26
|
Stallard S, Siddaway R, Miklja Z, Mullan B, Garcia T, Zamler D, Kasaian K, Cao X, Anderson B, Hervey-Jumper S, Castro MG, Lowenstein PR, Mody R, Chinnaiyan A, Venneti S, Hawkins C, Koschmann C. DIPG-38. ID1 EXPRESSION CORRELATES WITH H3F3A K27M MUTATION AND EXTRA-PONTINE INVASION IN DIPG. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
27
|
Morrow E, Lannigan A, Doughty J, Litherland J, Mansell J, Stallard S, Mallon E, Romics L. Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast. Br J Surg 2018; 105:987-995. [PMID: 29623677 DOI: 10.1002/bjs.10791] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/12/2017] [Accepted: 11/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared. METHODS All women diagnosed with pure ILC or IDC in the West of Scotland in 2012-2014 were identified from a database maintained prospectively within the Managed Clinical Network. Pretreatment axillary ultrasound imaging (AUS), core biopsy and fine-needle aspiration cytology (FNAC) results were compared between ILC and IDC. RESULTS Some 602 women with ILC and 4199 with IDC had undergone axillary surgery, of whom 209 and 1402 respectively had nodal metastases. Pretreatment AUS sensitivity was significantly lower in ILC than in IDC (32·1 versus 50·1 per cent respectively, P < 0·001; OR 0·47, 95 per cent c.i. 0·34 to 0·64). Core biopsy had equally high sensitivity of 86 per cent in both subtypes; however, FNAC was significantly less sensitive in both ILC (55 per cent; P = 0·003) and IDC (75·6 per cent; P = 0·006). Multivariable analysis revealed that cT3-4 status and symptomatic presentation were both significant in predicting nodal metastasis in patients with ILC and false-negative AUS findings (OR 3·77, 95 per cent c.i. 1·69 to 8·42, P = 0·001; and OR 1·92, 1·24 to 2·98, P = 0·003, respectively). CONCLUSION AUS is inferior in detecting axillary node metastasis in ILC compared with IDC. Women with cT3-4 lobular carcinoma may benefit from ultrasound-guided axillary biopsy regardless of the ultrasonographic appearance of the nodes.
Collapse
|
28
|
Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Abstract P4-13-01: Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-13-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. We studied the outcomes of OBC practice in Scotland and compare individual breast units.
Methods: a predefined database of patients treated with OBC was completed retrospectively in 11 breast units in Scotland. Patients were treated with OBC from 2005 onwards were included. For statistical calculations Chi-test, ANOVA and Pearson correlation analysis were used.
Results: Altogether 589 patients were included. Median age was 56 years [21-86]. Patients were diagnosed between September 2005 and March 2017. Number of patients treated with OBC per unit ranged between 4 and 145. High volume units were doing a mean of 19.3 OBCs per year [17.3 – 26.5] vs. low volume units doing 11.1 OBCs per year [7 .7– 14.4] (p=0.012).
23 different oncoplastic surgical techniques were applied. Range of oncoplastic techniques used was associated with case-loads: high volume units used a wider range (8 – 14 different techniques) compared to low volume units (3 – 6) (p=0.004). Volume displacement was done in 515 patients (91.3%), volume replacement in 49 patients (8.7%). OBC was carried out as a joint operation between a breast and a plastic surgeon in 66.3% (389 patients). Immediate contralateral symmetrisation rate was significantly higher when the procedure was carried out as a joint operation (70.7% vs. not joint operations: 29.8%; p<0.001).
Incomplete excision rate was 10.4% (60 of 578). Incomplete excision was significantly higher after invasive lobular carcinoma (18.9%; 10 of 43; p=0.0292). After neoadjuvant chemotherapy incomplete excision rate was significantly lower (3%; 2 of 66 vs. no neoadjuvant chemotherapy: 11%; 35 of 319; p=0.031).
Neodjuvant systemic treatment rate was 28.6% (142 of 496 patients). Of those 68 patients received neoadjuvant chemotherapy (13.7%) and 74 patients had neoadjuvant hormonal treatment (14.9%). Neoadjuvant systemic treatment rate varied amongst the units from 9.7% to 57.2% for patients with invasive carcinoma.
