than other patients considered to be acceptable for APBI treatment. However, the finding of axillary recurrence in patients with triple negative breast cancer does warrant a degree of caution in proceeding with accelerated partial breast irradiation technique in this patient group.
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Affiliation(s)
- Anabel Goulding
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
| | - Lina Asmar
- Statistics, Linasmar Consulting, Houston, TX, United States
| | - Yunfei Wang
- Statistics, Linasmar Consulting, Houston, TX, United States
| | - Shannon Tole
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
| | - Lora Barke
- Radiology, Invision Sally Jobe, Greenwood Village, CO, United States
| | - Jodi Widner
- Surgery, SurgOne, Greenwood Village, CO, United States
| | - Charles Leonard
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
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14
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Abstract
OBJECTIVE We assessed the changes that have resulted from the latest breast cancer staging guidelines and the potential impact on prognosis. BACKGROUND Contemporary data suggest that combining anatomic staging and tumor biology yields a predictive synergy for determining breast cancer prognosis. This forms the basis for the American Joint Committee on Cancer's (AJCC) Staging Manual, 8th edition. We assessed the changes that have resulted from the new staging guidelines and the potential impact on prognosis. METHODS Women with stages I to III breast cancer from 2010 to 2014 in the National Cancer Data Base were pathologically staged according to the 7th and 8th editions of the AJCC Staging Manual. Patient characteristics and restaging outcomes were summarized. Unadjusted overall survival (OS) was estimated, and differences were assessed. Cox proportional-hazards models were utilized to estimate the adjusted association of stage with OS. RESULTS After restaging the 493,854 women identified, 6.8% were upstaged and 29.7% were downstaged. The stage changes varied by tumor histology, receptor status, tumor grade, and Oncotype DX scores (all P < 0.0001). Applying the 8th edition criteria yielded an incremental reduction in survival for each increase in stage, which was not consistently seen in the 7th edition. In a subgroup analysis based on hormone receptor (HR) status, those with stages II and III, and HR- disease had a worse OS than those with HR+ disease. CONCLUSIONS Applying the 8th edition staging criteria resulted in a stage change for >35% of patients diagnosed with invasive breast cancer and refined OS estimates. Overall, the transition to the 8th edition is expected to better drive clinical care, treatment recommendations, and future research.
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15
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Lee J, Kim SH, Kang BJ. Prognostic Factors of Disease Recurrence in Breast Cancer Using Quantitative and Qualitative Magnetic Resonance Imaging (MRI) Parameters. Sci Rep 2020; 10:7598. [PMID: 32371907 PMCID: PMC7200757 DOI: 10.1038/s41598-020-64564-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to investigate prognostic factors predicting recurrence of breast cancer, focusing on imaging factors including morphologic features, quantitative MR parameters, and clinicopathologic factors. This retrospective study was approved by our institutional review board, and the requirement to obtain informed consent was waived. A total of 267 patients with breast cancer were enrolled in this study, who underwent dynamic contrast-enhanced magnetic resonance imaging (MRI) before surgery from February 2014 to June 2016. Imaging parameters of MRI, including morphologic features, perfusion parameters, and texture analysis, were retrospectively reviewed by two expert breast radiologists. Clinicopathologic information of enrolled patients was also reviewed using medical records. Univariable and multivariable Cox proportional hazards regression analyses were used to identify factors associated with cancer recurrence. C statistics was used to discriminate low and high risk patients for disease recurrence. Using Kaplan-Meier survival analysis, disease-free survival was compared between patients who experienced recurrence and those who did not. At a median follow up of 49 months, 32 patients (12%) showed disease: six cases of ipsilateral breast or axilla recurrence, one case of contralateral breast recurrence, 24 cases of distant metastasis, and one case of both ipsilateral breast recurrence and distant metastasis. Of multiple imaging features and parameters, increased ipsilateral vascularity and higher positive skewness of texture analysis showed significant association with disease recurrence in every multivariable model regardless of tumor subtype and pathologic stage. Pathologic stage, especially if higher than stage II, showed significant association with disease recurrence and its highest hazard ratio was 3.45 [95% confidence interval (CI): 1.37–8.67, p = 0.008]. Of the multivariable models, the model including clinico-pathologic factors and both qualitative and quantitative imaging parameters showed good discrimination with a high C index value of 0.825 (95% CI: 0.755–0.896). In addition, recurrence associated factors were associated with short interval time to disease recurrence by Kaplan-Meier survival analysis. Therefore, comprehensive analysis using both clinico-pathologic factors and qualitative and quantitative imaging parameters is more effective in predicting breast cancer recurrence. Among those factors, higher pathologic stage, increased ipsilateral vascularity and higher positive skewness of texture analysis could be good predictors of breast cancer recurrence. Moreover, when these three factors are applied comprehensively, they may also be the predictors for poor survival.
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Affiliation(s)
- Jeongmin Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Purswani JM, Shaikh F, Wu SP, Kim JC, Schnabel F, Huppert N, Perez CA, Gerber NK. Ipsilateral breast tumor recurrence in early stage breast cancer patients treated with breast conserving surgery and adjuvant radiation therapy: Concordance of biomarkers and tumor location from primary tumor to in-breast tumor recurrence. World J Clin Oncol 2020; 11:20-30. [PMID: 31976307 PMCID: PMC6935692 DOI: 10.5306/wjco.v11.i1.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with an in-breast tumor recurrence (IBTR) after breast-conserving therapy have a high risk of distant metastasis and disease-related mortality. Classifying clinical parameters that increase risk for recurrence after IBTR remains a challenge.
AIM To describe primary and recurrent tumor characteristics in patients who experience an IBTR and understand the relationship between these characteristics and disease outcomes.
METHODS Patients with stage 0-II breast cancer treated with lumpectomy and adjuvant radiation were identified from institutional databases of patients treated from 2003-2017 at our institution. Overall survival (OS), disease-free survival, and local recurrence-free survival (LRFS) were estimated using the Kaplan Meier method. We identified patients who experienced an isolated IBTR. Concordance of hormone receptor status and location of tumor from primary to recurrence was evaluated. The effect of clinical and treatment parameters on disease outcomes was also evaluated.
RESULTS We identified 2164 patients who met the eligibility criteria. The median follow-up for all patients was 3.73 [interquartile range (IQR) 2.27-6.07] years. Five-year OS was 97.7% (95%CI: 96.8%-98.6%) with 28 deaths; 5-year LRFS was 98.0% (97.2-98.8) with 31 IBTRs. We identified 37 patients with isolated IBTR, 19 (51.4%) as ductal carcinoma in situ and 18 (48.6%) as invasive disease, of whom 83.3% had an in situ component. Median time from initial diagnosis to IBTR was 1.97 (IQR: 1.03-3.5) years. Radiotherapy information was available for 30 of 37 patients. Median whole-breast dose was 40.5 Gy and 23 patients received a boost to the tumor bed. Twenty-five of thirty-two (78.1%) patients had concordant hormone receptor status, HER-2 receptor status, and estrogen receptor (ER) (P = 0.006) and progesterone receptor (PR) (P = 0.001) status from primary to IBTR were significantly associated. There were no observed changes in HER-2 status from primary to IBTR. The concordance between quadrant of primary to IBTR was 10/19 [(62.2%), P = 0.008]. Tumor size greater than 1.5 cm (HR = 0.44, 95%CI: 0.22-0.90, P = 0.02) and use of endocrine therapy upfront (HR = 0.36, 95%CI: 0.18-0.73, P = 0.004) decreased the risk of IBTR.
CONCLUSION Among patients with early stage breast cancer who had breast conserving surgery treated with adjuvant RT, ER/PR status and quadrant were highly concordant from primary to IBTR. Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy were significantly associated with decreased risk of IBTR.
