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Diskin B, Sevilimedu V, Morrow M, Van Zee K, Cody HS. Management of Ipsilateral Breast Tumor Recurrence Following Breast Conservation Surgery for Ductal Carcinoma In Situ: A Data-Poor Zone. Ann Surg Oncol 2024:10.1245/s10434-024-16133-8. [PMID: 39266787 DOI: 10.1245/s10434-024-16133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/21/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Breast conserving surgery (BCS) is well established for the management of ductal carcinoma in situ (DCIS), but neither randomized trials nor guidelines address management of ipsilateral breast tumor recurrence (IBTR) after BCS for DCIS. PATIENTS AND METHODS We identified women treated with BCS for DCIS who developed IBTR as a first event. Between those treated with mastectomy versus re-BCS, we compare the clinicopathologic characteristics, the use of adjuvant radiotherapy (RT) both upfront ("primary RT") and post IBTR ("secondary RT"), of tamoxifen, the rate of third events (local, regional, distant), and both breast cancer specific (BCSS) and overall survival (OS). RESULTS Of 3001 women treated with BCS for DCIS (1978-2010), 383 developed an IBTR as a first event (1983-2023) and were treated by mastectomy (51%) versus re-BCS (49%). Compared with re-BCS, mastectomy patients at initial treatment were higher grade (74% versus 59%, p = 0.004), with more frequent primary RT (61% versus 21%, p < 0.001). Third local events were more frequent for re-BCS than mastectomy (16% versus 3%, p = 0.001), but there were no differences in breast cancer specific or overall survival. CONCLUSIONS For isolated IBTR following BCS for DCIS and treated by mastectomy versus re-BCS (1) mastectomy was associated with less favorable initial pathology and more frequent use of primary RT, (2) re- recurrence was more frequent with re-BCS, and (3) BCSS and OS were comparable. Our data suggest a wider role for re-BCS and further study of the relationship between secondary RT and the rate of third breast events.
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Affiliation(s)
- Brian Diskin
- Breast Service, Department of Surgery, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostastistical Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly Van Zee
- Breast Service, Department of Surgery, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Leonardi MC, Arculeo S, Frassoni S, Zerella MA, Gerardi MA, Fodor C, Veronesi P, Galimberti VE, Magnoni F, Milovanova E, Rojas DP, Dicuonzo S, Morra A, Zaffaroni M, Vincini MG, Cattani F, Bagnardi V, Orecchia R, Jereczek-Fossa BA. Hypofractionated Partial Breast Reirradiation in the Conservative Retreatment of Breast Cancer Local Recurrence. Pract Radiat Oncol 2024:S1879-8500(24)00164-4. [PMID: 39069002 DOI: 10.1016/j.prro.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To evaluate the outcome of partial breast reirradiation (re-PBI) with intensity modulated radiation therapy using a hypofractionated scheme for breast cancer (BC) local relapse (LR) operated on with repeat breast-conservative surgery. METHODS AND MATERIALS Intensity modulated radiation therapy-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence of second LR, toxicity, disease-free survival (DFS), BC-specific survival, and overall survival were evaluated. RESULTS Between May 2012 and May 2021, 70 patients had re-PBI. The median follow-up (FU) was 6.3 years (quartiles 1-3, 4.0-8.1.). The median age at first LR was 62 years. The median primary BC first LR interval was 12.4 years (range, 1.6-26.7 years). Luminal A-like first LR accounted for 41% of the cases, and the median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: 3 second LRs (corresponding to an 8-year cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BC-specific survival, and overall survival were 76%, 90%, and 90%, respectively. At multivariate analysis, grade 3 and extensive intraductal components were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis, and cosmesis was deemed good/excellent in just >60% of the cases. CONCLUSIONS Re-PBI after repeat breast-conservative surgery represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.