259 patients diagnosed with (non)invasive carcinoma had a median follow-up time of 5 years [35-124]. Of these 7 patients (2.7%) developed isolated local recurrence. 5-year local recurrence rate after DCIS was higher than after pure invasive ductal carcinoma (DCIS: 8.3%; 3 of 36 vs. ductal: 1.6%; 3 of 181; p=0.02567). 5-year disease-free survival of these patients was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%.
145 of 510 patients developed complications, which is 28.4% overall complication rate. 71 patients had major complications (13.9%) and 74 patients had minor complications (14.5%). Overall complication rate was significantly lower after neoadjuvant chemotherapy (15.9%; 11 of 69) compared to patients who did not receive neoadjuvant chemotherapy (27.9%; 127 of 455 patients) (p=0.035).
Conclusion: this national audit demonstrated similar outcomes overall compared to relevant published data. Units should be urged to build stronger collaboration in order to reduce variability in OBC practices.
None of the authors have conflict of interest to declare.
Citation Format: Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-01.
Collapse
|
29
|
Kamran N, Kadiyala P, Stallard S, Alghamri M, Nunez F, Ayala MM, Stamatovic S, Andjelkovic-Zochowska A, Lowenstein P, Castro M. TMIC-29. MYELOID DERIVED SUPPRESSOR CELLS’ TRAFFICKING INTO GBM IS REGULATED BY CXCR2 SIGNALING. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Zaidi NB, Hwang C, Scott S, Stallard S, Purkiss J, Hortsch M. Climbing Bloom's taxonomy pyramid: Lessons from a graduate histology course. ANATOMICAL SCIENCES EDUCATION 2017; 10:456-464. [PMID: 28231408 DOI: 10.1002/ase.1685] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Bloom's taxonomy was adopted to create a subject-specific scoring tool for histology multiple-choice questions (MCQs). This Bloom's Taxonomy Histology Tool (BTHT) was used to analyze teacher- and student-generated quiz and examination questions from a graduate level histology course. Multiple-choice questions using histological images were generally assigned a higher BTHT level than simple text questions. The type of microscopy technique (light or electron microscopy) used for these image-based questions did not result in any significant differences in their Bloom's taxonomy scores. The BTHT levels for teacher-generated MCQs correlated positively with higher discrimination indices and inversely with the percent of students answering these questions correctly (difficulty index), suggesting that higher-level Bloom's taxonomy questions differentiate well between higher- and lower-performing students. When examining BTHT scores for MCQs that were written by students in a Multiple-Choice Item Development Assignment (MCIDA) there was no significant correlation between these scores and the students' ability to answer teacher-generated MCQs. This suggests that the ability to answer histology MCQs relies on a different skill set than the aptitude to construct higher-level Bloom's taxonomy questions. However, students significantly improved their average BTHT scores from the midterm to the final MCIDA task, which indicates that practice, experience and feedback increased their MCQ writing proficiency. Anat Sci Educ 10: 456-464. © 2017 American Association of Anatomists.
Collapse
|
31
|
Mansell J, Weiler-Mithoff E, Stallard S, Doughty JC, Mallon E, Romics L. Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast 2017; 32:179-185. [PMID: 28214785 DOI: 10.1016/j.breast.2017.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Support for the oncological safety of oncoplastic breast conservation surgery (OBCS) is mostly based on evidence comparing recurrence rates after OBCS to wide local excision (WLE). However, OBCS is often indicated for larger cancers and oncological results should also be compared to patients treated with mastectomy. In this study we compared recurrence and survival following OBCS, mastectomy and WLE. METHODS Patients treated with OBCS between 2009 and 2012 were identified from a prospectively maintained database. For comparison, consecutive patients treated with WLE or mastectomy with or without immediate reconstruction (Ms ± IR) over the same time period were identified. Histological variables of patients were compared using Fisher Exact or Chi squared tests, and recurrence and survival were compared using Kaplan-Meier and Cox regression survival analysis. RESULTS 980 patients' data were analysed (OBCS: n = 104; WLE: n = 558; Ms ± IR: n = 318). Tumour size, grade, nodal status, ER, and PR expression of patients treated with OBCS were all significantly more adverse compared with patients treated with WLE (p < 0.001). These histological variables were similar in patients treated with Ms ± IR and OBCS. 5-year local recurrence rates were similar in all three groups (WLE: 3.4 per cent, OBCS: 2 per cent, Ms ± IR: 2.6 per cent; log rank = 0.973), while distant recurrence rates were higher after Ms ± IR and OBCS (Ms ± IR:13.1 per cent, OBCS:7.5 per cent, WLE:3.3 per cent; log rank: p < 0.001). CONCLUSION OBCS is oncologically safe in patients even when histological results are similar to patients treated with Ms ± IR.
