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Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer. PLoS One 2022; 17:e0270528. [PMID: 35749525 PMCID: PMC9231765 DOI: 10.1371/journal.pone.0270528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 12/31/2022] Open
Abstract
Background The effect of postmastectomy radiotherapy (PMRT) on T1-2N1M0 triple-negative breast cancers (TNBC) remains unclear. The population-based study aimed to investigate the survival outcomes of T1-2N1M0 TNBC patients who underwent PMRT or not. Methods We selected 1743 patients with T1-2N1M0 TNBC who underwent mastectomy between 2010 and 2015 through the Surveillance, Epidemiology and End Results (SEER) database. After propensity score matching (PSM), the PMRT and no-PMRT groups consisted of 586 matched patients, respectively. The Kaplan-Meier method was applied to calculate breast cancer-specific survival (BCSS) and cox proportional hazard model was used to determine the prognostic factors of T1-2N1M0 TNBC. Results The 5-year BCSS for the PMRT and no-PMRT groups was 79.1% and 74.7%, respectively. Analysis showed that in patients with three nodes positive, radiotherapy could significantly improve BCSS (HR = 0.396, 95% CI = 0.175–0.900, P = 0.027), but it brought no significant advantage in BCSS in patients with one or two nodes positive (HR = 1.061, 95% CI = 0.725–1.552, P = 0.761; HR = 0.657, 95% CI = 0.405–1.065, P = 0.088). In addition, PMRT improves the BCSS in TNBC patients with T2 tumor concomitant with three positive lymph nodes (HR = 0.343, 95% CI = 0.132–0.890, P = 0.028). Conclusion TNBC patients with T2 tumor concomitant with three positive lymph nodes can benefit from PMRT.
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Adrada BE, Karbasian N, Huang M, Rauch GM, Woodtichartpreecha P, Whitman G. Imaging Surveillance of the Reconstructed Breast in a Subset of Patients May Aid in Early Detection of Breast Cancer Recurrence. J Clin Imaging Sci 2021; 11:58. [PMID: 34877066 PMCID: PMC8645461 DOI: 10.25259/jcis_113_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: The purpose of this study is to determine the biological markers more frequently associated with recurrence in the reconstructed breast, to evaluate the detection method, and to correlate recurrent breast cancers with the detection method. Material and Methods: An institutional review board-approved retrospective study was conducted at a single institution on 131 patients treated with mastectomy for primary breast cancer followed by breast reconstruction between 2005 and 2012. Imaging features were correlated with clinical and pathologic findings. Results: Of the 131 patients who met our inclusion criteria, 40 patients presented with breast cancer recurrence. The most common histopathologic type of primary breast cancer was invasive ductal carcinoma in 82.5% (33/40) of patients. Triple-negative breast cancer was the most common biological marker with 42.1% (16/38) of cases. Clinically, 70% (28/40) of the recurrences presented as palpable abnormalities. Of nine patients who underwent mammography, a mass was seen in eight patients. Of the 35 patients who underwent ultrasound evaluation, an irregular mass was found in 48.6% (17/35) of patients. Nine patients with recurrent breast cancer underwent breast MRI, and MRI showed an irregular enhancing mass in four patients, an oval mass in four patients, and skin and trabecular thickening in one patient. About 55% of patients with recurrent breast cancer were found to have distant metastases. Conclusion: Patients at higher risk for locoregional recurrence may benefit from imaging surveillance in order to detect early local recurrences.
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Affiliation(s)
| | - Niloofar Karbasian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Monica Huang
- Department of Breast Imaging, MD Anderson, Houston, Texas, United States
| | - Gaiane Maia Rauch
- Department of Breast and Abdominal Imaging, MD Anderson, Houston, Texas, United States
| | | | - Gary Whitman
- Department of Breast Imaging, MD Anderson, Houston, Texas, United States
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3
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Fancellu A, Houssami N, Sanna V, Porcu A, Ninniri C, Marinovich ML. Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis. Br J Surg 2021; 108:760-768. [PMID: 34057990 DOI: 10.1093/bjs/znab145] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), oncological and survival outcomes based on locoregional treatment are poorly understood. In particular, the safety of breast-conserving surgery (BCS) for TNBC has been questioned. METHODS A meta-analysis was performed to evaluate locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) rates in patients with TNBC who had breast-conserving surgery versus mastectomy. Estimates were pooled in random-effects analysis. The effect of study-level co-variables was assessed by univariable metaregression. RESULTS Fourteen studies, including 19 819 patients operated for TNBC met the inclusion criteria; 9828 patients (49.6 per cent) underwent BCS and 9991 (50.4 per cent) had a mastectomy. Patients with smaller tumours were more likely to be selected for BCS (pooled odds ratio (OR) for T1 tumours 1.95, 95 per cent c.i. 1.64 to 2.32; P < 0.001). The pooled OR for LRR was 0.64 (0.48 to 0.85; P = 0.002), indicating a statistically significantly lower odds of LRR among women who had BCS relative to mastectomy. The pooled OR for DM was 0.70 (0.53 to 0.94; P = 0.02), indicating a lower odds of DM among women who had BCS; however, this difference diminished with increasing study-level age and follow-up time. A pooled hazard ratio of 0.78 (0.69 to 0.89; P < 0.001) showed a significantly lower hazard for all-cause mortality among women undergoing BCS versus mastectomy. CONCLUSION These results should be interpreted cautiously owing to likely differences in selection for BCS or mastectomy in the included studies. Patients with TNBC selected for BCS do not, however, have a worse prognosis than those treated with mastectomy, and breast conservation can be offered when feasible clinically.
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Affiliation(s)
- A Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - N Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - V Sanna
- Azienda Ospedaliero-Universitaria di Sassari, Unit of Medical Oncology, Sassari, Italy
| | - A Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - C Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - M L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
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Kim S, Lee S, Bae Y, Lee S. Nipple-sparing mastectomy for breast cancer close to the nipple: a single institution's 11-year experience. Breast Cancer 2020; 27:999-1006. [PMID: 32372321 DOI: 10.1007/s12282-020-01104-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to analyze our 11-year experience using NSM with immediate breast reconstruction in breast cancer. METHODS Between January 2007 and December 2015, 251 NSMs were performed on 251 women with breast cancer for therapeutic purpose at Pusan National University Hospital. RESULTS The clinical and pathologic mean tumor size was 3.1 cm. Based on preoperative imaging, mean distance between tumor and nipple was 2.5 cm. Among 251 tumors, 119 cases (47.4%) and 69 cases (27.5%) with a distances ≤ 2 cm and ≤ 1 cm, respectively, were detected. There were 11 patients (4.4%) with locoregional recurrences during the mean follow-up period of 68.0 months. Of these 11 cases, one (0.4%) had local recurrence in the retained NAC, and the others had recurrence in the chest wall or skin. CONCLUSION Unless clinical and histological evidence of nipple involvement, NSM can be an oncologically safe surgical option for breast cancer, even if the tumor is located close to the nipple.
