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Zhang S, Yang H, Xu Y, Wang S. Do we need reshape rTNM staging system for ipsilateral breast tumor recurrence of breast cancer? A population-based, propensity score matched cohort study. Breast Cancer Res Treat 2024; 206:637-651. [PMID: 38727889 DOI: 10.1007/s10549-024-07340-8] [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: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The aim of the study was to explore the role of recurrent TNM (rTNM) staging in predicting prognosis for ipsilateral breast tumor recurrence (IBTR) and determine the optimal treatment strategy for IBTR. METHOD IBTR cases were identified from the Surveillance, Epidemiology, and End Results (SEER) database spanning the years 2000-2018. Cox proportional hazards analysis was performed to examine factors associated with overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) was employed to match IBTR with primary early breast cancer (EBC) based on clinicopathological characteristics. Investigations into the impact of different therapies were also included. RESULTS Of the 4375 IBTR cases included in the study, the 5-year OS was 87.1%, 71.6% and 58.7% in rTNM stages I, II and III, respectively. After PSM, while IBTR patients had worse survival to primary EBC patients, prognosis of IBTR for different rTNM stage always closely aligned with the corresponding stage of primary EBC. Repeat breast-conserving surgery (BCS) with radiation therapy was equivalent to mastectomy with respect to OS and BCSS. Chemotherapy was favorable for OS and BCSS in estrogen receptor (ER)-negative IBTR or IBTR occurring within a 60-month interval. CONCLUSIONS rTNM staging system has an outstanding prognostic value for survival outcome of patients with IBTR, and IBTR and primary EBC may have potentially analogous features in the context of TNM staging. BCS plus radiation therapy may be an alternative. IBTR cases who have experienced recurrence with short intervals and with ER-negative tumors might benefit from chemotherapy.
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Affiliation(s)
- Shuwei Zhang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Yaqian Xu
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China.
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2
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Loap P, Fourquet A, Kirova Y. Survival and toxicity after breast-conserving surgery and external beam reirradiation for localized ipsilateral breast tumour recurrence: A population-based study. Cancer Radiother 2024; 28:265-271. [PMID: 38897883 DOI: 10.1016/j.canrad.2024.03.001] [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: 01/03/2024] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result in a greater risk of cardiac adverse events. This study aimed to compare the incidence of cardiac mortality in patients treated for a localized ipsilateral breast tumour relapse, either with breast-conserving surgery followed by reirradiation or with total mastectomy between 2000 and 2020. MATERIALS AND METHODS All patients treated for a primary non-metastatic breast cancer with breast-conserving surgery and adjuvant radiotherapy were identified in the Surveillance, Epidemiology, and End Results (SEER) program database, and those who subsequently experienced a localized ipsilateral breast tumour relapse treated with breast-conserving surgery and reirradiation ("BCS+ReRT" group, n=239) or with total mastectomy ("TM" group, n=3127) were included. The primary objective was to compare the cardiac mortality rate between the patients who underwent breast-conserving surgery followed by reirradiation and total mastectomy. Secondary endpoints were overall survival and cancer specific survival. RESULTS Cardiac mortality was significantly higher in patients treated with breast-conserving surgery followed by reirradiation (hazard ratio [HR]: 2.40, 95% confidence interval [95% CI]: 1.19-4.86, P=0.006) in univariate analysis; non-statistically significant differences were observed after adjusting for age, laterality and chemotherapy on multivariate analysis (HR: 1.96, 95% CI: 0.96-3.94, P=0.067), age being the only confounding factor. A non-statistically significant difference towards lower overall survival was observed in patients who had breast-conserving surgery followed by reirradiation compared with those who underwent total mastectomy (HR: 1.37, 95% CI: 0.98-1.90, P=0.066), and no differences were observed in terms of cancer specific survival (HR: 1.01, 95% CI: 0.56-1.82, P=0.965). CONCLUSION In this study, the incidence of cardiac mortality was low, and breast-conserving surgery followed by reirradiation did not independently increased the risk of cardiac mortality for a localized ipsilateral breast tumour relapse.
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Affiliation(s)
- P Loap
- Department of Radiation Oncology, institut Curie, Paris, France
| | - A Fourquet
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France.
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Abdul-Latif M, Gal J, Schiappa R, Rizzi Y, Gautier M, Hannoun-Levi JM. Salvage brachytherapy for second ipsilateral breast tumor event: Relating dosimetric analysis to late side effects. Brachytherapy 2024; 23:335-341. [PMID: 38383205 DOI: 10.1016/j.brachy.2023.12.005] [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: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE For second ipsilateral breast tumor event (2ndIBTE), conservative treatment (CT) involving wide local excision plus accelerated partial breast reirradiation (APBrI) is increasingly used as an alternative to mastectomy. This study investigates the impact of APBrI technique and multicatheter interstitial high dose-rate brachytherapy (MIB) dosimetry parameters on toxicity and survival in patients with 2ndIBTE. MATERIALS-METHODS Data from patients with 2ndIBTE treated with CT, were analyzed. Inclusion criteria specified 2ndIBTE occurring at least one year after 1st CT for primary breast cancer. Treatment details and dosimetry parameters were recorded. Primary endpoint was late toxicity. Secondary endpoints were late toxicity prognostic factors analysis and oncological outcome. RESULTS From 07/2005 and 07/2023, 201 patients (pts) received 2nd CT. With a median follow-up of 49.6 months (44.9-59.5), tumor size was less than 2 cm (88.1%), with estrogen receptor positive (92.7%). Patients were low (63.7%) or intermediate (29.8%) GEC-ESTRO APBI risk classification. Late toxicities were observed in 34.8% (G1 52.3%, G2 40.7%). Cutaneous fibrosis was the most common toxicity. Cosmetic outcomes were excellent in 64.1%. Dosimetry analysis revealed positive correlations between complications and absolute volumes of CTV, V100, V150, and V200. Volumes requiring higher needle number and lower DNR resulted in fewer complications. 5-year disease-free and overall survival were 88% and 95% respectively. CONCLUSION Second CT for 2ndIBTE showed favorable oncological outcomes and survival rates. Complications were correlated with specific dosimetric parameters, emphasizing the importance of tailored treatment planning. This study provides valuable insights in risk stratification and MIB optimization for APBrI.
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Affiliation(s)
- Mohammed Abdul-Latif
- Department of Radiotherapy, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jocelyn Gal
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Yassine Rizzi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
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4
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Hannoun-Lévi JM, Savignoni A, Féron JG, Malhaire C, Ezzili C, Brédart A, Loap P, Kirova Y. Management of second ipsilateral breast tumor event: An advocacy for a randomized trial. Cancer Radiother 2024; 28:188-194. [PMID: 38216433 DOI: 10.1016/j.canrad.2023.11.001] [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: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Abstract
For a second ipsilateral breast tumor event, salvage mastectomy is the standard of care while second conservative treatment is a possible option. However, level 1 proofs are missing, leading to perform salvage mastectomy for patients who could receive second conservative treatment and consequently avoid psychological/quality of life salvage mastectomy deleterious impacts. A phase 3 randomized trial comparing salvage mastectomy to second conservative treatment is needed. Here we discuss what would be to us the optimal design of such trial to confirm the non-inferiority between the two salvage options, with a focus on methodological aspects in terms of patient characteristics and statistical issues.
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Affiliation(s)
- J-M Hannoun-Lévi
- Department of Radiation Oncology, centre Antoine-Lacassagne, université Côte d'Azur, Nice, France.
| | - A Savignoni
- Department of Biostatistics, institut Curie, Paris, France
| | - J-G Féron
- Department of Breast Surgery, institut Curie, Paris, France
| | - C Malhaire
- Department of Medical Imaging, institut Curie, Paris, France
| | - C Ezzili
- Department of Clinical Research, institut Curie, Paris, France
| | - A Brédart
- Psycho-Oncology Unit, institut Curie, Paris, France
| | - P Loap
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France
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Kurt S, İlgün AS, Özkurt E, Soybir G, Alço G, Ünal Ç, Çelebi FE, Duymaz T, Tapan TK, Ak N, Ordu Ç, Özmen V. Outcomes of reconstructive techniques in breast cancer using BCCT. core software. World J Surg Oncol 2024; 22:82. [PMID: 38519998 PMCID: PMC10960372 DOI: 10.1186/s12957-024-03343-3] [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: 10/03/2023] [Accepted: 02/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Surgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program. PATIENTS AND METHODS Patients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core. RESULTS The plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98). The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43). CONCLUSION Patients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply.