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Affiliation(s)
- Juhi M Purswani
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
| | - Fauzia Shaikh
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
| | - S Peter Wu
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
| | - Jennifer Chun Kim
- Department of Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Freya Schnabel
- Department of Surgery, New York University School of Medicine, New York, NY 10016, United States
| | - Nelly Huppert
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
| | - Carmen A Perez
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
| | - Naamit K Gerber
- Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
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17
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Arthur DW, Winter KA, Kuerer HM, Haffty B, Cuttino L, Todor DA, Anne PR, Anderson P, Woodward WA, McCormick B, Cheston S, Sahijdak WM, Canaday D, Brown DR, Currey A, Fisher CM, Jagsi R, Moughan J, White JR. Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: The NRG Oncology/RTOG 1014 Phase 2 Clinical Trial. JAMA Oncol 2020; 6:75-82. [PMID: 31750868 DOI: 10.1001/jamaoncol.2019.4320] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Mastectomy is standard for recurrence of breast cancer after breast conservation therapy with whole breast irradiation. The emergence of partial breast irradiation led to consideration of its application for reirradiation after a second lumpectomy for treatment of recurrence of breast cancer in the ipsilateral breast. Objectives To assess the effectiveness and adverse effects of partial breast reirradiation after a second lumpectomy and whether the treatment is an acceptable alternative to mastectomy. Design, Setting, and Participants The NRG Oncology/Radiation Therapy Oncology Group 1014 trial is a phase 2, single-arm, prospective clinical trial of 3-dimensional, conformal, external beam partial breast reirradiation after a second lumpectomy for recurrence of breast cancer in the ipsilateral breast after previous whole breast irradiation. The study opened on June 4, 2010, and closed June 18, 2013. Median follow-up was 5.5 years. This analysis used all data received at NRG Oncology through November 18, 2018. Eligible patients experienced a recurrence of breast tumor that was less than 3 cm and unifocal in the ipsilateral breast more than 1 year after breast-conserving therapy with whole breast irradiation and who had undergone excision with negative margins. Interventions Adjuvant partial breast reirradiation, 1.5 Gy twice daily for 30 treatments during 15 days (45 Gy), using a 3-dimensional conformal technique. Main Outcomes and Measures The main outcomes of the present study were the predefined secondary study objectives of recurrence of breast cancer in the ipsilateral breast, late adverse events (>1 year after treatment), mastectomy incidence, distant metastasis-free survival, overall survival, and circulating tumor cell incidence. Results A total of 65 women were enrolled, with 58 evaluable for analysis (mean [SD] age, 65.12 [9.95] years; 48 [83%] white). Of the recurrences of breast cancer in the ipsilateral breast, 23 (40%) were noninvasive and 35 (60%) were invasive. In all 58 patients, 53 (91%) had tumors 2 cm or smaller. All tumors were clinically node negative. A total of 44 patients (76%) tested positive for estrogen receptor, 33 (57%) for progesterone receptor, and 10 (17%) for ERBB2 (formerly HER2 or HER2/neu) overexpression. Four patients had breast cancer recurrence, with a 5-year cumulative incidence of 5% (95% CI, 1%-13%). Seven patients underwent ipsilateral mastectomies for a 5-year cumulative incidence of 10% (95% CI, 4%-20%). Both distant metastasis-free survival and overall survival rates were 95% (95% CI, 85%-98%). Four patients (7%) had grade 3 and none had grade 4 or higher late treatment adverse events. Conclusions and Relevance For patients experiencing recurrence of breast cancer in the ipsilateral breast after lumpectomy and whole breast irradiation, a second breast conservation was achievable in 90%, with a low risk of re-recurrence of cancer in the ipsilateral breast using adjuvant partial breast reirradiation. This finding suggests that this treatment approach is an effective alternative to mastectomy.
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Affiliation(s)
- Douglas W Arthur
- Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Laurie Cuttino
- Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - Dorin A Todor
- Massey Cancer Center, Virginia Commonwealth University, Richmond
| | | | | | | | | | - Sally Cheston
- University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland
| | | | | | - Doris R Brown
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Adam Currey
- Froedtert and the Medical College of Wisconsin, Milwaukee
| | | | - Reshma Jagsi
- University of Michigan Comprehensive Cancer Center, Ann Arbor
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Julia R White
- Ohio State University Comprehensive Cancer Center, Columbus
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18
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Kraus-Tiefenbacher U, Scheda A, Steil V, Hermann B, Kehrer T, Bauer L, Melchert F, Wenz F. Intraoperative Radiotherapy (Iort) for Breast Cancer Using the Intrabeam™ System. TUMORI JOURNAL 2019; 91:339-45. [PMID: 16277101 DOI: 10.1177/030089160509100411] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Intraoperative radiotherapy (IORT) with low-energy X-rays (30–50 KV) is an innovative technique that can be used both for accelerated partial breast irradiation (APBI) and intraoperative boosting in patients affected by breast cancer. Immediately after tumor resection the tumor bed can be treated with low-distance X-rays by a single high dose. Whereas often a geographic miss in covering the boost target occurs with external beam boost radiotherapy (EBRT), the purpose of IORT is to cover the tumor bed safely. This report will focus on the feasibility and technical aspects of the Intrabeam™ device and will summarize our experience with side effects and local control. Materials and methods Between February 2002 and June 2003 57 breast cancer patients, all eligible for breast conserving surgery (BCS), were treated at the Mannheim Medical Center with IORT using the mobile X-ray system Intrabeam™. The patient population in this feasibility study was not homogeneous consisting of 49 patients with primary stage I or II breast cancer, seven with local recurrence after previous EBRT and one with a second primary in a previously irradiated breast. The selection criteria for referral for IORT included tumor size, tumor cavity size, margin status and absence of an extensive intraductal component. The previously irradiated patients with local recurrences and 16 others received IORT as single modality. In all other cases IORT was followed by EBRT with a total dose of 46 Gy in 2-Gy fractions. The intraoperatively delivered dose after tumor resection was 20 Gy prescribed to the applicator surface. EBRT was delivered with a standard two-tangential-field technique using linear accelerators with 6- or 18-MV photons. Patients were assessed every three months by their radiation oncologist or surgeon during the first year after treatment and every six months thereafter. Breast ultrasound for follow-up was done every six months and mammographies once yearly. Acute side effects were scored according to the CTC/EORTC score and late side effects according to the Lent-Soma classification. Results Twenty-four patients received IORT only; eight patients because they had received previous radiotherapy, 16 because of a very favorable risk profile or their own preference. Thirty-three patients with tumor sizes between 1 and 30 mm and no risk factors were treated by IORT as a boost followed by EBRT. The Intrabeam™ system was used for IORT. The Intrabeam source produces 30–50 KV X-rays and the prescribed dose is delivered in an isotropic dose distribution around spherical applicators. Treatment time ranged between 20 and 48 minutes. No severe acute side effects or complications were observed during the first postoperative days or after 12 months. One local recurrence occurred 10 months after surgery plus IORT followed by EBRT. In two patients distant metastases were diagnosed shortly after BCS. Discussion IORT with the Intrabeam system is a feasible method to deliver a single high radiation dose to breast cancer patients. As a preliminary boost it has the advantage of reducing the EBRT course by 1.5 weeks, and as APBI it might be a promising tool for patients with a low risk of recurrence. The treatment is well tolerated and does not cause greater damage than the expected late reaction in normal tissue.
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Affiliation(s)
- Uta Kraus-Tiefenbacher
- Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, Germany.