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Affiliation(s)
| | - Simona Arculeo
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Cristiana Fodor
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Senology, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | | | - Francesca Magnoni
- Division of Senology, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Ekaterina Milovanova
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | | | - Samantha Dicuonzo
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Anna Morra
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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3
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Leonardi MC, Fodor AD, Frassoni S, Rojas DP, Fozza A, Blandino G, Ciabattoni A, Alessandro M, Catalano G, Ivaldi GB, Martini S, De Rose F, Fodor C, Veronesi P, Galimberti VE, Intra M, Cornacchia L, Braga F, Durante S, Dicuonzo S, Morra A, Zaffaroni M, Cattani F, Belgioia L, Palumbo I, Massaccesi M, Bagnardi V, Orecchia R, Jereczek-Fossa BA. Salvage Breast-Conserving Surgery and Reirradiation With Intraoperative Electrons for Recurrent Breast Cancer: A Multicentric Study on Behalf of Italian Association of Radiotherapy and Clinical Oncology (AIRO). Pract Radiat Oncol 2024:S1879-8500(24)00160-7. [PMID: 39032597 DOI: 10.1016/j.prro.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Intraoperative radiation therapy with electrons (IOERT) may represent a viable choice for partial breast reirradiation after repeat quadrantectomy for local recurrence (LR) for primary breast cancer (BC) in lieu of mastectomy. METHODS AND MATERIALS A database collecting data on partial breast reirradiation with IOERT from 8 Italian centers was set up in 2016 to 2018, providing data on cumulative incidence (CumI) of second LR and survival with a long follow-up. RESULTS From 2002 to 2015, 109 patients underwent the conservative retreatment. The median primary BC first LR interval was 11.1 years (range, 2.4-27.7). The median first LR size was 0.9 cm (range, 0.3-3.0), and 43.6% cases were luminal A. Median IOERT dose was 18 Gy (range, 12-21), and median collimator diameter was 4 cm (range, 3-6). Median follow-up duration was 11.7 years (IQR, 7.7-14.6). The second LR CumI was 12.2% (95% CI, 6.8%-19.2%) at 5 years and 32.3% at 10 years (95% CI, 22.8%-42.2%), occurring in the same site as the first LR in about half of the cases. Human epidermal growth factor receptor 2 status and collimator size were independent LR predictors. The 5- and 10-year overall survival rates were 95.2% and 88.3%, respectively, whereas 5- and 10-year BC-specific survival rates were 98% and 94.5%, respectively. The development of a second LR significantly reduced BC-specific survival (hazard ratio, 9.40; P < .001). Grade ≥3 fibrosis rate was 18.9%. Patient-reported cosmesis was good/excellent in 59.7% of the cases. CONCLUSIONS Second LR CumI was within the range of the literature but higher than expected, opening questions on radiation field extension and fractionation schedule. Because a second LR worsened the outcome, salvage modality must be carefully planned.
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Affiliation(s)
| | | | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Antonella Ciabattoni
- Radiotherapy Unit, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy; UniCamillus International Medical University in Rome, Roma, Italy
| | | | | | | | | | - Fiorenza De Rose
- Department of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Cristiana Fodor
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Breast Surgery, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | | | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Luigi Cornacchia
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesca Braga
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Stefano Durante
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Anna Morra
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Liliana Belgioia
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genoa, Genova, Italy
| | - Isabella Palumbo
- Università degli Studi di Perugia e Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Mariangela Massaccesi
- UOC Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, IEO IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Radiotherapy Division, European Institute of Oncology, IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Seto Y, Ishitobi M, Shien T, Oshiro C, Inoue H, Shima H, Kuba S, Watanabe N, Iwatani T, Nakayama T. Patient Preference for Surgical Methods for Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 2024; 31:4512-4517. [PMID: 38594578 DOI: 10.1245/s10434-024-15282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Mastectomy has been the standard surgical treatment for ipsilateral breast tumor recurrence (IBTR). Recently, there has been growing interest in repeat breast-conserving surgery (rBCS) for IBTR among breast surgeons; however, there is currently little information regarding patient preferences for surgical procedure for IBTR. The purpose of this study was to evaluate preference for surgical procedure (mastectomy vs. rBCS) among breast cancer patients who had undergone salvage surgery for IBTR. METHODS Overall, 100 breast cancer patients who had undergone salvage surgery for IBTR were asked about their preferred surgical methods for IBTR and the reason. The association of patient preference and the reasons related to various clinical and pathological factors were assessed. RESULTS Of the 100 respondents, only 11 patients (11%) preferred rBCS. Patients who had undergone rBCS and radiotherapy for IBTR were significantly more likely to prefer to undergo rBCS than other groups (p = 0.030). The most frequent reason for choosing rBCS was the patient's desire to minimize breast deformity and surgical wounds. CONCLUSIONS Our study revealed that there is a low rate of patients who opt to undergo rBCS among patients who had undergone salvage surgery for IBTR. Discrepancies in perceptions regarding the surgical procedure for IBTR between patients and their surgeons may exist.