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Affiliation(s)
- Sevgi Kurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
| | | | - Enver Özkurt
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | | | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Tuğba Kayan Tapan
- Department of Nutrition and Dietetics, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Naziye Ak
- Division of Medical Oncology, Department of Internal Medicine, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Massaccesi M, Fontana A, Palumbo I, Argenone A, De Santis MC, Masiello V, Pontoriero A, Ciabattoni A. Pattern of practice of re-irradiation for ipsilateral breast tumor recurrence in Italy: a survey by the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Clin Transl Oncol 2024; 26:644-652. [PMID: 37515701 DOI: 10.1007/s12094-023-03289-0] [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: 02/25/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The Re-irradiation and the Breast Cancer Working Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) conducted a survey to provide an overview of the policies for breast cancer (BC) re-irradiation (re-RT) among the Italian radiotherapy (RT) centers. METHODS In October 2021, 183 RT centers were invited to answer a survey: after an initial section about general aspects, the questionnaire focused on radiation oncologists' (ROs) attitude toward re-RT in three different scenarios: ipsilateral breast tumor recurrence (IBTR) treated with second conservative surgery, IBTR treated with mastectomy and inoperable IBTR. Surveyed ROs were also asked to express their interest in being involved in a prospective trials. RESULTS Seventy-seven/183 (42.0%) centers answered the Survey, only one RO per center was requested to answer. In particular, 86.5% ROs declared to have performed "curative" re-RT for IBTR during the previous two years (2019-2020): 76.7% respondents administered re-RT after second BCS, 50.9% after mastectomy, and 48.1% for inoperable IBTR. Re-RT practice varied widely among centers in terms of treatment volumes, dose and fractionation schedules, techniques and dose-volume constraints for organs at risks (OARs). Forty-six participants (59.7%) expressed their interest in participating in a prospective study investigating BC re-RT. CONCLUSIONS About one out of three RT centers in Italy delivered re-RT for IBTR. Nevertheless, practice of re-RT varied widely among centers highlighting the needs for prospective studies to improve knowledge in this field.
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Affiliation(s)
- Mariangela Massaccesi
- Radiation Oncology Unit, Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonella Fontana
- Radiotherapy Department, Santa Maria Goretti Hospital, Latina, Italy
| | - Isabella Palumbo
- Radiation Oncology Section, Department of Medicine and Surgery, Sant'Andrea delle Fratte, University of Perugia and Perugia General Hospital, 06156, Perugia, Italy.
| | | | - Maria Carmen De Santis
- Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Valeria Masiello
- Radiation Oncology Unit, Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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7
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Hannoun-Levi JM, Gal J, Polgar C, Strnad V, Loessl K, Polat B, Kauer-Domer D, Schiappa R, Gutierrez C. Second Conservative Treatment for Local Recurrence Breast Cancer: A GEC-ESTRO Oncological Outcome and Prognostic Factor Analysis. Int J Radiat Oncol Biol Phys 2023; 117:1200-1210. [PMID: 37459998 DOI: 10.1016/j.ijrobp.2023.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE For second ipsilateral breast tumor event (2nd IBTE), second conservative treatment (2nd CT) combining lumpectomy plus accelerated partial breast reirradiation (APBrI) represents a curative option. The aim of this study was to analyze oncological prognostic factors for patients with a 2nd IBTE treated with 2nd CT. METHODS AND MATERIALS An analysis of clinical practices was conducted across 7 academic hospitals/cancer centers in 6 European countries based on the GEC-ESTRO database. Patients presenting a 2nd IBTE occurring after conservative surgery (lumpectomy + axillary evaluation) and irradiation performed for the primary tumor underwent a 2nd CT with brachytherapy-based APBrI. The main outcome was 5-year cumulative incidence (CI) rate of second local relapse. All analyzed patients were classified according to risk groups for Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) accelerated partial breast irradiation (APBI) and molecular classification and time interval between first and second breast surgery (TIS1S2). Finally, we combined GEC-ESTRO APBI, molecular, and TIS1S2 risk groups, leading to the definition of a new score (named TAM: score based on the combination of time interval [T] between first and second surgery and APBI [A] and molecular [M] classifications) specifically designed for 2nd IBTE oncological outcome analysis. RESULTS From July 1994 to January 2021, a total of 508 patients received a 2nd CT. At the time of 2nd IBTE, median age was 64.6 years (range, 56.2-72.6). With a median follow-up of 60.9 months (56.2-72.6), the 5-year second local relapse CI rate was 4% (95% confidence interval [95% CI], 2%-6%). The 5-year distant metastasis disease CI rate was 7% (95% CI, 4%-10%). Five-year disease-free and overall survival rates were 89% (95% CI, 86%-93%) and 91% (95% CI, 88%-94%), respectively. In multivariate analysis, TAM score was an independent prognostic factor for all the oncological items (P < .001) except disease-specific survival (P = .07) and overall survival (P = .09). The grade ≥3 late toxicity rate was 12.1%. CONCLUSIONS This analysis of 2nd CT combining lumpectomy with APBrI for 2nd IBTE confirmed the excellent oncological results obtained after 2nd CT. Furthermore, the GEC-ESTRO TAM score appears to be an important prognostic factor, assisting patients and physicians in the decision-making process.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France.
| | - Jocelyn Gal
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Csaba Polgar
- Department of Oncology, Semmelweis University, Budapest, Hungary; Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Kristina Loessl
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bulent Polat
- Department of Radiation Oncology, Wurzburg University, Wurzburg, Germany
| | - Daniela Kauer-Domer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Renaud Schiappa
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Crisitna Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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8
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Tran J, Thaper A, Lopetegui-Lia N, Ali A. Locoregional recurrence in triple negative breast cancer: past, present, and future. Expert Rev Anticancer Ther 2023; 23:1085-1093. [PMID: 37750222 DOI: 10.1080/14737140.2023.2262760] [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: 07/17/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Triple negative breast cancer (TNBC) is a rare but aggressive biological subtype of breast cancer associated with higher locoregional and distant recurrence rates and lower overall survival despite advancements in diagnostic and treatment strategies. AREAS COVERED This review explores the evolving landscape of locoregional recurrence (LRR) in TNBC with improved surgical and radiation therapy delivery techniques including salvage breast conserving surgery (SBCS), re-irradiation, and thermo-radiation. We review current retrospective and prospective, albeit limited, clinical data highlighting the optimal management of locoregionally recurrent TNBC. We also discuss tumor genomic profiling and transcriptome analysis and review potential investigational directions. EXPERT OPINION Significant progress has been made in the prevention of LRR but rates remain suboptimal, particularly in the TNBC population, and outcomes following LRR are poor. Further prospective studies are needed to identify the most effective and safest systemic therapy regimens and to whom it should be offered. There has been growing interest in the role of molecular markers, genomic signatures, and tumor microenvironment in predicting outcomes and guiding LRR treatment. Transcriptome analyses and biomarker-driven investigations are currently being studied and represent a promising era of development in the management of LRR.
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Affiliation(s)
- Jennifer Tran
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
| | - Arushi Thaper
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nerea Lopetegui-Lia
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
| | - Azka Ali
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
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9
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Aristei C, Kaidar-Person O, Boersma L, Leonardi MC, Offersen B, Franco P, Arenas M, Bourgier C, Pfeffer R, Kouloulias V, Bölükbaşı Y, Meattini I, Coles C, Luis AM, Masiello V, Palumbo I, Morganti AG, Perrucci E, Tombolini V, Krengli M, Marazzi F, Trigo L, Borghesi S, Ciabattoni A, Ratoša I, Valentini V, Poortmans P. The 2022 Assisi Think Tank Meeting: White paper on optimising radiation therapy for breast cancer. Crit Rev Oncol Hematol 2023:104035. [PMID: 37244324 DOI: 10.1016/j.critrevonc.2023.104035] [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: 02/23/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. < 70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1-2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1-3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.
