1
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Touati R, Pauly L, Reyal F, Kirova Y. Breast Cancer and Mediastinal Hodgkin's Lymphomas: Multidisciplinary Discussion. Clin Breast Cancer 2023; 23:681-686. [PMID: 37419747 DOI: 10.1016/j.clbc.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/09/2023]
Abstract
Treatment for Hodgkin's lymphoma (HL) has evolved, with modern treatments combining less toxic chemotherapy and radiation, leading to improved long-term disease-free survival. However, there is a higher chance of second cancer, especially breast cancer, following effective HL treatment. The impact of reduced radiation doses and volumes, as well as the use of advanced irradiation techniques, on the risk of second malignancy is not clear. According to medical organizations, the history of chest irradiation is a relative contraindication to breast preservation therapy for women with initial breast cancer, leading to a paradigm of mastectomy. This article proposes a discussion between radiation oncologists and surgeons to review major trials and recent developments on the prevalence of breast cancer following HL therapy, the risk of contralateral cancer, the feasibility of breast conserving surgery (BCS), as well as breast reconstruction modalities.
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Affiliation(s)
- Ruben Touati
- Department of Radiation Oncology, Institut Curie Hospital, Paris, France
| | - Lea Pauly
- Department of Surgical Oncology, Institut Curie Hospital, Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie Hospital, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie Hospital, Paris, France.
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2
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Eisenberg ER, Weiss A, Prakash I, Skamene S, Basik M, Boileau JF, Ajjamada L, Pollak MN, Wong SM. Surgical Management and Contralateral Breast Cancer Risk in Women with History of Radiation Therapy for Hodgkin Lymphoma: Results from a Population-Based Cohort. Ann Surg Oncol 2022; 29:6673-6680. [PMID: 35668306 DOI: 10.1245/s10434-022-11947-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Women with history of chest irradiation for Hodgkin lymphoma are at increased risk of developing bilateral breast cancer, although contralateral breast cancer risk estimates in this population remain undefined. METHODS We queried the SEER database for women treated with radiation therapy for Hodgkin lymphoma prior to age 30 years and were diagnosed with a subsequent breast cancer between 1990-2016. Trends in surgical management and the 5- and 10-year cumulative incidence of contralateral breast cancer were evaluated. RESULTS The cohort included 295 women with a median age of 22 years (range 8-30 years) at Hodgkin lymphoma diagnosis, and 42 years (range 22-65 years) at breast cancer diagnosis. Overall, 263 (89.2%) presented with unilateral breast cancer, while 32 (10.8%) presented with synchronous bilateral breast cancer. Breast-conserving surgery was performed in 17.3% of patients, while mastectomy was performed in 82.7%. In 263 patients presenting with unilateral breast cancer, 50 (19.0%) underwent breast-conserving surgery and 213 (81.0%) underwent mastectomy. Subgroup analysis of mastectomy patients demonstrated a 40.5% bilateral mastectomy rate. The 5-year incidence of contralateral breast cancer in women who underwent unilateral surgery was 9.4% [95% confidence interval (CI), 5.6-15.4%], increasing to 20.2% (95% CI, 13.7-29.2%) at 10-year and 29.9% (95% CI, 20.8-41.9%) at 15-year follow-up. CONCLUSIONS Women with a history of prior chest radiation for Hodgkin lymphoma with a diagnosis of breast cancer have a 10-year contralateral breast cancer risk of 20%. These findings support consideration of contralateral prophylactic mastectomy during surgical decision-making for management of this high-risk patient population.
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Affiliation(s)
- Elisheva R Eisenberg
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada
| | - Anna Weiss
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Ipshita Prakash
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Sonia Skamene
- Department of Radiation Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Jean Francois Boileau
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Lissa Ajjamada
- Department of Hematology Oncology, McGill University Medical School, Montreal, QC, Canada.,Department of Hematology Oncology, University of Montreal, Montreal, QC, Canada
| | - Michael N Pollak
- Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Stephanie M Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada. .,Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada. .,Department of Oncology, McGill University Medical School, Montreal, QC, Canada. .,Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada.
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3
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Buglione M, Guerini AE, Filippi AR, Spiazzi L, Pasinetti N, Magli A, Toraci C, Borghetti P, Triggiani L, Alghisi A, Costantino G, Bertagna F, Giaj Levra N, Pegurri L, Magrini SM. A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin's Lymphoma. Crit Rev Oncol Hematol 2021; 167:103437. [PMID: 34358649 DOI: 10.1016/j.critrevonc.2021.103437] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/20/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Secondary malignant neoplasms (SMNs) and cardiovascular diseases induced by chemotherapy and radiotherapy represent the main cause of excess mortality for early-stage Hodgkin lymphoma patients, especially when the mediastinum is involved. Conformal radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) could allow a reduction of the dose to the organs-at-risk (OARs) and therefore limit long-term toxicity. METHODS We performed a systematic review of the current literature regarding comparisons between IMRT and conventional photon beam radiotherapy, or between different IMRT techniques, for the treatment of mediastinal lymphoma. RESULTS AND CONCLUSIONS IMRT allows a substantial reduction of the volumes of OARs exposed to high doses, reducing the risk of long-term toxicity. This benefit is conterbalanced by the increase of volumes receiving low doses, that could potentially increase the risk of SMNs. Treatment planning should be personalized on patient and disease characteristics. Dedicated techniques such as "butterfly" VMAT often provide the best trade-off.
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Affiliation(s)
- Michela Buglione
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Emanuele Guerini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
| | - Luigi Spiazzi
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Nadia Pasinetti
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy; Radiation Oncology Service, ASST Valcamonica Esine, Italy.
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy.
| | - Cristian Toraci
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Borghetti
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Luca Triggiani
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Alessandro Alghisi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy.
| | | | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and Spedali Civili of Brescia, Brescia, Italy.
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Italy.
| | - Ludovica Pegurri
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Maria Magrini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
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4
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Mulder RL, Hudson MM, Bhatia S, Landier W, Levitt G, Constine LS, Wallace WH, van Leeuwen FE, Ronckers CM, Henderson TO, Moskowitz CS, Friedman DN, Ng AK, Jenkinson HC, Demoor-Goldschmidt C, Skinner R, Kremer LC, Oeffinger KC. Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group. J Clin Oncol 2020; 38:4194-4207. [PMID: 33078972 PMCID: PMC7723685 DOI: 10.1200/jco.20.00562] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of childhood, adolescent, and young adult cancer. METHODS We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance. RESULTS The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non-chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation. CONCLUSION The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality.