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19
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Smanykó V, Mészáros N, Újhelyi M, Fröhlich G, Stelczer G, Major T, Mátrai Z, Polgár C. Second breast-conserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy 2019; 18:411-419. [PMID: 30890318 DOI: 10.1016/j.brachy.2019.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/29/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to report the clinical outcomes of a second breast-conserving therapy (2nd BCT) with perioperative interstitial brachytherapy (iBT) vs. those of salvage mastectomy (sMT) in the treatment of ipsilateral breast tumor recurrences (IBTRs). METHODS AND MATERIALS Between 1999 and 2015, 195 patients with IBTR after a previous breast-conserving treatment were salvaged either with reexcision and perioperative high-dose-rate iBT (n = 39), or with sMT (n = 156). In the 2nd BCT group, a total dose of 22 Gy in five fractions of 4.4 Gy was delivered to the tumor bed with intraoperatively implanted catheters for 3 consecutive days. RESULTS The median followup time was 59 months (1-189) in the 2nd BCT, and 56 months (3-189) in the sMT group. The mean size of IBTR was 16 mm (2-70) vs. 24 mm (2-90), respectively (p = 0.0005), but there were no other significant differences in patient- or IBTR-related parameters between the two groups. During the followup period, 4 of 39 (10.2%) and 28 of 156 (17.9%) second local recurrences (2nd LR) occurred in the 2nd BCT and the sMT group, respectively. The 5-year actuarial rate of 2nd LR was 6% vs. 18% (p = 0.22), the 5-year probability of disease-free, cancer-specific and overall survival was 69% vs. 65% (p = 0.13), 85% vs. 78% (p = 0.32), and 81% vs. 66% (p = 0.15), respectively. In the 2nd BCT group, the rate of good to excellent cosmesis was 70%. CONCLUSIONS 2nd BCT with perioperative high-dose-rate iBT is a safe and feasible option for the management of IBTR, resulting in similar 5-year oncological outcomes and better cosmetic results compared with sMT.
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Affiliation(s)
- Viktor Smanykó
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
| | - Norbert Mészáros
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Mihály Újhelyi
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Georgina Fröhlich
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Gábor Stelczer
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Tibor Major
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Csaba Polgár
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
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20
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Karanlik H, Igci A. Surgical Approach in Invasive Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Contemporary Guidelines in Whole-Breast Irradiation: An Alternative Perspective. Int J Radiat Oncol Biol Phys 2018; 104:567-573. [PMID: 30366007 DOI: 10.1016/j.ijrobp.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022]
Abstract
The American Society for Radiation Oncology produced an evidence-based guideline on whole-breast radiation therapy for patients with early-stage invasive breast cancer and ductal carcinoma in situ. This commentary points out areas where we believe the data are too limited to make definitive recommendations and where alternative approaches are supported by evidence.
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22
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Merino T, Ip T, Domínguez F, Acevedo F, Medina L, Villaroel A, Camus M, Vinés E, Sánchez C. Risk factors for loco-regional recurrence in breast cancer patients: a retrospective study. Oncotarget 2018; 9:30355-30362. [PMID: 30100994 PMCID: PMC6084401 DOI: 10.18632/oncotarget.25735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Although fairly uncommon, loco-regional recurrence in breast cancer (BC) has major consequences for the patient. Several predictors for locoregional have been previously reported from large randomized clinical trials mainly from Europe & North America; data from other geographical areas are somewhat scarce. Here we performed a retrospective review of medical records in a single academic center in Chile, searching for predictors of breast tumor recurrence. Results Median patient follow up was 61 months, 5 year overall survival (OS) rate was 94.2% (95% CI 93-95.3). We found that 108 out of 2,754 (5.3%) patients had loco-regional recurrence. The 2-year loco-regional control was 98% (95% CI 97.3-98.7) and 5-year was 94% (95% CI 92.6-95.4). Univariate analysis showed a correlation between recurrence and being <50 year-old, positive surgical margins, advanced stage, subtype, and presence of LVI and omission of adjuvant radiotherapy. Only the absence of adjuvant RT was predictor of locoregional recurrence in multivariable (p< 0.001). Conclusions Our study population presents high local control of BC. Age, surgical margins, stage, molecular subtype and absence of adjuvant radiotherapy were associated with loco-regional recurrence. Prospective trials and long-term follow up are required in order to confirm these results. Materials and Methods We analyzed medical records from 2,201 BC patients at the Pontificia Universidad Católica de Chile from 1997 to 2016. Collected data included: age at diagnosis, tumor size, axillary involvement, molecular subtype, margin status, histological grade, lympho-vascular invasion (LVI) and ipsilateral recurrence.
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Affiliation(s)
- Tomás Merino
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Teresa Ip
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Domínguez
- Department of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lidia Medina
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Villaroel
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Camus
- Department of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenio Vinés
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - César Sánchez
- Department of Hematology-Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Jales RM, Dória MT, Serra KP, Miranda MM, Menossi CA, Schumacher K, Sarian LO. Power Doppler Ultrasonography and Shear Wave Elastography as Complementary Imaging Methods for Suspected Local Breast Cancer Recurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1493-1501. [PMID: 29205428 DOI: 10.1002/jum.14493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/24/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To prospectively investigate the diagnostic accuracy and clinical consequences of power Doppler morphologic criteria and shear wave elastography (SWE) as complementary imaging methods for evaluation of suspected local breast cancer recurrence in the ipsilateral breast or chest wall. METHODS Thirty-two breast masses with a suspicion of local breast cancer recurrence on B-mode ultrasonography underwent complementary power Doppler and SWE evaluations. Power Doppler morphologic criteria were classified as avascular, hypovascular, or hypervascular. Shear wave elastography was classified according to a 5-point scale (SWE score) and SWE maximum elasticity. Diagnostic accuracy was assessed by the sensitivity, specificity, and area under the curve. A decision curve analysis assessed clinical consequences of each method. The reference standard for diagnosis was defined as core needle or excisional biopsy. RESULTS Histopathologic examinations revealed 9 (28.2%) benign and 23 (71.8%) malignant cases. Power Doppler ultrasonography (US) had sensitivity of 34.8% (95% confidence interval [CI], 6.6%-62.9%) and specificity of 45.4% (95% CI, 19.3%-71.5%). The SWE score (≥3) had sensitivity of 87.0% (95% CI, 66.4%-97.2%) and specificity of 44.4% (95% CI, 13.7%-78.8%). The SWE maximum elasticity (velocity > 6.5cm/s) had sensitivity of 87% (95% CI, 66.4%-97.2%) and specificity of 77.8% (95% CI, 40.0% to 97.2%). The areas under the curves for the SWE score and SWE maximum elasticity were 0.71 (95% CI, 0.53-0.87) and 0.82 (95% CI, 0.64-0.93), respectively (P = .32). CONCLUSIONS Power Doppler US is unsuitable for discrimination between local breast cancer recurrence and fibrosis. Although the SWE score and SWE maximum elasticity can make this discrimination, the use of these methods to determine biopsy may lead to poorer clinical outcomes than the current practice of performing biopsies of all suspicious masses.