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Affiliation(s)
- C Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | - O Kaidar-Person
- Breast Radiation Unit, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - L Boersma
- Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M C Leonardi
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - B Offersen
- Department of Experimental Clinical Oncology, Department of Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - P Franco
- Depatment of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, 'Maggiore della Carita`' University Hospital, Novara, Italy
| | - M Arenas
- Universitat Rovira I Virgili, Radiation Oncology Department, Hospital Universitari Sant Hoan de Reus, IISPV, Spain
| | - C Bourgier
- Radiation Oncology, ICM-Val d' Aurelle, Univ Montpellier, Montpellier, France
| | - R Pfeffer
- Oncology Institute, Assuta Medical Center, Tel Aviv and Ben Gurion University Medical School, Israel
| | - V Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, Medical School, National and Kapodistrian University of Athens, Greece
| | - Y Bölükbaşı
- Koc University, Faculty of Medicine, Department of Radiation Oncology, Istanbul, Turkey
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence & Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - C Coles
- Department of Oncology, University of Cambridge, UK
| | - A Montero Luis
- Department of Radiation Oncology, University Hospital HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - V Masiello
- Unità Operativa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagine, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - I Palumbo
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - A G Morganti
- DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - E Perrucci
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - V Tombolini
- Radiation Oncology, Department of Radiological, Oncological and Pathological Science, University "La Sapienza", Roma, Italy
| | - M Krengli
- DISCOG, Università di Padova e Istituto Oncologico Veneto - IRCCS
| | - F Marazzi
- Unità Operativa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagine, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - L Trigo
- Service of Brachytherapy, Department of Image and Radioncology, Instituto Português Oncologia Porto Francisco Gentil E.P.E., Portugal
| | - S Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - A Ciabattoni
- Department of Radiation Oncology, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
| | - I Ratoša
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - V Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore e Fondazione Policlinico Gemelli IRCSS Roma, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
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10
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Abeloos CH, Purswani JM, Galavis P, McCarthy A, Hitchen C, Choi JI, Gerber NK. Different Re-Irradiation Techniques after Breast-Conserving Surgery for Recurrent or New Primary Breast Cancer. Curr Oncol 2023; 30:1151-1163. [PMID: 36661737 PMCID: PMC9857440 DOI: 10.3390/curroncol30010088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Breast re-irradiation (reRT) after breast-conserving surgery (BCS) using external beam radiation is an increasingly used salvage approach for women presenting with recurrent or new primary breast cancer. However, radiation technique, dose and fractionation as well as eligibility criteria differ between studies. There is also limited data on efficacy and safety of external beam hypofractionation and accelerated partial-breast irradiation (APBI) regimens. This paper reviews existing retrospective and prospective data for breast reRT after BCS, APBI reRT outcomes and delivery at our institution and the need for a randomized controlled trial using shorter courses of radiation to better define patient selection for different reRT fractionation regimens.
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Affiliation(s)
| | - Juhi M. Purswani
- Department of Radiation Oncology, NYU School of Medicine, New York, NY 10016, USA
| | - Paulina Galavis
- Department of Radiation Oncology, NYU School of Medicine, New York, NY 10016, USA
| | - Allison McCarthy
- Department of Radiation Oncology, NYU School of Medicine, New York, NY 10016, USA
| | - Christine Hitchen
- Department of Radiation Oncology, NYU School of Medicine, New York, NY 10016, USA
| | - J. Isabelle Choi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Naamit K. Gerber
- Department of Radiation Oncology, NYU School of Medicine, New York, NY 10016, USA
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11
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Li Y, Li WW, Yuan L, Xu B. Is repeat breast conservation possible for small ipsilateral breast cancer recurrence? Cancer 2022; 128:3919-3928. [PMID: 36128621 DOI: 10.1002/cncr.34468] [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: 06/16/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most cases of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) involve small tumors. Although a few guidelines recommend mastectomy, several patients prefer repeat BCS (re-BCS). This study aimed to compare re-BCS and mastectomy in terms of prognosis in patients with IBTR and to identify candidates for re-BCS. METHODS The data of patients with small IBTR between 1999 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. The outcomes of interest were overall survival (OS) and breast cancer-specific survival (BCSS). Multivariable Cox proportional hazards regression models and propensity score matching were applied. RESULTS Of the 3648 patients with IBTR, 2831 (77.6%) underwent mastectomy and 817 (22.4%) underwent re-BCS. The multivariate Cox model showed that re-BCS was associated with a worse OS (hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.084-1.663) and BCSS (HR, 1.454; 95% CI, 1.004-2.105) compared with mastectomy. The omission of radiation after re-BCS was associated with worse survival overall and especially in patients with estrogen receptor (ER)-negative IBTR (HR, 1.384; 95% CI, 1.110-1.724; and HR, 1.577; 95% CI, 1.075-2.314, respectively). No statistically significant differences were observed in the OS and BCSS between re-BCS with radiation and mastectomy. Subgroup analysis indicated that the surgical approach was not an independent factor for survival in the ER-positive patients with IBTR. CONCLUSIONS Re-BCS should be considered with caution in patients with small IBTR. However, a positive ER status can be an important factor for choosing re-BCS, and radiation therapy may improve oncological safety after re-BCS. LAY SUMMARY Repeat breast-conserving surgery (re-BCS) was investigated to determine if it is safe for patients with small ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS). This population-based cohort study included 2831 patients with small IBTR. Re-BCS was associated with a worse overall survival and breast cancer-specific survival compared with mastectomy. Further analysis found that the IBTR estrogen receptor status was an important basis for choosing re-BCS, and radiation may improve oncological safety after re-BCS.
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Affiliation(s)
- Yong Li
- Department of Breast, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, People's Republic of China.,Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei-Wen Li
- Department of Breast, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, People's Republic of China
| | - Lin Yuan
- Department of Breast, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, People's Republic of China.,Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, People's Republic of China
| | - Bo Xu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, People's Republic of China.,Department of General Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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12
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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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13
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Morgan JL, Cheng V, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hartup S, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O'Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1510-1519. [PMID: 35410760 DOI: 10.1016/j.ejso.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management. METHODS UK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy. RESULTS 822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February-August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%). For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure. For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy. CONCLUSION This survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.
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Affiliation(s)
- Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - Vinton Cheng
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Ellen Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Rajiv Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Beatrix Elsberger
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | | | - Sue Hartup
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Brian Hogan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Kieran Horgan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Cliona C Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | - Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 2LX, UK
| | - Lisa Sheehan
- Wessex Deanery, Southern House, Otterbourne, Winchester, SO21 2RU, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
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14
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Mátrai Z, Kelemen P, Kósa C, Maráz R, Paszt A, Pavlovics G, Sávolt Á, Simonka Z, Tóth D, Kásler M, Kaprin A, Krivorotko P, Vicko F, Pluta P, Kolacinska-Wow A, Murawa D, Jankau J, Ciesla S, Dyttert D, Sabol M, Zhygulin A, Avetisyan A, Bessonov A, Lázár G. Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610377. [PMID: 35783360 PMCID: PMC9240205 DOI: 10.3389/pore.2022.1610377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/29/2022] [Indexed: 12/16/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Péter Kelemen
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Csaba Kósa
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Róbert Maráz
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Attila Paszt
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | | | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Zsolt Simonka
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
| | - Dezső Tóth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Miklós Kásler
- Minister of Human Capacities, Government of Hungary, Budapest, Hungary
| | - Andrey Kaprin
- National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Russian Academy of Sciences, Moscow, Russia
| | - Petr Krivorotko
- N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Ferenc Vicko
- Medical Faculty Novi Sad, Oncology Institute of Vojvodina Sremska Kamenica, University of Novi Sad, Novi Sad, Serbia
| | - Piotr Pluta
- Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital–Research Institute in Lodz, Lodz, Poland
| | - Agnieszka Kolacinska-Wow
- Department of Head and Neck Cancer Surgery, Medical University of Lodz, Lodz, Poland
- Department of Surgical Oncology, Cancer Center, Medical University of Lodz, Lodz, Poland
| | - Dawid Murawa
- Clinic of Surgical Oncology, Poznan University of Medical Sciences, Poznan, Poland
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Jerzy Jankau
- Plastic Surgery Department, Medical University of Gdańsk/University Hospitals, Gdansk, Poland
| | - Slawomir Ciesla
- General and Oncological Surgery Clinic, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Daniel Dyttert
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Martin Sabol
- Department of Surgical Oncology, St. Elisabeth Cancer Institute, Medical Faculty, Comenius University, Bratislava, Slovakia
| | | | | | - Alexander Bessonov
- Breast Cancer Department of the LOKOD, N.N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - György Lázár
- Department of Surgery, Faculty of Medicine, SZTE ÁOK, University of Szeged, Szeged, Hungary
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15
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Cozzi S, Augugliaro M, Ciammella P, Botti A, Trojani V, Najafi M, Blandino G, Ruggieri MP, Giaccherini L, Alì E, Iori F, Sardaro A, Finocchi Ghersi S, Deantonio L, Gutierrez Miguelez C, Iotti C, Bardoscia L. The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes. Cancers (Basel) 2022; 14:cancers14102564. [PMID: 35626168 PMCID: PMC9139312 DOI: 10.3390/cancers14102564] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Breast cancer is the most common cancer in the female population. Adjuvant radiotherapy has become increasingly important as conservative treatment. Muticatheter interstitial brachytherapy is a type of radiation technique wherein the radioactive sources are directly implanted into or close to the target tissue and may be considered an extremely precise, versatile, and variable radiation technique. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy, with particular focus on the implant description, limits, and advantages of the technique. Abstract Breast cancer represents the second leading cause of cancer-related death in the female population, despite continuing advances in treatment options that have significantly accelerated in recent years. Conservative treatments have radically changed the concept of healing, also focusing on the psychological aspect of oncological treatments. In this scenario, radiotherapy plays a key role. Brachytherapy is an extremely versatile radiation technique that can be used in various settings for breast cancer treatment. Although it is invasive, technically complex, and requires a long learning curve, the dosimetric advantages and sparing of organs at risk are unequivocal. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy, with longer follow-up than new, emerging radiation techniques, whose effectiveness is proven by over 20 years of experience. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy to perform breast lumpectomy boost, breast-conserving accelerated partial breast irradiation, and salvage reirradiation for ipsilateral breast recurrence, with particular focus on the implant description, limits, and advantages of the technique.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
- Correspondence: ; Tel.: +39-329-731-7608
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy;
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500 Lugano, Switzerland;
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy;
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16
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Ahmadsei M, Christ SM, Seiler A, Vlaskou Badra E, Willmann J, Hertler C, Guckenberger M. Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy. Clin Transl Radiat Oncol 2022; 34:23-29. [PMID: 35313618 PMCID: PMC8933336 DOI: 10.1016/j.ctro.2022.03.006] [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: 02/06/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple repeat radiotherapy courses are used more frequently. Prediction of tolerability, quality of life and toxicity remains a challenge. Patients treated with a minimum of five radiotherapies show a stable quality of life. Yet, fatigue and low levels of hemoglobin and lymphocytes are long-term side effects.
