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Chen Y, Qi Y, Wang K. Neoadjuvant chemotherapy for breast cancer: an evaluation of its efficacy and research progress. Front Oncol 2023; 13:1169010. [PMID: 37854685 PMCID: PMC10579937 DOI: 10.3389/fonc.2023.1169010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) for breast cancer is widely used in the clinical setting to improve the chance of surgery, breast conservation and quality of life for patients with advanced breast cancer. A more accurate efficacy evaluation system is important for the decision of surgery timing and chemotherapy regimen implementation. However, current methods, encompassing imaging techniques such as ultrasound and MRI, along with non-imaging approaches like pathological evaluations, often fall short in accurately depicting the therapeutic effects of NAC. Imaging techniques are subjective and only reflect macroscopic morphological changes, while pathological evaluation is the gold standard for efficacy assessment but has the disadvantage of delayed results. In an effort to identify assessment methods that align more closely with real-world clinical demands, this paper provides an in-depth exploration of the principles and clinical applications of various assessment approaches in the neoadjuvant chemotherapy process.
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Affiliation(s)
- Yushi Chen
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Pathology, Basic Medical School, Central South University, Changsha, Hunan, China
| | - Yu Qi
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Pathology, Basic Medical School, Central South University, Changsha, Hunan, China
| | - Kuansong Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Pathology, Basic Medical School, Central South University, Changsha, Hunan, China
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2
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Wilkinson AN, Seely JM, Rushton M, Williams P, Cordeiro E, Allard-Coutu A, Look Hong NJ, Moideen N, Robinson J, Renaud J, Mainprize JG, Yaffe MJ. Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing. Curr Oncol 2023; 30:7860-7873. [PMID: 37754486 PMCID: PMC10527628 DOI: 10.3390/curroncol30090571] [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: 07/19/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. METHODS ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. RESULTS BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. CONCLUSION The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.
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Affiliation(s)
- Anna N. Wilkinson
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Jean M. Seely
- Department of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Moira Rushton
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Phillip Williams
- Division of Anatomic Pathology, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada;
| | - Erin Cordeiro
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | - Alexandra Allard-Coutu
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | | | - Nikitha Moideen
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Jessica Robinson
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Julie Renaud
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - James G. Mainprize
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
| | - Martin J. Yaffe
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
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Jing H, Tang Y, Wang ZZ, Wei R, Jin JY, Li J, Zhao LY, Jin J, Liu YP, Song YW, Fang H, Chen B, Qi SN, Lu NN, Tang Y, Li N, Zhai YR, Zhang WW, Wang SL, Li YX. Individualized Clinical Target Volume for Irradiation of the Supraclavicular Region in Breast Cancer Based on Mapping of the Involved Ipsilateral Supraclavicular Lymph Nodes. Int J Radiat Oncol Biol Phys 2023; 115:922-932. [PMID: 36368434 DOI: 10.1016/j.ijrobp.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To map supraclavicular fossa-involved lymph nodes (SCF-LNs) in patients with nonmetastatic breast cancer, evaluate the coverage of widely adopted atlases, and propose modified borders for individualized regional irradiation. METHODS AND MATERIALS M0 patients with biopsy-proven SCF-LNs who were SCF treatment-naïve were included. The SCF was spatially divided into subregions, with each node mapped on the original images. The geographic misses after the borders of multiple atlases were evaluated and factors affecting SCF-LNs' spread pattern were analyzed. RESULTS From 1998 to 2022, 209 patients with 1242 SCF-LNs were eligible. Patients had a median of 4 nodes. At least 537 nodes (43.2%) in 147 patients (70.3%) were lateral to the sternocleidomastoid muscle (SCM), and 403 nodes (32.4%) in 127 patients (60.8%) were dorsal to the anterior scalene muscle (ASM). In the 88 patients with ≤3 SCF-LNs, at least 66 nodes (39.1%) in 40 patients (45.5%) were lateral to the SCM, and 34 nodes (20.1%) in 29 patients (33.0%) were dorsal to the ASM. These nodes were not covered by the Radiation Therapy Oncology Group (RTOG) atlas and partly within the Radiotherapy Comparative Effectiveness atlas. One hundred four patients (49.8%) had 432 SCF-LNs (34.8%) beyond the upper border of the European Society for Radiotherapy and Oncology (ESTRO) atlas. In multivariate regression, nodal sizes were associated with wider spread in the primary group. Being triple-negative (TN) subtype was associated with less spread in the recurrent group. Situation-based clinical target volumes (CTVs) were theorized, in which for a sequential spread, the posterior border could be the posterior scalene muscle or even be more constringent; otherwise, it should touch the anterior trapezius surface. CONCLUSIONS SCF-LNs tend to spread laterally and dorsally beyond the RTOG borders, even in M0 stages with ≤3 SCF-LNs. The ESTRO upper border does not guarantee coverage with multiple SCF-LNs. Nodal burden and non-TN types are predictive of wider dissemination. A situation-based CTV is possibly feasible. Deciphering the SCF-LN spread route is needed.