Collapse
|
32
|
Romics L, Kabir SA, Mansell J, Mallon EA, Stallard S, Doughty JC. Abstract P2-12-14: Therapeutic mammoplasty reduces high incomplete excision rate in lobular cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-12-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Incomplete excision rate for lobular cancer is much higher compared to other types of breast cancer, since lobular cancer is frequently occult on imaging. This, and the inability to downstage lobular cancer with neoadjuvant therapy lead to the highest mastectomy rate of all subtypes. Here, we investigated the association between histopathological characteristics and incomplete excision as well as mastectomy rates.
Further, we investigated whether the application of level 2 therapeutic mammoplasty (TM) would extend the indication for conservation with lobular cancers.
Methods: Data of 1389 consecutive patients underwent surgery for (non)invasive breast cancer between January 2008 and June 2012 was analysed. Pathological and preoperative radiological results were analysed in the context of final surgery and tumour excision margins. Statistical significance was calculated using Chi-square, Mann-Whitney and Z-tests with a significance<0.05.
Results: Overall incomplete excision rate was 13.74% (131/953), and mastectomy rate was 35.35% (491/1389). Higher incomplete excision and mastectomy rates were strongly associated with lobular subtype (IE: 26.03% (19/73)); M: 51.22% (63/123); p<0.01 vs. other subtypes), node positivity (IE: 25% (36/144) vs. 10.43% (68/652); p=0 and M: 60.69% (193/318) vs. 25.65% (216/842); p=0) and tumour size (IE:T3 80% (4/5) vs. T2 22.51% (43/191) vs. T1 9.23% (55/596); all p<0.01; and M: T3 95.35% (41/43) vs. 59.46% (242/407) vs. 16.16% (112/693); all p=0). Incomplete excision rates were independent of hormonal and HER-2 expressions (ER+: 12.55% (89/709) vs. ER-: 16.67% (15/90); p=0.27 and HER2 neg.: 12.67% (91/718) vs. HER2 pos.: 16.67% (13/78); p=0.32) and it was just higher in grade 2 and 3 cancers (14.6% (60/411); p=0.037 and 16.22% (36/222); p=0.021 vs. G1:6.86% (7/102). However, hormonal and HER-2 expressions as well as tumour grade were in strong association with mastectomy rate (ER pos.: 33.28% (335/1007) vs. ER neg.: 48.75% (78/160); p<0.01; HER2 neg.: 33.43% (341/1020) vs. HER2 pos.: 49.65% (71/143); p<0.01; G3: 50.49% (205/406) vs. G2: 30.77%(172/559) vs. G1: 14.28% (17/119); all p=0).
135 patients underwent surgery for lobular cancer (simple wide excision: 66; TM:19; mastectomy: 50). TM was offered for significantly larger tumours than lumpectomy (28.29mm (10-62) vs. 19.96mm(5-57);p<0.01; vs. mastectomy: 37.56 mm(5-110);p=0.096). Incomplete margins were found with significantly smaller tumours when lumpectomy was applied compared to TM(25.94 mm(6-56) vs. 38.6 mm(30-45);p=0.031). Conservation was achieved with significantly bigger tumours when TM was used (25.46mm (10-62) vs. 17.66mm (5-57); p=0.032). Multifocality, however, significantly increased the chance for incomplete excision even after TM (4/7; p=0.019).