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Affiliation(s)
- Renée L. Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Melissa M. Hudson
- Departments of Epidemiology and Cancer Control, and Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gill Levitt
- Department of Oncology/Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - W. Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Institute for Biostatistics and Registry Research, Medical University Brandenburg, Theodor Fontane, Neuruppin, Germany
| | - Tara O. Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Chaya S. Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle N. Friedman
- Departments of Pediatrics and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Helen C. Jenkinson
- Department of Paediatric Oncology, Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Charlotte Demoor-Goldschmidt
- Centre for Research in Epidemiology and Population Health, Cancer and Radiation team, University of Paris-Sud, Villejuif, France
- Department of Pediatric and Adolescent Hematology/Oncology, CHU Angers, Angers, France
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children’s Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
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5
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Bakkach J, Pellegrino B, Elghazawy H, Novosad O, Agrawal S, Bennani Mechita M. Current overview and special considerations for second breast cancer in Hodgkin lymphoma survivors. Crit Rev Oncol Hematol 2020; 157:103175. [PMID: 33321295 DOI: 10.1016/j.critrevonc.2020.103175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 06/28/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Second breast cancer (SBC) is the most common solid cancer among Hodgkin Lymphoma (HL) female survivors. We reviewed the related modifying risk factors, radiation-induced carcinogenesis, tumors characteristics, management specificities, prevention and surveillance modalities based on current evidence. The risk of developing SBC may be influenced essentially by the age at HL treatment, follow-up latency, dose of irradiation received and the extent of irradiated field. SBCs generally develop at younger age, they are often bilateral, and exhibit more aggressive biological features and worse prognosis. No firm answer about the benefits of breast surveillance is provided by literature, but compelling evidence tends toward a clinical benefit in early detection. Increasing awareness among health providers' care and current survivors as well as the implementation of screening measures is crucial. Great efforts are ongoing in individualizing treatment strategies for future HL patients and response-adapted approaches are holding promise in prevention of these second malignancies.
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Affiliation(s)
- Joaira Bakkach
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
| | | | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Egypt.
| | - Olga Novosad
- Onco-Hematology Department, National Cancer Institute of the MPH Ukraine, Kiev, Ukraine.
| | - Sanjit Agrawal
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India.
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
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6
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Demoor-Goldschmidt C, Supiot S, Mahé MA, Oberlin O, Allodji R, Haddy N, Helfre S, Vigneron C, Brillaud-Meflah V, Bernier V, Laprie A, Ducassou A, Claude L, Diallo I, de Vathaire F. Clinical and histological features of second breast cancers following radiotherapy for childhood and young adult malignancy. Br J Radiol 2018; 91:20170824. [PMID: 29493262 DOI: 10.1259/bjr.20170824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the characteristics of early second breast cancer (SBC) among survivors of childhood and young adult malignancy treated with irradiation. METHODS We conducted a multicenter retrospective study of women who presented with breast cancer aged 50 years or younger in nine French centers. RESULTS 121 patients and 141 SBC were analyzed (invasive = 130; non-invasive = 11). The mean age at first cancer diagnosis was 15 years and at initial SBC diagnosis was 38 years. Bilateral disease before the age of 51 years was diagnosed in 16% of the females. The majority of SBC were invasive carcinomas (92%). Among the invasive carcinomas, 39% had a histoprognostic score of III, 3.1% overexpressed HER2 and 29% were triple negative. The proportion of triple negative phenotype SBC was higher in patients older at first cancer diagnosis [RR = 1.2, 95% CI (1.1-1.3)]. 94% of triple negative SBCs developed in breast tissue which had received >20 Gy. CONCLUSION We found a high proportion of aggressive SBC following thoracic radiotherapy in childhood or early adulthood. Advances in knowledge: SBC screening is recommended by scientific societies for these child/young-adulthood cancer survivors in the same way as the one for high risk women because of constitutional mutations. Our results support these recommendations, not only because of a similar cumulative risk, but also because of the aggressive histological characteristics.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Stéphane Supiot
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Marc-André Mahé
- 3 Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , Saint-Herblain , France
| | - Odile Oberlin
- 4 Department of Pediatric Oncology, Institut Gustave Roussy , Villejuif , France
| | - Rodrigue Allodji
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Nadia Haddy
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Sylvie Helfre
- 5 Department of Radiotherapy, Institut Curie , Paris , France
| | - Céline Vigneron
- 6 Department of Radiotherapy, Centre Paul Strauss , Strasbourg , France
| | | | - Valérie Bernier
- 8 Department of Radiotherapy, Centre Alexis Vautrin , Nancy , France
| | | | | | | | - Ibrahim Diallo
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
| | - Florent de Vathaire
- 1 CESP University. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France.,2 Cancer and Radiation Team, Gustave Roussy , Villejuif , France
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7
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Bakkach J, Mansouri M, Loudiyi A, Nourouti NG, Barakat A, Mechita MB. Secondary breast cancer after Hodgkin lymphoma: a case report and literature review. Ecancermedicalscience 2018; 12:810. [PMID: 29492104 PMCID: PMC5828673 DOI: 10.3332/ecancer.2018.810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 01/29/2023] Open
Abstract
The occurrence of secondary breast cancers in women previously exposed to chest irradiation for Hodgkin lymphoma (HL) is considered as a major issue for the quality of life of these long-term survivors as well as a challenge for clinical management. This study reports a case of a woman treated for HL at the age of 24 years, who developed breast cancer after an interval of 20 years. This case highlights once again the importance of awareness among HL survivors about their increased breast cancer risk and re-launches the debate about the efficacy of adoption of breast screening guidelines.