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Affiliation(s)
- Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zong-Zhan Wang
- Department of Radiation Oncology, Qingdao Central Hospital, Qing Dao, Shan Dong, China
| | - Ran Wei
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Jin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Radiation Oncology, Beijng Hospital, Beijing, China
| | - Li-Yun Zhao
- Department of Radiation Oncology, Beijng Hospital, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Rui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Lin B, Fan J, Liu F, Wen Y, Li J, Gao F, Zhang Y, Feng G, Du X, Chen W. Efficacy and Safety of Dual Anti-HER2 Blockade and Docetaxel With or Without Carboplatin as Neoadjuvant Regimen for Treatment of HER2-Positive Breast Cancer. Technol Cancer Res Treat 2023; 22:15330338231218152. [PMID: 38031361 PMCID: PMC10687954 DOI: 10.1177/15330338231218152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/21/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: This study aimed to compare the efficacy and safety of docetaxel + trastuzumab + pertuzumab and docetaxel + carboplatin + trastuzumab + pertuzumab for treating HER2-positive breast cancer. Method: HER2-positive breast cancer from patients diagnosed between January 2020 and September 2022 were included in this retrospective study. Docetaxel + trastuzumab + pertuzumab or docetaxel + carboplatin + trastuzumab + pertuzumab was selected as the neoadjuvant regimen. The primary endpoint was a complete pathological remission rate. Secondary endpoints were toxicity during neoadjuvant treatment, adjustment of the neoadjuvant therapy scheme, and adjuvant medication. Result: A total of 81 patients were included in this study (38 in the docetaxel + carboplatin + trastuzumab + pertuzumab treatment group and 43 in the docetaxel + trastuzumab + pertuzumab group). The complete pathological remission rates in the docetaxel + carboplatin + trastuzumab + pertuzumab and docetaxel + trastuzumab + pertuzumab groups were 44.7% (95% confidence interval: 30.2%-60.3%) and 51.2% (95% confidence interval: 36.8%-65.4%), respectively. The incidence of grade 3 or higher toxicity in the docetaxel + carboplatin + trastuzumab + pertuzumab group was significantly higher than that in the docetaxel + trastuzumab + pertuzumab group (68.4% vs 39.5%, P = .009). Neutropenia and asthenia were the most common grade 3 or higher toxicities. The incidence of neoadjuvant scheme adjustment was significantly higher in the docetaxel + carboplatin + trastuzumab + pertuzumab group than in the docetaxel + trastuzumab + pertuzumab group (26.3% vs 7.0%, P = .039). The proportion of patients who received <6 cycles of neoadjuvant therapy was significantly higher in the docetaxel + carboplatin + trastuzumab + pertuzumab group than in the docetaxel + trastuzumab + pertuzumab group (31.6% vs 4.7%, P = .004). Patients in the docetaxel + carboplatin + trastuzumab + pertuzumab group received higher doses of granulocyte-macrophage colony-stimulating factor. Conclusion: In the neoadjuvant treatment of HER2-positive breast cancer, the docetaxel + trastuzumab + pertuzumab regimen might be more tolerated than the docetaxel + carboplatin + trastuzumab + pertuzumab regimen and did not show a lower complete pathological remission rate. However, our findings require further validation through prospective studies.
