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Yang Q, Luo T, Zhang W, Zhong X, He P, Zheng H. Data-driven treatment pathways mining for early breast cancer using cSPADE algorithm and system clustering. Int J Health Plann Manage 2022; 37:2569-2584. [PMID: 35445441 DOI: 10.1002/hpm.3483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Due to the multidimensional, multilayered, and chronological order of the cancer data, it was challenging for us to extract treatment paths. To determine whether the cSPADE algorithm and system clustering proposed in this study can effectively identify the treatment pathways for early breast cancer. METHODS We applied data mining technology to the electronic medical records of 6891 early breast cancer patients to mine treatment pathways. We provided a method of extracting data from EMR and performed three-stage mining: determining the treatment stage through the cSPADE algorithm → system clustering for treatment plan extraction → cSPADE mining sequence pattern for treatment. The Kolmogorov-Smirnov test and correlation analysis were used to cross-validate the sequence rules of early breast cancer treatment pathways. RESULTS We unearthed 55 sequence rules for early breast cancer treatment, 3 preoperative neoadjuvant chemotherapy regimens, three postoperative chemotherapy regimens, and 2 chemotherapy regimens for patients without surgery. Through 5-fold cross-validation, Pearson and Spearman correlation tests were performed. At the significance level of p < 0.05, all correlation coefficients of support, confidence and lift were greater than 0.89. Using the Kolmogorov-Smirnov test, we found no significant differences between the sequence distributions. CONCLUSIONS We have proved that cSPADE algorithm combined system clustering is an effective technique for identifying temporal relationships between treatment modalities, enabling hierarchical and vertical mining of breast cancer treatment models. In addition, we confirmed the robustness of the results by cross-validation of these treatment pathway ordering rules. Through this method, the treatment path of early breast cancer patients can be revealed, and the real-world breast cancer treatment behaviour model can be evaluated, which can provide reference for the redesign and optimization of treatment path.
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Affiliation(s)
- Qing Yang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luo
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaorong Zhong
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Ping He
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Zheng
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
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Comparison of conventional and hypofractionated radiation after mastectomy in locally advanced breast cancer: a prospective randomised study on dosimetric evaluation and treatment outcome. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396919000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Although hypofractionated radiotherapy has been standardised in early breast cancer, even in post-mastectomy no such consensus has been developed for locally advanced breast cancer (LABC), probably due to complex planning and field matching. This study is directed towards dosimetric evaluation and comparison of toxicity, response and disease-free survival (DFS) comparison between hypofractionation and conventional radiotherapy in post-mastectomy LABC.Methodology:In total, 222 female breast cancer patients were randomly assigned to be treated with either hypofractionated radiotherapy (n = 120) delivering 40 Gy in 15 fractions over 3 weeks or conventional radiotherapy (n = 102) with 50 Gy in 25 fractions over 5 weeks after modified radical mastectomy (MRM) along with neoadjuvant and/or adjuvant chemotherapy. All patients were planned with treatment planning software and assessed regularly during and after treatment.Results:Median follow-up period was 178 weeks in conventional arm (CRA) and 182 weeks in hypofractionation arm (HFA). There exists a dosimetric difference between the two arms of treatment, in spite of similar dose coverage [planning treatment volume (PTV) D90 92·04% in CRA versus 92·5% in HFA; p = 0·49], average dose in HFA is less than that of CRA (p < 0·001); so is the maximum clinical target volume (CTV) dose (p < 0·001). Similarly, average lung dose in HFA arm is significantly lower than CRA (9·9 versus 10·84; p = 0·06), but the V20Gy of lung and V30Gy of heart had no difference. The toxicity of radiation was comparable with similar mean time to produce toxicity [CRA: 7 W, HFA: 10 W; hazard ratio 0·64, 95% confidence interval (CI) = 0·28–1·45]. Three-year recurrence event was alike in two arms (CRA: 4·9%, HFA: 5·8%; p = 0·76). Mean DFS in CRA is 230 weeks and that of HFA is 235 weeks with hazard ratio 1·01 (95% CI = 0·32–3·19; p = 0·987).Conclusion:Though biologically effective dose (BED) in hypofractionation is lesser than that of conventional fractionation, there are indistinguishable toxicity, locoregional recurrence, distant failure rate and DFS between the two modalities.