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Affiliation(s)
- Rodrigo Menezes Jales
- Dr Jose Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Maira Teixeira Dória
- Breast Imaging Extension Course, Postgraduate Program, Program, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Kátia Piton Serra
- Breast Imaging Extension Course, Postgraduate Program, Program, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Mila Meneguelli Miranda
- Breast Imaging Extension Course, Postgraduate Program, Program, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Carlos Alberto Menossi
- Breast Imaging Extension Course, Postgraduate Program, Program, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Klaus Schumacher
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - Luis Otávio Sarian
- Dr Jose Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
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Cetintaş SK, Kurt M, Ozkan L, Engin K, Gökgöz S, Taşdelen I. Factors Influencing Axillary Node Metastasis in Breast Cancer. TUMORI JOURNAL 2018; 92:416-22. [PMID: 17168435 DOI: 10.1177/030089160609200509] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The status of the axillary lymph nodes at the time of diagnosis has been accepted as one of the most important prognostic factors for the overall and disease-free survival of patients with breast cancer. The aim of our study was to determine which factors influence axillary node involvement in invasive breast cancer. Methods The data presented here were obtained from 344 patients who were treated for invasive breast cancer at the Department of Radiation Oncology, Uludag University Medical College, Bursa, Turkey. Possible prognostic factors were categorized as patient related and tumor related. The Mann-Whitney U test was used for univariate analysis and logistic regression was used for multivariate analysis. Results In univariate analysis, a familial cancer history (P = 0.0042), age <40 years (P = 0.0276), higher T stage (P <0.0000), nipple involvement (P = 0.0345), skin involvement (P = 0.0270), perineural invasion (P = 0.0231), and lymphatic vessel invasion (P <0.0000) were correlated with increased axillary node involvement. A higher incidence of ≥4 involved lymph nodes was associated with higher T stage (P = 0.0004), nipple involvement (P = 0.0292), presence of an extensive intraductal component (P = 0.0023), skin involvement (P = 0.0008), perineural invasion (P = 0.0523), and lymphatic vessel invasion (P <0.0000) in univariate analysis. In multivariate analysis, age <40 years (P = 0.0454), cancer history within the family (P = 0.0024), higher T stage (P = 0.0339), lymphatic vessel invasion (P = 0.0003), and perineural invasion (P = 0.0408) were found to be independent factors for axillary lymph node positivity. Age <40 years (P = 0.0221), perineural invasion (P = 0.0408), and an extensive intraductal component (P = 0.0132) were associated with an increased incidence of ≥4 involved nodes in the logistic regression analysis. In patients with breast cancer, the incidence of axillary lymph node involvement was independently influenced by age <40 years, presence of cancer history within the family, higher T stage, lymphatic vessel invasion, and perineural invasion. Conclusions In conclusion, absence of familial cancer history, presence of lymphatic vessel invasion, higher T stage, and age below 40 years independently increased the risk of axillary node involvement. Presence of perineural invasion and lymphatic vessel invasion, age below 40, and an extensive intraductal component of more than 25% independently affected the risk of having ≥4 nodes involved. Patients characterized by these factors may be classified into a higher risk group for nodal involvement, but more data are needed to define factors that can help in the decision-making regarding the omission of axillary treatment.
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Marcenaro M, Sacco S, Pentimalli S, Berretta L, Andretta V, Grasso R, Parodi RC, Guarrera M, Scarpati D. Measures of Late Effects in Conservative Treatment of Breast Cancer with Standard or Hypofractionated Radiotherapy. TUMORI JOURNAL 2018; 90:586-91. [PMID: 15762361 DOI: 10.1177/030089160409000609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background To confirm the equivalence in terms of late effects between two fractionation schedules of radiotherapy in conservative treatment of breast cancer. Methods Fifty-eight patients treated at our institution from 1999 to 2002, with a median follow-up of 15 months (range, 7-46 months), were evaluated retrospectively. Twenty-nine patients (group A) were treated with standard fractionation: 5000 cGy/25fx/5 weeks, and 29 patients (group B) were treated with a hypofractionated schedule: 4500 cGy/15fx/5 weeks, three fractions per week. Late effects were evaluated using the LENT-SOMA scoring scale. The cosmetic results were assessed on a five-point scale. Skin elasticity was measured using a dedicated device (Cutometer SEM 575). Results There were no differences in breast volume, age at diagnosis and follow-up between groups. The LENT-SOMA toxicity observed in groups A and B, respectively, was as follows: grade 2-3 pain in five patients in each group; grade 2 breast edema in two and three patients; grade 2-3 and grade 2 fibrosis in six and eight patients; grade 2 and grade 2-3 telangiectasia in two and three patients; grade ≥2 and 2 arm edema in two and one patients; no ulceration or atrophy were observed. Two patients in group A and one patient in group B needed treatment for breast and arm edema and arm edema, respectively. Very good, good-acceptable, and poor cosmetic results were observed in seven and two, fifteen and nineteen, and six and eight patients, respectively. Median skin elasticity loss due to treatment was −4.19% in group A and −6.29% in group B. These results are not statistically different. Conclusions LENT-SOMA toxicities were minimal and no differences were observed between groups. Few patients in the hypofractionated group had very good cosmetic results, but it is debatable if radiotherapy was the only cause. Skin elasticity was not different between groups. Our results seem to suggest that it is possible to treat patients with both schedules, with similar late toxicity.
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Survival Prediction of Patients with Breast Cancer: Comparisons of Decision Tree and Logistic Regression Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.9176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dominici LS, King TA. How do age and molecular subtypes impact surgical decisions? BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2017-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tumor molecular subtype and patient age are the predominant drivers of recommendations for systemic therapy in patients with breast cancer. Yet, the impact of these factors on surgical decision-making remains controversial. Younger women often receive the most extensive surgical therapy despite a lack of evidence that bigger surgery translates into better outcomes. In contrast, among older women, there is a desire to minimize local therapy and its associated morbidity. Here, we review contemporary data highlighting the relationship between patient age and breast cancer molecular subtype, and local therapy outcomes. Our perspective is that tumor biology, rather than age, should be the driving factor in determining appropriate local therapy for breast cancer.
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Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA 02215, USA
- Department of Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Tari A King
- Surgical Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA 02215, USA
- Department of Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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28
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Risk factors and state-of-the-art indications for boost irradiation in invasive breast carcinoma. Brachytherapy 2017; 16:552-564. [DOI: 10.1016/j.brachy.2017.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
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Reirradiation for locally recurrent breast cancer. Breast 2017; 33:159-165. [PMID: 28395234 DOI: 10.1016/j.breast.2017.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/02/2017] [Accepted: 03/18/2017] [Indexed: 01/12/2023] Open
Abstract
The aim of this study is to review the current status of reirradiation therapy (Re-RT) for locally recurrent breast cancer. The overall outcome of breast/chest wall Re-RT is difficult to assess because of the wide range of different treatments that a patient may have undergone and the patient's individual features. The local control and complete response rates were reported to be 43-96% and 41-71%, respectively. The combination of Re-RT and hyperthermia seems to be related to improved outcomes. Toxicity rates vary between studies, and Re-RT is generally well tolerated. Re-RT may be considered an option for patients with breast cancer relapse after prior irradiation. Further studies are needed to determine the best irradiation volume and treatment modality for patients with locally recurrent disease.
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30
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Risque de récidive locale en fonction de la classification moléculaire, exemple du cancer du sein. ONCOLOGIE 2017. [DOI: 10.1007/s10269-017-2697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Arthur DW, Winter KA, Kuerer HM, Haffty BG, Cuttino LW, Todor DA, Simone NL, Hayes SB, Woodward WA, McCormick B, Cohen RJ, Sahijdak WM, Canaday DJ, Brown DR, Currey AD, Fisher CM, Jagsi R, White J. NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-Year Toxicity Report From a Phase 2 Study of Repeat Breast-Preserving Surgery and 3-Dimensional Conformal Partial-Breast Reirradiation for In-Breast Recurrence. Int J Radiat Oncol Biol Phys 2017; 98:1028-1035. [PMID: 28721885 DOI: 10.1016/j.ijrobp.2017.03.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/01/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation. METHODS AND MATERIALS Eligibility criteria included in-breast recurrence occurring >1 year after whole-breast irradiation, <3 cm, unifocal, and resected with negative margins. Partial-breast reirradiation was targeted to the surgical cavity plus 1.5 cm; a prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments was used. The primary objective was to evaluate the rate of grade ≥3 treatment-related skin, fibrosis, and/or breast pain adverse events (AEs), occurring ≤1 year from re-treatment completion. A rate of ≥13% for these AEs in a cohort of 55 patients was determined to be unacceptable (86% power, 1-sided α = 0.07). RESULTS Between 2010 and 2013, 65 patients were accrued, and the first 55 eligible and with 1 year follow-up were analyzed. Median age was 68 years. Twenty-two patients had ductal carcinoma in situ, and 33 had invasive disease: 19 ≤1 cm, 13 >1 to ≤2 cm, and 1 >2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 (<2%) grade ≥3 and identified as grade 3 fibrosis of deep connective tissue. CONCLUSION Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare.