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Affiliation(s)
- Binwei Lin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Jinjia Fan
- Departmant of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Fang Liu
- Departmant of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yixue Wen
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Jie Li
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Feng Gao
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Yu Zhang
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Gang Feng
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Xiaobo Du
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Department of Oncology, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
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Toss A, Venturelli M, Civallero M, Piombino C, Domati F, Ficarra G, Combi F, Cabitza E, Caggia F, Barbieri E, Barbolini M, Moscetti L, Omarini C, Piacentini F, Tazzioli G, Dominici M, Cortesi L. Predictive factors for relapse in triple-negative breast cancer patients without pathological complete response after neoadjuvant chemotherapy. Front Oncol 2022; 12:1016295. [DOI: 10.3389/fonc.2022.1016295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
IntroductionTriple-negative breast cancer (TNBC) patients who do not obtain pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) present higher rate of relapse and worse overall survival. Risk factors for relapse in this subset of patients are poorly characterized. This study aimed to identify the predictive factors for relapse in TNBC patients without pCR after NACT.MethodsWomen with TNBC treated with NACT from January 2008 to May 2020 at the Modena Cancer Center were included in the analysis. In patients without pCR, univariate and multivariable Cox analyses were used to determine factors predictive of relapse.ResultsWe identified 142 patients with a median follow-up of 55 months. After NACT, 62 patients obtained pCR (43.9%). Young age at diagnosis (<50 years) and high Ki-67 (20%) were signi!cantly associated with pCR. Lack of pCR after NACT resulted in worse 5-year event-free survival (EFS) and overall survival (OS). Factors independently predicting EFS in patients without pCR were the presence of multifocal disease [hazard ratio (HR), 3.77; 95% CI, 1.45–9.61; p=0.005] and residual cancer burden (RCB) III (HR, 3.04; 95% CI, 1.09–9.9; p=0.04). Neither germline BRCA status nor HER2-low expression were associated with relapse.DiscussionThese data can be used to stratify patients and potentially guide treatment decision-making, identifying appropriate candidates for treatment intensi!cation especially in neo-/adjuvant setting.
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Zhang Y, Qiu L, Ren Y, Cheng Z, Li L, Yao S, Zhang C, Luo Z, Lu H. A meta-learning approach to improving radiation response prediction in cancers. Comput Biol Med 2022; 150:106163. [PMID: 37070625 DOI: 10.1016/j.compbiomed.2022.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/18/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Predicting the efficacy of radiotherapy in individual patients has drawn widespread attention, but the limited sample size remains a bottleneck for utilizing high-dimensional multi-omics data to guide personalized radiotherapy. We hypothesize the recently developed meta-learning framework could address this limitation. METHODS AND MATERIALS By combining gene expression, DNA methylation, and clinical data of 806 patients who had received radiotherapy from The Cancer Genome Atlas (TCGA), we applied the Model-Agnostic Meta-Learning (MAML) framework to tasks consisting of pan-cancer data, to obtain the best initial parameters of a neural network for a specific cancer with smaller number of samples. The performance of meta-learning framework was compared with four traditional machine learning methods based on two training schemes, and tested on Cancer Cell Line Encyclopedia (CCLE) and Chinese Glioma Genome Atlas (CGGA) datasets. Moreover, biological significance of the models was investigated by survival analysis and feature interpretation. RESULTS The mean AUC (Area under the ROC Curve) [95% confidence interval] of our models across nine cancer types was 0.702 [0.691-0.713], which improved by 0.166 on average over other the four machine learning methods on two training schemes. Our models performed significantly better (p < 0.05) in seven cancer types and performed comparable to the other predictors in the rest of two cancer types. The more pan-cancer samples were used to transfer meta-knowledge, the greater the performance improved (p < 0.05). The predicted response scores that our models generated were negatively correlated with cell radiosensitivity index in four cancer types (p < 0.05), while not statistically significant in the other three cancer types. Moreover, the predicted response scores were shown to be prognostic factors in seven cancer types and eight potential radiosensitivity-related genes were identified. CONCLUSIONS For the first time, we established the meta-learning approach to improving individual radiation response prediction by transferring common knowledge from pan-cancer data with MAML framework. The results demonstrated the superiority, generalizability, and biological significance of our approach.
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Ariani R, Hwang L, Maliglig AM, Ragab O, Ye JC. Temporality and Patterns of Metastatic Recurrence in Node-Positive Breast Cancer Following Trimodality Therapy: Opportunity for Improved Oligometastases Detection and Salvage Local Therapy. Am J Clin Oncol 2022; 45:88-94. [PMID: 34991105 DOI: 10.1097/coc.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is evidence that detection and treatment of oligometastases (≤5 lesions) may improve survival in breast cancer patients. However, there are no current national guidelines for screening of early, asymptomatic metastases. This study examined the patterns and timing of recurrence with respect to survival in node-positive breast cancer (NPBC) patients at higher risk for developing metastases. METHODS A single-institution retrospective review of NPBC patients treated with trimodality therapy was performed to collect patient and disease characteristics, recurrence location, method of detection, and survival outcome. Univariate and multivariate analyses were done to identify factors associated with recurrence. RESULTS Ninety-four NPBC patients treated at a safety-net hospital between 2008 and 2019 were identified. Twenty-one developed recurrence and were divided into oligometastatic (OM) (n=10) or diffusely metastatic (DM) (n=11) subgroups. Median recurrence-free survival in OM and DM was 18 and 36 months, respectively. Median overall survival (OS) for OM was not reached. Median OS for DM was 57 months. Four patients with OM progressed to diffuse disease in a median period of 17 months; median survival thereafter was 57 months. All patients with recurrence had distant metastases on initial detection, with the most common site being bone (14). Recurrence was most frequently detected by computed tomography (CT) (13), with the majority of disease located within the thorax region. CONCLUSIONS All NPBC patients had distant metastasis at time of recurrence. Patients with OM had shorter interval to recurrence yet longer OS compared with DM. This study highlights improved surveillance imaging for timely detection of OM breast cancer that may yet be amenable to aggressive local salvage therapy to prevent progression to diffuse disease.