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Maes‐Carballo M, Muñoz‐Núñez I, Martín‐Díaz M, Mignini L, Bueno‐Cavanillas A, Khan KS. Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review. Health Expect 2020; 23:1045-1064. [PMID: 32748514 PMCID: PMC7696137 DOI: 10.1111/hex.13112] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is not clear whether clinical practice guidelines (CPGs) and consensus statements (CSs) are adequately promoting shared decision making (SDM). OBJECTIVE To evaluate the recommendations about SDM in CPGs and CSs concerning breast cancer (BC) treatment. SEARCH STRATEGY Following protocol registration (Prospero no.: CRD42018106643), CPGs and CSs on BC treatment were identified, without language restrictions, through systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2010 to December 2019. INCLUSION CRITERIA CPGs and CSs on BC treatment were selected whether published in a journal or in an online document. DATA EXTRACTION AND SYNTHESIS A 31-item SDM quality assessment tool was developed and used to extract data in duplicate. MAIN RESULTS There were 167 relevant CPGs (139) and CSs (28); SDM was reported in only 40% of the studies. SDM was reported more often in recent publications after 2015 (42/101 (41.6 %) vs 46/66 (69.7 %), P = .0003) but less often in medical journal publications (44/101 (43.5 %) vs 17/66 (25.7 %), P = .009). In CPGs and CSs with SDM, only 8/66 (12%) met one-fifth (6 of 31) of the quality items; only 14/66 (8%) provided clear and precise SDM recommendations. DISCUSSION AND CONCLUSIONS SDM descriptions and recommendations in CPGs and CSs concerning BC treatment need improvement. SDM was more frequently reported in CPGs and CSs in recent years, but surprisingly it was less often covered in medical journals, a feature that needs attention.
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Affiliation(s)
- Marta Maes‐Carballo
- Department of General SurgeryComplexo Hospitalario de OurenseOurenseSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
| | | | | | | | - Aurora Bueno‐Cavanillas
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
- Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
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Kitahara M, Hozumi Y, Takeuchi N, Ichinohe S, Fujiwara S, Machinaga M, Saitoh H, Iijima T. Distant Metastasis after Surgery for Encapsulated Papillary Carcinoma of the Breast: A Case Report. Case Rep Oncol 2020; 13:1196-1201. [PMID: 33173485 PMCID: PMC7590764 DOI: 10.1159/000510308] [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: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
In the absence of clear interstitial invasion, encapsulated papillary carcinoma (EPC) of the breast may be attributed to an extremely good prognosis if handled similarly to ductal carcinoma in situ (DCIS) with suitable local treatment. Here, we report our experience with a case of EPC of the breast that presented with carcinomatous pleuritis and lymphangitis carcinomatosa postoperatively, which rapidly resulted in a poor outcome. A 67-year-old woman was diagnosed with DCIS of the left breast and underwent left partial mastectomy and sentinel lymph node biopsy. EPC was diagnosed because the pathological examination showed no sign of interstitial infiltration. Postoperative radiation therapy was performed. Five years and 9 months postoperatively, the patient began experiencing cough and shortness of breath on exertion. Imaging showed right pleural effusion and consolidation of the lung field, but nothing suggesting local recurrence in the preserved left breast, local lymph nodes, or opposite breast was observed. Postoperative recurrence of breast cancer, carcinomatous pleuritis, and lymphangitis carcinomatosa were diagnosed based on the results of pleural fluid cytology. One month later, multiple brain metastases were found, and the patient died of the primary disease 5 months after recurrence. After surgery for EPC without clear interstitial infiltration, there was a small possibility of a poor outcome from distant metastasis. Therefore, although distant metastasis is uncommon, regular examination and testing should be performed.