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Affiliation(s)
- Douglas W Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Laurie W Cuttino
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Dorin A Todor
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Nicole L Simone
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Wendy A Woodward
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Randi J Cohen
- Department of Radiation Oncology, University of Maryland Medical System, Baltimore, Maryland
| | - Walter M Sahijdak
- Department of Radiation Oncology, Michigan Cancer Research Consortium Community Clinical Oncology Program, Ann Arbor, Michigan
| | | | - Doris R Brown
- Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Adam D Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver, Denver, Colorado
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Julia White
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
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Breast Cancer Posttreatment Surveillance: Diagnosis and Management of Recurrent Disease. Clin Obstet Gynecol 2016; 59:772-778. [DOI: 10.1097/grf.0000000000000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Massimino KP, Jochelson MS, Burgan IE, Stempel M, Morrow M. How Beneficial is Follow-Up Mammography in Elderly Breast Cancer Survivors? Ann Surg Oncol 2016; 23:3518-3523. [PMID: 27306905 DOI: 10.1245/s10434-016-5301-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to determine the rate of non-palpable cancer detection and benign biopsy rates for follow-up mammograms in elderly breast cancer survivors. METHODS Women 80 years of age and older who underwent operation for ductal carcinoma in situ or invasive breast cancer from 2005 to 2010 and who had at least 6 months of follow-up were identified from a single-institution, prospectively maintained, Health Insurance Portability and Accountability Act (HIPAA)-compliant database. Patients with mammographic, other imaging, or palpable abnormalities were identified, and the results of their imaging studies and biopsies were reviewed. Number of locoregional recurrences, contralateral cancers, and benign biopsies were determined. Follow-up and survival data were recorded. RESULTS Overall, 429 women with a mean age of 83.4 years were included. Mean follow-up was 50.0 months (range 6-113). Patients had a median of four follow-up mammograms (range 0-11). The 1466 mammograms detected 17 biopsy-proven cancers and generated 18 benign biopsies. In the 305 women who had had breast-conserving surgery, 18 (5.9 %) experienced local recurrence, 9 detected by mammography alone (mean size 1.2 cm) and 9 palpable (mean size 2.0 cm). Contralateral cancer developed in 4 (0.9 %) of the 429 patients, all detected on screening mammogram alone. CONCLUSION Overall, 13 non-palpable breast cancers were detected in 1466 mammograms (0.9 %). While these results are acceptable for screening programs in healthy populations, further study of the need for routine follow-up imaging in the elderly, and the appropriate interval, is needed to maximize resource utilization.
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Affiliation(s)
- Kristen P Massimino
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Maxine S Jochelson
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Imelda E Burgan
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Sabatier R, Sabiani L, Zemmour C, Taix S, Chereau E, Gonçalves A, Jalaguier-Coudray A, Charafe-Jauffret E, Resbeut M, Extra JM, Viens P, Tallet A. Invasive ductal breast carcinoma with predominant intraductal component: Clinicopathological features and prognosis. Breast 2016; 27:8-14. [PMID: 27212694 DOI: 10.1016/j.breast.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/14/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Invasive ductal carcinoma with predominant intraductal component (IDCPIC) represents almost 5% of breast cancers. Nevertheless few data exist concerning their characteristics and prognostic behaviour. Our objective was to describe IDCPIC's clinicopathological and prognostic features and compare them to that of invasive ductal carcinoma without predominant intraductal component (IDC). METHODS Retrospective single centre study including all the localized invasive ductal carcinoma listed in our institutional database. Clinical, radiological and pathological criteria were collected as well as disease-free survival (DFS) data. RESULTS From 1995 to 2008, 4109 invasive ductal breast cancers treated were included. Out of them 192 (4.7%) were IDCPIC. Most of IDCPIC (63%) were discovered by radiological screening whereas IDC suspicion was more often clinical (82.7% vs 49.5%, p < 0.001). Pathological lymph node involvement was less frequent in IDCPIC (35.8 vs 44.3%, p = 0.04). Invasive tumour median size was 2-fold smaller in IDCPIC (10 mm vs 20 mm, p<0.001). Hormone receptors expression was similar between both groups whereas HER2 overexpression was more frequent in IDCPIC (32% vs 14.3%, p<0.001). Mastectomy was more frequently performed for IDCPIC (67.7% vs 30.3%, p < 0.001) whereas chemotherapy and radiation therapy were less frequent (55.5% vs 68%, and 82.8% vs 95.5%, respectively, p < 0.001 for both). After matching for discriminant clinicopathological features (tumour size, lymph node involvement, vascular invasion, HER2), DFS was similar in both groups (5-year DFS of 87.4% vs 84.4%, p = 0.47). CONCLUSION IDCPIC and other IDC with invasive components showing similar clinicopathological features display a similar prognosis.
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Affiliation(s)
- Renaud Sabatier
- Department of Oncology, Institut Paoli-Calmettes, Marseille, France; Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, Marseille, France; Aix-Marseille Université, Marseille, France
| | - Laura Sabiani
- Aix-Marseille Université, Marseille, France; Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - Christophe Zemmour
- Department of Clinical Research and Innovation, Methodology and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Taix
- Aix-Marseille Université, Marseille, France; Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | - Elisabeth Chereau
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anthony Gonçalves
- Department of Oncology, Institut Paoli-Calmettes, Marseille, France; Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, Marseille, France; Aix-Marseille Université, Marseille, France
| | | | - Emmanuelle Charafe-Jauffret
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, Marseille, France; Aix-Marseille Université, Marseille, France; Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | - Michel Resbeut
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marc Extra
- Department of Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Patrice Viens
- Department of Oncology, Institut Paoli-Calmettes, Marseille, France; Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, Marseille, France; Aix-Marseille Université, Marseille, France
| | - Agnès Tallet
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
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Dixon JM, Newlands C, Dodds C, Thomas J, Williams LJ, Kunkler IH, Bing A, Macaskill EJ. Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer. Br J Surg 2016; 103:830-8. [DOI: 10.1002/bjs.10126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/18/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Completeness of excision is the most important factor influencing local recurrence after breast-conserving surgery (BCS). The aim of this case–control study was to determine factors influencing incomplete excision in patients undergoing BCS.
Methods
Women with invasive breast cancer treated by BCS between 1 June 2008 and 31 December 2009 were identified from a prospectively collected database in the Edinburgh Breast Unit. The maximum size of the tumour, measured microscopically, was compared with the size estimated before operation by mammography and ultrasound imaging. A multivariable analysis was performed to investigate factors associated with incomplete excision.
Results
The cohort comprised 311 women, of whom 193 (62·1 per cent) had a complete (CE group) and 118 (40·7 per cent) an incomplete (IE group) excision. Mammography underestimated tumour size in 75·0 per cent of the IE group compared with 40·7 per cent of the CE group (P < 0·001). Ultrasound imaging underestimated tumour size in 82·5 per cent of the IE group compared with 56·5 per cent of the CE group (P < 0·001). The risk of an incomplete excision was greater when mammography or ultrasonography underestimated pathological size: odds ratio (OR) 4·38 (95 per cent c.i. 2·59 to 7·41; P < 0·001) for mammography, and OR 3·64 (2·03 to 6·54; P < 0·001) for ultrasound imaging. For every 1-mm underestimation of size by mammography and ultrasonography, the relative odds of incomplete excision rose by 10 and 14 per cent respectively.