Background Treatment of metastatic cancer patients with multiple repeat courses of radiotherapy has become more frequent due to their improved overall survival. However, very little is known about their long-term outcome. This analysis reports on the quality-of-life, hematologic toxicity, patient-reported experiences and satisfaction, and psychological distress of cancer patients treated with multiple repeat radiotherapy. Methods All patients treated with ≥5 courses of radiotherapy between 2011 and 2019 at the Department of Radiation Oncology, University Hospital Zurich (USZ) were screened for this study. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. All patients completed two questionnaires: EORTC QLQ-C30 questionnaire for quality-of-life and a questionnaire evaluating psychological distress and patient-reported experiences. Hematologic toxicities were assessed via a recent blood sample. Results Of n = 33 patients treated with ≥5 radiotherapy courses and being alive, 20 (60.6%) participated in this study. The most common primary tumor was non-small cell lung cancer (n = 14, 42.4%). The most common sites of irradiation were brain (n = 78, 37.1%) and bone metastases (n = 59, 28.1%). All participating patients reported that they had experienced a subjective benefit from multiple repeat radiotherapy and denied increased side effects in later radiotherapy courses. Yet, 45% (n = 9) of the patients reported an increase of psychological distress with increasing numbers of radiotherapy treatments. While global health status was stable, patients having received multiple repeat radiotherapy reported increased fatigue (p = <0.006). Blood analysis showed significantly reduced hemoglobin and lymphocyte levels compared to the healthy population (p = <0.03). Discussion and conclusion Patient-reported experiences and satisfaction of long-term cancer patients treated with multiple repeat radiotherapy are positive. However, increased levels of fatigue and significantly reduced hemoglobin and lymphocyte levels were observed. These data indicate the need to further investigate the effects of multiple courses of radiotherapy in chronic cancer patients.
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17
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Pisano CE, Kharouta MZ, Harris EE, Shenk R, Lyons JA. Partial Breast Re-Irradiation for Patients with Ipsilateral Breast Tumor Recurrence After Initial Treatment with Breast Conservation for Early Stage Breast Cancer. Pract Radiat Oncol 2022; 12:e493-e500. [PMID: 35447386 DOI: 10.1016/j.prro.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Accelerated partial breast irradiation (APBI), including intraoperative radiation therapy (IORT), is an evidence based treatment option in patients undergoing breast conserving surgery (BCS) for early-stage breast cancer. However, literature regarding re-irradiation for patients with ipsilateral breast tumor recurrences (IBTR) is limited. This prospective study assessed the feasibility and efficacy of using APBI in patients who had prior whole breast irradiation. METHODS AND MATERIALS This is a single institution, prospective study of patients who were previously treated with BCS and adjuvant whole breast radiation. At the time of enrollment, all had unifocal IBTR, histologically confirmed invasive ductal carcinoma with negative margins after repeat BCS. Patients received either IORT in a single fraction at time of BCS or MammoSite® brachytherapy twice daily over 5 days. Follow-up data and patient surveys were collected at 1, 3, 6, 9 and 12 months, then annually for at least a 5-year period. RESULTS From 2008 to 2014, 13 patients were enrolled. Median time to recurrence after initial course of radiation was 12.5 years. Median follow-up after re-treatment was 7.8 years. One patient in the IORT group had a subsequent tumor bed recurrence, yielding a local control of 92%. One patient had distant recurrence. At baseline, 69% reported excellent-good cosmesis compared to 39% at 5-years. All patients indicated total satisfaction with overall treatment experience. CONCLUSIONS APBI using IORT was well tolerated with excellent local control and may be a reasonable alternative to mastectomy for IBTR. Further study is needed to determine the most suitable candidates for this approach.
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Affiliation(s)
- Courtney E Pisano
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106
| | - Michael Z Kharouta
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106.
| | - Eleanor E Harris
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106
| | - Robert Shenk
- Department of Surgery, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106
| | - Janice A Lyons
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106.
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18
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Sutherland A, Huppe A, Wagner JL, Amin AL, Balanoff CR, Kilgore LJ, Larson KE. The clinical impact of MRI on surgical planning for patients with in-breast tumor recurrence. Breast Cancer Res Treat 2022; 193:515-522. [PMID: 35415789 DOI: 10.1007/s10549-022-06589-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the clinical utility of breast MRI for patients with known in-breast tumor recurrence (IBTR). The aim was to determine if the addition of breast MRI altered surgical approach or multidisciplinary management. Previous studies have focused on using breast MRI for surgical planning for index breast cancers (BC) or detecting IBTR. However, the clinical impact of obtaining MRI in the setting of known IBTR has not been evaluated. METHODS A single-institution retrospective chart review was performed to compare surgical approach and multidisciplinary management for patients diagnosed with isolated IBTR who did and did not undergo breast MRI following IBTR diagnosis. RESULTS IBTR was identified in 69 patients, 46% of whom underwent MRI. There was no difference in the operative approach (p = 0.14) for IBTR patients who did and did not undergo breast MRI Additionally, there was no difference in multidisciplinary care, treatment order, metastatic disease identification, or mortality between cohorts. A relatively small subgroup of patients (n = 3) required change in surgical plan based on MRI results. Patients proceeding with surgery first who also underwent breast MRI experienced a significantly longer time to surgical intervention (p = 0.03). CONCLUSION Breast MRI following IBTR diagnosis infrequently impacted clinical management, including surgical approach and multidisciplinary care. MRI for local disease assessment at the time of IBTR should be used selectively based on clinical concern.
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Affiliation(s)
- Amanda Sutherland
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Ashley Huppe
- Department of Radiology, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Jamie L Wagner
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Amanda L Amin
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Christa R Balanoff
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Lyndsey J Kilgore
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA
| | - Kelsey E Larson
- Department of Surgery, Division of Breast Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City, KS, 66160, USA.