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Affiliation(s)
- Miyuki Kitahara
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Yasuo Hozumi
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Naoto Takeuchi
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Satoko Ichinohe
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Saori Fujiwara
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Mitsuki Machinaga
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Hitoaki Saitoh
- Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
| | - Tatsuo Iijima
- Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan
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Duane FK, McGale P, Teoh S, Mortimer C, Broggio J, Darby SC, Dodwell D, Lavery B, Oliveros S, Vallis KA, Taylor CW. International Variation in Criteria for Internal Mammary Chain Radiotherapy. Clin Oncol (R Coll Radiol) 2019; 31:453-461. [PMID: 31060973 PMCID: PMC6575151 DOI: 10.1016/j.clon.2019.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 11/29/2022]
Abstract
AIMS Evidence has emerged that internal mammary chain (IMC) radiotherapy reduces breast cancer mortality, leading to changes in treatment guidelines. This study investigated current IMC radiotherapy criteria and the percentages of patients irradiated for breast cancer in England who fulfilled them. MATERIALS AND METHODS A systematic search was undertaken for national guidelines published in English during 2013-2018 presenting criteria for 'consideration of' or 'recommendation for' IMC radiotherapy. Patient and tumour variables were collected for patients who received breast cancer radiotherapy in England during 2012-2016. The percentages of patients fulfilling criteria stipulated in each set of guidelines were calculated. RESULTS In total, 111 729 women were recorded as receiving adjuvant breast cancer radiotherapy in England during 2012-2016 and full data were available on 48 095 of them. Percentages of patients fulfilling IMC radiotherapy criteria in various national guidelines were: UK Royal College of Radiologists 13% (6035/48 095), UK National Institute for Health and Care Excellence 18% (8816/48 095), Germany 32% (15 646/48 095), Ireland 56% (26 846/48 095) and USA 59% (28 373/48 095). Differences between countries occurred because in Ireland and the USA, treatment may be considered in some node-negative patients, whereas in the UK, treatment is considered if at least four axillary nodes are involved or for high-risk patients with one to three positive nodes. In Germany, treatment may be considered for all node-positive patients. CONCLUSIONS There is substantial variability between countries in criteria for consideration of IMC radiotherapy, despite guidelines being based on the same evidence. This will probably lead to large variations in practice and resource needs worldwide.
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Affiliation(s)
- F K Duane
- St Luke's Radiation Oncology Network, St. James's Hospital, Dublin, Ireland.
| | - P McGale
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - S Teoh
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - C Mortimer
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - J Broggio
- Public Health England, Birmingham, UK
| | - S C Darby
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Dodwell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - B Lavery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Oliveros
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K A Vallis
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - C W Taylor
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Aibe N, Karasawa K, Aoki M, Akahane K, Ogawa Y, Ogo E, Kanamori S, Kawamori J, Saito AI, Shiraishi K, Sekine H, Tachiiri S, Yoshimura M, Yamauchi C. Results of a nationwide survey on Japanese clinical practice in breast-conserving radiotherapy for breast cancer. JOURNAL OF RADIATION RESEARCH 2019; 60:142-149. [PMID: 30476198 PMCID: PMC6373682 DOI: 10.1093/jrr/rry095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/04/2018] [Indexed: 06/09/2023]
Abstract
The Breast Cancer Group of the Japanese Radiation Oncology Study Group conducted a nationwide questionnaire survey on the clinical practice of postoperative radiotherapy for breast-conserving treatment for breast cancer. This questionnaire consisted of 18 questions pertaining to the annual number of treated patients, planning method, contouring structure, field design, dose-fractionated regimen, application of hypofractionated radiotherapy, boost irradiation, radiotherapy for synchronously bilateral breast cancer, and accelerated partial breast irradiation. The web-based questionnaire had responses from 293 Japanese hospitals. The results indicated the following: treatment planning is performed using relatively similar field designs and delivery methods; the field-in-field technique is used at more than one-third of institutes; the commonest criteria for boost irradiation is based on the surgical margin width (≤5 mm) and the second commonest criteria was age (≤40 or ≤50 years), although some facilities applied a different age criterion (>70 years) for omitting a tumor bed boost; for conventional fractionation, almost all institutes delivered 50 Gy in 25 fractions to the conserved whole breast and 10 Gy in 5 fractions to the tumor bed. This survey revealed that 43% of hospitals offered hypofractionated radiotherapy, and the most common regimens were 42.56 Gy in 16 fractions for whole-breast irradiation and 10.64 Gy in 4 fractions for boost irradiation. Almost all of the facilities irradiated both breasts simultaneously for synchronously bilateral breast cancer, and accelerated partial breast irradiation was rarely offered in Japan. This survey provided an overview of the current clinical practice of radiotherapy for breast-conserving treatment of breast cancer in Japan.