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Affiliation(s)
- Joaira Bakkach
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Mohamed Mansouri
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco.,Oncology Clinic AL AMAL of Tangier, 90 060, Morocco
| | - Ali Loudiyi
- Oncology Clinic AL AMAL of Tangier, 90 060, Morocco
| | - Naima Ghailani Nourouti
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Amina Barakat
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
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8
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Orecchia R, Jereczek-Fossa BA, Rondi E, Bossi-Zanetti I, Meaglia I, Luraschi R, Leonardi MC, Rotmensz N, Botteri E, Fodor C, Cecconi A, Morra A, Lazzari R, Ferrari A, Cattani F, Galimberti V, Luini A, Veronesi P, Zurrida S, Magrini S, Doerr W, Humble N, Trott KR, Ottolenghi A, Smyth V, Veronesi U. Second Malignancies following Breast Cancer Treatment: A Case-Control Study Based on the Peridose Methodology. ALLEGRO Project (Task 5.4). TUMORI JOURNAL 2018; 98:715-21. [DOI: 10.1177/030089161209800607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims and background To calculate peripheral radiation dose to the second primary site in patients who have developed a second malignancy after breast cancer radiotherapy (index cases) and to compare it with dose in the analogous anatomical site in radiotherapy-treated breast cancer patients who did not experience a second malignancy (controls). To evaluate the feasibility of Peridose-software peripheral dose calculation in retrospective case-control studies. Material and study design A case-control study on 12,630 patients who underwent adjuvant breast radiotherapy was performed. Minimum 5-year follow-up was required. Each index case was matched with 5 controls by 1) year of birth, 2) year of radiotherapy and 3) follow-up duration. Peridose-software was used to calculate peripheral dose. Results 195 second cancers were registered (0.019% of all patients treated with adjuvant irradiation). Several methodological limitations of the Peridose calculation were encountered including impossibility to calculate the peripheral dose in the patients treated with intraoperative or external electron beam radiotherapy, in case of second tumors located at <15 cm from the radiotherapy field etc. Moreover, Peridose requires full radiotherapy data and the distance between radiotherapy field and second primary site. Due to these intrinsic limitations, only 6 index cases were eligible for dose calculation. Calculated doses at the second cancer site in index cases and in an analogous site in controls ranged between 7.5 and 145 cGy. The mean index-control dose difference was −3.15 cGy (range, −15.8 cGy and +2.7 cGy). Conclusions The calculated peripheral doses were low and the index-control differences were small. However, the small number of eligible patients precludes a reliable analysis of a potential dose-response relationship. Large patient series followed for a long period and further improvement in the methodology of the peripheral dose calculation are necessary in order to overcome the methodological challenges of the study.
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Affiliation(s)
- Roberto Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Isa Bossi-Zanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Ilaria Meaglia
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Rosa Luraschi
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Nicole Rotmensz
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Edoardo Botteri
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Agnese Cecconi
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Annamaria Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Federica Cattani
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Alberto Luini
- Department of Senology, European Institute of Oncology, Milan
| | - Paolo Veronesi
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Stefano Zurrida
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | | | - Wolfgang Doerr
- Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Klinik für Strahlentherapie und Radioonkologie, Dresden, Germany
- Dept of Radiation Oncology & Christian Doppler Laboratory for Medical Radiation Research in Radiooncology, Medical University, Vienna, Austria
| | - Nicole Humble
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Klaus R Trott
- University College of London, Cancer Institute, London, UK
- Physics Dept, University of Pavia, Pavia, Italy
| | | | - Vere Smyth
- Physics Dept, University of Pavia, Pavia, Italy
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9
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Ud Din N, Ahmad Z, Minhas K, Uddin Z, Ahmed A. Synchronous and Metachronous Malignant Epithelial and Lymphoid Tumors: a Clinicopathologic Study of 10 Patients
from a Major Tertiary Care Center in Pakistan. Asian Pac J Cancer Prev 2017; 18:2067-2072. [PMID: 28843223 PMCID: PMC5697461 DOI: 10.22034/apjcp.2017.18.8.2067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Case reports and case series documenting unfortunate patients with more than one malignant neoplasm are rare but well established. While majority of such patients have two malignancies, cases with three or even four malignant neoplasms in the same patient have been published in literature. A number of factors influencing carcinogenesis have been implicated in such cases including exposure to large amounts of radiation, chemotherapy for the original malignancy; prolonged history of heavy smoking and exposure to other environmental carcinogens; aging; and underlying genetic alterations. Concomitant multiple malignant neoplasms may be synchronous-two or more malignant neoplasms histologically distinct from each other, arising in the same site and detected simultaneously (for example during the same hospital admission) or detected one after the other in sequence in a period less than 6 months; or metachronous-two or more malignant neoplasms of similar or distinct histologic type detected at different times (after an interval of greater than 6 months) in different anatomic sites. Any combination of malignant tumors can occur in the same patient for example carcinomas with other carcinomas, carcinomas with Non-Hodgkin or Hodgkin lymphomas, carcinomas with mesotheliomas, carcinomas with sarcomas etc. We have reported several cases with multiple malignancies during our practice, and these cases were composed of the different combinations described above. The aim of the present study is to document 10 such cases of combined carcinoma and Non Hodgkin lymphoma in the same patient which were diagnosed in our section.
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10
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Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30years of life: A French multicentre cohort study. Radiother Oncol 2017; 124:200-203. [PMID: 28733054 DOI: 10.1016/j.radonc.2017.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Irradiation (>3Gy) to the breast or axillae before 30years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. PATIENTS AND METHODS This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3Gy) on part or all of the breast before 30years of age, for any type of tumour except BC. RESULTS A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. CONCLUSION Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient's age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.
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Breast Cancer in Lymphoma Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_30] [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]
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12
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Burt LM, Poppe M, Kokeny KE, Gaffney DK, Shrieve DC, Tward JD. Comparison of treatment modalities for breast cancer arising in Hodgkin’s lymphoma survivors. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13566-016-0262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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CE: Cardiotoxicity and Breast Cancer as Late Effects of Pediatric and Adolescent Hodgkin Lymphoma Treatment. Am J Nurs 2016; 116:32-42; quiz 43. [PMID: 26974745 DOI: 10.1097/01.naj.0000482143.27671.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American Cancer Society estimates that in 2014 nearly 16,000 U.S. children and adolescents developed cancer, and in roughly 1,200 of these cases the cancer was Hodgkin lymphoma (HL). The great majority of these patients will survive, joining the thousands who have been diagnosed and treated successfully in decades past. Nurses' familiarity with and attention to the late effects of the chemotherapy and radiation therapy used to treat HL, which include breast cancer as well as cardiotoxicity and its sequelae, are essential in helping these patients maintain their overall health.
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Management of breast cancer after Hodgkin’s lymphoma and paediatric cancer. Eur J Cancer 2015; 51:1667-74. [DOI: 10.1016/j.ejca.2015.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/12/2015] [Accepted: 05/30/2015] [Indexed: 11/20/2022]
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Allen SD, Wallis MG, Cooke R, Swerdlow AJ. Radiologic Features of Breast Cancer after Mantle Radiation Therapy for Hodgkin Disease: A Study of 230 Cases. Radiology 2014; 272:73-8. [DOI: 10.1148/radiol.14131789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2014; 14:e621-9. [PMID: 24275135 DOI: 10.1016/s1470-2045(13)70303-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and to reduce the detrimental consequences of cancer treatment; however, surveillance recommendations vary among the existing long-term follow-up guidelines. We applied evidence-based methods to develop international, harmonised recommendations for breast cancer surveillance among female survivors of CAYA cancer who were given chest radiation before age 30 years. The recommendations were formulated by an international, multidisciplinary panel and are graded according to the strength of the underlying evidence.