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Affiliation(s)
- Sunhyun Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seungju Lee
- Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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He L, Wu Q, Xiong J, Su Z, Zhang B, Song Y. Do early HER2-overexpression breast cancer patients benefit from undergoing neoadjuvant trastuzumab and mastectomy? A meta-analysis. Cancer Manag Res 2019; 11:8043-8054. [PMID: 31507328 PMCID: PMC6718741 DOI: 10.2147/cmar.s208319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/21/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose To assess the overall survival (OS) of early human epidermal growth factor receptor 2 (HER2)-enriched breast cancer patients after receiving neoadjuvant trastuzumab (NAT) compared to adjuvant trastuzumab (AT) treatment and the difference in local-regional relapse (LRR) rate with this tumor and treatment between women after mastectomy and women after breast-conserving therapy (BCT). Methods Articles were retrieved from PubMed, Embase, Web of Science, and Cochrane Library. A pooled odds ratio (OR) with a 95% confidential interval (CI) was calculated. The StataSE version 12.0 software was employed for meta-analysis. Results Twelve available clinical studies containing 2366 subjects were included. The OS of NAT compared with that of AT was not significantly different (pooled OR=1.04; 95% CI, 0.47–2.33). There was a significantly lower LRR rate for patients with mastectomy compared to those with BCT (pooled OR=0.58; 95% CI, 0.38–0.89); however, subgroup analysis revealed that the significant advantage of LRR for mastectomy compared to BCT was only represented in women without trastuzumab treatment (pooled OR=0.52; 95% CI, 0.31–0.88) compared to those who received trastuzumab treatment (pooled OR=0.71; 95% CI, 0.34–1.49). Conclusion Early stage HER2-overexpression breast cancer patients benefit with an equivalent OS from NAT treatment compared to AT. Patients who underwent mastectomy and BCT experienced a similar LRR rate if they received anti-HER2 targeted therapy of trastuzumab, but the LRR rate was discernibly reduced in patients who received mastectomy compared to BCT if they did not also receive trastuzumab treatment. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/NZW1HV69ESk
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Affiliation(s)
- Lin He
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Qian Wu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Jing Xiong
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Zhumin Su
- Department of Neurology, The People's Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Biyuan Zhang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
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He L, Zhao S, Liu M, Su Z, Ren Y, Song Y. The reciprocal influences of prognosis between two types of surgical interventions and early breast cancer patients with diverse luminal subtypes: A meta-analysis. Medicine (Baltimore) 2019; 98:e14912. [PMID: 30882711 PMCID: PMC6426479 DOI: 10.1097/md.0000000000014912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate and compare the effects of breast-conserving therapy (BCT) and mastectomy on the disease recurrence and long-term survival in early-stage luminal breast cancer and the difference in prognosis across diverse luminal subtypes receiving single surgical modality. METHODS The databases of PubMed and Embase were retrieved to select eligible trials that were published from inception to 13 November 2018. The clinical trials that offered the details about recurrent disease and/or survival in luminal tumors underwent BCT or mastectomy met the inclusion criteria (n=24). With the random- or fixed-effect model basing on heterogeneity Chi test with its significant level of P < .1, pooled odds ratio (OR) with its 95% CI, and P value were identified for endpoints. RESULTS The analyzed data were constituted of 25 qualified trials with 13,032 unique women suffered from luminal cancers. The fixed-effect models were utilized. On the LRR regarding BCT versus mastectomy, the pooled data indicated no significant difference in luminal carcinomas (OR, 0.84; 95%CI, 0.43-1.64; P = .61; n = 867). In BCT cohort, the pooled data showed that there were some significant benefits favoring luminal A over luminal B in LR (OR, 0.61; 95%CI, 0.46-0.81; P = .0007; n = 5406), DM (OR, 0.53; 95%CI, 0.41-0.69; P < .00001; n = 4662), DFS (OR, 0.59; 95%CI, 0.36-0.96; P = .03; n = 776) and OS (OR, 0.65; 95%CI, 0.42-0.99; P = .05; n = 1149), but not in LRR (OR, 0.74; 95%CI, 0.48-1.13; P = .16; n = 3732), coupled with luminal A/B over luminal-HER2 in LRR (OR, 0.43; 95%CI, 0.25-0.76; P = .004; n = 890), DM (OR, 0.56; 95%CI, 0.35-0.90; P = .02; n = 1396), DFS (OR, 0.47; 95%CI, 0.27-0.83; P = .009; n = 532); in mastectomy cohort, there were apparent advantages of LRR (OR, 0.58; 95%CI, 0.36-0.92; P = .02; n = 1768), LR (OR,0.56; 95%CI, 0.38-0.83; P = .004; n = 1209), DM (OR, 0.58; 95%CI, 0.40-0.84; P = .004; n = 652) and OS (OR, 0.62; 95%CI, 0.43-0.89; P = .009; n = 652) in luminal A vs luminal B. CONCLUSION For early luminal breast cancer, the equality of LRR was achieved in BCT and mastectomy. In comparison, luminal A cancers benefit the most improved tumor re-appearence and survival in luminal diseases regardless of the option of surgical modality, whereas luminal-HER2 is affected by the worst clinical outcomes in them who follows BCT.
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Affiliation(s)
| | | | - Min Liu
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
| | - Zhumin Su
- Department of Neurology, The People's Hospital of China Medical University, Shenyang, Liaoning Province
| | - Yuanzhong Ren
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Giarratano T, Miglietta F, Giorgi CA, Tsvetkova V, Michieletto S, Evangelista L, Polico I, Dieci MV, Guarneri V. Exceptional and Durable Responses to TDM-1 After Trastuzumab Failure for Breast Cancer Skin Metastases: Potential Implications of an Immunological Sanctuary. Front Oncol 2018; 8:581. [PMID: 30560092 PMCID: PMC6287048 DOI: 10.3389/fonc.2018.00581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/19/2018] [Indexed: 01/09/2023] Open
Abstract
Breast Cancer (BC) skin metastases represent a challenging clinical scenario. Although they usually arise when other distant metastases are already present, they may also represent a form of locoregional recurrence (LRR). Systemic therapy in this setting may have a role both in case a radical locoregional approach is unfeasible in order to achieve disease control, and as adjuvant strategy after radical removal of cutaneous lesions, in order to prevent or delay subsequent disease spread. Systemic therapy for HER2+ metastatic BC (MBC) currently relies on anti-HER2 targeted agents. In this context TDM1 is an option in trastuzumab-resistant patients.Here we present 2 cases of isolated skin metastases in patients with HER2+ BC progressing during or early after trastuzumab-based therapy, showing impressive responses to TDM1. We hypothesize that the unique properties of skin immune microenvironment may explain the failure of trastuzumab, which exerts its action also through immunological mechanisms, and the subsequent outlier responses to TDM1, that relies on a partially different mechanism of action.
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Affiliation(s)
- Tommaso Giarratano
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federica Miglietta
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carlo A Giorgi
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Vassilena Tsvetkova
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Anatomy and Histology Unit, Azienda Ospedaliera di Padua, Padua, Italy
| | | | - Laura Evangelista
- Nuclear Medicine and Molecular Imaging Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Ilaria Polico
- Breast Imaging Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Maria V Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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8
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Ignatov A, Eggemann H, Burger E, Ignatov T. Patterns of breast cancer relapse in accordance to biological subtype. J Cancer Res Clin Oncol 2018; 144:1347-1355. [PMID: 29675790 DOI: 10.1007/s00432-018-2644-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the pattern of recurrence of breast cancer according to its biological subtype in a large cohort of patients treated with therapy representative of current practice. PATIENTS AND METHODS Patients treated between 2000 and 2016 with known biological subtype were eligible. Data were prospectively collected. Primary endpoint was the subtype-dependent pattern and time of recurrence. Loco-regional and distant site and time of recurrence were assessed. RESULTS Median follow-up time was 80.8 months. For 12,053 (82.5%) of 14,595 patients with primary non-metastatic invasive breast cancer a subtype classification was possible. The luminal A subtype had the highest 10-year survival followed by luminal B and luminal/HER2. The worst survival demonstrated HER2 enriched and TNBC. HER2 and TNBC had the highest rate of recurrence in the first 5 years, whereas the rate of recurrence for luminal A and luminal B tumors was initially low, but remained continuously even after 10 years of follow-up. Luminal A tumors demonstrated the lowest rate of distant metastases predominantly in bone. So did luminal B tumors. HER2 enriched subtype was characterized with increased rate of loco-regional recurrence and distant metastases in bone, liver and brain. Luminal/HER2 had pattern of relapse similar to HER2 enriched tumors, with exception of loco-regional relapse and brain metastases. TNBC had higher rate of lung, bone and brain metastases as well as loco-regional relapse. CONCLUSION Breast cancer subtypes are associated with different time and pattern of recurrence and it should be considered during treatment decision.
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Affiliation(s)
- Atanas Ignatov
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany.
| | - Holm Eggemann
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany
| | - Elke Burger
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany
| | - Tanja Ignatov
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany
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Ramella S, Ippolito E, Fiore M, Greco C, Iurato A, Trodella LE, Floreno B, Di Donato A, D'Angelillo RM, Trodella L. The Role of Mammography after Breast-Conserving Surgery and Adjuvant Chemotherapy. TUMORI JOURNAL 2018; 99:199-203. [DOI: 10.1177/030089161309900213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To investigate the impact of postchemotherapy mammography on radiotherapy timing and detection of early locoregional recurrences in breast cancer patients treated with breast-conserving surgery and adjuvant chemotherapy. Methods Bilateral mammography was performed before radiotherapy. Mammogram assessments were collected using the Breast Imaging Reporting and Data System (BI-RADS) scale. Differences in waiting times for radiotherapy between patients who needed further evaluation after mammograms and who did not were tested by the nonparametric Mann-Whitney U test. Results A total of 277 patients who underwent locoregional restaging after conservative surgery and adjuvant chemotherapy were evaluated. All patients had surgical margins greater than 2 mm. No locoregional recurrences were detected. Only in 2 patients (0.7%) did preradiotherapy mammograms reveal a contralateral breast cancer, which was histologically confirmed. After chemotherapy, the waiting times for radiotherapy were not different between patients who needed further imaging evaluation and patients who did not (34 days, 95% CI: 29–65 vs 38 days, 95% CI: 32–39; P = NS). Conclusion According to these data, postchemotherapy mammography detected a contralateral breast cancer in very few cases (0.7%); thus, even if performing these exams did not delay the start of radiotherapy, we believe that preradiotherapy mammograms are not necessary for patients undergoing adjuvant chemotherapy after breast-conserving surgery.
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Affiliation(s)
- Sara Ramella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Edy Ippolito
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Michele Fiore
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Carlo Greco
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Aurelia Iurato
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Luca E Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Barnaba Floreno
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - Alessia Di Donato
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | | | - Lucio Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
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Abstract
In the era of personalized medicine, there has been significant progress regarding the molecular analysis of breast cancer subtypes. Research efforts have focused on how classification of subtypes could provide information on prognosis and influence treatment planning. Although much is known about the impact of different molecular subtypes on disease-specific survival, more recent studies have investigated the role of the different molecular subtypes on local-regional recurrence. This is an area of active study, and in recent years there has been significant progress. This article describes outcomes among disease subtypes to aid in optimal surgical decision-making to improve local-regional control.
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Affiliation(s)
- Simona Maria Fragomeni
- Division of Gynecologic Oncology, Multidisciplinary Breast Center, Catholic University of the Sacred Heart of Rome, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Andrew Sciallis
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Jacqueline S Jeruss
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA; Division of Surgical Oncology, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA.