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Affiliation(s)
- Norihiro Aibe
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Kumiko Karasawa
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiation Oncology, Tokyo Women's Medical University, School of Medicine, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masahiko Aoki
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu, Hirosaki city, Aomori, Japan
| | - Keiko Akahane
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Saitama, Japan
| | - Yasuhiro Ogawa
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Director, Hyogo Prefectural Kakogawa Medical Center, 203 Kann, Kakogawa cityi, Hyogo, Japan
| | - Etsuyo Ogo
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka, Japan
| | - Shuichi Kanamori
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiation Oncology, Kindai University, Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, Japan
| | - Jiro Kawamori
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiation Oncology, St Luke`s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Anneyuko I Saito
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Division of Radiation Oncology, Department of Radiology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kenshiro Shiraishi
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Hiroshi Sekine
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiology, the Jikei University, School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku,Tokyo, Japan
| | - Seiji Tachiiri
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Therapeutic Radiology, Uji Tokushukai Medical Center, 145 Ishibashi, Maxima-cho, Uji City, Kyoto, Japan
| | - Michio Yoshimura
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Chikako Yamauchi
- Breast Cancer Group of the Japanese Radiation Oncology Study Group
- Department of Radiation Oncology, Shiga General Hospital, 30-4-5 Moriyama, Moriyama City, Shiga, Japan
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Nakajima N, Oguchi M, Kumai Y, Yoshida M, Inoda H, Yoshioka Y, Iwase T, Ito Y, Akiyama F, Ohno S. Clinical outcomes and prognostic factors in patients with stage II-III breast cancer treated with neoadjuvant chemotherapy followed by surgery and postmastectomy radiation therapy in the modern treatment era. Adv Radiat Oncol 2018; 3:271-279. [PMID: 30202796 PMCID: PMC6128027 DOI: 10.1016/j.adro.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/27/2018] [Accepted: 04/16/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose There are no randomized studies on the indication for postmastectomy radiation therapy (PMRT) in patients who receive neoadjuvant chemotherapy (NAC) followed by a mastectomy. The aim of this study was to determine clinical outcomes and identify reliable prognostic factors in patients with locally advanced breast cancer treated with NAC followed by a mastectomy and PMRT. Methods and materials We retrospectively evaluated the relationship between clinicopathological factors and outcomes in 351 patients with stage II or III breast cancer who underwent NAC followed by radical mastectomy and PMRT between March 2005 and December 2013. Results The median follow-up duration was 81 months (Range, 12-156 months). For all patients, the 5-year locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 91.3 %, 69.8 %, and 83.4 %, respectively. On multivariate analysis, estrogen-receptor positivity, and complete response of cancer in axillary nodes (ypN0) were significant prognostic factors for better LRFS, while lympho-vascular invasion and clinical stage IIIC were independent prognostic factors for worse LRFS. The number of axillary node metastasesafter surgery was an independent prognostic factor of DMFS and OS. Patients with hormone receptor- and human epidermal growth factor receptor 2 positivity had significantly better 5-year LRFS rates. Conclusions We identified several prognostic factors in our study. In particular, the number of axillary node metastases is significantly related to OS.