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Risk-Reducing Mastectomy: Who Is a Candidate and What Are the Outcomes? CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Chadha M, Boolbol SK, Kirstein L, Boachie-Adjei K, Osborne MP, Harrison LB. Patterns of relapse and risk for new malignancies following partial breast re-irradiation. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Colin C, de Vathaire F, Noël A, Charlot M, Devic C, Foray N, Valette PJ. Updated Relevance of Mammographic Screening Modalities in Women Previously Treated with Chest Irradiation for Hodgkin Disease. Radiology 2012; 265:669-76. [DOI: 10.1148/radiol.12120794] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Breast cancer surveillance in patients treated by radiotherapy for Hodgkin's lymphoma. LA RADIOLOGIA MEDICA 2012; 118:401-14. [PMID: 22872454 DOI: 10.1007/s11547-012-0862-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 09/26/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE The authors evaluated the relative risk of developing radiation-induced breast cancer (BC) in women treated with radiotherapy for Hodgkin's disease (HD) and analysed the imaging features of these breast neoplasms. MATERIALS AND METHODS We retrospectively studied 54 women who had all undergone radiotherapy between 1980 and 2010 (median age, 36.6 years). Women aged ≤30 years were screened with clinical breast examination, ultrasound (US) and, if necessary, mammography; women >30 years had clinical breast examination, US and mammography. Three women underwent magnetic resonance (MR) imaging as well. RESULTS Mammography detected seven invasive breast cancers in 6/54 women (11.1%). Median age at diagnosis was 26.1 years for HD and 42.4 for breast cancer. Breast cancer was diagnosed following a median latent period from radiotherapy of 15.1 years. Mean radiation dose was 37.6 Gy in women who developed breast cancer and 31.3 Gy in the other women. CONCLUSIONS In our study, women who were exposed to radiation for HD had a 6.2-fold higher risk of developing breast cancer than the general population. In consideration of the young age and high breast density, women aged ≤30 years should be monitored by US and MR imaging; women aged >30 years should be monitored by US, mammography and, when necessary, MR imaging.
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Lambert K, Patani N, Mokbel K. Ductal carcinoma in situ: recent advances and future prospects. Int J Surg Oncol 2012; 2012:347385. [PMID: 22675624 PMCID: PMC3362914 DOI: 10.1155/2012/347385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 02/22/2012] [Indexed: 01/15/2023] Open
Abstract
Introduction. This article reviews current management strategies for DCIS in the context of recent randomised trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment. Methods. Literature review facilitated by Medline, PubMed, Embase and Cochrane databases. Results. DCIS should be managed in the context of a multidisciplinary team. Local control depends upon clear surgical margins (at least 2 mm is generally acceptable). SLNB is not routine, but can be considered in patients undergoing mastectomy (Mx) with risk factors for occult invasion. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions should be treated by Mx and immediate reconstruction should be discussed. Adjuvant hormonal treatment may reduce the risk of LR in selected cases with hormone sensitive disease. Conclusion. Further research is required to determine the role of new RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of tumour biology in DCIS to rationalise treatment. Reliable identification of low-risk lesions could allow treatment to be less radical.
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Affiliation(s)
- Kelly Lambert
- The Breast Unit, University Hospitals Leicester, Leicester LE3 9QP, UK
| | - Neill Patani
- The London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK
| | - Kefah Mokbel
- The London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK
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Haberer S, Belin L, Le Scodan R, Kirova YM, Savignoni A, Stevens D, Moisson P, Decaudin D, Pierga JY, Reyal F, Campana F, Fourquet A, Bollet MA. [Breast conserving surgery in locoregional treatment of breast carcinoma after Hodgkin lymphoma]. Cancer Radiother 2012; 16:128-35. [PMID: 22341508 DOI: 10.1016/j.canrad.2011.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 09/09/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery. PATIENTS AND METHODS Medical records of 72 women who developed either ductal carcinoma in situ or stage I-III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed. RESULTS Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40 Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%). CONCLUSIONS Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position.
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Affiliation(s)
- S Haberer
- Département de radiothérapie, institut Curie, Paris, France.
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Zygogianni AG, Kyrgias G, Gennatas C, Ilknur A, Armonis V, Tolia M, Papaloukas C, Pistevou G, Kouvaris J, Kouloulias V. Male Breast Carcinoma: Epidemiology, Risk Factors and Current Therapeutic Approaches. Asian Pac J Cancer Prev 2012; 13:15-9. [DOI: 10.7314/apjcp.2012.13.1.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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[Hodgkin's disease and breast cancer: for which patients is there an association? A series from Institut Bergonié]. ACTA ACUST UNITED AC 2011; 40:284-90. [PMID: 22099978 DOI: 10.1016/j.gyobfe.2011.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 07/12/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Breast cancer is the most frequent secondary tumor for women treated for Hodgkin's disease. It is important to study the risk factors associated to be able to adapt the monitoring of these women. PATIENTS AND METHODS This is a retrospective study from Institut Bergonié, a comprehensive French Cancer Center, concerning the women treated for Hodgkin's disease and having developed a breast cancer. RESULTS Among 328 women treated for Hodgkin's disease between January 1968 and December 1994, 20 patients developed 25 breast cancers. The average age of the patients during the irradiation was 24 years and the average period of occurrence of the cancer was 19 years. An irradiation of the chest wall and an under-diaphragmatic irradiation in doses of 40Gy are risk factors for the occurrence of breast cancer. A young age, less than 30, in the treatment of Hodgkin's disease tend to be significant. DISCUSSION AND CONCLUSION This population of women with a high risk of breast cancer thus has to benefit from an appropriate monitoring program, which is what we suggest setting up in the Institut Bergonié.
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Intra M, Mattar D, Sangalli C, Rotmensz N, Viale G, Galimberti V, Luini A, Veronesi P, Colleoni M, Zurrida S, Orecchia R, Veronesi U. Local therapy for breast cancer in malignant lymphoma survivors. Breast 2011; 20 Suppl 3:S99-103. [DOI: 10.1016/s0960-9776(11)70304-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
Breast cancer is the malignant disease most frequently diagnosed in women of all races and nationalities. Since the 1970s the worldwide incidence of this disease has increased 30-40% in postmenopausal women, in whom, paradoxically, the risk of developing breast cancer is significantly reduced by an early first full term pregnancy (FTP) as compared to nulliparous and late parous women. Although the cause of breast cancer is not known, the mechanisms mediating the protection conferred by an early FTP have been identified to reside in the breast itself, and to be modulated by endogenous and environmental exposures that might negatively affect this organ during specific windows in its development that extend from prenatal life until the first pregnancy. Soon after conception the embryo initiates the production of human chorionic gonadotropin (hCG), the glycoprotein hormone that is diagnostic of pregnancy. HCG in conjunction with ovarian steroid hormones primes the hypothalamic neuroendocrine system for maintaining the pregnancy. Higher levels of hCG during the first trimester of pregnancy have been associated with a reduction in maternal breast cancer incidence after age 50. In preclinical studies it has been demonstrated that both FTP and hCG treatment of virgin rats prevent the development of chemically-induced mammary tumors, a phenomenon mediated by the differentiation of the mammary gland epithelial cells prior to carcinogen exposure. Complete differentiation proceeds through complex morphological, physiological and molecular changes that occur during pregnancy and lactation, that ultimately result in increased DNA repair capabilities of the mammary epithelium, activation of genes controlling differentiation and programmed cell death and imprinting in the breast epithelium a specific and permanent genomic signature of pregnancy. This signature is indicative of a reduced breast cancer risk and serves as a molecular biomarker of differentiation for evaluating the potential use of chemopreventive agents.
