2
|
Spring LM, Specht MC, Jimenez RB, Isakoff SJ, Wang GX, Ly A, Shin JA, Bardia A, Moy B. Case 22-2020: A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic. N Engl J Med 2020; 383:262-272. [PMID: 32610007 PMCID: PMC7346678 DOI: 10.1056/nejmcpc2002422] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Laura M Spring
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Michelle C Specht
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Rachel B Jimenez
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Steven J Isakoff
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Gary X Wang
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Amy Ly
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Jennifer A Shin
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Aditya Bardia
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| | - Beverly Moy
- From the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Massachusetts General Hospital, and the Departments of Medicine (L.M.S., S.J.I., J.A.S., A.B., B.M.), Surgery (M.C.S.), Radiation Oncology (R.B.J.), Radiology (G.X.W.), and Pathology (A.L.), Harvard Medical School - both in Boston
| |
Collapse
|
3
|
Raphael MJ, Saskin R, Singh S. Association between waiting time for radiotherapy after surgery for early-stage breast cancer and survival outcomes in Ontario: a population-based outcomes study. ACTA ACUST UNITED AC 2020; 27:e216-e221. [PMID: 32489271 DOI: 10.3747/co.27.5629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background After surgery for early-stage breast cancer (bca), adjuvant radiotherapy (rt) decreases the risk of locoregional recurrence and death from bca. It is unclear whether delays to the initiation of adjuvant rt are associated with inferior survival outcomes. Methods This population-based retrospective cohort study included a random sample of 25% of all women with stage i or ii bca treated with adjuvant rt in Ontario between 1 September 2001 and 31 August 2002, when, because of capacity issues, wait times for radiation were abnormally long. Pathology reports were manually abstracted and deterministically linked to population-level administrative databases to obtain information about recurrence and survival outcomes. Cox proportional hazards modelling was used to evaluate the association between waiting time and survival outcomes. A composite survival outcome was used to ensure that all possible measurable harms of delay would be captured. The composite outcome, event-free survival, included locoregional recurrence, development of metastatic disease, and bca-specific mortality. Results We identified 1028 women with stage i or ii bca who were treated with breast-conserving surgery and adjuvant rt. For the 599 women who were treated with adjuvant radiation without intervening chemotherapy, a waiting time of 12 weeks or more from surgery to the start of radiation appeared to be associated with worse event-free survival after a median follow-up of 7.2 years (hazard ratio for the composite outcome: 1.44; 95% confidence interval: 0.98 to 2.11; p = 0.07). For the 429 women who received intervening adjuvant chemotherapy, a waiting time of 6 weeks or more from completion of chemotherapy to start of radiation was associated with worse event-free survival after a median follow-up of 7.4 years (hazard ratio: 1.50; 95% confidence interval: 1.00 to 2.22; p = 0.047). Conclusions Delay to the initiation of adjuvant rt after breast-conserving surgery is associated with inferior bca survival outcomes. The good prognosis for patients with early-stage bca limits the statistical power to detect an effect of delay to rt. Given that there is no plausible advantage to delay, we agree with Mackillop that time to initiation of rt should be kept "as short as reasonably achievable."
Collapse
Affiliation(s)
- M J Raphael
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON
| | | | - S Singh
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON.,ices, Toronto, ON
| |
Collapse
|
4
|
van Maaren MC, Bretveld RW, Jobsen JJ, Veenstra RK, Groothuis-Oudshoorn CG, Struikmans H, Maduro JH, Strobbe LJ, Poortmans PM, Siesling S. The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. Br J Cancer 2017; 117:179-188. [PMID: 28588320 PMCID: PMC5520509 DOI: 10.1038/bjc.2017.159] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/28/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort. Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes. Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38–0.94)) and 42–55 days (HR 0.64 (95% CI: 0.45–0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42–55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days. Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.
Collapse
Affiliation(s)
- Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands.,Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
| | - Reini W Bretveld
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
| | - Jan J Jobsen
- Department of Radiation Oncology, Medical Spectrum Twente, PO Box 217, Enschede 7500 AE, The Netherlands
| | - Renske K Veenstra
- Department of Operations, Medical Research Data Management B.V., PO Box 90, Deventer 7400 AB, The Netherlands
| | - Catharina Gm Groothuis-Oudshoorn
- Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
| | - Hendrik Struikmans
- Department of Radiation Oncology, Haaglanden Medical Center, PO Box 432, The Hague 2501 CK, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Luc Ja Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Philip Mp Poortmans
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, Paris 75005, France
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands.,Department of Health Technology &Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
| |
Collapse
|
6
|
Dave R, O'Connell R, Rattay T, Tolkien Z, Barnes N, Skillman J, Williamson P, Conroy E, Gardiner M, Harnett A, O'Brien C, Blazeby J, Potter S, Holcombe C. The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy. BMJ Open 2016; 6:e012678. [PMID: 27855106 PMCID: PMC5073644 DOI: 10.1136/bmjopen-2016-012678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy. METHODS AND ANALYSIS Breast and plastic surgery centres in the UK performing mastectomy with or without (±) IBR will be invited to participate in the study through the trainee research collaborative network. All women undergoing mastectomy ± IBR for breast cancer between 1 July and 31 December 2016 will be included. Patient demographics, operative, oncological and complication data will be collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR will be compared to determine the impact that IBR has on the time of delivery of adjuvant therapy. Prospective data on 3000 patients from ∼50 centres are anticipated. ETHICS AND DISSEMINATION Research ethics approval is not required for this study. This has been confirmed using the online Health Research Authority decision tool. This novel study will explore whether IBR impacts the time to delivery of adjuvant therapy. The study will provide valuable information to help patients and surgeons make more informed decisions about their surgical options. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative (MFAC) and the Reconstructive Surgery Trials Network (RSTN), the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Participating units will have access to their own data and collective results will be presented at relevant surgical conferences and published in appropriate peer-reviewed journals.
Collapse
Affiliation(s)
- Rajiv Dave
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester, UK
| | - Zoe Tolkien
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicola Barnes
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Paula Williamson
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Conroy
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Jane Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| |
Collapse
|