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Affiliation(s)
- Yukiko Seto
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Ishitobi
- Department of Breast Surgery, Mie University School of Medicine, Tsu, Japan.
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | - Hiroaki Inoue
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Medical Sciences, Tokushima, Japan
| | - Hiroaki Shima
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Osaka, Japan
| | - Sayaka Kuba
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriyuki Watanabe
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tsuguo Iwatani
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
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5
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Galaychuk I. REPEATED BREAST-CONSERVING SURGERIES AS REFLECTION OF THE EVOLUTION IN BREAST CANCER TREATMENT (CASE REPORT WITH LITERATURE REVIEW). Exp Oncol 2023; 45:386-392. [PMID: 38186016 DOI: 10.15407/exp-oncology.2023.03.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 01/09/2024]
Abstract
The clinical case of a patient with multicentric breast cancer who underwent organ-sparing surgery after neoadjuvant chemo-radiation therapy is presented. An ipsilateral cancer recurrence was diagnosed 8 years after the first operation. The repeated organ-sparing surgery (lumpectomy) was done with a good cosmetic result and without disease progression during 1-year follow-up. The literature review shows that neoadjuvant systemic therapy accounting for molecular subtypes of cancer has radically changed breast cancer surgeries. The evolution of surgical approaches in stage I-II breast cancer patients consists in the de-escalation of surgery from mastectomy to organsparing or oncoplastic surgery, minimally directed surgery, and repeated breast-conserving surgery. De-escalation of surgical interventions in the area of the regional lymphatic collector consists in the transition from total axillary lymphatic dissection to sentinel lymph node biopsy or targeted removal of metastatic lymph nodes. The repeated breast-conserving surgery can be safely performed for ipsilateral recurrence in patients with all molecular subtypes of breast cancer.
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Affiliation(s)
- I Galaychuk
- I. Horbachevsky National Medical University, Ternopil, Ukraine
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6
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Downs-Canner S, Cody HS. Five decades of progress in surgical oncology: Breast. J Surg Oncol 2022; 126:852-859. [PMID: 36087082 PMCID: PMC9472874 DOI: 10.1002/jso.27035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
Surgery remains the single most effective treatment for breast cancer but coincident with a deeper understanding of tumor biology and advances in multidisciplinary care (encompassing breast imaging, systemic adjuvant therapy, radiotherapy, and genomics) continues to de-escalate, supported by strong level I data. We have moved from mastectomy to breast conservation, and from routine axillary dissection to sentinel lymph node biopsy to selective omission of axillary node staging altogether. We have further de-escalated through consensus over margin width in breast conservation, through improvements in neoadjuvant therapy, and by demonstrating no benefit for upfront surgery in patients with stage IV disease. For patients with ipsilateral breast tumor recurrence, reconservation surgery and reirradiation are promising. Cell cycle and immune checkpoint inhibitors, when added to conventional systemic therapy, have now moved beyond stage IV disease to phase III trials in the adjuvant and neoadjuvant settings, promising even further de-escalation of surgery. Finally, with genomic profiling we are moving away from the primacy of axillary node status for prognostication and into a new era allowing prediction of response to therapy.