Conclusion: Higher incomplete excision rate is strongly associated with lobular subtype, node positivity and tumour size, but independent of hormonal end HER-2 expression, while tumour grade is not a strong predictor. All histopathological characteristics are strong predictors of final mastectomy rate. Using TM, breast conservation can be achieved for significantly larger lobular cancers, and incomplete excision rate decreased in smaller cancers, which are routinely treated with wide excision.
Citation Format: Romics L, Kabir SA, Mansell J, Mallon EA, Stallard S, Doughty JC. Therapeutic mammoplasty reduces high incomplete excision rate in lobular cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-14.
Collapse
|
33
|
Kamran N, Stallard S, Raja N, Ayala MM, Calinescue A, Nunez F, Andjelkovic A, Lowenstein P, Castro M. TMIC-15MYELOID DERIVED SUPPRESSOR CELLS' TRAFFICKING INTO GBM IS REGULATED BY CXCR2 SIGNALING. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov236.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
34
|
Mansell J, Weiler-Mithoff E, Martin J, Khan A, Stallard S, Doughty JC, Romics L. How to compare the oncological safety of oncoplastic breast conservation surgery - To wide local excision or mastectomy? Breast 2015; 24:497-501. [PMID: 26009307 DOI: 10.1016/j.breast.2015.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/13/2015] [Accepted: 05/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comparative studies suggest that patients treated with oncoplastic breast conservation surgery (OBCS) have similar pathology to patients treated with wide local excision (WLE). However, patients treated with OBCS have never been compared to patients treated with mastectomy. The aim of this study was to identify which control group was comparable to patients undergoing OBCS. METHODS Commonly reported histopathological variables of patients treated with OBCS, WLE or mastectomy ± immediate reconstruction (Ms ± IR) were compared using Fisher Exact or Chi squared tests. RESULTS 1000 patients' data were analysed (OBCS: n = 119; WLE: n = 600; Ms ± IR: n = 281). Tumour size was significantly bigger after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.138). Tumour grade was higher after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.497). More axillary nodes were involved in patients with OBCS than WLE (p < 0.001), but comparable to Ms ± IR (p = 0.175). ER and PR expressions were lower after OBCS compared to WLE (p = 0.007, p = 0.009), but identical to Ms ± IR (p = 1, p = 0.904 respectively). Differences in application of systemic (neo)adjuvant therapy followed the above trend. CONCLUSION Striking similarities found between OBCS and mastectomy patients' histopathological results are in sharp contrast with previously published data. This study suggests that oncological outcomes following OBCS should be compared to mastectomy besides WLE.
Collapse
|
35
|
Mansell J, Martin J, Khan A, Weiler-Mithoff E, Stallard S, Doughty JC, Romics L. Abstract P5-15-07: Therapeutic mammaplasty - Radical breast conservation or conservative mastectomy? A comperative analysis of 1000 patients’ pathology results. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-15-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: oncological principles of therapeutic mammaplasty (TM) is based on evidence arising from studies on the oncological safety of traditional breast conservation, i.e. wide local excision (WLE). Hence, oncological safety of TM is benchmarked to patients treated with WLE. However, TM can also be defined as a conversion of mastectomy (Ms) to breast conservation surgery applying plastic surgical techniques in patients conventionally requiring mastectomy. The aim of this study was to decide if TM was similar to WLE or Mx in terms of pathological characteristics.
Methods: 1006 consequtive patients were involved in the analysis, who were treated with TM, WLE or Ms in two Glasgow breast units between 2008 and 2011. Histopathological characteristics of patients treated with TM were compared to those treated with WLE or Ms. Statistical calculations were carried out with Chi-square test. The difference was considered statistically significant if p>0.05.