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Affiliation(s)
- Irma H Russo
- Molecular Endocrinology Section, Breast Cancer Research Laboratory, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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27
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Haberer S, Belin L, Le Scodan R, Kirova YM, Savignoni A, Stevens D, Moisson P, Decaudin D, Pierga JY, Reyal F, Campana F, Fourquet A, Bollet MA. Locoregional treatment for breast carcinoma after Hodgkin's lymphoma: the breast conservation option. Int J Radiat Oncol Biol Phys 2011; 82:e145-52. [PMID: 21605948 DOI: 10.1016/j.ijrobp.2011.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/01/2011] [Accepted: 03/17/2011] [Indexed: 01/30/2023]
Abstract
PURPOSE To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. METHODS AND MATERIALS Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. RESULTS Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). CONCLUSIONS Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and lung.
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Affiliation(s)
- Sophie Haberer
- Department of Radiation Oncology, Institut Curie, Paris, France.
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Elkin EB, Klem ML, Gonzales AM, Ishill NM, Hodgson D, Ng AK, Marks LB, Weidhaas J, Freedman GM, Miller RC, Constine LS, Myrehaug S, Yahalom J. Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma: a multi-institutional, matched cohort study. J Clin Oncol 2011; 29:2466-73. [PMID: 21576642 DOI: 10.1200/jco.2010.32.4079] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). PATIENTS AND METHODS Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. RESULTS A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). CONCLUSION In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.
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Affiliation(s)
- Elena B Elkin
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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Cutuli B, Kanoun S, Tunon De Lara C, Baron M, Livi L, Levy C, Cohen-Solal-Lenir C, Lesur A, Kerbrat P, Provencio M, Gonzague-Casabianca L, Mege A, Lemanski C, Delva C, Lancrenon S, Velten M. Breast cancer occurred after Hodgkin's disease: clinico-pathological features, treatments and outcome: analysis of 214 cases. Crit Rev Oncol Hematol 2011; 81:29-37. [PMID: 21333547 DOI: 10.1016/j.critrevonc.2011.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/30/2010] [Accepted: 01/13/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Secondary tumours (ST) represent a major concern in survivors of Hodgkin's disease (HD). Breast cancer (BC) is the most frequent ST among young treated women. MATERIAL AND METHODS One hundred and eighty-nine women treated for HD by radiotherapy (RT) and/or chemotherapy (CT) subsequently developed 214 BCs. RESULTS Median age at HD diagnosis was 25 years (34% were less than 20). Median interval between HD and BC was 18.6 years, with a 42-year median age at first BC. According to the TNM classification, there were 30 (14%) T0 (non palbable lesions), 86 (40%) T1, 56 (26%) T2, 13 (6%) T3T4 and 29 (14%) Tx. There were 25 (13.2%) contralateral BC. 160 (75%) and 15 (7%) tumours were infiltrating ductal and lobular carcinomas, 7 (3.3%) were other subtypes and 27 (22%) DCIS. The rate of axillary nodal involvement was 32%. Among 203 operated tumours, 79 (39%) were treated by breast conserving surgery (BCS), with RT in 56 (71%) cases. CT and hormonal treatment were delivered in 51% and 45% of the patients. With a 50-month median follow-up, local recurrence occurred in 12% of the tumours (9% after mastectomy, 21% after lumpectomy alone and 13.7% after lumpectomy with RT). Metastasis occurred in 47 (26%) patients. The risk factors were pN+, pT, high SBR grade and young age (< 50 years). The ten-year overall and specific survival rates were 53% and 63.5%, respectively. The ten-year specific survival rates were 79% for pT0T1T2, 48% for pT3T4 (p = 0.0002) and 79% for pN0 versus 38.5% for pN+ (p = 0.00026). Among 67 deaths, 43 (73%) were due to BC. CONCLUSION Patients and physicians should be aware that BC is the most frequent secondary tumour in young women treated for HD. The new RT modalities (lower doses and involved fields) may decrease the risk in the future. However, these women require a careful monitoring as from 8 to 10 years after HD treatment, combining mammography, ultrasound and MRI according to several ongoing studies. BC with whole breast irradiation is feasible in some selected cases.
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Affiliation(s)
- Bruno Cutuli
- Radiation Oncology Department, Polyclinique de Courlancy, 38 rue de Courlancy, 51100 Reims, France.
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Patani N, Khaled Y, Al Reefy S, Mokbel K. Ductal carcinoma in-situ: an update for clinical practice. Surg Oncol 2010; 20:e23-31. [PMID: 21106367 DOI: 10.1016/j.suronc.2010.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/30/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Ductal carcinoma in-situ (DCIS) is a heterogeneous entity with an elusive natural history. The objective of radiological, histological and molecular characterisation remains to reliably predict the biological behaviour and optimise clinical management strategies. Increases in diagnostic frequency have followed the introduction of mammographic screening and increased utility of magnetic resonance imaging. However, progress remains limited in distinguishing non-progressive incidental lesions from their progressive and clinically relevant counterparts. This article reviews current management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment. METHODS Literature review facilitated by Medline, PubMed, Embase and Cochrane databases. RESULTS DCIS should be managed in the context of a multidisciplinary team. Local control depends upon adequate surgical clearance with margins of at least 2 mm. SLNB is not routinely indicated and should be reserved for those with concurrent or recurrent invasive disease. SLNB can be considered in patients undergoing mastectomy (MX) and those with risk factors for invasion such as palpability, comedo morphology, necrosis or recurrent disease. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting the omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions (particularly in cases of prior RT) should be treated by MX with the opportunity for immediate reconstruction. Adjuvant Tamoxifen may reduce the risk of LR in selected cases with hormone sensitive disease. CONCLUSION Further research is required to determine the role of contemporary RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of the tumour biology of this condition and rationalise its treatment. Reliable identification of low-risk lesions could allow treatment to be less radical or safely omitted.