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19
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Frasson AL, Lichtenfels M, Barbosa F, Souza ABAD, Falcone AB, Miranda I, Vollbrecht B, Malhone C, Tariki JY. Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:489-496. [PMID: 35211933 PMCID: PMC9948044 DOI: 10.1055/s-0042-1743098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). METHODS Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. RESULTS The patients were followed up for a mean time of 132 months since the first surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. CONCLUSION In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery. We demonstrated that NSM may be considered after IBTR for patients who did not want to undergo total mastectomy.
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Affiliation(s)
| | - Martina Lichtenfels
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Isabela Miranda
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Betina Vollbrecht
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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20
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Gentile D, Sagona A, Barbieri E, Antunovic L, Franceschini D, Losurdo A, Fernandes B, Tinterri C. Breast conserving surgery versus salvage mastectomy for ipsilateral breast cancer recurrence: a propensity score matching analysis. Updates Surg 2021; 74:479-489. [PMID: 34181187 DOI: 10.1007/s13304-021-01122-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/21/2021] [Indexed: 01/01/2023]
Abstract
Salvage mastectomy is regarded as the treatment of first choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast conserving surgery (BCS) is feasible. The purpose of this study was to compare the long-term oncological outcomes of IBCR patients who had undergone either mastectomy or second BCS, performing a propensity score matching (PSM) analysis to reduce the selection bias. All the consecutive patients with IBCR were retrospectively reviewed and divided into two different groups of treatment: repeat BCS versus salvage mastectomy. The propensity score predicting the probability of surgical treatment was determined for each patient and a 1:1 matching was performed. Disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and breast cancer-specific survival (BCSS) were analyzed and compared between the two groups. A total of 309 patients underwent surgical treatment for IBCR. After PSM, 108 patients treated with repeat BCS and 108 patients treated with salvage mastectomy were included in the analysis. There was no significant difference in terms of DFS between patients with IBCR receiving repeat BCS or salvage mastectomy (p = 0.167). However, patients with IBCR undergoing second BCS had significantly better DDFS, OS, and BCSS compared to salvage mastectomy (p < 0.001). Salvage mastectomy should not be considered the optimal treatment for IBCR and it does not seem to improve prognosis compared to repeat conserving surgery. Second BCS for IBCR is a safe option with encouraging long-term oncological outcomes and should be proposed to all patients, when technically feasible.
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Affiliation(s)
- Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, , Milan, Italy.
| | - Andrea Sagona
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Lidija Antunovic
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Agnese Losurdo
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Bethania Fernandes
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, , Milan, Italy
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21
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Wang J, Tang H, Yin K, Li X, Xie X, Hughes KS. Second invasive breast cancers in patients treated with breast-conserving therapy. Eur J Surg Oncol 2021; 47:2492-2498. [PMID: 34134902 DOI: 10.1016/j.ejso.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/05/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Second breast cancers after breast-conserving therapy (BCT) include ipsilateral breast tumor recurrence (IBTR) and metachronous contralateral breast cancer (CBC). Each IBTR is further classified as true recurrence (TR) or new primary tumor (NP). We aim to compare survival outcomes of TR, NP and CBC, and explore the optimal treatments. METHODS 168,427 patients with primary breast cancer who underwent BCT between 1990 and 2005 were identified in the SEER database. The risks of IBTR and CBC were estimated by annual hazard rate. The breast cancer-specific survival (BCSS) were assessed using multivariable Cox regression analysis. RESULTS With median follow-up of 13 years after BCT, 5413 patients developed an IBTR and 4050 patients had a CBC. The risk of IBTR peaked between 10 and 15 years after BCT, while the risk of CBC distributed evenly. 45.9% of IBTRs were classified as a TR and 54.1% as an NP. The time interval from primary breast cancer to NP was longer than to TR and CBC (P < 0.001). Patients with TR had a poorer BCSS than NP (P = 0.003) and CBC (P = 0.002). There was no difference in BCSS between mastectomy and repeat BCT for treating TR (P = 0.584) or NP (P = 0.243). The BCSS of CBCs treated with BCT was better than mastectomy (P = 0.010). Chemotherapy didn't improve the survival of patients with TR (P = 0.058). However, TRs with grade III or negative hormone receptors benefited from chemotherapy significantly. CONCLUSION Patients with TR had a poorer BCSS than NP and CBC. Classifying IBTR may provide clinical significance for treatments.
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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 of Cancer Medicine, Guangzhou, China; Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xing Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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22
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Bottero M, Borzillo V, Pergolizzi S, Jereczek-Fossa BA, Ippolito E, Frezza GP, Fortunato L, Corvò R, Pappagallo GL, Arcangeli S, Magrini SM, D'Angelillo RM. The Italian Association of Radiotherapy and Oncology Recommendation for Breast Tumor Recurrence: Grades of Recommendation, Assessment, Development and Evaluation Criteria. J Breast Cancer 2021; 24:241-252. [PMID: 34128365 PMCID: PMC8250101 DOI: 10.4048/jbc.2021.24.e27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/10/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Salvage mastectomy is currently considered the standard of care for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and postoperative radiotherapy (RT). Alternative treatment options for these patients, such as a second BCS followed by repeated RT, have been suggested. The panel of the Italian Association of Radiotherapy and Clinical Oncology developed clinical recommendations for second BCS followed by re-irradiation over mastectomy alone for women with IBTR using the Grades of Recommendation, Assessment, Development, and Evaluation methodology and the evidence to decision framework. The following outcomes were identified by the panel: locoregional control, metastasis-free survival, overall survival, and cancer-specific survival; acute and late toxicity, specific late toxicity, second locoregional tumor, and death related to treatment. An Embase and PubMed literature search was performed by two independent authors. Five retrospective observational studies were eligible for inclusion in the present analysis. According to the reports in the literature and our analysis, the advantages of second quadrantectomy and re-irradiation (re-QUART) outweigh its side effects, with overall good rates of survival and adequate toxicity without increasing costs. Given the very low level of evidence, the panel stated that a second BCS plus re-irradiation can be considered as an alternative to salvage mastectomy for selected patients with IBTR.
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Affiliation(s)
- Marta Bottero
- Department of Radiation Oncology, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale - Napoli, Italy.
| | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Edy Ippolito
- Radioterapia Oncologica, Università Campus Bio-Medico, Roma, Italy
| | | | - Lucio Fortunato
- Centro di Senologia Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, National Cancer Research Institute and University, Genova, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca," Milan, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, University of Brescia, Brescia, Italy
| | - Rolando M D'Angelillo
- Radioterapia, Dipartimento di Biomedicina e prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy
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23
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Chatzikonstantinou G, Strouthos I, Scherf C, Köhn J, Solbach C, Rödel C, Tselis N. Interstitial multicatheter HDR-brachytherapy as accelerated partial breast irradiation after second breast-conserving surgery for locally recurrent breast cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:465-472. [PMID: 33604659 PMCID: PMC8127653 DOI: 10.1093/jrr/rrab004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/27/2020] [Indexed: 06/12/2023]
Abstract
Our aim was to evaluate the efficacy and toxicity of interstitial multicatheter high dose rate brachytherapy (imHDR-BRT) as accelerated partial breast irradiation (APBI) after second breast-conserving surgery (BCS) in patients with ipsilateral breast tumor recurrence (IBTR). Between January 2010 and December 2019, 20 patients with IBTR who refused salvage mastectomy (sMT) were treated with second BCS and post-operative imHDR-BRT as APBI. All patients had undergone primary BCS followed by adjuvant external beam radiotherapy. Median imHDR-BRT dose was 32 Gy delivered in twice-daily fractions of 4 Gy. Five-year IBTR-free survival, distant metastasis-free survival (DMFS), overall survival (OS) as well as toxicity and cosmesis were evaluated in the present retrospective analysis. Median age at recurrence and median time from the first diagnosis to IBTR was 65.1 years and 12.2 years, respectively. After a median follow-up of 69.9 months, two patients developed a second local recurrence resulting in 5-year IBTR free-survival of 86.8%. Five-year DMFS and 5-year OS were 84.6% and 92.3%, respectively. Grade 1-2 fibrosis was noted in 60% of the patients with no grade 3 or higher toxicity. Two (10%) cases of asymptomatic fat necrosis were documented. Cosmetic outcome was classified as excellent in 6 (37.5%), good in 6 (37.5%), fair in 3 (18.75%) and poor in 1 (6.25%) patient, respectively. We conclude that imHDR-BRT as APBI re-irradiation is effective and safe for IBTR and should be considered in appropriately selected patients.