Results: 121 patients were treated with TM, while 600 patients were treated with WLE and 285 with Ms. Tumour size of TM was significantly different from WLE as well as Ms, although the difference between TM and WLE was more significant than between TM and Ms (TM/Ms/WLE: T1: 43.8%, 34%, 78%; T2: 52.1%, 54.7%, 21%; T3: 4.1%, 11.2%, 1%; TM vs. WLE: p<0.001; vs. Ms: p = 0.03). Tumour grade of TM was significantly higher than grade of WLE, but there was no significant difference between the grades of TM and Ms (TM/Ms/WLE: G1: 6.4%, 4.5%, 19.3%; G2: 37.6%, 41.8%, 54.8%; G3: 56%, 53.7%, 26%; TM vs. SZE: p<0.001; vs. Ms: p = 0.625). Similarly, significantly more axillary nodes were involved in patients treated with TM compared to patients with WLE, while the same was comparable in patients with TM and Ms (TM/Ms/WLE: 0: 73.5%, 70.4%, 87.7%; 1-3: 24.5%, 25.6%, 12.2%; >3: 2%, 4%, 0.2%; TM vs. WLE: p<0.001; vs. Ms: p = 0.601). In terms of histological subtypes, again, there was a significant difference between TM and WLE, but we found no difference when TM was compared to Ms (TM vs. WLE: p = 0.027; vs. Ms: p = 0.582). There was statistically significantly more ER and/or PR positive patients in the group treated with WLE compared to TM (ER/PR TM vs. WLE p = 0.012 / = 0.014), but ER/PR expression was similar in TM and Ms patients (ER/PR TM vs. Ms p = 0.890 / = 0.635). While the trend above was similar in HER-2 expression pattern, there was no statistically significant difference could be demonstrated in between the groups (table).
Discussion: pathological characteristics of patients treated with therapeutic mammaplasty is similar to patients treated with mastectomy, but significantly different from patients who were treated with WLE. Pathology after WLE is significantly more favourable compared to TM. Hence, studies investigating oncological safety of TM comparing to patients treated with WLE only may not be adequate, and Ms patients should be included in the analyses.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-15-07.
Collapse
|
36
|
Schaverien MV, Stallard S, Dodwell D, Doughty JC. Use of boost radiotherapy in oncoplastic breast-conserving surgery - a systematic review. Eur J Surg Oncol 2013; 39:1179-85. [PMID: 23988230 DOI: 10.1016/j.ejso.2013.07.240] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/10/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The use of local boost radiotherapy to the tumour bed has been demonstrated in randomised-controlled trials to reduce local recurrence rates following breast-conserving surgery (BCS) and is the standard of care. Oncoplastic BCS techniques with parenchymal rearrangement present new challenges to the localisation of the tumour bed and therefore delivery of local boost radiotherapy. The aim of this review was to evaluate the reporting of boost radiotherapy in the oncoplastic BCS literature. METHODS Pubmed, Ovid MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for studies reporting oncoplastic BCS using volume displacement techniques. RESULTS 24 studies met the inclusion criteria (n = 1933 patients). Use of boost radiotherapy was reported in 11 studies, in 2 of which it was for the treatment of incomplete or close margins, and marking of the tumour bed was only reported in 8 studies. None of the studies reported the number of patients where the tumour bed could not be localised. CONCLUSIONS The use of local boost radiotherapy and tumour bed marking was not reported in the majority of studies of oncoplastic BCS. Future studies need to provide detailed information regarding the use of boost radiotherapy and difficulties determining the target volume so that current radiotherapy approaches can be reviewed and improved for these advanced techniques.