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11
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Mu L, Liu Y, Xiao M, Liu W, Liu M, Wang X. No association between triple-negative breast cancer and prognosis of patients receiving breast-conserving treatment. Oncol Lett 2017; 14:7862-7872. [PMID: 29250179 PMCID: PMC5727599 DOI: 10.3892/ol.2017.7251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/13/2017] [Indexed: 12/30/2022] Open
Abstract
The role of triple-negative breast cancer (TNBC) in breast-conserving treatment is controversial. The present study aimed at evaluating the prognosis of patients with TNBC following breast-conserving treatment (BCT) within 5 years. The present study investigated a cohort of 757 patients with early stage breast cancer, diagnosed and treated with BCT between January 2002 and March 2010 at Tianjin Medical University Cancer Institute and Hospital. The patients were divided into three groups according to receptor expression: Estrogen receptor (ER) or progesterone receptor (PR)-positive; epidermal growth factor receptor 2 (HER2)-enriched: ER and PR negative but HER2-positive; TNBC: ER, PR and HER2 receptor-negative. The primary endpoint was recurrence or mortality within 5 years after breast cancer diagnosis. Multivariable Cox analysis was used to determine the risk of locoregional relapse, distant metastases, total relapse and mortality associated with the intrinsic subtypes. Of the 757 patients with status of all receptors available, 541 (71.5%) were luminal, 66 (8.7%) were HER2-enriched and 150 (19.8%) were TNBC. Patients with TNBC were more likely to have histological grade III tumors (27.3%) compared with luminal (8.3%) and HER2-enriched (16.7%) subtypes (P<0.001). Within 5 years, locoregional recurrence rate was 2.4, 7.6 and 7.3% for luminal, HER2-enriched and TNBC, respectively (P=0.005). Mortality rate was 2.2, 9.1 and 4.7% for luminal, HER2-enriched and TNBC, respectively (P=0.007). There was no significant difference in rates of distant metastases (P=0.164) and total relapse (P=0.138). TNBC was not an independent prognostic predictor for women treated with BCT within 5 years after breast cancer diagnosis on multivariate analysis. Patients with TNBC were not at significantly increased 5-year risks of locoregional recurrence, distant metastasis, total relapse or mortality at so remain appropriate candidates for BCT.
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Affiliation(s)
- Lan Mu
- First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, P.R. China
| | - Yuxiang Liu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Meng Xiao
- First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, P.R. China
| | - Weise Liu
- First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, P.R. China
| | - Miao Liu
- First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, P.R. China
| | - Xin Wang
- First Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin 300060, P.R. China
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12
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Grubb W, Young R, Efird J, Jindal C, Biswas T. Local therapy for triple-negative breast cancer: a comprehensive review. Future Oncol 2017; 13:1721-1730. [PMID: 28776394 DOI: 10.2217/fon-2017-0056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Owing to its aggressive course, triple-negative breast cancer remains an important clinical issue of current interest compared with hormone-receptor positive subtypes. Recent research has focused on determining the optimal local therapy (breast conversation therapy vs mastectomy) for this cancer subtype. In this overview, we examine outcomes based on immunohistochemistry, gene expression profiles, type of local therapy and in the era of neoadjuvant chemotherapy. Based on multiple observational reports risk for locoregional recurrence appears to be similar to reported outcomes in other subtypes. However, distant recurrence continues to be a significant concern for triple-negative breast cancer, indicating the need for better systemic therapies. To date, insufficient evidence exists to determine whether breast conserving therapy or mastectomy results in superior outcomes.
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Affiliation(s)
- William Grubb
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Rebekah Young
- Department of Radiation Oncology, The James Cancer Center, Stefanie Spielman Comprehensive Breast Center, Columbus, OH 43212, USA
| | - Jimmy Efird
- School of Medicine & Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Charulata Jindal
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH 44106, USA.,School of Medicine & Public Health, University of Newcastle, Newcastle, NSW, Australia.,Department of Radiation Oncology, The James Cancer Center, Stefanie Spielman Comprehensive Breast Center, Columbus, OH 43212, USA
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH 44106, USA
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13
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Mamtani A, King TA. Targeted Therapy and Local Control: The Dynamic Duo. Ann Surg Oncol 2017; 24:3110-3112. [PMID: 28748442 DOI: 10.1245/s10434-017-6022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Anita Mamtani
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tari A King
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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14
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Riet F, Fayard F, Arriagada R, Santos M, Bourgier C, Ferchiou M, Heymann S, Delaloge S, Mazouni C, Dunant A, Rivera S. Preoperative radiotherapy in breast cancer patients: 32 years of follow-up. Eur J Cancer 2017; 76:45-51. [DOI: 10.1016/j.ejca.2017.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
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15
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Chen F, Pu F. Role of postmastectomy radiotherapy in early-stage (T1-2N0-1M0) triple-negative breast cancer: a systematic review. Onco Targets Ther 2017; 10:2009-2016. [PMID: 28435291 PMCID: PMC5388262 DOI: 10.2147/ott.s123803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Triple-negative breast cancer (TNBC), which represents 15%–20% of all breast cancers, is defined by the absence of estrogen receptor (ER) and progesterone receptor (PR) and overexpression of human epidermal growth factor receptor 2 (HER2). Owing to the absence of specific therapeutic targets and its aggressive biologic characteristics, TNBC patients often experience a high risk of disease progression and poor overall survival. Furthermore, TNBC exhibits an early pattern of recurrence with a peak recurrence risk at 2–3 years after surgery. Currently, chemotherapy continues to be the mainstay in TNBC patients; however, such treatment leaves them associated with a high rate of local and systemic relapses even in early-stage (T1–2N0–1M0). Therefore, in early-stage disease, greater emphasis is placed on locoregional treatments, based on radiation therapy (RT) after surgery, to reduce local and systemic relapses. However, there are no specific treatment guidelines for early-stage (T1–2N0–1M0) TNBC patients. In this review, we discuss the type of surgery received and the relevant adverse clinicopathologic factors and underlying BRCA1 mutation status regarding the influence of tailing postmastectomy radiotherapy (PMRT). In addition, we assess the role of PMRT in early-stage (T1–2N0–1M0) TNBC patients.
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Affiliation(s)
- Fengxia Chen
- Department of Medical Oncology, General Hospital of The Yangtze River Shipping
| | - Feifei Pu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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16
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Yoon TI, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Kim HJ, Ko BS, Son BH, Gong G, Kim SB, Kim SS, Ahn SD, Chung M, Ahn SH. No Association of Positive Superficial and/or Deep Margins with Local Recurrence in Invasive Breast Cancer Treated with Breast-Conserving Surgery. Cancer Res Treat 2017; 50:275-282. [PMID: 28421725 PMCID: PMC5784642 DOI: 10.4143/crt.2017.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We evaluated the effect of positive superficial and/or deep margin status on local recurrence (LR) in invasive breast cancer treated with breast-conserving surgery (BCS) followed by radiotherapy. MATERIALS AND METHODS In total, 3,403 stage 1 and 2 invasive breast cancer patients treated with BCS followed by radiotherapy from January 2000 to December 2008 were included in this study. These patients were divided into three groups according to margin status: clear resection margin status for all sections (group 1, n=3,195); positive margin status in superficial and/or deep sections (group 2, n=121); and positive peripheral parenchymal margin regardless of superficial and/or deep margin involvement (group 3, n=87). The LR-free survival between these three groups was compared and the prognostic role of margin status was analyzed. RESULTS Across all groups, age, tumor size, nodal status, and human epidermal growth factor receptor 2 status did not significantly differ. High grade, positive extensive intraductal component, hormone receptor positivity, hormone therapy received, and chemotherapy not received were more prevalent in groups 2 and 3 than in group 1. Five-year LR rates in groups 1, 2, and 3 were 1.9%, 1.7%, and 7.7%, respectively. Multivariate analysis revealed that group 3 was a significant predictor for LR (hazard ratio [HR], 4.78; p < 0.001), but that positive superficial and/or deep margin was not (HR, 0.66; p=0.57). CONCLUSION Superficial and/or deep margin involvement following BCS is not an important predictor for LR.
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Affiliation(s)
- Tae In Yoon
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Guiyun Sohn
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Young Chung
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsung Chung
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sei Hyun Ahn
- Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Bernier J. Precision medicine for early breast cancer radiotherapy: Opening up new horizons? Crit Rev Oncol Hematol 2017; 113:79-82. [PMID: 28427525 DOI: 10.1016/j.critrevonc.2017.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/11/2017] [Indexed: 11/19/2022] Open
Abstract
So far most efforts put forth to test the value of predictive and prognostic tools in the field of breast radiotherapy remained globally disappointing, or at least below the convincing levels reached for systemic therapy. Nevertheless the addition of predictive tools to the clinical armament tends to prevail over the use of the sole prognostic factors, also in radiotherapy. A number of predictive assays, clinically validated or not, have recently elicited significant associations between molecular profiles and tumor biological aggressiveness and/or radiosensitivity levels. Will it take a long time for these radiation-specific assays to provide added value to the - already crowded - constellation of predictive tools in the breast cancer? On the one hand, optimizing radiotherapy through the integration of precision medicine into the breast cancer management still remains a challenging issue. On the other hand, recent advances in predictive assays aimed at distinguishing patients with a more radioresistant tumor that necessitates radiation dose escalation or a switch to therapeutic approaches other than radiotherapy, plea in favor of an increasing role, in a near future, for radiation-specific molecular signatures. Streamlining predictive assays platforms via concerted actions should imperatively be given high priority, also in terms of health economics.