Conclusion
Underestimation of tumour size by current imaging techniques is a major factor associated with incomplete excision in women undergoing BCS.
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Affiliation(s)
- J M Dixon
- Edinburgh Breast Unit, University of Edinburgh, Edinburgh, UK
| | - C Newlands
- Edinburgh University Medical School, University of Edinburgh, Edinburgh, UK
| | - C Dodds
- South East Scotland Cancer Network, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - J Thomas
- Edinburgh Breast Unit, University of Edinburgh, Edinburgh, UK
| | - L J Williams
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - I H Kunkler
- Edinburgh Breast Unit, University of Edinburgh, Edinburgh, UK
| | - A Bing
- Edinburgh Breast Unit, University of Edinburgh, Edinburgh, UK
| | - E J Macaskill
- Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, UK
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Brenner DR, Brockton NT, Kotsopoulos J, Cotterchio M, Boucher BA, Courneya KS, Knight JA, Olivotto IA, Quan ML, Friedenreich CM. Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control 2016; 27:459-72. [PMID: 26970739 PMCID: PMC4796361 DOI: 10.1007/s10552-016-0726-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/06/2016] [Indexed: 02/06/2023]
Abstract
Almost 7 % of breast cancers are diagnosed among women age 40 years and younger in Western populations. Clinical outcomes among young women are worse. Early age-of-onset increases the risk of contralateral breast cancer, local and distant recurrence, and subsequent mortality. Breast cancers in young women (BCYW) are more likely to present with triple-negative (TNBC), TP53-positive, and HER-2 over-expressing tumors than among older women. However, despite these known differences in breast cancer outcomes and tumor subtypes, there is limited understanding of the basic biology, epidemiology, and optimal therapeutic strategies for BCYW. Several modifiable lifestyle factors associated with reduced risk of developing breast cancer have also been implicated in improved prognosis among breast cancer survivors of all ages. Given the treatment-related toxicities and the extended window for late effects, long-term lifestyle modifications potentially offer significant benefits to BCYW. In this review, we propose a model identifying three main areas of lifestyle factors (energy imbalance, inflammation, and dietary nutrient adequacy) that may influence survival in BCYW. In addition, we provide a summary of mechanisms of action and a synthesis of previous research on each of these topics.
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Affiliation(s)
- Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Nigel T Brockton
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Julia A Knight
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ivo A Olivotto
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - May Lynn Quan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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37
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Harms W, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Krug D, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Wenz F, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences. Strahlenther Onkol 2016; 192:199-208. [PMID: 26931319 PMCID: PMC4833793 DOI: 10.1007/s00066-015-0939-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023]
Abstract
Objective To update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on the current German interdisciplinary S3 guidelines 2012. Methods A comprehensive survey of the literature using the search phrases “locoregional breast cancer recurrence”, “chest wall recurrence”, “local recurrence”, “regional recurrence”, and “breast cancer” was performed, using the limits “clinical trials”, “randomized trials”, “meta-analysis”, “systematic review”, and “guidelines”. Conclusions Patients with isolated in-breast or regional breast cancer recurrences should be treated with curative intent. Mastectomy is the standard of care for patients with ipsilateral breast tumor recurrence. In a subset of patients, a second breast conservation followed by partial breast irradiation (PBI) is an appropriate alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory. The largest reirradiation experience base exists for multicatheter brachytherapy; however, prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. Following primary mastectomy, patients with resectable locoregional breast cancer recurrences should receive multimodality therapy including systemic therapy, surgery, and radiation +/− hyperthermia. This approach results in high local control rates and long-term survival is achieved in a subset of patients. In radiation-naive patients with unresectable locoregional recurrences, radiation therapy is mandatory. In previously irradiated patients with a high risk of a second local recurrence after surgical resection or in patients with unresectable recurrences, reirradiation should be strongly considered. Indication and dose concepts depend on the time interval to first radiotherapy, presence of late radiation effects, and concurrent or sequential systemic treatment. Combination with hyperthermia can further improve tumor control. In patients with isolated axillary or supraclavicular recurrence, durable disease control is best achieved with multimodality therapy including surgery and radiotherapy. Radiation therapy significantly improves local control and should be applied whenever feasible.
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Affiliation(s)
- Wolfgang Harms
- Abteilung für Radioonkologie, St. Claraspital, Kleinriehenstrasse 30, 4016, Basel, Switzerland.
| | - W Budach
- Heinrich-Heine-University, Duesseldorf, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - W Haase
- Formerly St.-Vincentius-Hospital, Karlsruhe, Germany
| | - D Krug
- University Hospital Heidelberg, Heidelberg, Germany
| | - M D Piroth
- HELIOS-Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - F Sedlmayer
- Paracelsus Medical University Hospital, Salzburg, Austria
| | - R Souchon
- Formerly University Hospital Tuebingen, Tuebingen, Germany
| | - F Wenz
- University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Ishitobi M, Okuno J, Kittaka N, Nakayama T, Koyama H, Tamaki Y. Distant Recurrence Risk after Late Ipsilateral Breast Tumor Recurrence: Results of a Retrospective, Single-Institution Study. Oncology 2015; 89:269-74. [PMID: 26484529 DOI: 10.1159/000437440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES There is limited information regarding risk factors for distant recurrence in patients with late ipsilateral breast tumor recurrence (IBTR). METHODS Late IBTR was defined as IBTR occurring >5 years after the initial surgery. Seventy-eight patients with late IBTR were reviewed to examine the risk factors of distant recurrence. RESULTS The negative estrogen receptor and positive HER2 statuses of IBTR were significantly correlated with poorer distant disease-free survival (p=0.03 and 0.02, respectively). Multivariate analyses demonstrated that the HER2 status of IBTR was an independent predictive factor of distant recurrence (p=0.04). CONCLUSIONS The results of our retrospective, single-institution study revealed that the HER2 status of IBTR was an independent predictive factor of distant recurrence in patients with late IBTR.
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Affiliation(s)
- Makoto Ishitobi
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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39
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Maluta S, Kolff MW. Role of Hyperthermia in Breast Cancer Locoregional Recurrence: A Review. Breast Care (Basel) 2015; 10:408-12. [PMID: 26989361 DOI: 10.1159/000440792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In patients with locoregional recurrences of breast cancer not suitable for resection, subsequent local control is difficult to maintain in previously irradiated areas when reirradiation alone or reirradiation with chemotherapy is used. Due to the limited number of treatment options there is a high risk of subsequent failure and uncontrollable local disease. In this group of patients, local hyperthermia combined with radiotherapy increases the clinical response and local control, adding limited acute and late toxicity, as has been shown in randomized trials. Hyperthermia is an artificial elevation of tissue temperature (range 40-44°C for 30-60 min). If hyperthermia is applied shortly before or after radiation, the effect of radiation is enhanced by influencing intratumoral hypoxia and by inhibiting sublethal damage repair in the tumor. Moreover, hyperthermia combined with radiation reduces the total dose of radiation needed compared to radiation alone, of which a higher dose is needed to obtain the same effect. Few data are available on the combination of radiotherapy and hyperthermia with chemotherapy, although the results of trimodality treatment consisting of reirradiation and hyperthermia together with liposomal doxorubicin are promising. Therefore, this literature review was performed to provide more comprehensive data on the mechanism and use of hyperthermia in locoregional recurrence of breast cancer.