Collapse
|
37
|
Khan J, Barrett S, Forte C, Stallard S, Weiler-Mithoff E, Doughty JC, Romics L. Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients. Eur J Surg Oncol 2013; 39:887-91. [PMID: 23746877 DOI: 10.1016/j.ejso.2013.05.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2013] [Accepted: 05/08/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION There is hardly any evidence that oncoplastic breast conservation surgery (OBCS) does not lead to a delay in the commencement of adjuvant chemotherapy. Although this is an integral part of overall oncological safety, no controlled studies have been published so far. Therefore, our aim was to determine whether OBCS led to a delay when compared to simple wide local excision (WLE), mastectomy (Ms) or mastectomy with immediate reconstruction (MsIR). METHODS Breast cancer patients who required adjuvant chemotherapy after OBCS, WLE, Ms and MsIR were identified from prospectively maintained institutional databases. Time between multidisciplinary team decision to offer chemotherapy and delivery of first cycle of chemotherapy was measured and compared among the four groups of patients. RESULTS time to chemotherapy of breast cancer patients (n = 169) treated with OBCS (n = 31) were 29 [16-58] days, while it was 29.5 [15-105] days after WLE (n = 66), 29 [15-57] days after Ms (n = 56) and 31 [15-58] days after MsIR (n = 16). A combined analysis involving all four groups demonstrated no statistically significant difference (p = 0.524). Similarly, inter-group analysis revealed no significant differences in between patients treated with OBCS compared to any of the three control groups (OBCS to WLE: p = 0.433; OBCS to Ms: p = 0.800; OBCS to MsIR: p = 0.405). CONCLUSION OBCS seems as safe as WLE, Ms or MsIR in terms of delivery of adjuvant chemotherapy, and, therefore, should not adversely affect breast cancer outcome in this respect.
Collapse
|
38
|
Khan J, Barrett S, Stallard S, Forte C, Weiler-Mithoff E, Reid I, Winter A, Doughty J, Romics L. Abstract P4-14-13: Therapeutic mammaplasty does not cause a delay in the delivery of chemotherapy in high risk breast cancer patients. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-14-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: oncosurgical safety of therapeutic mammaplasty (TM) is widely investigated. The interval between surgery and delivery of adjuvant chemotherapy is an integral part of overall oncological safety. Therefore, we examined the time between TM and AC, and compared it to wide local excision (WLE) and mastectomy (Mx) with or without immediate breast reconstruction (IBR), respectively.
Methods: data of 174 patients who underwent TM, WLE and Mx±IBR was analyzed retrospectively. All patients were operated within three breast units of Glasgow during a period of 48 months. Time between decision to offer adjuvant chemotherpay and delivery of the first cycle of chemotherapy was analyzed. Significance was calculated with Mann-Whitney and Kruskal-Wallis tests (two and four groups compared, respectively).
Results: median time to adjuvant chemotherapy after TM (n = 36) was 29 [16–58] days, WLE (n = 66) was 29.5 [15–105], Mx only (n = 56) was 29 [15–57], and Mx and IBR (n = 16) was 31 [15–58] days. No significant difference was found in terms of time to adjuvant chemotherpay in patients treated with TM compared to WLE (p = 0.384), Mx only (p = 0.828) or Mx and IBR (p = 0.366). Further, there was no significant difference when a cumulative comparison of the four groups was carried out (p = 0.507).
Conclusions: our data indicate that oncosurgical safety of TM in terms of time to chemotherapy is similar to other high risk breast cancer patients treated WLE and Mx with or without IBR. This also suggests that there is no significant difference in postoperative complication rates after these four ways of surgical treatment of breast cancer, which would possibly be the primary cause for a delay in delivering adjuvant chemotherapy.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-13.
Collapse
|
39
|
Romics L, Chew B, Stallard S, Doughty J, Weiler-Mithoff E. 565 Does Immediate Breast Reconstruction Technique Influence True Local Recurrence Rate After Skin-sparing Mastectomy? Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70630-5] [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]
|
40
|
Chakrabarti M, Fitzgerald C, Obondo C, Weiler-Mithoff E, Reid I, Stallard S, Romics L. 533 Patient Counselling and Socioeconomic Deprivation – Two Factors That Profoundly Influence Immediate Breast Reconstruction Rate After Mastectomy. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70598-1] [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]
|
41
|
Romics L, Chew BK, Weiler-Mithoff E, Doughty JC, Brown IM, Stallard S, Wilson CR, Mallon EA, George WD. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 2012; 99:799-806. [PMID: 22367773 DOI: 10.1002/bjs.8704] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The oncological safety of skin-sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is debated owing to a presumed compromise in the completeness of mastectomy. Current evidence is poor as it is based mostly on short-term follow-up data from highly selected patients. METHODS A prospectively maintained institutional database was searched to identify patients who underwent SSM and IBR between 1995 and 2000. A retrospective review of medical records was carried out, including only patients with ductal carcinoma in situ and invasive breast cancer. During this time all patients treated with mastectomy were offered IBR regardless of tumour stage. RESULTS Follow-up data from 253 consecutive patients with IBR were reviewed. Patients with incomplete follow-up data and those undergoing SSM for recurrent disease following previous lumpectomy were disregarded, leaving 207 for analysis. Offering IBR to all women requiring mastectomy resulted in a large proportion of patients with advanced disease. During a median follow-up of 119 months, 17 (8·2 per cent) locoregional, six (2·9 per cent) local and 22 (10·6 per cent) distant recurrences were detected; the overall recurrence rate was 39 (18·8 per cent). Overall recurrence rate was associated with axillary lymph node metastasis (P = 0·009), higher stage (P < 0·001) and higher tumour grade (P = 0·031). The breast cancer-specific survival rate was 90·8 per cent (19 of 207 women died from recurrence). CONCLUSION Based on these long-term follow-up data, SSM combined with IBR is an oncologically safe treatment option regardless of tumour stage.