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Affiliation(s)
- Naomi Nakajima
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
- Corresponding author. Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo 135-8550, Japan.
| | - Masahiko Oguchi
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuko Kumai
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hirotaka Inoda
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Ito
- Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Division of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Ogawa Y, Ikeda K, Watanabe C, Kamei Y, Tokunaga S, Tsuboguchi Y, Inoue T, Fukushima H, Ichiki M. Sentinel node biopsy for axillary management after neoadjuvant therapy for breast cancer: a single-center retrospective analysis with long follow-up. Surg Today 2017. [PMID: 28647776 DOI: 10.1007/s00595-017-1558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Sentinel node biopsy (SNB) after neoadjuvant therapy (NAT) for breast cancer remains controversial. We conducted a retrospective study of patients who underwent SNB after NAT to evaluate the effectiveness of this procedure. METHODS A consecutive 105 women with locally advanced breast cancer (cT1-4, cN0-3, M0) were treated with NAT between 2006 and 2015. The subjects were 80 of these patients who became or remained clinically node-negative after NAT, 53 of whom had axillary management determined by SNB (group A) and the other 27 underwent axillary lymph node dissection (ALND) without SNB (group B). SNB was performed using a modified dye method. RESULTS The sentinel node (SN) identification rate was 94.3% and the mean number of removed SNs was 2.4. ALND was avoided in 33 patients, who were confirmed as SN-negative. There was no difference in recurrence-free and overall survival rates between groups A and B (p = 0.71 and p = 0.46, respectively) during the median follow-up time of 63 months. Of the 33 patients who did not undergo ALND, 10 suffered recurrence (33%). One patient (3%) had recurrence in an axillary lymph node and four had recurrence in a supraclavicular lymph node. CONCLUSION Axillary SNB after NAT did not affect the axillary failure rate or the prognosis. SNB may be a reliable procedure, even after NAT.
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Affiliation(s)
- Yoshinari Ogawa
- Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
| | - Katsumi Ikeda
- Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Chika Watanabe
- Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yuri Kamei
- Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Shinya Tokunaga
- Department of Medical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yuko Tsuboguchi
- Department of Medical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hiroko Fukushima
- Department of Pathology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Makoto Ichiki
- Department of Radiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
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Sekiguchi K, Kawamori J, Yamauchi H. Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology. Breast Cancer 2017; 24:511-520. [PMID: 28108966 DOI: 10.1007/s12282-017-0754-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 12/31/2022]
Abstract
Breast reconstruction (BR) represents a suitable option for women who are not expected to require postmastectomy radiotherapy (PMRT). As recent evidence has led to an extension of the indications for PMRT, this has also appeared to increase the incidence of reconstructive complications. Nevertheless, in the USA at least, trends towards BR are changing. The frequency of immediate reconstruction continues to increase, even in the setting of PMRT. In immediate implant-based reconstruction, a staged approach is preferred. The failure rate of PMRT in implant patients is lower than that with expander patients. In delayed implant-based construction, tissue expansion of irradiated skin leads to a significantly increased risk of complications. In contrast, autologous tissue appears to tolerate radiation damage better than implant-based reconstructions. No significant differences have been described when complication rates of immediate autologous tissue BR with PMRT were compared with delayed autologous tissue BR following PMRT. In previously radiated patients, autologous tissue BR is preferred, and it may be safer when carried out ≥ 12 months after PMRT. Several other problems are associated with radiation delivery after BR and the clues to solve them are reviewed in this paper.
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Affiliation(s)
- Kenji Sekiguchi
- Sonoda-kai Radiation Oncology Clinic, 3-4-19 Hokima, Adachi-ku, Tokyo, 121-0064, Japan.
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
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