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Affiliation(s)
- Jacques Bernier
- Genolier Cancer Center, Genolier Clinic, Route du Muids 3, 1272 Genolier, Switzerland.
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18
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Barajas RF, Krohn KA, Link JM, Hawkins RA, Clarke JL, Pampaloni MH, Cha S. Glioma FMISO PET/MR Imaging Concurrent with Antiangiogenic Therapy: Molecular Imaging as a Clinical Tool in the Burgeoning Era of Personalized Medicine. Biomedicines 2016; 4:biomedicines4040024. [PMID: 28536391 PMCID: PMC5344267 DOI: 10.3390/biomedicines4040024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 01/17/2023] Open
Abstract
The purpose of this article is to provide a focused overview of the current use of positron emission tomography (PET) molecular imaging in the burgeoning era of personalized medicine in the treatment of patients with glioma. Specifically, we demonstrate the utility of PET imaging as a tool for personalized diagnosis and therapy by highlighting a case series of four patients with recurrent high grade glioma who underwent 18F-fluoromisonidazole (FMISO) PET/MR (magnetic resonance) imaging through the course of antiangiogenic therapy. Three distinct features were observed from this small cohort of patients. First, the presence of pseudoprogression was retrospectively associated with the absence of hypoxia. Second, a subgroup of patients with recurrent high grade glioma undergoing bevacizumab therapy demonstrated disease progression characterized by an enlarging nonenhancing mass with newly developed reduced diffusion, lack of hypoxia, and preserved cerebral blood volume. Finally, a reduction in hypoxic volume was observed concurrent with therapy in all patients with recurrent tumor, and markedly so in two patients that developed a nonenhancing reduced diffusion mass. This case series demonstrates how medical imaging has the potential to influence personalized medicine in several key aspects, especially involving molecular PET imaging for personalized diagnosis, patient specific disease prognosis, and therapeutic monitoring.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Kenneth A Krohn
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Radiochemistry Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Jeanne M Link
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Radiochemistry Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Randall A Hawkins
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
| | - Jennifer L Clarke
- Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
- Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
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19
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Kim SW, Chun M, Han S, Jung YS, Choi JH, Kang SY, Yim H, Kang SH. Young Age Is Associated with Increased Locoregional Recurrence in Node-Positive Breast Cancer with Luminal Subtypes. Cancer Res Treat 2016; 49:484-493. [PMID: 27554479 PMCID: PMC5398391 DOI: 10.4143/crt.2016.246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/09/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The effects of biological subtypes within breast cancer on prognosis are influenced by age at diagnosis. We investigated the association of young age with locoregional recurrence (LRR) between patients with luminal subtypes versus those with nonluminal subtypes. MATERIALS AND METHODS Medical records of 524 breast cancer patients with positive lymph nodes between 1999 and 2010 were reviewed retrospectively. All patients received curative surgery and adjuvant chemotherapy based on contemporary guidelines. Radiation was delivered for patients who underwent breast conserving surgery or those who had four or more positive lymph nodes after mastectomy. Adjuvant hormone therapy was administered to 413 patients with positive hormone receptors according to their menstrual status. RESULTS During median follow-up of 84 months, the 10-year locoregional recurrence-free survival rate (LRRFS) was 84.3% for all patients. Patients < 40 years showed significantly worse 10-year LRRFS than those ≥ 40 years (73.2% vs. 89.0%, respectively; p=0.01). The negative effect of young age on LRRFS was only observed in luminal subtypes (69.7% for < 40 years vs. 90.8% for ≥ 40 years; p < 0.01). Multivariate analysis using luminal subtypes ≥ 40 years as a reference revealed luminal subtypes < 40 years were significantly associated with increased risk of LRR (hazard ratio, 2.33; p < 0.01). CONCLUSION Young breast cancer patients with positive lymph nodes had a higher risk of LRR than those aged ≥ 40 years. This detrimental effect of young age on LRR was confined in luminal subtypes.
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Affiliation(s)
- Sang-Won Kim
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Sehwan Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yong Sik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jin Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hee Kang
- Department of Radiation Oncology, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
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20
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Güler SA, Uğurlu MÜ, Kaya H, Şen S, Nazlı Y, Güllüoğlu BM. Impact of cyclooxygenase-2 over-expression on the prognosis of breast cancer patients. ULUSAL CERRAHI DERGISI 2016; 32:81-8. [PMID: 27436928 DOI: 10.5152/ucd.2016.3146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/14/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this present study was to assess the impact of COX-2 over-expression on breast cancer survival. MATERIAL AND METHODS Non-metastatic invasive breast cancer patients who received adequate loco-regional and systemic treatments were evaluated. Patients' demographic, clinical, pathologic, and treatment-related and survival data were retrieved from their hospital files. COX-2, estrogen/progesterone receptor (ER/PR), HER-2/neu expression and Ki67 index of the tumors were determined immunohistochemically. As the primary objective, COX-2 positive and negative patients were compared in terms of overall (OS), disease-free (DFS) and breast cancer-specific survival (BCSS). Secondary objectives were to assess the independent prognostic factors for survival. In addition, the correlation of COX-2 expression with conventional prognostic and predictive factors of breast cancer was assessed. RESULTS Two hundred and seventeen patients who underwent adequate breast cancer treatment between November 2004 and December 2013 were included in the study. The median follow-up was 37 months (range: 5-107). Eighty-one (37%) patients were COX-2 positive. OS, DFS, and BCSS were similar in COX-2 positive and negative patients. Ki67 index and age were significantly correlated with COX-2 expression (r=-0.116; p=0.02; r=0.159; p=0.02). PR expression was found to be the only independent factor for predicting OS, tumor size and molecular subtype classification were found to be the only independent factors for predicting DFS, and PR expression was found to be the only independent factor for predicting BCSS. CONCLUSION Among the independent predictive and prognostic factors of breast cancer, COX-2 over-expression was only correlated with Ki67 index and age.
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Affiliation(s)
- Sertaç Ata Güler
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Mustafa Ümit Uğurlu
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Handan Kaya
- Department of Pathology, Marmara University School of Medicine, İstanbul, Turkey
| | - Semiha Şen
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Yasemin Nazlı
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Bahadır M Güllüoğlu
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
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21
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Prasad S, Efird JT, James SE, Walker PR, Zagar TM, Biswas T. Failure patterns and survival outcomes in triple negative breast cancer (TNBC): a 15 year comparison of 448 non-Hispanic black and white women. SPRINGERPLUS 2016; 5:756. [PMID: 27386241 PMCID: PMC4912515 DOI: 10.1186/s40064-016-2444-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Triple negative breast cancer (TNBC) is a distinct subtype of breast cancer with unique pathologic, molecular and clinical behavior. It occurs more frequently in young blacks and has been reported to have a shorter disease-free interval. We undertook this study to analyze the demographic characteristics, failure patterns, and survival outcomes in this disease. METHODS A total of 448 non-Hispanic black and white women were identified over a 15 year period from 1996 to 2011. Demographic and clinical information including age, race, menopausal status, stage, tumor characteristics, and treatments were collected. Fisher's exact test and multivariable Cox regression were used to compare failure patterns and survival outcomes between races. RESULTS 49 % (n = 223) were black. 59 % patients were between 41 and 60 years, with 18 % ≤40 years. 57 % were premenopausal and 89 % had grade 3 tumors. Stage II (47 %) was most frequent stage at diagnosis followed by stage III (28 %). 32 % had lymphovascular invasion. Adjusting for age, stage, and grade, there was no difference in survival outcomes (OS, DFS, LFFS, and DFFS) between the two races. 62 (14 %) patients failed locally either in ipsilateral breast or chest wall, and 19 (4 %) failed in the regional lymphatics. Lung (18 %) was the most frequent distant failure site with <12 % each failing in brain, liver and bones. CONCLUSION Failure patterns and survival outcomes did not differ by race in this large collection of TNBC cases. Lung was the predominate site of distant failure followed by brain, bone, and liver. Few patients failed in the regional lymphatics.
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Affiliation(s)
- Shreya Prasad
- />Department of Internal Medicine, North Shore-Long Island Jewish Medical Center, Manhasset, NY USA
| | - Jimmy T. Efird
- />Center for Health Disparities, Brody School of Medicine, Office of Research, College of Nursing, East Carolina University, Greenville, NC USA
| | - Sarah E. James
- />Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Paul R. Walker
- />Division of Hematology/Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC USA
| | - Timothy M. Zagar
- />Department of Radiation Oncology and Neurosurgery, Cyberknife Radiosurgery Program, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Tithi Biswas
- />Department of Radiation Oncology, University Hospitals Sideman Cancer Center, Case Western Reserve University, Cleveland, OH USA
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22
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Bernier J, Poortmans PMP. Surgery and radiation therapy of triple-negative breast cancers: From biology to clinics. Breast 2016; 28:148-55. [PMID: 27318170 DOI: 10.1016/j.breast.2016.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 01/02/2023] Open
Abstract
Triple negative breast cancer refers to tumours lacking the expression of the three most used tumour markers, namely oestrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2). These cancers are known to carry a more dismal prognosis than the other molecular subtypes. Whether a more aggressive local-regional treatment is warranted or not in patients with triple-negative breast cancer is still a matter of debate. Indeed there remain a number of grey zones with respect to the optimization of the extent and the timing of surgery and radiation therapy (RT) in this patient population, also in consideration of the significant heterogeneity in biological behaviour and response to treatment identified for these tumours. The objective of this review is to provide an insight into the biological and clinical behaviour of triple-negative breast cancers and revisit the most recent advances in their management, focussing on local-regional treatments.
