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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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2
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Improving efficacy and efficiency through the implementation of a new organisational model in a Radiation Oncology Department. Clin Transl Oncol 2017; 19:1375-1381. [DOI: 10.1007/s12094-017-1678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
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3
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van Maaren MC, Bretveld RW, Jobsen JJ, Veenstra RK, Groothuis-Oudshoorn CG, Struikmans H, Maduro JH, Strobbe LJ, Poortmans PM, Siesling S. The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. Br J Cancer 2017; 117:179-188. [PMID: 28588320 PMCID: PMC5520509 DOI: 10.1038/bjc.2017.159] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/28/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort. Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes. Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38–0.94)) and 42–55 days (HR 0.64 (95% CI: 0.45–0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42–55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days. Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands.,Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
| | - Reini W Bretveld
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
| | - Jan J Jobsen
- Department of Radiation Oncology, Medical Spectrum Twente, PO Box 217, Enschede 7500 AE, The Netherlands
| | - Renske K Veenstra
- Department of Operations, Medical Research Data Management B.V., PO Box 90, Deventer 7400 AB, The Netherlands
| | - Catharina Gm Groothuis-Oudshoorn
- Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
| | - Hendrik Struikmans
- Department of Radiation Oncology, Haaglanden Medical Center, PO Box 432, The Hague 2501 CK, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Luc Ja Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Philip Mp Poortmans
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, Paris 75005, France
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands.,Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
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4
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Alexander M, Blum R, Burbury K, Coutsouvelis J, Dooley M, Fazil O, Griffiths T, Ismail H, Joshi S, Love N, Opat S, Parente P, Porter N, Ross E, Siderov J, Thomas P, White S, Kirsa S, Rischin D. Timely initiation of chemotherapy: a systematic literature review of six priority cancers - results and recommendations for clinical practice. Intern Med J 2017; 47:16-34. [DOI: 10.1111/imj.13190] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Alexander
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - R. Blum
- Department of Medical Oncology; Bendigo Health; Bendigo Victoria Australia
| | - K. Burbury
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - J. Coutsouvelis
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - M. Dooley
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - O. Fazil
- Pharmacy Department; Monash Health; Melbourne Victoria Australia
| | - T. Griffiths
- Olivia Newton-John Cancer Wellness and Research Centre; Austin Health; Melbourne Victoria Australia
| | - H. Ismail
- Departments of Pharmacy; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. Joshi
- Department of Medical Oncology; Latrobe Regional Hospital; Traralgon Victoria Australia
| | - N. Love
- Department of Nursing; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - S. Opat
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - P. Parente
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
- Department of Eastern Clinical School; Monash University; Melbourne Victoria Australia
| | - N. Porter
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - E. Ross
- Division of Neurosciences, Cancer and Infection Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Siderov
- Pharmacy Department; Austin Health; Melbourne Victoria Australia
| | - P. Thomas
- Departments of Nursing; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. White
- Department of Medical Oncology; Northern Hospital; Melbourne Victoria Australia
| | - S. Kirsa
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - D. Rischin
- Department of Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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5
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Gupta S, King W, Korzeniowski M, Wallace D, Mackillop W. The Effect of Waiting Times for Postoperative Radiotherapy on Outcomes for Women Receiving Partial Mastectomy for Breast Cancer: a Systematic Review and Meta-Analysis. Clin Oncol (R Coll Radiol) 2016; 28:739-749. [DOI: 10.1016/j.clon.2016.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 05/26/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
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6
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Process management in a Radiation Oncology Department of Spain: Effectiveness and efficiency. Radiother Oncol 2016; 118:581-2. [DOI: 10.1016/j.radonc.2015.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/18/2015] [Indexed: 11/23/2022]
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7
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Koh HK, Shin KH, Kim K, Lee ES, Park IH, Lee KS, Ro J, Jung SY, Lee S, Kim SW, Kang HS, Chie EK, Han W, Noh DY, Lee KH, Im SA, Ha SW. Effect of Time Interval between Breast-Conserving Surgery and Radiation Therapy on Outcomes of Node-Positive Breast Cancer Patients Treated with Adjuvant Doxorubicin/Cyclophosphamide Followed by Taxane. Cancer Res Treat 2015; 48:483-90. [PMID: 26044160 PMCID: PMC4843752 DOI: 10.4143/crt.2015.111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/22/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study evaluated the effect of surgery-radiotherapy interval (SRI) on outcomes in patients treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) and adjuvant four cycles of doxorubicin/cyclophosphamide (AC) followed by four cycles of taxane. MATERIALS AND METHODS From 1999 to 2007, 397 eligible patients were diagnosed. The effect of SRI on outcomes was analyzed using a Cox proportional hazards model, and a maximal chi-square method was used to identify optimal cut-off value of SRI for each outcome. RESULTS The median SRI was 6.7 months (range, 5.6 to 10.3 months). A SRI of 7 months was the significant cut-off value for distant metastasis-free survival (DMFS) and disease-free survival (DFS) using a maximal chi-square method. For overall survival, a significant cut-off value was not found. The patients with SRI > 7 months had worse 6-year DMFS and DFS than those with SRI ≤ 7 months on univariate analysis (DMFS, 81% vs. 91%, p=0.003; DFS, 78% vs. 89%, p=0.002). On multivariate analysis, SRI > 7 months did not affect DMFS and DFS. CONCLUSION RT delayed for more than 7 months after BCS and adjuvant four cycles of AC followed by four cycles of taxane did not compromise clinical outcomes.