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Affiliation(s)
- Neill Patani
- The London Breast Institute, The Princess Grace Hospital, London, UK
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Milano MT, Li H, Gail MH, Constine LS, Travis LB. Long-term survival among patients with Hodgkin's lymphoma who developed breast cancer: a population-based study. J Clin Oncol 2010; 28:5088-96. [PMID: 20975072 DOI: 10.1200/jco.2010.29.5683] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The increased risk of breast cancer (BC) among women receiving chest radiotherapy for Hodgkin's lymphoma (HL) is well-established. However, there are no large population-based studies that describe overall survival (OS) and cause-specific survival (CSS) compared with women with first primary BC. METHODS For 298 HL survivors who developed BC (HL-BC group) and 405,223 women with a first or only BC (BC-1 group), actuarial OS and CSS were compared, accounting for age, BC stage, hormone receptor status, sociodemographic status, radiation for HL, and other variables. All patients were derived from the population-based Surveillance, Epidemiology, and End Results program. RESULTS OS among patients with HL-BC was significantly inferior that of to patients with BC-1: 15-year OS was 48% versus 69% (P < .0001) for localized BC, and 33% versus 43% (P < .0001) for regional/distant BC. Patients with HL-BC had a significantly increased seven-fold risk (P < .0001) of death from other cancers (ie, not HL or BC) compared with patients with BC-1. Mortality from heart disease among patients with HL-BC with either localized or regional/distant disease was also significantly increased (hazard ratio = 2.22, P = .04; and hazard ratio = 4.28, P = .02, respectively) compared with patients with BC-1. Although 10-year BC-CSS was similar for patients with HL-BC and BC-1 with regional/distant disease, it was inferior for patients with localized BC (82% v 88%, respectively; P = .002). CONCLUSION Women with HL may survive a subsequent diagnosis of BC, only to experience significant excesses of death from other primary cancers and cardiac disease. Greater awareness of screening for cardiac disease and subsequent primary cancers in patients with HL-BC is warranted.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Henderson TO, Amsterdam A, Bhatia S, Hudson MM, Meadows AT, Neglia JP, Diller LR, Constine LS, Smith RA, Mahoney MC, Morris EA, Montgomery LL, Landier W, Smith SM, Robison LL, Oeffinger KC. Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med 2010. [PMID: 20368650 DOI: 10.1059/0003-4819-152-7-201004060-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women treated with therapeutic chest radiation may develop breast cancer. PURPOSE To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer. DATA SOURCES Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008). STUDY SELECTION Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation? DATA EXTRACTION Three investigators independently extracted data and assessed study quality. DATA SYNTHESIS Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited. LIMITATION The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size. CONCLUSION Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.
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Affiliation(s)
- Tara O Henderson
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Henderson TO, Amsterdam A, Bhatia S, Hudson MM, Meadows AT, Neglia JP, Diller LR, Constine LS, Smith RA, Mahoney MC, Morris EA, Montgomery LL, Landier W, Smith SM, Robison LL, Oeffinger KC. Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med 2010; 152:444-55; W144-54. [PMID: 20368650 PMCID: PMC2857928 DOI: 10.7326/0003-4819-152-7-201004060-00009] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Women treated with therapeutic chest radiation may develop breast cancer. PURPOSE To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer. DATA SOURCES Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008). STUDY SELECTION Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation? DATA EXTRACTION Three investigators independently extracted data and assessed study quality. DATA SYNTHESIS Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited. LIMITATION The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size. CONCLUSION Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.
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Affiliation(s)
- Tara O Henderson
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Meattini I, Livi L, Saieva C, Marrazzo L, Rampini A, Iermano C, Papi MG, Detti B, Scoccianti S, Biti G. Breast Cancer Following Hodgkin’s Disease: The Experience of the University of Florence. Breast J 2010; 16:290-6. [DOI: 10.1111/j.1524-4741.2010.00904.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Late effects of therapy for childhood cancer are frequent and serious. Fortunately, many late effects are also modifiable. Proactive and anticipatory risk-based care can reduce the frequency and severity of treatment-related morbidity. The primary care clinician should be an integral component in risk-based care of survivors. Continued communication between the "late effects" staff at the cancer center and the primary care clinician is essential for optimum care of this high-risk population.
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Affiliation(s)
- Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Braschoss S, Hirsch B, Dübel S, Stein H, Dürkop H. New anti-CD30 human pancreatic ribonuclease-based immunotoxin reveals strong and specific cytotoxicityin vivo. Leuk Lymphoma 2009; 48:1179-86. [PMID: 17577782 DOI: 10.1080/10428190701272264] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although the therapy of Hodgkin lymphoma and anaplastic large cell lymphoma has been considerably improved during the last decades, high therapeutic toxicity, relapses, secondary tumors, and primary treatment failure(s) occur. Both malignancies are well suited for CD30-targeted immunotherapy because of their strong CD30 expression. We constructed an immunotoxin composed of a single chain variable fragment of a CD30 antibody fused to the human pancreatic ribonuclease, showing CD30-specific binding and ribonucleolytic activity resistant to the inhibitor RNasin. This immunotoxin revealed CD30-specific anti-tumor activity in BALB/c mice that were challenged with CD30-positive or CD30-negative syngeneic tumor cells.
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Affiliation(s)
- Sandra Braschoss
- Institut für Pathologie, Charité--Campus Benjamin Franklin (FU Berlin), Germany
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Abstract
Earlier, estrogens were considered simply the most important hormones involved in female physiology and reproduction. Nowadays it has become familiar that they have pivotal roles in gene regulation of cell differentiation and proliferation. There are many contradictions concerning the associations of female sexual steroids and cancer. Cancers of the highly estrogen dependent organs are in the forefront of tumors as they are regarded as hormone associated ones. However, re-evaluation of earlier results supporting the carcinogenic capacity of estrogen exhibited many shortcomings and controversies. Recently, the clinical studies on hormone replacement therapy in postmenopausal women justified beneficial anticancer effects in several organs even in the female breast. The newly revealed association between estrogen deficiency and oral cancer risk also means a contradiction of the traditional concept of estrogen-induced cancer. Distinction between cancers of moderately and highly estrogen dependent tumors can be based on their different epidemiological features. The vast majority of the so-called smoking associated malignancies of the moderately estrogen dependent organs occur typically in the late postmenopausal life of women when the ovarian estrogen production is fairly decreased. However cancers of the highly estrogen dependent organs such as breast, endometrium and ovary exhibit both premenopausal and postmenopausal occurrence. In spite of the different epidemiological data of these two groups of cancers the mechanism of gene regulation disorder in the background of tumor initiation cannot act through quite opposite pathways. This suggests that in moderately estrogen sensitive organs a serious, in the highly estrogen dependent sites even a mild estrogen deficiency is enough to provoke gene regulation disorders. The new findings both on smoking associated and hormone related cancers might lead to the same conversion; not estrogen but rather its deficiency may provoke cancer initiation.