Collapse
|
42
|
Chakrabarti M, Stallard S, Fitzgerald C, Obondo C, Weiler-Mithoff E, Doughty J, Romics L. P2-16-11: Role of Proper Patient Counselling in Combination with Effect of Socioeconomic Deprivation on the Rate of Immediate Breast Reconstruction after Mastectomy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-16-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: current guidelines in the United Kingdom suggest that the possibility of breast reconstruction should be discussed with all patients prior to mastectomy. However, the majority of patients are still treated with mastectomy alone and no reconstruction is carried out. It has also been suggested that women from more deprived areas are less likely to undergo immediate breast reconstruction (IBR). We investigated potential pitfalls in patient counselling and consequent decision making contributing to present IBR rate in combination with the effect of socioeconomic deprivation.
Methods: data from 89 consecutive mastectomy patients was prospectively collected in a single centre in Glasgow between August 2010 and March 2011. Each patient was scored for deprivation based on The Scottish Index of Multiple Deprivation. The patients were then divided into two groups: high and low deprivation levels. Consultations about IR and patients’ acceptance of counselling were analysed. For statistical calculations Fischer's exact test was applied. Results: IBR was offered to 41 (46%) patients, but it was not to 42 (47%) (6 were excluded due to incomplete data). 25 patients accepted IBR, and of those 24 (27%) underwent IBR. 16 of 41 patients refused to undergo IBR due to lack of interest (10), not feeling ready for it (2), preference of delayed procedure (2) and fear of delaying adjuvant therapy (2). Of 42 patients whom IBR was not offered, only 10 were documented in the notes, while there was no reference for discussing reconstruction in 32 (36%) cases. Reasons for not even discussing reconstruction were the following: age (15), co-morbidities (18), locally advanced cancer (2), co-morbidities with age (5), and locally advanced cancer with age (2). As regards to socioeconomic deprivation; 44 (49%) patients were from deprived areas and 39 (44%) from affluent areas. 41 patients were offered IBR and of these 23 (26%) were from affluent areas compared to 18 (20%). Of the 42 patients who were not offered IR, 26 (29%) were from deprived while 16 (18%) from affluent areas (p<0.05). Of the 44 deprived patients, 18 were offered IBR but 26 were not. 15 of 25 patients, who accepted IBR, were from affluent areas. The 16 patients who refused IBR had equal distribution of deprivation.
Conclusions: while none of the reasons for not offering IBR represent absolute contraindication to IBR, decisions about refusal are based mostly on patients’ subjective intuitions. Further, a greater proportion of the patients who were not offered IBR were from more deprived areas, and it seems that patients from affluent areas are more likely to be offered IBR compared to ones from deprived areas. However, confounding factors such as co-morbidities may contribute to the above. We believe, therefore, that detailed counselling about reconstruction of each patient requiring mastectomy is necessary, which is likely to further increase IBR rate.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-11.