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Affiliation(s)
| | | | - Ana M Maliglig
- Radiology, Keck School of Medicine of University of Southern California, Los Angeles, CA
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8
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Lognos B, Glondu-Lassis M, Senesse P, Gutowski M, Jacot W, Lemanski C, Amouyal M, Azria D, Guerdoux E, Bourgier C. [Non-pharmalogical interventions and breast cancer: What benefit in addition to radiotherapy?]. Cancer Radiother 2021; 26:637-645. [PMID: 34756691 DOI: 10.1016/j.canrad.2021.09.011] [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: 06/21/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
Adjuvant radiotherapy is one of the major anticancer treatments in early breast cancer patients. Acute and late radio-induced effects may occur during or after breast cancer radiotherapy, and their medical management is a major issue for radiation oncologists. Here, the present review of literature embraces complementary non-pharmacological interventions, which could be combined to adjuvant radiotherapy in order to improve patients care.
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Affiliation(s)
- Béatrice Lognos
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France; UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France; Maison de santé pluriprofessionnelle universitaire Pauline Lautaud, St Georges d'Orques, Prades le Lez, Vendargues, France.
| | - Murielle Glondu-Lassis
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France; UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France
| | - Pierre Senesse
- Département des Soins de Support, Institut Régional du Cancer de Montpellier (ICM), France
| | - Marian Gutowski
- Département de Chirurgie, Institut Régional du Cancer de Montpellier (ICM), France
| | - William Jacot
- Département d'oncologie Médicale, Institut Régional du Cancer de Montpellier (ICM), France
| | - Claire Lemanski
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France
| | - Michel Amouyal
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France
| | - David Azria
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Univ Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - Estelle Guerdoux
- UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France; Département des Soins de Support, Institut Régional du Cancer de Montpellier (ICM), France
| | - Céline Bourgier
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Univ Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
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Belkacemi Y, Debbi K, Loganadane G, Ghith S, Hadhri A, Hassani W, Cherif MA, Coraggio G, To NH, Colson-Durand L, Grellier N. [Adjuvant and neoadjuvant radiotherapy in breast cancer: A literaure review and update on the state of the evidence in 2020]. Cancer Radiother 2020; 24:482-492. [PMID: 32839105 DOI: 10.1016/j.canrad.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Radiation therapy has benefited from many developments over the past 20 years. These developments are mainly linked to the technology, imaging and informatics evolutions which allow better targets definitions, ensure better organs-at-risk sparing and excellent reproducibility of treatments, with a perfect control of patient positioning. In breast cancer radiotherapy, the evolution was marked by the possibility of reducing the duration of treatments from 6-7 to 3-4 weeks by using hypofractionated regimens, or by further reducing the irradiation to one week when treatment is solely focalised to the tumour bed. This concept of accelerated partial breast irradiation has challenged the paradigm of the obligation to irradiate the whole breast after conservative surgery in all patients. In addition, the technical mastery of accelerated partial breast irradiation and the development of stereotactic radiotherapy techniques are currently contributing to the development of research projects in neoadjuvant settings. Thus, numerous ongoing studies are evaluating the impact of high-dose preoperative tumour irradiation, alone or in combination with systemic treatments, on biological tumor changes, on anti-tumour immunity, and on the pathologic complete response, which is considered as predictive of better long-term survival in some molecular breast cancer subtypes. In this review, we discuss all these developments which allow breast radiation therapy to enter the era of personalisation of treatments in oncology.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - G Loganadane
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France
| | - S Ghith
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
| | - A Hadhri
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - W Hassani
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - M A Cherif
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - G Coraggio
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - N H To
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
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