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Affiliation(s)
- Sergio Maluta
- Department of Hyperthermia, Serena Medical Center, Padova, Italy
| | - Merel Willemijn Kolff
- Department of Radiotherapy and Hyperthermia, Academic Medical Center, Amsterdam, The Netherlands
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40
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Patients with N1 breast cancer: Who could benefit from supraclavicular fossa radiotherapy? Breast 2014; 23:749-53. [DOI: 10.1016/j.breast.2014.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/29/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022] Open
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41
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Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer 2014; 17:301-7. [PMID: 25548576 PMCID: PMC4278047 DOI: 10.4048/jbc.2014.17.4.301] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/05/2014] [Indexed: 12/16/2022] Open
Abstract
Young age breast cancer (YABC) has unique clinical and biological features that are not seen in older patients. Breast tumor biology is more aggressive and is associated with an unfavorable prognosis in younger women. The diagnosis of breast cancer is often delayed, resulting in their initial presentation with more advanced disease. Together, these characteristics lead to a poorer prognosis in younger women than in older women. Young women who receive breast-conserving therapy have a higher rate of local recurrence. Therefore, it is important to secure sufficient resection margins and consider boost radiotherapy to prevent local treatment failure. Based on age alone, patients with YABC should be regarded as high-risk cases, and they should be treated with adjuvant chemotherapy. Special considerations regarding psychosocial factors and fertility should be taken into account for young patients. This review discusses the major considerations and principles concerning the management of patients with YABC.
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Affiliation(s)
- Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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42
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Wei JT, Huang WH, Du CW, Qiu SQ, Wei XL, Liu J, Zhang GJ. Clinicopathological features and prognostic factors of young breast cancers in Eastern Guangdong of China. Sci Rep 2014; 4:5360. [PMID: 24942640 PMCID: PMC5381536 DOI: 10.1038/srep05360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/02/2014] [Indexed: 02/05/2023] Open
Abstract
Breast cancer in young women is typically with higher proportion of adverse pathological features. Breast cancer with BRCA1 mutation is often early-onset, and is usually associated with triple negative phenotpe. In this study, we aim to analyze the clinicopathological characteristics and prognosis in young breast cancer patients (≤35 years old) comparing to non-young patients (>35 years old). A total of 1913 cases of primary breast carcinoma with stage I-III were enrolled, with 283 cases diagnosed as young patients. No significant difference was observed in tumor size, TNM staging, lymph node metastasis, ER, HER-2 or histological grade between young and non-young patients. Multivariate analysis demonstrated that age was an independent prognostic factor for overall survival (OS). In 70 samples of young patients available, BRCA1 was immunohistochemically positive 85.7% in cytoplasm and 41.4% in nuclear. BRCA1 nuclear expression is not significantly associated with clinicopathological characteristics in young breast cancer patients.
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Affiliation(s)
- Jin-Tao Wei
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
- These authors contributed equally to this work
- Current address: Breast Tumor Center, Chancheng District Central Hospital of Foshan City, Foshan 528031, China
| | - Wen-He Huang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
- These authors contributed equally to this work
| | - Cai-Wen Du
- Department of Breast Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Si-Qi Qiu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Xiao-Long Wei
- Cancer Research Center, Shantou University Medical College, Shantou 515041, China
| | - Jing Liu
- Cancer Research Center, Shantou University Medical College, Shantou 515041, China
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
- Cancer Research Center, Shantou University Medical College, Shantou 515041, China
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Dent R, Valentini A, Hanna W, Rawlinson E, Rakovitch E, Sun P, Narod SA. Factors associated with breast cancer mortality after local recurrence. ACTA ACUST UNITED AC 2014; 21:e418-25. [PMID: 24940101 DOI: 10.3747/co.21.1563] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery. EXPERIMENTAL DESIGN Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women's College Hospital from 1987 to 1997 and who later developed local recurrence. Clinical information and tumour receptor status were abstracted from medical records and pathology reports. Patients were followed from the date of local recurrence until death or last follow-up. Survival analysis used a Cox proportional hazards model. RESULTS Among the 267 women with a local recurrence, 97 (36.3%) died of breast cancer within 10 years (on average 2.6 years after the local recurrence). The actuarial risk of death was 46.1% at 10 years from recurrence. In a multivariable model, predictors of death included short time from diagnosis to recurrence [hazard ratio (hr) for <5 years compared with ≥10 years: 3.40; 95% confidence interval (ci): 1.04 to 11.1; p = 0.04], progesterone receptor positivity (hr: 0.35; 95% ci: 0.23 to 0.54; p < 0.001), lymph node positivity (hr: 2.1; 95% ci: 1.4 to 3.3; p = 0.001), and age at local recurrence (hr for age >45 compared with age ≤45 years: 0.61; 95% ci: 0.38 to 0.95; p = 0.03). CONCLUSIONS The risk of death after local recurrence varies widely. Risk factors for death after local recurrence include node positivity, progesterone receptor negativity, young age at recurrence, and short time from diagnosis to recurrence.
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Affiliation(s)
- R Dent
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, ON
| | - A Valentini
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - W Hanna
- Department of Pathology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - E Rawlinson
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - E Rakovitch
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - P Sun
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
| | - S A Narod
- Women's College Research Institute, Women's College Hospital and University of Toronto, Toronto, ON
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Ishitobi M, Matsushita A, Nakayama T, Motomura K, Koyama H, Tamaki Y. Regional lymphatic recurrence after salvage surgery for ipsilateral breast tumor recurrence of breast cancer without local treatment for regional lymphatic basin. J Surg Oncol 2014; 110:265-9. [PMID: 24863697 DOI: 10.1002/jso.23642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/10/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is limited information regarding rates of and risk factors for regional lymphatic recurrence (RLR) after salvage surgery for ipsilateral breast tumor recurrence (IBTR) without local treatment for the regional lymphatic basin. METHODS One hundred two patients, who underwent salvage breast surgery without local treatment for the regional lymphatic basin (surgery or radiotherapy) for IBTR that relapsed after breast-conserving surgery for primary breast cancer, were reviewed retrospectively to examine the rate of and risk factors for RLR. RESULTS Of the 102 patients, 9 patients (8.8%) had RLR with a median follow-up period of 3.7 years after salvage breast surgery for IBTR. The estrogen receptor (ER) status and lymphovascular invasion of the recurrent breast tumor were both independent predictive factors of RLR (P = 0.04 and 0.02, respectively). CONCLUSIONS The rate of RLR was not low in patients with IBTR who received salvage breast surgery only without any treatment for the regional lymphatic basin. The ER status and lymphovascular invasion of the recurrent breast tumor were predictive factors of RLR.