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Affiliation(s)
- Georgios Chatzikonstantinou
- Corresponding author. Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. Tel: +49 69 6301 5130; Fax: +49 69 6301 5091;
| | | | - Christian Scherf
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Janett Köhn
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Christine Solbach
- Department of Gynecology and Obstetrics, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
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24
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Smit A, Coetzee B, Roomaney R, Swartz L. Understanding the subjective experiences of South African women with recurrent breast cancer: A qualitative study. J Health Psychol 2021; 27:1959-1970. [PMID: 33855880 DOI: 10.1177/13591053211002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the subjective experiences of 12 South African women diagnosed with recurrent breast cancer. Women were invited to take part in unstructured narrative interviews, and to complete a diary in which they could reflect on their breast cancer experiences. Most responded to their recurrence with an optimistic stance. Religious beliefs and support structures were important coping strategies. Women's perceptions of their changed bodies varied from being of least concern, to becoming the most distressing aspect. The findings highlight the complexity of illness experience and the different ways in which women make sense of a second episode of cancer.
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Affiliation(s)
- Anri Smit
- Stellenbosch University, South Africa
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25
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Morkavuk ŞB, Güner M, Çulcu S, Eroğlu A, Bayar S, Ünal AE. Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer. Int J Clin Pract 2021; 75:e13897. [PMID: 33280209 DOI: 10.1111/ijcp.13897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the relation between LVI and molecular subtypes in invasive breast cancers and to find out whether LVI which is a histopathologic indicator has a role in subtype classification or not. METHODS One hundred and seventy-six patients who had mastectomy for breast cancer between 2013 and 2018 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University were retrospectively analysed. One hundred and thirty-two patients who had LVI, ER, PR, Her 2 and Ki-67 index status information provided in their pathology results were included in the study. The relationship between molecular subtypes and LVI was investigated. RESULTS One hundred and thirty-two patients were analysed retrospectively. Eighty-two patients had LVI and 50 patients had not. We found a relationship between Luminal B with Her2(-) and LVI, basal like and LVI (P = .00). No significant statistical difference was found between LVI and other molecular subtypes. We confirmed these results with multiple variable analysis (%77.3 correlation). CONCLUSIONS As a result, we found that LVI can affect molecular subtypes. This showed that a histopathological factor may affect tumour biology. In other words, breast cancer is a heterogeneous disease with many different predictors and prognostic variables.
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Affiliation(s)
| | - Murat Güner
- Department of General Surgery, Usak Research and Training Hospital, Usak, Turkey
| | - Serdar Çulcu
- Department of General Surgery, Dr. Abdurrahman Yurtaslan Research and Training Hospital, Ankara, Turkey
| | - Aydan Eroğlu
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sancar Bayar
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ekrem Ünal
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
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26
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Walstra CJEF, Schipper RJ, van Riet YE, van der Toorn PPG, Smidt ML, Sangen MJCV, Voogd AC, Nieuwenhuijzen GAP. Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands. Breast Cancer Res Treat 2021; 187:499-514. [PMID: 33713244 PMCID: PMC8189996 DOI: 10.1007/s10549-021-06154-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/20/2021] [Indexed: 12/02/2022]
Abstract
Background In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT. Aim To investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against and perceived requirements to consider a repeat BCT in case of IBTR. Patients and methods An online survey consisting of a maximum of 26 open and multiple-choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists. Results Forty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centres responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient’s preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible. Conclusion An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation.
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Affiliation(s)
- Coco J E F Walstra
- Department of Surgical Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgical Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Yvonne E van Riet
- Department of Surgical Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | | | - Marjolein L Smidt
- Department of Surgical Oncology Maastricht, Universitair Medisch Centrum, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maurice J C Vd Sangen
- Department of Radiation Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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27
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Li Q, Wang K, Yang L, Wu Q, Zhu W, Li Z, Shi Y, Zhang X, Li H. Long-term Survival Comparison of Repeated Breast-conserving Surgery Versus Mastectomy for Patients with DCIS with Ipsilateral Breast Tumor Recurrence: A Real-world Longitudinal Study. Clin Breast Cancer 2021; 21:360-372. [PMID: 33846099 DOI: 10.1016/j.clbc.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although patients diagnosed with ductal carcinoma in situ (DCIS) harbor excellent overall survival (OS) after breast-conserving therapy, the evidence regarding to surgical management for ipsilateral breast tumor recurrence (IBTR) is scarce. This study aimed to assess the prognosis of repeated breast-conserving surgery (BCS) versus mastectomy for IBTR in DCIS survivors. MATERIALS AND METHODS Herein, 5344 DCIS cases with IBTR were identified during 702,748 person-years of follow-up, 3532 (66.09%) received mastectomy, and 1812 (33.91%) received repeated BCS. Cox regression and competing risk regression were employed to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for OS and breast cancer-specific survival (BCSS), which was respectively calculated within spontaneous and matched cohorts. RESULTS After adjustment for confounders, no statistically significant survival difference was observed between the repeated BCS and mastectomy for patients with DCIS with IBTR. The stratified analyses further revealed that patients with DCIS with IBTR receiving repeated BCS combined with radiation therapy were associated with both superior OS (HR, 0.79; CI, 0.64-0.98; P = .04) and BCSS (HR, 0.54; CI, 0.33-0.90; P = .02) compared with counterparts undergoing mastectomy. Furthermore, patients with DCIS who were age older than 60 years at IBTR diagnosis benefit from repeated BCS with radiotherapy (HR, 0.44; CI, 0.24-0.84; P = .01) than mastectomy. CONCLUSION We suggest that repeated BCS with radiation therapy deserves consideration when DCIS survivors suffered IBTR. The choice of surgical management should be tailored based on patients' age at IBTR diagnosis and size of recurrent disease.
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Affiliation(s)
- Qing Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Kang Wang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China; Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ling Yang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Qianxue Wu
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Wenming Zhu
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Zhuyue Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Shi
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Xiang Zhang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
| | - Hongyuan Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
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Van den Bruele AB, Chen I, Sevilimedu V, Le T, Morrow M, Braunstein LZ, Cody HS. Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy. Breast Cancer Res Treat 2021; 187:105-112. [PMID: 33433775 DOI: 10.1007/s10549-020-06080-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/24/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Breast conservation therapy (BCT) is well established for the management of primary operable breast cancer, with oncologic outcomes comparable to those of mastectomy. It remains unclear whether re-conservation therapy (RCT) is suitable for those patients who develop ipsilateral breast tumor recurrence (IBTR), for whom mastectomy is generally recommended. METHODS We identified women who underwent BCT for invasive or ductal carcinoma in situ and developed IBTR as a first event, comparing the pattern of subsequent events and survival for those treated by RCT versus mastectomy. RESULTS Of 16,968 patents who had BCT, 322 (1.9%) developed an isolated IBTR as a first event between 1999 and 2019. 130 (40%) had RCT and 192 (60%) mastectomy. Compared to mastectomy, the RCT patients were older (66 vs 53, < 0.001), had a longer disease-free interval (DFI: 5.8 vs 2.7 years (p < 0.001)), were less likely to have received RT (p < 0.001), endocrine therapy (ET) (p < 0.005) or combined RT/ET (< 0.001) as initial treatment, but the characteristics of their initial primary cancers and of their IBTR were comparable. At a median follow-up of 10.7 years following initial BCT and 6.5 years following IBTR, there were no differences in BCSS or OS between RCT and mastectomy. CONCLUSION For BCT patients who developed IBTR as a first event, we observed comparable BCSS and OS from time of initial treatment and from time of IBTR, whether treated by RCT or mastectomy. These results support wider consideration of RCT in the management of IBTR, especially in the setting of older age and longer DFI.