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Affiliation(s)
- Jacques Bernier
- Department of Radiation Oncology, Swiss Medical Network, Genolier, Geneva, Switzerland.
| | - Philip M P Poortmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Scheer AS, Zih FSW, Maki E, Koch CA, McCready DR. Post-mastectomy Radiation: Should Subtype Factor into the Decision? Ann Surg Oncol 2016; 23:2462-70. [DOI: 10.1245/s10434-015-5071-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Indexed: 01/17/2023]
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24
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Bae MS, Moon HG, Han W, Noh DY, Ryu HS, Park IA, Chang JM, Cho N, Moon WK. Early Stage Triple-Negative Breast Cancer: Imaging and Clinical-Pathologic Factors Associated with Recurrence. Radiology 2016; 278:356-64. [DOI: 10.1148/radiol.2015150089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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25
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Blum JL, Gonçalves A, Efrat N, Debled M, Conte P, Richards PD, Richards D, Lardelli P, Nieto A, Cullell-Young M, Delaloge S. A phase II trial of trabectedin in triple-negative and HER2-overexpressing metastatic breast cancer. Breast Cancer Res Treat 2016; 155:295-302. [DOI: 10.1007/s10549-015-3675-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/01/2022]
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26
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Krajewski AC, Boughey JC, Degnim AC, Jakub JW, Jacobson SR, Hoskin TL, Hieken TJ. Expanded Indications and Improved Outcomes for Nipple-Sparing Mastectomy Over Time. Ann Surg Oncol 2015. [PMID: 26202567 DOI: 10.1245/s10434-015-4737-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Demand for nipple-sparing mastectomy (NSM) has increased. The authors' initial NSM guidelines included risk reduction and cancers 2 cm or smaller located more than 2 cm from the nipple. The relative contraindications included obesity, large and/or ptotic breasts, and prior radiation. This study aimed to evaluate changes over time in NSM indications, surgical approach, and early outcomes. METHODS After institutional review board approval, the study identified 354 patients scheduled for 588 NSMs, 341 (96%) of whom underwent 566 NSMs. Changes across time [early (2009-2010), mid (2011-2012), and recent (2013-6/2014)] were assessed using tests for linear trend. RESULTS For patients undergoing reconstruction, NSMs increased from 24% (early) to 40% (recent) (p = 0.004). Among the NSM patients, average body mass index, proportion with bra cup sizes of C or larger, and prior radiation increased significantly over time. Performance of NSM for tumors 2 cm or less from the nipple increased from 5 to 18%, and after neoadjuvant therapy, from 8 to 21.5% (p = 0.02). Use of inframammary, radial, and reduction-type incisions increased over time, together with intraoperative laser angiography (both p < 0.0001). Concomitantly, the overall complication rate, complications requiring treatment, and postoperative nipple loss decreased. During a median follow-up period of 19 months, five locoregional recurrences (LRR) were observed, for an estimated 2-year LRR rate of 1.7% [95% confidence interval (CI), 0-3.9%]. CONCLUSIONS Over time, the indications for NSM expanded in terms of patient characteristics, tumor stage, and prior therapy, whereas the complication rates decreased. Excellent short-term outcomes suggest that NSM is a reasonable approach for many risk-reduction and cancer patients without disease in the nipple-areolar complex. Further study is needed to assess long-term aesthetics, patient satisfaction, and oncologic safety.
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Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, Blitzblau RC, Moy B, Breslin T, Edge SB, Hassett MJ, Punglia RS. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys 2015; 93:622-30. [PMID: 26461004 DOI: 10.1016/j.ijrobp.2015.07.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype. METHODS AND MATERIALS Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2-, low/intermediate grade), luminal B (ER/PR+, HER2-, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER-, PR-, HER2-). LRR hazard ratios (HR) were estimated with multivariable Fine and Gray models. The effect of PMRT on LRR was evaluated with Fine and Gray models stratified by propensity for PMRT. RESULTS With a median follow-up time of 50.1 months, there were 19 iLRR and 109 LRR events. HER2 patients with trastuzumab had no iLRR and only a single LRR. Compared with luminal A patients, TN patients had significantly greater adjusted risk of iLRR (HR 14.10; 95% CI 2.97%-66.90%), with a similar trend among luminal B (HR 4.94; 95% CI 0.94%-25.82%) and HER2 patients without trastuzumab (HR 4.41; 95% CI 0.61%-32.11%). Although PMRT reduced LRR, the effect of PMRT varied by subgroup, with the greatest and smallest effects seen among luminal A (HR 0.17; 95% CI 0.05%-0.62%) and TN patients (HR 0.59; 95% CI 0.25%-1.35%), respectively. CONCLUSIONS TN patients had the highest risk of LRR and the least benefit from PMRT; these patients may benefit from alternative treatment strategies. In contrast, in the era of HER2-directed therapy, the role of local therapy may need to be reassessed among HER2 patients.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Hajime Uno
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce C Niland
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard Theriault
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tara Breslin
- Division of Surgical Oncology, Department of Surgery, Northwestern Lake Forest Hospital, Lake Forest, Illinois
| | - Stephen B Edge
- Baptist Cancer Center, Memphis, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to.
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An overview of triple negative breast cancer for surgical oncologists. Surg Oncol 2015; 24:276-83. [PMID: 26092709 DOI: 10.1016/j.suronc.2015.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/07/2015] [Indexed: 11/22/2022]
Abstract
Triple negative breast cancers (TNBCs) represent a distinct subgroup of breast cancers with an immunohistochemical phenotype that is negative for oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). The aim of this article is to provide a broad overview of recent developments in the diagnosis and management of TNBC for surgical oncologists. This overview discusses the subtypes of TNBC and the relationship between this type of breast cancer and the BRCA1 gene. In addition, the article explores recent advances in the treatment of TNBC from a surgical, radiation, and medical oncology point of view. Lastly, evolving therapeutic strategies that have potential to enhance outcomes for patients with TNBC are also discussed.
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Ulas A, Kos T, Avci N, Cubukcu E, Olmez OF, Bulut N, Degirmenci M. Patients with HER2-positive early breast cancer receiving adjuvant trastuzumab: clinicopathological features, efficacy, and factors affecting survival. Asian Pac J Cancer Prev 2015; 16:1643-9. [PMID: 25743846 DOI: 10.7314/apjcp.2015.16.4.1643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate clinicopathological characteristics of our early stage breast cancer patients who are epidermal growth factor receptor 2 (HER2) overexpressed/ amplified (HER2+), the efficacy of trastuzumab treatment and survival results. MATERIALS AND METHODS Patients with HER2- positive early stage breast cancer receiving adjuvant trastuzumab were investigated retrospectively. Clinicopathological features of 210 patients and treatment outcome were analysed. To evaluate survival rates, the Kaplan-Meier method was used. Univariate and multivariate analyses were conducted with the Cox regression model. RESULTS Mean age of the patients was 51.8, 71.9% being postmenopausal. Some 37.6% of patients were node negative, and 31% had T1 tumor size and 52.4% were positive for estrogen receptor. Of 210 patients, 89.5% completed planned 52 weeks adjuvant trastuzumab treatment. The median follow up was 27.5 months (6.0-86.0 ). Relapse free survival (RFS) was 68.0 months (95% CI: 62.1-74.0) and overall survival (OS) was 74.8 months (95% CI: 69.5-80.1). The 3 year OS for all patients was 92.0% and RFS was 79.6%. During follow up, relapse was detected at the rate of 14.3%. Trastuzumab associated cardiotoxicity was found at the rate of 3.3%. In univariate analyses, larger tumor size and grade III were significantly associated (p<0.05) with RFS. Multivariate analyses of covariates displaying p<0.05 identified grade III as an independent prognostic factor. CONCLUSIONS In the present study, it was established that trastuzumab had a satisfactory safety profile and treatment efficacy as in other clinical studies and that among clinicopathological factors evaluated, only being grade 3 had a significant effect on RFS. The occurrence of relapse with adjuvant trastuzumab makes it necessary to identify molecular predictors, which will define this group better and help explain resistance to anti HER2 based therapies.