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Affiliation(s)
- Zsuzsanna Suba
- Semmelweis Egyetem, Fogorvostudományi Kar Arc-, Allcsont-, Szájsebészeti és Fogászati Klinika, Orálpatológiai Részleg Budapest.
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Breast-conserving therapy after previous irradiation for lymphoma. Breast Cancer Res Treat 2009; 124:845-9. [DOI: 10.1007/s10549-009-0421-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
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Cox CL, Oeffinger K, Montgomery M, Hudson MM, Leisenring W, Whitton J, Robison LL. Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors: Results From the Childhood Cancer Survivor Study. Oncol Nurs Forum 2009; 36:335-344. [PMID: 19596651 PMCID: PMC2712119 DOI: 10.1188/09.onf.335-344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose/Objectives: To identify treatment, intrapersonal, and provider factors that influence childhood cancer survivors' adherence to recommended mammography screening.Design: Secondary analysis of data derived from three consecutive surveys within the Childhood Cancer Survivor Study.Sample: Female childhood cancer survivors: N = 335, X age = 30.92, X years after diagnosis = 21.79.Methods: T tests and structural equation modeling.Main Research Variables: Mammogram recency, health concerns, affect, motivation, and survivor-provider interaction.Findings: Forty-three percent of the variance was explained in mammogram recency. Survivors most likely to follow the recommended mammogram schedule were directly influenced by cancer treatment exposure to mantle radiation (p = 0.01), less intrinsic motivation (p = 0.01), positive affect (p = 0.05), recent visits to an oncology clinic (p = 0.01), discussion of subsequent cancer risks with a physician (p = 0.001), perceptions of more severe late effects (p = 0.05), age (40 years or older) (p = 0.001), and a print media intervention detailing breast cancer risks and follow-up strategies.Conclusions: Perceived symptoms, motivation, affect, provider influences, readiness for medical follow-up, and knowledge of treatment exposures are potential modifiable targets for intervention to support mammography screening in childhood cancer survivors at risk.Implications for Nursing: (a) Provide written summaries of treatment exposures and recommended schedule of mammography screening at the end of cancer treatment and throughout follow-up; (b) identify and address survivor symptoms and concerns that may negate screening; and (c) enhance motivation for screening by tailoring personal risk information to health concerns, affect, and readiness for follow-up.
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Affiliation(s)
- Cheryl L. Cox
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michele Montgomery
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Partial Breast Brachytherapy as the Primary Treatment for Breast Cancer Diagnosed After Mantle Radiation Therapy for Hodgkin's Disease. Am J Clin Oncol 2009; 32:132-6. [DOI: 10.1097/coc.0b013e318180c880] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Russo IH, Russo J. Use of human chorionic gonadotropin in the prevention of breast cancer. ACTA ACUST UNITED AC 2009; 4:1-5. [PMID: 19072445 DOI: 10.2217/17455057.4.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nathan PC, Ford JS, Henderson TO, Hudson MM, Emmons KM, Casillas JN, Lown EA, Ness KK, Oeffinger KC. Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort. J Clin Oncol 2009; 27:2363-73. [PMID: 19255308 DOI: 10.1200/jco.2008.21.1441] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Childhood cancer survivors are at risk for medical and psychosocial late effects as a result of their cancer and its therapy. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify the evolution of these late effects. This manuscript summarizes publications from the Childhood Cancer Survivor Study (CCSS) that have examined health behaviors, risk-based health care, and interventions to promote healthy lifestyle practices. Long-term survivors use tobacco and alcohol and have inactive lifestyles at higher rates than is ideal given their increased risk of cardiac, pulmonary, and metabolic late effects. Nearly 90% of survivors report receiving some form of medical care. However, only 18% report medical visits related to their prior cancer that include discussion or ordering of screening tests or counseling on how to reduce the specific risks arising from their cancer. One low-cost, peer-driven intervention trial has been successful in improving smoking cessation within the CCSS cohort. On the basis of data from CCSS investigations, several trials to promote improved medical surveillance among high-risk groups within the cohort are underway. Despite their long-term risks, many survivors of childhood cancer engage in risky health behaviors and do not receive adequate risk-based medical care.
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Robison LL. Treatment-associated subsequent neoplasms among long-term survivors of childhood cancer: the experience of the Childhood Cancer Survivor Study. Pediatr Radiol 2009; 39 Suppl 1:S32-7. [PMID: 19083220 PMCID: PMC2664260 DOI: 10.1007/s00247-008-1066-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 11/29/2022]
Abstract
With improvements in survival among individuals diagnosed and treated for cancer there is an increasing recognition of the risk of long-term adverse effects of therapy. Second neoplasms represent one of the more serious late effects of treatment and are associated with a substantial level of morbidity and mortality. Survivors of childhood cancers, because of their potential longevity, are at particular risk for this adverse outcome. The Childhood Cancer Survivor Study is a large cohort consisting of adult survivors of childhood cancer diagnosed and treated between 1970 and 1986. The CCSS has provided important data to quantify radiation-associated risk for subsequent cancers including neoplasms of the breast, thyroid and central nervous system.