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Affiliation(s)
| | - Ishita Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 300 East 66th St, New York, NY, 10065, USA
| | - Tiana Le
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Hannoun-Levi JM, Gal J, Van Limbergen E, Chand ME, Schiappa R, Smanyko V, Kauer-Domer D, Pasquier D, Lemanski C, Racadot S, Houvenaeghel G, Guix B, Belliere-Calandry A, Loessl K, Polat B, Gutierrez C, Galalae R, Polgar C, Strnad V. Salvage Mastectomy Versus Second Conservative Treatment for Second Ipsilateral Breast Tumor Event: A Propensity Score-Matched Cohort Analysis of the GEC-ESTRO Breast Cancer Working Group Database. Int J Radiat Oncol Biol Phys 2020; 110:452-461. [PMID: 33383125 DOI: 10.1016/j.ijrobp.2020.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Second conservative treatment has emerged as an option for patients with a second ipsilateral breast tumor event after conserving surgery and breast irradiation. We aimed to address the lack of evidence regarding second breast event treatment by comparing oncologic outcomes after conservative treatment or mastectomy. METHODS AND MATERIALS Oncologic outcomes were analyzed using a propensity score-matched cohort analysis study on patients who received a diagnosis of a second breast event between January 1995 and June 2017. Patient data were collected from 15 hospitals/cancer centers in 7 European countries. Patients were offered mastectomy or lumpectomy plus brachytherapy. Propensity scores were calculated with logistic regression and multiple imputations. Matching (1:1) was achieved using the nearest neighbor method, including 10 clinical/pathologic data related to the second breast event. The primary endpoint was 5-year overall survival from the salvage surgery date. Secondary endpoints were 5-year cumulative incidence of third breast event, regional relapse and distant metastasis, and disease-free and specific survival. Complications and 5-year incidence of mastectomy were investigated in the conservative treatment cohort. RESULTS Among the 1327 analyzed patients (mastectomy, 945; conservative treatment, 382), 754 were matched by propensity score (mastectomy, 377; conservative treatment, 377). The median follow-up was 75.4 months (95% confidence interval [CI], 65.4-83.3) and 73.8 months (95% CI, 67.5-80.8) for mastectomy and conservative treatment, respectively (P = .9). In the matched analyses, no differences in 5-year overall survival and cumulative incidence of third breast event were noted between mastectomy and conservative treatment (88% [95% CI, 83.0-90.8] vs 87% [95% CI, 82.1-90.2], P = .6 and 2.3% [95% CI, 0.7-3.9] vs 2.8% [95% CI, 0.8-4.7], P = .4, respectively). Similarly, no differences were observed for all secondary endpoints. Five-year cumulative incidence of mastectomy was 3.1% (95% CI, 1.0-5.1). CONCLUSIONS To our knowledge, this is the largest matched analysis of mastectomy and conservative treatment combining lumpectomy with brachytherapy for second breast events. Compared with mastectomy, conservative treatment does not appear to be associated with any differences in terms of oncologic outcome. Consequently, conservative treatment could be considered a viable option for salvage treatment.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France.
| | - Jocelyn Gal
- Department of Epidemiology and Biostatistics, Antoine Lacassagne Cancer Centre, University of Cote d'Azur, Nice, France
| | - Erik Van Limbergen
- Department of Radiation Oncology, Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Epidemiology and Biostatistics, Antoine Lacassagne Cancer Centre, University of Cote d'Azur, Nice, France
| | - Viktor Smanyko
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Daniela Kauer-Domer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - David Pasquier
- Department of Radiation Oncology, Oscar Lambret Cancer Centre, Lille University, Lille, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France
| | - Séverine Racadot
- Department of Radiation Oncology, Leon Berard Cancer Centre, Lyon, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Paoli-Calmettes Cancer Institute, Marseille, France
| | - Benjamin Guix
- Department of Radiation Oncology, Medical Institute for Radiotherapy & Oncology, Barcelona, Spain
| | | | - Kristina Loessl
- Department of Radiation Oncology, Radiation Oncology, Inselspital, Bern University Hospital, Switzerland
| | - Bulent Polat
- Department of Radiation Oncology, Wurzburg University, Wurzburg, Germany
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Razvan Galalae
- MedAustron Centre for Ion Therapy and Research, Wiener Neustadt, Austria
| | - Csaba Polgar
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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Sagona A, Gentile D, Anghelone CAP, Barbieri E, Marrazzo E, Antunovic L, Franceschini D, Tinterri C. Ipsilateral Breast Cancer Recurrence: Characteristics, Treatment, and Long-Term Oncologic Results at a High-Volume Center. Clin Breast Cancer 2020; 21:329-336. [PMID: 33431329 DOI: 10.1016/j.clbc.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Salvage mastectomy is considered the treatment of choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast-conserving surgery (BCS) is feasible. The purpose of this study was to describe the characteristics of IBCR patients, to compare the 2 therapeutic options in terms of long-term outcomes, and to identify independent factors that may predict the type of treatment. PATIENTS AND METHODS A total of 309 IBCR patients who underwent either repeat BCS or mastectomy were identified. All the analyzed patients with IBCR had true recurrence. RESULTS Repeat BCS and salvage mastectomy were performed in 143 and 166 patients, respectively. Age < 65 years (59.6% vs 37.1% if age ≥ 65 years; odds ratio, 2.374; 95% confidence interval, 0.92-5.24; P = .018) and disease-free interval < 24 months (15.7% vs 10.5% if disease-free interval ≥ 24 months; odds ratio, 2.705; 95% confidence interval, 1.42-5.97; P = .007) were found to significantly increase the probability of receipt of mastectomy. Disease-free survival rates at 3, 5, and 10 years were 79.2%, 68.2%, and 36.9%; and 77.2%, 65.9%, and 55.3% in patients receiving repeat BCS or mastectomy, respectively (P = .842). Overall survival rates at 3, 5, and 10 years were 95.4%, 91.4%, and 68.5%; and 87.3%, 69.3%, and 57.9%, respectively, in patients receiving repeat BCS or mastectomy (P = .018). CONCLUSION Salvage mastectomy should not be considered the only treatment option for IBCR. A second BCS can still be evaluated and proposed to IBCR patients, with acceptable locoregional control and survival. The risk of poor long-term prognosis after mastectomy should be shared with the patient.
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Affiliation(s)
- Andrea Sagona
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Damiano Gentile
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Erika Barbieri
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Emilia Marrazzo
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Lidija Antunovic
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Corrado Tinterri
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
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Walstra CJEF, Schipper RJ, Winter-Warnars GA, Loo CE, Voogd AC, Vrancken Peeters MJTFD, Nieuwenhuijzen GAP, Beets-Tan RGH. Local staging of ipsilateral breast tumor recurrence: mammography, ultrasound, or MRI? Breast Cancer Res Treat 2020; 184:385-395. [PMID: 32770456 PMCID: PMC7599170 DOI: 10.1007/s10549-020-05850-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite increasingly effective curative breast-conserving treatment (BCT) regimens for primary breast cancer, patients remain at risk for an ipsilateral breast tumor recurrence (IBTR). With increasing interest for repeat BCT in selected patients with IBTR, a reliable assessment of the size of IBTR is important for surgical planning. AIM The primary aim of this study is to establish the performance in size estimation of XMG, US, and breast MRI in patients with IBTR. The secondary aim is to compare the detection of multifocality and contralateral lesions between XMG and MRI. PATIENTS AND METHODS The sizes of IBTR on mammography (XMG), ultrasound (US), and magnetic resonance imaging (MRI) in 159 patients were compared to the sizes at final histopathology. The accuracy of the size estimates was addressed using Pearson's coefficient and Bland-Altman plots. Secondary outcomes were the detection of multifocality and contralateral lesions between XMG and MRI. RESULTS Both XMG and US significantly underestimated the tumor size by 3.5 and 4.8 mm, respectively, while MRI provided accurate tumor size estimation with a mean underestimation of 1.1 mm. The sensitivity for the detection of multifocality was significantly higher for MRI compared to XMG (25.5% vs. 5.5%). A contralateral malignancy was found in 4.4% of patients, and in 1.9%, it was detected by MRI only. CONCLUSION The addition of breast MRI to XMG and US in the preoperative workup of IBTR allows for more accurate size estimation. MRI provides a higher sensitivity for the detection of multifocality compared to XMG.