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Affiliation(s)
- Arife Ulas
- Department of Medical Oncology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey E-mail :
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Casbas-Hernandez P, Sun X, Roman-Perez E, D'Arcy M, Sandhu R, Hishida A, McNaughton KK, Yang XR, Makowski L, Sherman ME, Figueroa JD, Troester MA. Tumor intrinsic subtype is reflected in cancer-adjacent tissue. Cancer Epidemiol Biomarkers Prev 2014; 24:406-14. [PMID: 25465802 DOI: 10.1158/1055-9965.epi-14-0934] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Overall survival of early-stage breast cancer patients is similar for those who undergo breast-conserving therapy (BCT) and mastectomy; however, 10% to 15% of women undergoing BCT suffer ipsilateral breast tumor recurrence. The risk of recurrence may vary with breast cancer subtype. Understanding the gene expression of the cancer-adjacent tissue and the stromal response to specific tumor subtypes is important for developing clinical strategies to reduce recurrence risk. METHODS We utilized two independent datasets to study gene expression data in cancer-adjacent tissue from invasive breast cancer patients. Complementary in vitro cocultures were used to study cell-cell communication between fibroblasts and specific breast cancer subtypes. RESULTS Our results suggest that intrinsic tumor subtypes are reflected in histologically normal cancer-adjacent tissue. Gene expression of cancer-adjacent tissues shows that triple-negative (Claudin-low or basal-like) tumors exhibit increased expression of genes involved in inflammation and immune response. Although such changes could reflect distinct immune populations present in the microenvironment, altered immune response gene expression was also observed in cocultures in the absence of immune cell infiltrates, emphasizing that these inflammatory mediators are secreted by breast-specific cells. In addition, although triple-negative breast cancers are associated with upregulated immune response genes, luminal breast cancers are more commonly associated with estrogen-response pathways in adjacent tissues. CONCLUSIONS Specific characteristics of breast cancers are reflected in the surrounding histologically normal tissue. This commonality between tumor and cancer-adjacent tissue may underlie second primaries and local recurrences. IMPACT Biomarkers derived from cancer-adjacent tissue may be helpful in defining personalized surgical strategies or in predicting recurrence risk.
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Affiliation(s)
- Patricia Casbas-Hernandez
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xuezheng Sun
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erick Roman-Perez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monica D'Arcy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rupninder Sandhu
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Asahi Hishida
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kirk K McNaughton
- Department of Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland
| | - Liza Makowski
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland
| | - Melissa A Troester
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Haffty BG, Mahmoud O. The Evolution of Regional Nodal Irradiation in Breast Cancer. Breast J 2014; 21:32-41. [DOI: 10.1111/tbj.12351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bruce G. Haffty
- Department of Radiation Oncology; Rutgers Robert Wood Johnson Medical School; New Jersey Medical School and Cancer Institute of New Jersey; New Brunswick New Jersey
| | - Omar Mahmoud
- Department of Radiation Oncology; Rutgers Robert Wood Johnson Medical School; New Jersey Medical School and Cancer Institute of New Jersey; New Brunswick New Jersey
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Current challenges and future perspectives of radiotherapy for locally advanced breast cancer. Curr Opin Support Palliat Care 2014; 8:46-52. [PMID: 24441684 DOI: 10.1097/spc.0000000000000032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW To discuss current issues in the field of radiation oncology for locally advanced breast cancer (LABC). RECENT FINDINGS Large randomized studies involving nodal irradiation have recently been completed. The incremental benefit of treating the internal mammary nodes (IMNs) remains controversial. A randomized study specifically evaluating internal mammary node radiation (IMNR) failed to demonstrate significant benefit. A high impact, population-based study detected a proportional increase in major coronary events with increasing radiation dose. Advanced treatment techniques should be employed to reduce cardiac exposure. In patients with stage IV breast cancer (BCa), there is increasing evidence to suggest that locoregional treatments may improve overall survival (OS). Radiotherapy alone, without surgery, may provide equivalent local control and OS in patients with distant metastasis. High-dose stereotactic radiation regimens can be used to treat breast tumors with good local control rates in as few as three visits.BCa biomarkers are predictive of locoregional recurrence risk and should be used to guide radiotherapy in conjunction with standard staging. Clinically validated genetic profiling can measure tumor radiosensitivity and also help to predict normal tissue toxicity. SUMMARY We are entering an era of personalized radiotherapy for LABC. Radiation treatments must be tailored to each individual patient's risk and intrinsic tumor biology.
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Karhade M, Hall C, Mishra P, Anderson A, Kuerer H, Bedrosian I, Krishnamurthy S, Lucci A. Circulating tumor cells in non-metastatic triple-negative breast cancer. Breast Cancer Res Treat 2014; 147:325-33. [PMID: 25164970 PMCID: PMC4149877 DOI: 10.1007/s10549-014-3103-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
Abstract
Circulating tumor cells (CTCs) can be identified in approximately 25 % of stage I-III breast cancer patients; CTCs presence is a predictor of poor outcome in metastatic breast cancer, but little is known regarding the prognostic significance of CTCs in non-metastatic triple-negative breast cancer (TNBC) patients. The aim of this study was to determine whether CTCs predict worse outcome in non-metastatic TNBC patients. We evaluated CTCs in 113 patients with stages I-III TNBC at the time of definitive surgery. CTCs were assessed using the CellSearch System®. Progression-free and overall survival were defined as time elapsed between date of diagnosis and either date of clinical disease progression, death, or last follow-up. Log-rank test and Cox regression analysis were used to determine associations of CTCs with progression-free and overall survival. The median follow-up was 40 months. CTCs were identified in 23/113 (20 %) of patients. No primary tumor characteristic or lymph node status predicted the presence of CTCs. The identification of ≥2 CTCs predicted shorter progression-free (log rank P ≤ 0.001; hazard ratio 8.30, 95 % CI 2.61–26.37) and overall survival (log rank P = 0.0004; hazard ratio 7.19, 95 % CI 1.98–26.06) versus survival for patients with <2 CTCs. Two or more CTCs predict shorter progression-free and overall survival in TNBC patients. Larger studies are needed to determine whether CTC assessment provides beneficial information that could be used in stratifying TNBC patients at increased risk for disease progression. Finally, CTCs characterization could facilitate the development of novel treatment approaches for TNBC.
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Affiliation(s)
- Mandar Karhade
- Department of Surgical Oncology, Unit 0444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Smith SL, Truong PT, Lu L, Lesperance M, Olivotto IA. Identification of patients at very low risk of local recurrence after breast-conserving surgery. Int J Radiat Oncol Biol Phys 2014; 89:556-62. [PMID: 24929165 DOI: 10.1016/j.ijrobp.2014.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). METHODS AND MATERIALS Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. RESULTS The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). CONCLUSIONS Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR.
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Affiliation(s)
- Sally L Smith
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada.
| | - Pauline T Truong
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada
| | - Linghong Lu
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | - Mary Lesperance
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | - Ivo A Olivotto
- Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Is Biological Subtype Prognostic of Locoregional Recurrence Risk in Women With pT1-2N0 Breast Cancer Treated With Mastectomy? Int J Radiat Oncol Biol Phys 2014; 88:57-64. [DOI: 10.1016/j.ijrobp.2013.09.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/29/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022]
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Valeur pronostique des sous-types moléculaires et du Ki67 pour les cancers du sein indemnes d’envahissement ganglionnaire après mastectomie : expérience de l’institut Curie–hôpital René-Huguenin et revue de la littérature. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2013.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zurawska U, Baribeau DA, Giilck S, Victor C, Gandhi S, Florescu A, Verma S. Outcomes of her2-positive early-stage breast cancer in the trastuzumab era: a population-based study of Canadian patients. ACTA ACUST UNITED AC 2013; 20:e539-45. [PMID: 24311954 DOI: 10.3747/co.20.1523] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
UNLABELLED Breast cancer is heterogenous, with variable expression of the estrogen receptor (er), progesterone receptor (pr), and human epidermal growth factor receptor 2 (her2). Overexpression of her2 is generally considered a negative prognostic feature, but whether outcomes for her2-positive early breast cancer remain different from those for other subtypes in the era of trastuzumab-based adjuvant therapy is unknown. METHODS Using a retrospective chart review, we compared overall survival (os) and relapse-free survival (rfs) in 3 groups of patients with early-stage breast cancer: er-positive or pr-positive (or both) and her2-negative ["hormone receptor-positive" (hr+)]; her2-positive (her2+); and er-negative, pr-negative, and her2-negative ["triple-negative" (tn)]. RESULTS In the 503 charts analyzed (332 hr+, 94 her2+, 77 tn), the 5-year os and rfs were, respectively, 94.2% and 87.2% for hr+ patients, 88.6% and 74.9% for her2+ patients, and 85.4% and 76.2% for tn patients. On multivariate analysis, the os for the her2+ subtype was similar to that for the hr+ subtype (hazard ratio:1.07; 95% confidence interval: 0.31 to 3.67 with hr+ as reference), but os was significantly worse for tn patients than for hr+ patients (hazard ratio: 4.37; 95% confidence interval: 1.56 to 12.24). In her2+ patients, the 5-year os and rfs trended better for patients with er+ or pr+ disease than for patients with er-negative and pr-negative disease (5-year os: 92.1% vs. 86.9%; 5-year rfs: 79.8% vs. 71.4%). Of her2+ patients, just 80.9% received trastuzumab, including 33.3% of her2+ patients with sub-centimetre tumours. CONCLUSIONS In the trastuzumab era, patients with her2+ and hr+ early breast cancer have similar outcomes, while tn patients experience a significantly worse os than either of the foregoing groups. Outcomes for her2+ patients may differ by er and pr status. Trastuzumab was underutilized in this cohort.