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Affiliation(s)
- Stephanie Downs-Canner
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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7
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Omission of axillary surgery for ipsilateral breast tumor recurrence with negative nodes after previous breast-conserving surgery: is it oncologically safe? Breast Cancer Res Treat 2022; 196:97-109. [PMID: 36040640 PMCID: PMC9550716 DOI: 10.1007/s10549-022-06708-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
Purpose Salvage mastectomy is traditionally recommended for patients who developed ipsilateral breast tumor recurrence (IBTR) in light of previous breast irradiation. However, it remains controversial whether surgical axillary staging (SAS) is necessary for IBTR patients with negative nodes. This study aimed to evaluate the oncologic safety of omitting SAS for IBTR. Methods We retrospectively identified patients who developed invasive IBTR with negative nodes after undergoing breast-conserving surgery (BCS) from 2010 to 2018. Patterns of care in nodal staging were analyzed based on prior axillary staging status. Clinicopathologic characteristics and adjuvant treatment of the initial tumor, as well as the IBTR, were compared between the SAS and no SAS groups. Kaplan–Meier method and Cox regression model were utilized to compare the locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates after IBTR removal between the two groups. Results A total of 154 IBTR patients were eligible for final analysis. Compared to the no SAS group, SAS group was less likely to undergo ALND (15.1 vs 73.3%, p < 0.001) at initial BCS, had a longer recurrence interval (2.8 vs 2.1 years, p = 0.03), and were more likely to have discordant molecular subtype (35.8 vs 12.9%, p = 0.001) and different quadrant location (37.7 vs 19.8%, p = 0.02) with primary tumor. However, the extent of axillary staging did not affect systemic or radiation recommendations. In the subgroup of patients without previous ALND, the clinicopathologic characteristics were roughly comparable. No significant differences were observed in LRRFS, DMFS or OS between the two groups. Conclusion For node-negative IBTR patients, we observed selection bias on the basis of prior ALND, shorter recurrence interval, and concordant molecular subtype favoring no SAS but comparable LRRFS, DMFS, and OS. These results support a wider consideration of sparing SAS in the management of IBTR, especially in patients without previous ALND. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06708-y.
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8
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Courtinat F, Cottu P, Féron JG, Jehanno N, Fourquet A, Kirova Y, Beddok A. Multidisciplinary management and role of reirradiation in the treatment of a breast cancer patient with four locoregional recurrences. Cancer Radiother 2022; 27:154-157. [PMID: 36041968 DOI: 10.1016/j.canrad.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 10/15/2022]
Abstract
Breast cancer is a frequent and sometimes fatal disease. The risk of locoregional recurrence has considerably decreased since the introduction of adjuvant treatments (radiotherapy, chemotherapy, hormone therapy). Nevertheless, some patients present a risk of multiple local recurrences. We report here the case of a patient who had four locoregional breast cancer recurrences. There is currently no validated biomarker that allows the prediction of recurrence. Salvage surgery, most often mastectomy, remains the recommended treatment for the management of these recurrences in the irradiated field. However, increasingly, depending on the patient's wishes and the technical possibilities of multiple surgeries, the question of a second conservative treatment and reirradiation arises. This type of management must in all cases be multidisciplinary and in specialized centers. Reirradiation must in any case try to give maximum priority to the protection of healthy tissue already irradiated.
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Affiliation(s)
- F Courtinat
- Radiation Oncology Department, institut Curie, 25 rue d'Ulm, Paris, France
| | - P Cottu
- Medical Oncology Department, institut Curie, Paris France
| | - J-G Féron
- Surgical Oncology Department, institut Curie, Paris France
| | - N Jehanno
- Nuclear Medicine Department, institut Curie, Paris France
| | - A Fourquet
- Radiation Oncology Department, institut Curie, 25 rue d'Ulm, Paris, France
| | - Y Kirova
- Radiation Oncology Department, institut Curie, 25 rue d'Ulm, Paris, France
| | - A Beddok
- Radiation Oncology Department, institut Curie, 25 rue d'Ulm, Paris, France.