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Affiliation(s)
- Coco J E F Walstra
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | | | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Ma W, Zhang Y, Yu M, Wang B, Xu S, Zhang J, Li X, Ye X. In-vitro and in-vivo anti-breast cancer activity of synergistic effect of berberine and exercise through promoting the apoptosis and immunomodulatory effects. Int Immunopharmacol 2020; 87:106787. [PMID: 32707493 DOI: 10.1016/j.intimp.2020.106787] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/12/2020] [Accepted: 07/04/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer is the most common reason of cancer death in women. Berberine (BBR), a main alkaloid in Coptis chinensis, exerted anti-cancer activities. Exercise is a new immunotherapy treatment against cancer. However, it is unclear whether exercise has effects on breast cancer and whether exercise has synergistic anti-cancer effect when co-treated with BBR. Thus, it is assumed that exercise might exert an anti-cancer effect through the immune way. METHOD The anti-tumor effect of exercise and BBR in vivo was studied in mice. The MTT method, hoechst staining and cell morphology were performed to determine the synergistic effect of exercise and BBR on breast cancer in vitro. At the same time, Western blotting, intestinal microbial and SCFA detection, Q-PCR and other methods were used to study the anti-cancer molecular mechanism. RESULTS The study found that exercise and BBR co-treatment significantly slowed the progression of breast cancer in 4T1 tumor-bearing mice (p < 0.01). Compared with the TC group, the infiltration of NK cells increased in the combined group of BBR and exercise (p < 0.01), and the expression of immune factors and cytokines was also regulated. At the same time, the synergistic effect significantly increased the level of short chain fatty acids (SCFA). SCFA can promote apoptosis of 4T1 cells and change the inflammatory factors in vitro. The expression of bcl-2 and XIAP was reduced in tumor tissues, and the expression of Fas, Fadd, Bid, Cyto-C, and Caspase-3/8/9 was also increased in vitro experiments (p < 0.05). CONCLUSIONS These results indicate that the synergistic treatment of exercise and BBR can improve the immune system, regulate intestinal microbial metabolite (SCFA), activate the mitochondrial apoptosis pathway and Fas death receptor apoptosis pathway, and thus play an anticancer role. This may provide a new method for the treatment of breast cancer.
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Affiliation(s)
- Wenyu Ma
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Yaru Zhang
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Min Yu
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Bin Wang
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Shiyu Xu
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Jian Zhang
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China
| | - Xuegang Li
- School of Pharmaceutical Sciences, Southwest University, Chongqing 400716, China.
| | - Xiaoli Ye
- Chongqing Key Laboratory of Plant Resource Conservation and Germplasm Innovation, School of Life Sciences, Southwest University, Chongqing 400715, China.
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Vavassori A, Riva G, Cavallo I, Spoto R, Dicuonzo S, Fodor C, Comi S, Cambria R, Cattani F, Morra A, Leonardi MC, Lazzari R, Intra M, Luini A, Galimberti VE, Veronesi P, Orecchia R, Jereczek-Fossa BA. High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study. J Contemp Brachytherapy 2020; 12:207-215. [PMID: 32695191 PMCID: PMC7366017 DOI: 10.5114/jcb.2020.96860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate clinical results of catheter-based interstitial high-dose-rate (HDR) brachytherapy (BT) as adjuvant treatment in previously irradiated recurrent breast cancer. MATERIAL AND METHODS Between January 2011 and September 2015, 31 consecutive patients with histologically confirmed recurrent breast cancer after conservative surgery and conventional whole breast radiotherapy, were retreated with a second conservative surgical resection and reirradiated with adjuvant interstitial HDR-BT. None of the brachytherapy implant was performed during the quadrantectomy procedure. A dose of 34 Gy in 10 fractions, 2 fractions per day, with a minimal interval of 6 hours was delivered. RESULTS At the time of the implant, the median age of patients was 59.7 years (range, 39.3-74.9 years). The median time from first treatment until BT for local recurrence was 11.9 years (range, 2.5-27.8 years). The median interval between salvage surgery and BT was 3.6 months (range, 1-8.2 months). No acute epidermitis or soft tissue side effects higher than grade 2 were recorded, with good cosmetic results in all patients. Most of the patients presented grade 1-2 late side effects. Only one patient developed grade 3 liponecrosis. After a median follow-up of 73.7 months (range, 28.8-102.4 months), the overall survival and cancer specific survival were 87.1% and 90.3%, respectively; 5-year local control and 5-year progression-free survival rate were 90.3% and 83.9%, respectively. CONCLUSIONS Our preliminary analysis showed that HDR-BT is a feasible treatment for partial breast reirradiation offering very low complications rate and fast procedure. Higher patients' cohort is warranted in order to define the role of this treatment modality in the breast conservative management of local recurrence.
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Affiliation(s)
- Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Riva
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Iacopo Cavallo
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy
| | - Ruggero Spoto
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Cristiana Fodor
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Morra
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Roberta Lazzari
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Luini
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Paolo Veronesi
- Department of Breast Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy
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Buchholz TA, Ali S, Hunt KK. Multidisciplinary Management of Locoregional Recurrent Breast Cancer. J Clin Oncol 2020; 38:2321-2328. [PMID: 32442059 DOI: 10.1200/jco.19.02806] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas A Buchholz
- Division of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, CA
| | - Sonia Ali
- Division of Medical Oncology, Scripps MD Anderson Cancer Center, San Diego, CA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ozmen V, Ilgun S, Celet Ozden B, Ozturk A, Aktepe F, Agacayak F, Elbuken F, Alco G, Ordu C, Erdogan Iyigun Z, Emre H, Pilancı K, Soybir G, Ozmen T. Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates. World J Surg Oncol 2020; 18:87. [PMID: 32370753 PMCID: PMC7201547 DOI: 10.1186/s12957-020-01858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. PATIENTS AND METHODS The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. RESULTS A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14-116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). DISCUSSION The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
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Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Istanbul, Turkey
| | - Serkan Ilgun
- Department of General Surgery, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Burcu Celet Ozden
- Department of Plastic and Reconstructive Surgery, School of Medicine, Altinbas University, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, School of Medicine, Biruni University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Department of Physical Therapy and Rehabilitation, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Hocaoglu Emre
- Department of Plastic & Reconstructive Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban Pilancı
- Department of Medical Oncology, Bahcesehir Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Tolga Ozmen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Montagne L, Hannoun A, Hannoun-Levi JM. Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques. Breast 2020; 49:274-280. [PMID: 31945697 PMCID: PMC7375668 DOI: 10.1016/j.breast.2020.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
AIM To address the different partial breast re-irradiation techniques available in the context of second conservative treatment (SCT), as an alternative to salvage mastectomy, for 2nd ipsilateral breast tumor event (IBTE) and summarize their respective oncological and toxicity outcomes. MATERIAL AND METHODS A literature search was made based on MeSH/PubMed, including papers from 1995 to 2019. Each article was described according to the main irradiation technique, fractionation, oncological results and grade 3 toxicities related to the salvage conservative treatment. RESULTS Twenty-two articles were identified, reporting the outcomes of over 1 000 patients. MIB Brachytherapy was the most used re-irradiation technique in case of SCT, with a median 3rdIBTE-FS rate of 88% and summed up grade 3 toxicities of 6%. As for IORT, the average rate of 3rdIBTE-FS was about Finally, external beam partial re-irradiation was recently tested in this indication with encouraging results in terms of tolerance. CONCLUSION When presenting a 2ndIBTE, a SCT can safely be proposed to carefully selected and well-informed patients, as an alternative to salvage mastectomy. MIB appears to be the first intention and most robust choice. IORT, external beam radiotherapy and balloon brachytherapy are interesting alternatives but have only been tested in small series. Further investigations are required and their use should be limited to clinical trial only.
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Affiliation(s)
- Lucile Montagne
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote D'Azur, Nice, France
| | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote D'Azur, Nice, France.
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Leonardi MC, Tomio L, Radice D, Takanen S, Bonzano E, Alessandro M, Ciabattoni A, Ivaldi GB, Bagnardi V, Alessandro O, Francia CM, Fodor C, Miglietta E, Veronesi P, Galimberti VE, Orecchia R, Tagliaferri L, Vidali C, Massaccesi M, Guenzi M, Jereczek-Fossa BA. Local Failure After Accelerated Partial Breast Irradiation with Intraoperative Radiotherapy with Electrons: An Insight into Management and Outcome from an Italian Multicentric Study. Ann Surg Oncol 2019; 27:752-762. [DOI: 10.1245/s10434-019-08075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Indexed: 12/19/2022]
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Al-Hilli Z, Grobmyer SR. Management Strategies for Locally Recurrent Breast Cancer: Redo-Lumpectomy, Redo-Sentinel Node Biopsy, Redo-Radiation. Ann Surg Oncol 2019; 26:3018-3024. [DOI: 10.1245/s10434-019-07545-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/27/2022]
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