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Affiliation(s)
- U Zurawska
- Department of Medicine, University of Toronto, Toronto, ON
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Wang J, Xie X, Wang X, Tang J, Pan Q, Zhang Y, Di M. Locoregional and distant recurrences after breast conserving therapy in patients with triple-negative breast cancer: a meta-analysis. Surg Oncol 2013; 22:247-55. [PMID: 24144808 DOI: 10.1016/j.suronc.2013.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/03/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND With higher incidence of recurrence, ongoing dispute exists on whether triple-negative breast cancer (TNBC) is a good candidate for breast conserving therapy (BCT). OBJECTIVE We aimed to appraise the safety of BCT in treating TNBC, in comparison with modified radical mastectomy. The prognostic effect of TN phenotype in conservatively managed patients was also assessed. METHODS A systematic search for studies regarding recurrences in patients with TNBC or treated by BCT was conducted up to March 2013. Summary relative risks (RRs) for ipsilateral locoregional recurrence (ILRR) and distant metastasis (DM) were calculated in a fixed-effects model. RESULTS Twenty-two studies concerning 15,312 breast cancer patients were analyzed. In the cohort of TNBC, the patients receiving BCT were less likely to develop ILRR and DM in comparison with mastectomy (RR 0.75, 95% CI 0.65-0.87; RR 0.68, 95% CI 0.60-0.76). In the cohort of BCT, the TN subtype increased the risks of both ILRR and DM than non-TN subtypes (RR 1.88, 95% CI 1.58-2.22; RR 2.12, 95% CI 1.72-2.62). Further subgroup analyses of BCT cohort revealed that the luminal phenotype had the most favorable prognosis. Notably, TN subtype was less likely to develop ILRR than HER-2 subtype (RR 0.69, 95% CI 0.53-0.91), there was no difference in DM rate between them. CONCLUSIONS BCT benefits patients with TNBC than mastectomy does. However, TN subtype predicts a poorer prognosis than non-TN subtype, suggesting more aggressive adjuvant therapy for TNBC be established in future trials.
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Affiliation(s)
- Jin Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Hagen KR, Zeng X, Lee MY, Tucker Kahn S, Harrison Pitner MK, Zaky SS, Liu Y, O'Regan RM, Deng X, Saavedra HI. Silencing CDK4 radiosensitizes breast cancer cells by promoting apoptosis. Cell Div 2013; 8:10. [PMID: 23886499 PMCID: PMC3733890 DOI: 10.1186/1747-1028-8-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background The discovery of molecular markers associated with various breast cancer subtypes has greatly improved the treatment and outcome of breast cancer patients. Unfortunately, breast cancer cells acquire resistance to various therapies. Mounting evidence suggests that resistance is rooted in the deregulation of the G1 phase regulatory machinery. Methods To address whether deregulation of the G1 phase regulatory machinery contributes to radiotherapy resistance, the MCF10A immortalized human mammary epithelial cell line, ER-PR-Her2+ and ER-PR-Her2- breast cancer cell lines were irradiated. Colony formation assays measured radioresistance, while immunocytochemistry, Western blots, and flow cytometry measured the cell cycle, DNA replication, mitosis, apoptosis, and DNA breaks. Results Molecular markers common to all cell lines were overexpressed, including cyclin A1 and cyclin D1, which impinge on CDK2 and CDK4 activities, respectively. We addressed their potential role in radioresistance by generating cell lines stably expressing small hairpin RNAs (shRNA) against CDK2 and CDK4. None of the cell lines knocked down for CDK2 displayed radiosensitization. In contrast, all cell lines knocked down for CDK4 were significantly radiosensitized, and a CDK4/CDK6 inhibitor sensitized MDA-MB-468 to radiation induced apoptosis. Our data showed that silencing CDK4 significantly increases radiation induced cell apoptosis in cell lines without significantly altering cell cycle progression, or DNA repair after irradiation. Our results indicate lower levels of phospho-Bad at ser136 upon CDK4 silencing and ionizing radiation, which has been shown to signal apoptosis. Conclusion Based on our data we conclude that knockdown of CDK4 activity sensitizes breast cancer cells to radiation by activating apoptosis pathways.
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Affiliation(s)
- Katie R Hagen
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Xiangbin Zeng
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Mi-Young Lee
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Shannon Tucker Kahn
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | | | - Sandra S Zaky
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, USA
| | - Ruth M O'Regan
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, USA
| | - Xingming Deng
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Harold I Saavedra
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
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Chen JQ, Bao Y, Lee J, Murray JL, Litton JK, Xiao L, Zhou R, Wu Y, Shen XY, Zhang H, Sahin AA, Katz RL, Bondy ML, Berinstein NL, Hortobagyi GN, Radvanyi LG. Prognostic value of the trichorhinophalangeal syndrome-1 (TRPS-1), a GATA family transcription factor, in early-stage breast cancer. Ann Oncol 2013; 24:2534-2542. [PMID: 23729783 DOI: 10.1093/annonc/mdt190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND TRPS-1 is a new GATA transcription factor that is differentially expressed in breast cancer (BC) where it been found recently to regulate epithelial-to-mesenchymal transition (EMT). PATIENTS AND METHODS We carried out a quantitative immunohistochemistry (qIHC) analysis of TRPS-1 expression in 341 primary-stage I-III BC samples in relation to patient clinical characteristics as well as its prognostic value, especially in an estrogen receptor-positive (ER+) subgroup. RESULTS Higher TRPS-1 expression was significantly associated with a number of clinical and pathological characteristics as well as with improved overall survival (OS) and disease-free survival (DFS). Among stage I/II ER+ BC patients who received endocrine therapy alone, those with high TRPS-1 expression had significantly longer OS and DFS. There was also a strong association between TRPS-1 levels and the EMT marker E-cadherin in the ER+ invasive ductal carcinoma cases. Analysis of gene expression data on a panel of BC lines found that TRPS-1 expression was low or absent in BC lines having enriched mesenchymal features. CONCLUSIONS Our data indicated that TRPS-1 is an independent prognostic marker in early-stage BC and a new EMT marker that can distinguish patients with ER+ BC who will respond longer to adjuvant endocrine therapy.
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Affiliation(s)
- J Q Chen
- Departments of Breast Medical Oncology; Melanoma Medical Oncology
| | - Y Bao
- Departments of Breast Medical Oncology; Melanoma Medical Oncology
| | | | | | | | - L Xiao
- Pathology, UT MD Anderson Cancer Center, Houston, USA; Department of Pathology, Shanghai Huadong Hospital, Shanghai, China
| | - R Zhou
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston
| | - Y Wu
- Pathology, UT MD Anderson Cancer Center, Houston, USA
| | - X Y Shen
- Department of Pathology, Veterans Administration Hospital, Baylor College of Medicine, Houston, USA
| | - H Zhang
- Pathology, UT MD Anderson Cancer Center, Houston, USA
| | - A A Sahin
- Pathology, UT MD Anderson Cancer Center, Houston, USA
| | - R L Katz
- Pathology, UT MD Anderson Cancer Center, Houston, USA
| | - M L Bondy
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston
| | | | | | - L G Radvanyi
- Departments of Breast Medical Oncology; Melanoma Medical Oncology.
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42
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Oliveira M, Cortés J, Bellet M, Balmaña J, De Mattos-Arruda L, Gómez P, Muñoz E, Ortega V, Pérez J, Saura C, Vidal M, Rubio I, Di Cosimo S. Management of the axilla in early breast cancer patients in the genomic era. Ann Oncol 2013; 24:1163-70. [DOI: 10.1093/annonc/mds592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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43
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Chen X, Yu X, Chen J, Yang Z, Shao Z, Zhang Z, Guo X, Feng Y. Radiotherapy can improve the disease-free survival rate in triple-negative breast cancer patients with T1-T2 disease and one to three positive lymph nodes after mastectomy. Oncologist 2013; 18:141-7. [PMID: 23335622 DOI: 10.1634/theoncologist.2012-0233] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Several studies have demonstrated poor locoregional control in patients with triple-negative breast cancer (TNBC), compared with other molecular subtypes of breast cancer. We sought to evaluate whether or not postmastectomy radiotherapy (PMRT) improves locoregional recurrence-free survival (LRFS) and disease-free survival (DFS) outcomes in TNBC patients. METHODS AND MATERIALS Between January 2000 and July 2007, 553 TNBC patients treated with modified radical mastectomy from a single institution were analyzed retrospectively. Patients were categorized into three groups: low risk (stage T1-T2N0), intermediate risk (stage T1-T2N1), and high risk (stage T3-T4 and/or N2-N3). Cox proportional hazards models were used to evaluate the association between PMRT and LRFS and DFS times after adjusting for other clinicopathologic covariates. RESULTS With a median follow-up of 65 months (range, 1-140 months), 51 patients (9.2%) developed locoregional recurrence and 135 patients (24.4%) experienced disease recurrence. On multivariate analysis, PMRT was associated with significantly longer LRFS and DFS times in the entire cohort. In the intermediate-risk group, PMRT was associated with a longer DFS time but not with the LRFS interval. In the high-risk group, PMRT was associated with significantly longer LRFS and DFS times. CONCLUSION PMRT is associated with longer LRFS and DFS times in high-risk TNBC patients and a longer DFS time in intermediate-risk TNBC patients. Prospective randomized studies are needed to investigate the best locoregional treatment approaches for patients with this molecular subtype of breast cancer.
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Affiliation(s)
- Xingxing Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai 200032, China
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44
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Kneubil MC, Brollo J, Botteri E, Curigliano G, Rotmensz N, Goldhirsch A, Lohsiriwat V, Manconi A, Martella S, Santillo B, Petit JY, Rietjens M. Breast cancer subtype approximations and loco-regional recurrence after immediate breast reconstruction. Eur J Surg Oncol 2013; 39:260-5. [PMID: 23313014 DOI: 10.1016/j.ejso.2012.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 11/06/2012] [Accepted: 12/07/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features. METHODS We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥ 14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied. RESULTS Median follow up time was 74 months (range 3-165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥ 25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR. CONCLUSION Luminal B/HER2 positive, triple negative subtypes and BMI ≥ 25 are independent prognostic factors for risk of LRR after IBR.