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Affiliation(s)
- Hyeon Kang Koh
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiation Oncology, Konkuk University Medical Center, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - In Hae Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Keun Seok Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jungsil Ro
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seeyoun Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seok Won Kim
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Han-Sung Kang
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Whan Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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8
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Simmonds SJ, Syddall HE, Walsh B, Evandrou M, Dennison EM, Cooper C, Aihie Sayer A. Understanding NHS hospital admissions in England: linkage of Hospital Episode Statistics to the Hertfordshire Cohort Study. Age Ageing 2014; 43:653-60. [PMID: 24598084 DOI: 10.1093/ageing/afu020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND concern over the sustainability of the National Health Service (NHS) is often focussed on rising numbers of hospital admissions, particularly among older people. Hospital admissions are enumerated routinely by the Hospital Episode Statistics (HES) Service, but published data do not allow individual-level service use to be explored. This study linked information on Hertfordshire Cohort Study (HCS) participants with HES inpatient data, with the objective of describing patterns and predictors of admissions among individuals. METHODS 2,997 community-dwelling men and women aged 59-73 years completed a baseline HCS assessment between 1998 and 2004; HES and mortality data to 31 March 2010 were linked with the HCS database. This paper describes patterns of hospital use among the cohort at both the admission and individual person level. RESULTS the cohort experienced 8,741 admissions; rates were 391 per 1,000 person-years among men (95% CI: 380, 402) and 327 among women (95% CI: 316, 338), P < 0.0001 for gender difference. A total of 1,187 men (75%) and 981 women (69%) were admitted to hospital at least once; among these, median numbers of admissions were 3 in men (inter-quartile range, (IQR): 1, 6) and 2 in women (IQR: 1, 5). Forty-eight percent of those ever admitted had experienced an emergency admission and 70% had been admitted overnight. DISCUSSION It is possible to link routinely collected HES data with detailed information from a cohort study. Hospital admission is common among community-dwelling 'young-old' men and women. These linked datasets will facilitate research into lifecourse determinants of hospital admission and inform strategies to manage demand on the NHS.
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Affiliation(s)
- Shirley J Simmonds
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Holly E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Bronagh Walsh
- Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Maria Evandrou
- Centre for Research on Ageing, University of Southampton, Southampton SO17 1BJ, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Avan Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK Academic Geriatric Medicine, University of Southampton, Southampton SO16 6YD, UK
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9
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Downing A, Twelves C, Forman D, Lawrence G, Gilthorpe MS. Time to Begin Adjuvant Chemotherapy and Survival in Breast Cancer Patients: A Retrospective Observational Study Using Latent Class Analysis. Breast J 2013; 20:29-36. [PMID: 24438064 DOI: 10.1111/tbj.12209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Amy Downing
- Cancer Epidemiology Group; Centre for Epidemiology & Biostatistics; St James’ University Hospital; University of Leeds; Leeds UK
| | - Christopher Twelves
- Leeds Cancer Research UK Centre; St James’ University Hospital; University of Leeds; Leeds UK
| | - David Forman
- Cancer Epidemiology Group; Centre for Epidemiology & Biostatistics; St James’ University Hospital; University of Leeds; Leeds UK
- National Cancer Registration Service (Northern and Yorkshire); Public Health England; St James’ University Hospital; Leeds UK
| | - Gill Lawrence
- National Cancer Registration Service (West Midlands); Public Health England; Birmingham UK
| | - Mark S Gilthorpe
- Division of Biostatistics; Centre for Epidemiology & Biostatistics; University of Leeds; Leeds UK
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