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Affiliation(s)
- Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA,
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44
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Oeffinger KC, Ford JS, Moskowitz CS, Diller LR, Hudson MM, Chou JF, Smith SM, Mertens AC, Henderson TO, Friedman DL, Leisenring WM, Robison LL. Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer. JAMA 2009; 301:404-14. [PMID: 19176442 PMCID: PMC2676434 DOI: 10.1001/jama.2008.1039] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Women treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer at a young age and are recommended to have an annual screening mammogram starting at age 25 years or 8 years after radiation, whichever occurs last. OBJECTIVE To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening. DESIGN, SETTING, AND PARTICIPANTS Between June 2005 and August 2006, a 114-item questionnaire was administered to a random sample of 625 women aged 25 through 50 years who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS), a North American cohort of long-term survivors diagnosed from 1970-1986. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the CCSS siblings cohort (n = 712). MAIN OUTCOME MEASURE Screening mammogram within the previous 2 years. RESULTS Of 1976 cancer survivors and siblings who were contacted, 87.9% participated. Among the 551 women with a history of chest radiation, 55% reported a screening mammogram in the past 2 years (ages 25-39 years, 36.5%; 95% confidence interval [CI], 31.0%-42.0%; ages 40-50 years, 76.5%; 95% CI, 71.3%-81.7%). In comparison, 40.5% of survivors without chest radiation and 37.0% of CCSS siblings reported a screening mammogram in the same time interval. Notably, among women with a history of chest radiation, 47.3% (95% CI; 41.6%-53.0%) of those younger than 40 years had never had a mammogram and only 52.6% (95% CI; 46.4%-58.8%) of women aged 40 through 50 years were being regularly screened (2 mammograms within 4 years). Screening rates were higher among women who reported a physician recommendation than those who did not (ages 25-39 years, 76.0% vs 17.6%; ages 40-50 years, 87.3% vs 58.3%). In multivariate models, the association was particularly strong for younger women (ages 25-39 years, prevalence ratio [PR], 3.0; 95% CI, 2.0-4.0; ages 40-50 years, PR, 1.3; 95% CI, 1.1-1.6). CONCLUSIONS In this cohort of women who had childhood cancer treated with chest radiation, 63.5% of those aged 25 through 39 years and 23.5% of those aged 40 through 50 years had not had mammography screening for breast cancer within the previous 2 years despite a guideline recommendation that survivors of childhood cancer who were treated with chest radiation should undergo annual screening mammography.
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Affiliation(s)
- Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Guilcher GMT, Fitzgerald C, Pritchard S. A questionnaire based review of long-term follow-up programs for survivors of childhood cancer in Canada. Pediatr Blood Cancer 2009; 52:113-5. [PMID: 18821577 DOI: 10.1002/pbc.21701] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major advances have been made in the treatment of childhood cancer; however, survivors of childhood cancer are at increased risk for morbidity and mortality. There is little literature regarding available long-term follow-up programs for survivors of childhood cancer. PROCEDURE In March 2007, 16 surveys were sent to pediatric hematology/oncology programs across Canada to determine what programs were available for survivors of childhood cancer, and the nature of such programs. RESULTS Of 15 participating centers, 13 (87%) have multi-disciplinary programs for the long-term follow-up of pediatric cancer survivors. Research databases were documented in 9/15 (60%) of centers to document late effects. Dedicated programs for adult survivors of childhood cancer were established in 8/15 (53%) of centers. Access to subspecialty care for survivors was rated as quite good. Concerns were raised by many participants about patients being lost to follow-up. Respondents indicated that primary care physicians appear to be under-represented within dedicated long-term follow-up programs. CONCLUSION Long-term follow-up programs for survivors of childhood cancer are available in 87% of Canadian pediatric oncology centers. While programs reported good access to care for childhood survivors, many adult survivors of childhood cancer have more limited timely access to services and patients are often lost to follow-up. New models of care incorporating primary care physicians are necessary due to growing numbers of survivors.
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Affiliation(s)
- G M T Guilcher
- Division of Pediatric Hematology, University of Calgary, Calgary, Canada.
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46
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Weinstein JL, Ayyanar K, Watral MA. Secondary neoplasms following treatment for brain tumors. Cancer Treat Res 2009; 150:239-273. [PMID: 19834673 DOI: 10.1007/b109924_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joanna L Weinstein
- Division of Hematology, Oncology and Stem Cell Transplantation, Children's Memorial Hospital, Chicago, IL, USA.
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47
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Cutuli B. [Ductal carcinoma in situ of the breast (DCIS) under 40: a specific management?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2008; 36:705-706. [PMID: 18539513 DOI: 10.1016/j.gyobfe.2008.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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48
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Kwong A, Hancock SL, Bloom JR, Pal S, Birdwell RL, Mariscal C, Ikeda DM. Mammographic Screening in Women at Increased Risk of Breast Cancer after Treatment of Hodgkin’s Disease. Breast J 2008; 14:39-48. [DOI: 10.1111/j.1524-4741.2007.00524.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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49
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Russo J, Balogh GA, Russo IH. Full-term pregnancy induces a specific genomic signature in the human breast. Cancer Epidemiol Biomarkers Prev 2008; 17:51-66. [PMID: 18199711 DOI: 10.1158/1055-9965.epi-07-0678] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast cancer risk has traditionally been linked to nulliparity or late first full-term pregnancy, whereas young age at first childbirth, multiparity, and breast-feeding are associated with a reduced risk. Early pregnancy confers protection by inducing breast differentiation, which imprints a specific and permanent genomic signature in experimental rodent models. For testing whether the same phenomenon was detectable in the atrophic breast of postmenopausal parous women, we designed a case-control study for the analysis of the gene expression profile of RNA extracted from epithelial cells microdissected from normal breast tissues obtained from 18 parous and 7 nulliparous women free of breast pathology (controls), and 41 parous and 8 nulliparous women with history of breast cancer (cases). RNA was hybridized to cDNA glass microarrays containing 40,000 genes; arrays were scanned and the images were analyzed using ImaGene software version 4.2. Normalization and statistical analysis were carried out using Linear Models for Microarrays and GeneSight software for hierarchical clustering. The parous control group contained 2,541 gene sequences representing 18 biological processes that were differentially expressed in comparison with the other three groups. Hierarchical clustering of these genes revealed that the combined parity/absence of breast cancer data generated a distinct genomic profile that differed from those of the breast cancer groups, irrespective of parity history, and from the nulliparous cancer-free group, which has been traditionally identified as a high-risk group. The signature that identifies those women in whom parity has been protective will serve as a molecular biomarker of differentiation for evaluating the potential use of preventive agents.
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Affiliation(s)
- Jose Russo
- Breast Cancer Research Laboratory, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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50
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Patani N, Cutuli B, Mokbel K. Current management of DCIS: a review. Breast Cancer Res Treat 2007; 111:1-10. [PMID: 17902049 DOI: 10.1007/s10549-007-9760-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 09/10/2007] [Indexed: 11/28/2022]
Abstract
Ductal carcinoma in-situ (DCIS) is a heterogeneous disease, in terms of its radiological characteristics, histological morphology and molecular attributes. This diversity is reflected in its natural history and influences optimal treatment strategy. A significant proportion of DCIS lesions behave in a clinically benign fashion and do not progress to invasive disease. Reliable identification of these patients could allow treatment to be less radical or safely omitted. Management should be tailored to the individual within the context of a multidisciplinary team. Approaches such as biological profiling and molecular analysis represent an opportunity to improve our understanding of the tumour biology of this condition and rationalise its treatment. This article reviews the management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy, adjuvant radiotherapy and tamoxifen.
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Affiliation(s)
- Neill Patani
- The London Breast Institute, The Princess Grace Hospital, 45 Nottingham Place, London, W1U 5NY, UK.
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