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Affiliation(s)
- M C Kneubil
- Division of Plastic Reconstruction Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
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Cabezón T, Gromova I, Gromov P, Serizawa R, Timmermans Wielenga V, Kroman N, Celis JE, Moreira JMA. Proteomic profiling of triple-negative breast carcinomas in combination with a three-tier orthogonal technology approach identifies Mage-A4 as potential therapeutic target in estrogen receptor negative breast cancer. Mol Cell Proteomics 2012; 12:381-94. [PMID: 23172894 DOI: 10.1074/mcp.m112.019786] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is a very heterogeneous disease, encompassing several intrinsic subtypes with various morphological and molecular features, natural history and response to therapy. Currently, molecular targeted therapies are available for estrogen receptor (ER)(-) and human epidermal growth factor receptor 2 (Her2)-positive breast tumors. However, a significant proportion of primary breast cancers are negative for ER, progesterone receptor (PgR), and Her2, comprising the triple negative breast cancer (TNBC) group. Women with TNBC have a poor prognosis because of the aggressive nature of these tumors and current lack of suitable targeted therapies. As a consequence, the identification of novel relevant protein targets for this group of patients is of great importance. Using a systematic two dimensional (2D) gel-based proteomic profiling strategy, applied to the analysis of fresh TNBC tissue biopsies, in combination with a three-tier orthogonal technology (two dimensional PAGE/silver staining coupled with MS, two dimensional Western blotting, and immunohistochemistry) approach, we aimed to identify targetable protein markers that were present in a significant fraction of samples and that could define therapy-amenable sub-groups of TNBCs. We present here our results, including a large cumulative database of proteins based on the analysis of 78 TNBCs, and the identification and validation of one specific protein, Mage-A4, which was expressed in a significant fraction of TNBC and Her2-positive/ER negative lesions. The high level expression of Mage-A4 in the tumors studied allowed the detection of the protein in the tumor interstitial fluids as well as in sera. The existence of immunotherapeutics approaches specifically targeting this protein, or Mage-A protein family members, and the fact that we were able to detect its presence in serum suggest novel management options for TNBC and human epidermal growth factor receptor 2 positive/estrogen receptor negative patients bearing Mage-A4 positive tumors.
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Affiliation(s)
- Teresa Cabezón
- Department of Proteomics in Cancer, Institute of Cancer Biology, Danish Cancer Society, DK-2100, Copenhagen, Denmark
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46
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Haque R, Ahmed SA, Inzhakova G, Shi J, Avila C, Polikoff J, Bernstein L, Enger SM, Press MF. Impact of breast cancer subtypes and treatment on survival: an analysis spanning two decades. Cancer Epidemiol Biomarkers Prev 2012; 21:1848-55. [PMID: 22989461 DOI: 10.1158/1055-9965.epi-12-0474] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated the impact of breast cancer molecular subtypes and treatment on survival in a cohort of medically insured women followed for more than 20 years. METHODS We examined 934 female members of an integrated health care delivery system newly diagnosed with invasive breast cancer between 1988 and 1995 and followed them through 2008. Tumors were classified into four molecular subtypes on the basis of their expression profile: luminal A; luminal B; basal-like; and HER2-enriched. We followed women from the surgery date to death, health plan disenrollment, or study's end. HR and 95% confidence intervals (CI) were fit using Cox proportional hazards models adjusting for cancer treatments and tumor characteristics. RESULTS A total of 223 (23.9%) women died because of breast cancer during the 21-year study period. Compared with women with luminal A tumors, women with HER2-enriched (HR 2.56, 95% CI 1.53-4.29) and luminal B tumors (HR 1.96, 95% CI: 1.08-3.54) had roughly a two-fold increased adjusted risk of breast cancer mortality. In addition, the survival curves suggest that risk of late mortality persists in women with luminal A tumors. CONCLUSION Among women with health care coverage, molecular subtypes were important predictors of breast cancer mortality. Women with HER2-enriched tumors and luminal B subtypes had the poorest survival despite adjusting for important covariates. IMPACT In a cohort followed for more than 20 years, women with HER2-enriched tumors had worse survival, but interestingly, the survival curve for women with luminal A tumors continued to steadily decline after 10 years of follow-up.
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Affiliation(s)
- Reina Haque
- Kaiser Permanente Southern California, Department of Research & Evaluation, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA.
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Petit JY, Veronesi U, Orecchia R, Curigliano G, Rey PC, Botteri E, Rotmensz N, Lohsiriwat V, Cassilha Kneubil M, Rietjens M. Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia. Ann Oncol 2012; 23:2053-2058. [PMID: 22231025 DOI: 10.1093/annonc/mdr566] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To identify risk factors of recurrence in a large series of patients with breast cancer who underwent a nipple-sparing mastectomy (NSM). PATIENTS AND METHODS Breast-related recurrences and local recurrences (LR) in the breast and the nipple areola complex (NAC) were studied. Cumulative incidences of events were estimated through competing risk analysis. Multivariate Cox regression models were also applied. RESULTS We identified 934 consecutive NSM patients during 2002-2007. Median follow-up was 50 months. In 772 invasive carcinoma patients, the rate of LR in the breast and in the NAC was 3.6% and 0.8%, respectively. In the 162 patients with intraepithelial neoplasia, the rate of LR in the breast and in the NAC was 4.9% and 2.9%, respectively. The significant risk factors of LR in the breast for the group A were grade, overexpression/amplification of HER2/neu and breast cancer molecular subtype Luminal B. In group B, the risk factors of LR in the breast and in the NAC were age (<45 years), absence of estrogen receptors, grade, HER2/neu overexpression and high Ki-67. CONCLUSIONS The LR rate after NSM in our series was low. Biological features of disease and young age should be taken into account when considering NSM in breast cancer patients.
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Affiliation(s)
| | | | | | | | | | - E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Lohsiriwat
- Division of Plastic Surgery; Division of Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
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Eiermann W, Vallis K. Locoregional treatments for triple-negative breast cancer. Ann Oncol 2012; 23 Suppl 6:vi30-4. [DOI: 10.1093/annonc/mds192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Brouckaert O, Laenen A, Vanderhaegen J, Wildiers H, Leunen K, Amant F, Berteloot P, Smeets A, Paridaens R, Christiaens MR, Floris G, Moerman P, Van Limbergen E, Peeters S, Weltens C, Vergote I, Neven P. Applying the 2011 St Gallen panel of prognostic markers on a large single hospital cohort of consecutively treated primary operable breast cancers. Ann Oncol 2012; 23:2578-2584. [PMID: 22492698 DOI: 10.1093/annonc/mds062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Many easily measurable and readily available factors are now established as being prognostic in primary operable breast cancer. We here applied the 2011 St Gallen surrogate definition for breast cancer subclassification using tumor grade instead of Ki67. PATIENTS AND METHODS Four thousand three hundred and eighteen consecutive patients who had surgery for primary operable breast cancer (1 January 2000 and 31 December 2009) in UZ Leuven excluding primary metastastic male breast cancers and those receiving neoadjuvant therapy. Five different surrogate phenotypes were created using the combined expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 together with tumor grade. Disease-free interval (DFI), distant metastastis-free interval (DMFI), locoregional relapse-free interval (LRRFI), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated. RESULTS Surrogate phenotypes present with significant differences in DFI, DMFI, LRRFI, BCSS and OS. 'Luminal A' tumors presented with the best outcome parameters but the effect weakened at longer follow-up. CONCLUSIONS The four surrogate markers, agreed upon by the 2011 St Gallen consensus, defined five prognostic surrogate phenotypes in a large series of consecutively treated breast cancer patients. Their prognostic value changed with longer follow-up. The added value of gene expression profile over classical pathological assessment remains to be defined.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven.
| | - A Laenen
- Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - J Vanderhaegen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - H Wildiers
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - K Leunen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - F Amant
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Berteloot
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - A Smeets
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - R Paridaens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - M R Christiaens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - G Floris
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Moerman
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - E Van Limbergen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - S Peeters
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - C Weltens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - I Vergote
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Neven
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
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50
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[Proposal for a new multidisciplinary therapeutic strategy in the breast cancer patient with sentinel lymph node metastasis]. Cir Esp 2011; 90:626-33. [PMID: 22209478 DOI: 10.1016/j.ciresp.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 12/13/2022]
Abstract
Sentinel lymph node (SLN) biopsy is the standard of practice for assessing axillary spread in clinically node-negative breast cancer patients. On the other hand, axillary lymph node dissection (ALND) is the ideal procedure for patients with SLN metastasis. Different studies over the last few years have suggested that some patients with positive SLN can be treated without ALND. This article presents a literature review carried out by our multidisciplinary group and its strategy for avoiding routine ALND in women with SLN metastases. In this new strategy ALND should not be performed on women with T1 tumours, with 1-2 positive SLN and undergoing breast conservative surgery. On the other hand, ALND would be indicated in those patients with three or more positive SLN, presence of extracapsular invasion, mastectomised women and triple negative subtype or HER2+ tumours that have not received biological treatment with antibodies.
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