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Affiliation(s)
- Makoto Ishitobi
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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45
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Bollet MA, Kirova YM, Fourquet A, de Cremoux P, Reyal F. Prognostic factors for local recurrence following breast-conserving treatment in young women. Expert Rev Anticancer Ther 2014; 10:1215-27. [DOI: 10.1586/era.10.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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46
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Accelerated partial breast irradiation using 3D conformal radiotherapy: Toxicity and cosmetic outcome. Breast 2013; 22:1136-41. [DOI: 10.1016/j.breast.2013.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/19/2013] [Accepted: 07/16/2013] [Indexed: 11/17/2022] Open
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47
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Reyal F, Hajage D, Savignoni A, Feron JG, Bollet MA, Kirova Y, Fourquet A, Pierga JY, Cottu P, Dieras V, Fourchotte V, Laki F, Alran S, Asselain B, Vincent-Salomon A, Sigal-Zafrani B, Sastre-Garau X. Long-term prognostic performance of Ki67 rate in early stage, pT1-pT2, pN0, invasive breast carcinoma. PLoS One 2013; 8:e55901. [PMID: 23526930 PMCID: PMC3602517 DOI: 10.1371/journal.pone.0055901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/07/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Molecular signatures may become of use in clinical practice to assess the prognosis of breast cancers. However, although international consensus conferences sustain the use of these new markers in the near future, concerns remain about their degree of discordance and cost-effectiveness in different international settings. The present study aims to validate Ki67 as prognostic factor in a large cohort of early-stage (pT1-pT2, pN0) breast cancer patients. METHODS 456 patients treated in 1995-1996 were identified in the Institut Curie database. Ki67 (MIB1) was retrospectively assessed by immunohistochemistry for all cases. The prognostic value of this index was compared to that of histological grade (HG), Estrogen receptor (ER) and HER2 status. Distant disease free interval, loco-regional recurrence, time-lapse from first metastatic diagnosis to death were analyzed. RESULTS All 456 patients were treated by lumpectomy plus axillary dissection and radiotherapy. 27 patients (5.9%) received systemic treatment. Tumors were classified as HG1 in 35%, HG2 in 42% and HG3 in 23% of cases. ER was expressed in 86% of the tumors, HER2 in 5% and 14% were triple negative. The median follow-up was 151 [5-191] months. Distant and loco-regional disease recurrences were observed in 16% and 18%, respectively. High (>20%) Ki67 rate [HR = 3 (1.8-4.8), p<10e-06] and HG3 [HR = 4.4 (2.2-8.6), p = 0.00002] were associated with an increased rate of distant relapse. In multivariate analysis, the Ki67 remained the only significant prognostic factor in the subgroups of ER positive HER2 negative [HR = 2.6 (1.5-4.6), p = 0.0006] and ER positive HER2 negative HG2 tumors [HR = 2.2 (1.01-4.8), p = 0.04]. CONCLUSIONS We validate the prognosis value of the Ki67 rate in small size node negative breast cancer. We conclude that Ki67 is a potential cost-effective decision marker for adjuvant therapy in early-stage HG2, pT1-pT2, pN0, breast cancers.
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Affiliation(s)
- Fabien Reyal
- Department of Surgery, Institut Curie, Paris, France
| | - David Hajage
- Department of Biostatistic, Institut Curie, Paris, France
| | | | | | | | - Youlia Kirova
- Départment of Radiation Oncology, Institut Curie, Paris, France
| | - Alain Fourquet
- Départment of Radiation Oncology, Institut Curie, Paris, France
| | | | - Paul Cottu
- Département of Medical Oncology, Institut Curie, Paris, France
| | | | | | - Fatima Laki
- Department of Surgery, Institut Curie, Paris, France
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Sakr RA. [Does molecular biology play any role in ductal carcinoma in situ?]. ACTA ACUST UNITED AC 2013; 41:45-53. [PMID: 23286959 DOI: 10.1016/j.gyobfe.2012.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
The natural history of ductal carcinoma in situ (DCIS) is not fully elucidated, but it is recognized that DCIS is the true precursor of invasive carcinoma. Studies could show that DCIS is as heterogeneous as invasive ductal carcinoma, yet, they were unable to predict which DCIS will progress to invasion. Several biomarkers were also demonstrated to have a certain prognostic value. However, except for estrogen receptors and HER2, biomarkers are not yet widely used in clinical practice since their predictive value has not proven to be better than the grade and the classical classifying systems of DCIS. Identifying biomarkers for risk of invasiveness in DCIS could be of great value to help high risk patients through the management of their disease and to avoid overtreatment in low risk patients.
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Affiliation(s)
- R A Sakr
- UMRS938, service de gynécologie, université Pierre-et-Marie-Curie, hôpital Tenon, 4, rue de la Chine, Paris, France.
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Kim YH, Kim JH, Choi YW, Lim SK, Yim H, Kang SY, Chung YS, Lee GY, Park TJ. Gankyrin is frequently overexpressed in breast cancer and is associated with ErbB2 expression. Exp Mol Pathol 2012; 94:360-5. [PMID: 23276718 DOI: 10.1016/j.yexmp.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/19/2012] [Indexed: 01/26/2023]
Abstract
Gankyrin is a subunit of the 26S proteasome, and has been known to degrade p53 and retinoblastoma protein and promote the tumorigenicity and metastasis in some malignancies. However, the role of gankyrin in breast cancer has not been explored. In this study, we investigated the expression of gankyrin in breast cancer and evaluated its effect on breast cancer. Representative cancer tissues including normal breasts from 60 patients with breast cancer were stained immunohistochemically for gankyrin, estrogen receptor, progesterone receptor, and ErbB2. We evaluated the relationship between gankyrin expression and clinicopathologic parameters or prognostic markers. We also attempted to clarify the mechanism of gankyrin involved in breast carcinogenesis by using MCF7 breast cancer cells. Gankyrin was weakly expressed in normal breast epithelial cells, however, tumor regions of 37/60 (61.7%) cases showed an overexpression of gankyrin. Gankyrin overexpression was associated with extensive intraductal carcinoma (p=0.014) and ErbB2 positivity (p=0.031) in invasive ductal carcinoma. In MCF7 breast cancer cells, downregulation of gankyrin was associated with a reduction of cell proliferation and tumorigenicity. In conclusion, gankyrin was identified in normal breasts and overexpressed in invasive breast cancers. The overexpression of gankyrin was associated with extensive intraductal carcinoma and ErbB2 expression in breast cancer.
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Affiliation(s)
- Yeong Hwa Kim
- Department of Biochemistry and Molecular Biology, Brain Korea 21 Division of Cell Transformation and Restoration, Ajou University, School of Medicine, Suwon 443-721, Republic of Korea
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Spooner D, Stocken DD, Jordan S, Bathers S, Dunn JA, Jevons C, Dodson L, Morrison JM, Oates GD, Grieve RJ. A randomised controlled trial to evaluate both the role and the optimal fractionation of radiotherapy in the conservative management of early breast cancer. Clin Oncol (R Coll Radiol) 2012; 24:697-706. [PMID: 23036277 DOI: 10.1016/j.clon.2012.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 07/09/2012] [Accepted: 08/16/2012] [Indexed: 11/17/2022]
Abstract
AIMS Postoperative radiotherapy is routinely used in early breast cancer employing either 50 Gy in 25 daily fractions (long course) or 40 Gy in 15 daily fractions (short course). The role of radiotherapy and shorter fractionation regimens require validation. MATERIALS AND METHODS Patients with clinical stage I and II disease were randomised to receive immediate radiotherapy or delayed salvage treatment (no radiotherapy). Patients receiving radiotherapy were further randomised between long (50 Gy in 25 daily fractions) or short (40 Gy in 15 daily fractions) regimens. The primary outcome measure was time to first locoregional relapse. Reported results are at a median follow-up of 16.9 years (interquartile range 15.4-18.8). RESULTS In total, 707 women were recruited between 1985 and 1992: median age 59 years (range 28-80), 68% postmenopausal, median tumour size 2.0 cm (range 0.12-8.0); 271 patients have relapsed: 110 radiotherapy, 161 no radiotherapy. The site of first relapse was locoregional158 (64%) and distant 87 (36%). There was an estimated 24% reduction in the risk of any competing event (local relapse, distant relapse or death) with radiotherapy (hazard ratio = 0.76; 95% confidence interval 0.65, 0.88). The benefit of radiotherapy treatment for all competing event types was statistically significant (X(Wald)(2) = 36.04, P < 0.001). Immediate radiotherapy reduced the risk of locoregional relapse by 62% (hazard ratio = 0.38; 95% confidence interval 0.27, 0.53), consistent across prognostic subgroups. No differences were seen between either radiotherapy fractionation schedules. CONCLUSIONS This study confirmed better locoregional control for patients with early breast cancer receiving radiotherapy. A radiotherapy schedule of 40 Gy in 15 daily fractions is an efficient and effective regimen that is at least as good as the international conventional regimen of 50 Gy in 25 daily fractions.
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Affiliation(s)
- D Spooner
- The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
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