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9
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Tollan CJ, Pantiora E, Valachis A, Karakatsanis A, Tasoulis MK. A Systematic Review and Meta-Analysis on the Role of Repeat Breast-Conserving Surgery for the Management of Ipsilateral Breast Cancer Recurrence. Ann Surg Oncol 2022; 29:6440-6453. [PMID: 35849299 DOI: 10.1245/s10434-022-12197-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The standard surgical management of ipsilateral breast cancer recurrence (IBCR) in patients previously treated with breast-conserving surgery (BCS) and radiotherapy (RT) is mastectomy. Recent international guidelines provide conflicting recommendations. The aim of this study was to perform a systematic literature review and meta-analysis of the oncological outcomes in patients with IBCR treated with repeat BCS (rBCS). METHODS The MEDLINE and EMBASE databases were searched for relevant English-language publications, with no date restrictions. All relevant studies providing sufficient data to assess oncological outcomes (second local recurrence [LR] and overall survival [OS]) of rBCS for the management of IBCR after previous BCS and RT were included (PROSPERO registration CRD42021286123). RESULTS Forty-two observational studies met the criteria and were included in the analysis. The pooled second LR rate after rBCS was 15.7% (95% confidence interval [CI] 12.1-19.7), and 10.3% (95% CI 6.9-14.3) after salvage mastectomy. On meta-analysis of comparative studies (n = 17), the risk ratio (RR) for second LR following rBCS compared with mastectomy was 2.103 (95% CI 1.535-2.883; p < 0.001, I2 = 55.1%). Repeat RT had a protective effect (coefficient: - 0.317, 95% CI - 0.596 to - 0.038; p = 0.026, I2 = 40.4%) for second LR. Pooled 5-year OS was 86.8% (95% CI 83.4-90.0) and 79.8% (95% CI 74.7-84.5) for rBCS and salvage mastectomy, respectively. Meta-analysis of comparative studies (n = 20) showed a small OS benefit in favor of rBCS (RR 1.040, 95% CI 1.003-1.079; p = 0.032, I2 = 70.8%). Overall evidence certainty was very low. CONCLUSIONS This meta-analysis suggests rBCS could be considered as an option for the management of IBCR in patients previously treated with BCS and RT. Shared decision making, appropriate patient selection, and individualized approach are important for optimal outcomes.
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Affiliation(s)
| | - Eirini Pantiora
- Department of Surgery, Uppsala University Hospital - Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Andreas Karakatsanis
- Department of Surgery, Uppsala University Hospital - Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Marios Konstantinos Tasoulis
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK. .,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK.
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10
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Progress in breast cancer surgical management. Eur J Cancer Prev 2022; 31:551-553. [DOI: 10.1097/cej.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Magnoni F, Alessandrini S, Alberti L, Polizzi A, Rotili A, Veronesi P, Corso G. Breast Cancer Surgery: New Issues. Curr Oncol 2021; 28:4053-4066. [PMID: 34677262 PMCID: PMC8534635 DOI: 10.3390/curroncol28050344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women's psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
| | - Sofia Alessandrini
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
| | - Luca Alberti
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
| | - Andrea Polizzi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
| | - Anna Rotili
- Division of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Paolo Veronesi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.A.); (L.A.); (A.P.); (P.V.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Hannoun-Levi JM, Polgar C, Strnad V. In regard to Van den Bruele AB et al. Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy. Breast Cancer Res Treat. 2021 May;187(1):105-112. doi: 10.1007/s10549-020-06080-9. Epub 2021 Jan 12. PMID: 33433775; PMCID: PMC8068641. Breast Cancer Res Treat 2021; 190:3-4. [PMID: 34357492 DOI: 10.1007/s10549-021-06348-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Radiation Oncology Department, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, 33 Avenue Valombrose, 06107 CEDEX, Nice, France.
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