Collapse
|
43
|
Saldanha JD, Garrett RM, Snaddon L, Longmuir M, Bradshaw N, Watt C, George WD, Wilson CR, Doughty JC, Stallard S, Reid I, Murday V, Davidson R. Impact of national guidelines on family history breast cancer surveillance. Scott Med J 2011; 56:203-5. [PMID: 22089040 DOI: 10.1258/smj.2011.011158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The breast cancer risk of women already under family history surveillance was accurately assessed according to national guidelines in an attempt to rationalize the service. Women attending two breast units in Glasgow between November 2003 and February 2005 were included. One thousand and five women under annual surveillance were assessed and had their relatives diagnoses verified. Four hundred and ninety-seven women were at significantly increased risk and eligible for follow-up. Five hundred and eight (50%) women attending were not eligible for family history surveillance, and 498 (98%) of these women accepted discharge. In conclusion, national guidelines have helped to more clearly define women who should undergo surveillance. This avoids unnecessary and potentially harmful routine investigations, and the service has been improved.
Collapse
|
44
|
Chakrabarti M, Fitzgerald K, Obondo C, Weiler-Mithoff E, Stallard S, Romics L. Effect of socioeconomic deprivation on the rate of immediate breast reconstruction after mastectomy. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
45
|
Obondo CA, Fitzgerald K, Gray J, Chakarabharti M, Stallard S, Romics L. Pre-operative Ultrasound Staging of the Axilla in Breast Cancer - Repeat Audit Cycle. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
46
|
Chakrabarti M, Fitzgerald K, Obondo C, Weiler-Mithoff E, Stallard S, Romics L. Role of proper patient counselling about immediate breast reconstruction after mastectomy. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
47
|
Gray J, Glynn C, Stallard S. Pre-operative ultrasound staging of the axilla in breast cancer - a retrospective audit. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
48
|
Marla S, Roxburgh P, Burton P, Stallard S, Mallon E, Canney P, Cooke T. HER2 positive early breast cancers: tumour demographics and trastuzumab therapy in the real-world. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3159
Background: Various trials have shown substantial benefits of addition of Trastuzumab (Herceptin®) to adjuvant chemotherapy in Early Breast Cancer (EBC). We analysed our breast cancer population to determine the incidence of HER2 positive Early Breast Cancers, the tumour demographics and the number of patients eligible for and receiving trastuzumab therapy in this group.
 Methods: Data for all patients diagnosed with EBC in 2006 was recorded prospectively in a database. Case notes were consulted where the HER2 positive patients, determined by a combination of IHC and FISH, had not received trastuzumab, to ascertain the reasons.
 Results: A total of 951 patients were diagnosed with Breast Cancer in 2006. 417 (43.9%) of these were screen-detected cancers.
 There were 123 (12.9%) HER2 positive newly diagnosed Breast Cancers of whom 117 were EBCs. The HER2 positivity rate in the screen detected cancers (n=417) was 9% and 17% in the symptomatic cancers (n=433).
 1. Demographics of the HER2 positive Early Breast Cancer Population:
 The median age at diagnosis was 61 yrs (range: 30-92).
 
 2. Fifty nine (50.4%) of the HER2 positive EBCs received trastuzumab therapy.
 
 Conclusions: The HER2 positivity rate is lower than that previously reported suggestive of changing demographics secondary to a high screen detected cancer population. A third of the HER2 positive tumours are screen detected. The percentage of ER positive, node negative and low grade tumours was higher than anticipated.
 Only 50% of HER 2 positive EBC patients received trastuzumab therapy. Of those who did not receive trastuzumab, the commonest reason was low risk status or age and co-morbidities precluded chemotherapy.
 HER 2 positivity alone confers high risk irrespective of pathological stage. Further trials are required to evaluate whether the substantial number of patients who are at present not eligible for trastuzumab therapy might also benefit.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3159.
Collapse
|
49
|
Forder A, Romics L, Ogston K, Stallard S, Cooke T, Mallon E, Weiller-Mithoff E. The oncological safety of axillary node clearance in the lateral decubitus position in patients with immediate ALD reconstructions. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
50
|
Saldanha J, Garret R, Longmuir M, Watt C, George D, Wilson C, Doughty J, Smith D, Stallard S, Davidson R. A multidisciplinary team approach to family history risk assessment reduced clinic attendance by half. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|