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Barnes LL, Chew J, Lem M, Park C, Yang JC, Prionas N, Piper M. Modifiable Postmastectomy Radiation Therapy Factors and Impact on Implant-Based Breast Reconstruction Outcomes. Plast Reconstr Surg 2024; 153:1000-1009. [PMID: 37335545 DOI: 10.1097/prs.0000000000010824] [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: 06/21/2023]
Abstract
BACKGROUND Intensity-modulated radiation therapy and other modifiable radiation factors have been associated with decreased radiation toxicity. These factors could allow for improved reconstructive outcomes in patients requiring postmastectomy radiation therapy (PMRT). However, they have not yet been well studied in implant-based breast reconstruction. METHODS The authors performed a retrospective chart review of patients who underwent mastectomy with immediate tissue expander placement followed by PMRT. Radiation characteristics were collected, including radiation technique, bolus regimen, x-ray energy, fractionation, maximum radiation hot spot, and tissue volume receiving more than 105% or more than 107% of the prescription dose. Reconstructive complications occurring after initiation of PMRT were analyzed with respect to these radiation characteristics. RESULTS Sixty-eight patients (70 breasts) were included in this study. The overall complication rate was 28.6%, with infection being the most common complication (24.3%), requiring removal of the tissue expander or implant in greater than half of infections (15.7%). Maximum radiation hot spot was greater in patients who required explantation after PMRT, and this approached statistical significance (114.5% ± 7.2% versus 111.4% ± 4.4%; P = 0.059). Tissue volume receiving more than 105% and 107% were also greater in patients who required explantation after PMRT (42.1% ± 17.1% versus 33.0% ± 20.9% and 16.4% ± 14.5% versus 11.3% ± 14.6%, respectively); however, this was not statistically significant ( P = 0.176 and P = 0.313, respectively). There were no significant differences in complication rates between patients with respect to radiation technique or other radiation characteristics studied. CONCLUSION Minimizing the radiation hot spots and volumes of tissue receiving greater than the prescription dose of radiation may improve reconstructive outcomes in patients undergoing implant-based breast reconstruction followed by PMRT. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Jessica Chew
- Department of Radiation Oncology, University of California, San Francisco
| | - Melinda Lem
- From the Division of Plastic and Reconstructive Surgery
| | - Catherine Park
- Department of Radiation Oncology, University of California, San Francisco
| | - Joanna C Yang
- Department of Radiation Oncology, Washington University
| | - Nicolas Prionas
- Department of Radiation Oncology, University of California, San Francisco
| | - Merisa Piper
- From the Division of Plastic and Reconstructive Surgery
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Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group. Radiol Med 2020; 125:674-682. [DOI: 10.1007/s11547-020-01147-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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Liu N, Yang Z, Liu X, Niu Y. Lymph node status in different molecular subtype of breast cancer: triple negative tumours are more likely lymph node negative. Oncotarget 2017; 8:55534-55543. [PMID: 28903439 PMCID: PMC5589678 DOI: 10.18632/oncotarget.15022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/09/2017] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives To investigate the association between different molecular subtype (MST) and the axillary lymph nodal (ALN) status. Materials and Methods A total of 528 female patients with primary breast cancer were collected. Survival estimates were calculated using the Kaplan-Meier method, univariate and multivariate logistic regression models. Results Triple negative and Luminal A breast cancers were more frequently node-negative (N0) when compared to Luminal B and Her-2 positive cancers (77.4% and 73.4% vs. 45.3% and 40.0%, respectively; P < 0.0001). We observed a clearly significant difference among ALN status in patients with Her-2 positive (P = 0.001) and Luminal B (P < 0.0001) breast cancer. While no significant prognostic diffreence among different LN status was detected in the Triple negative (P = 0.070) and Luminal A subtype (P = 0.660). On the other hand, we detected no prognostic diffreence among different MST in N1 and N3 subgroups (P = 0.569 and P = 0.484, respectively). Multivariate analysis showed that lymph node status (P < 0.01), molecular subtype (P < 0.01), and tumor size (P < 0.01) were significantly and independently prognostic factors. The c-index of the prognosis nomogram for recurrence prediction was 0.70. Conclusion Triple negative breast cancer is not associated more frequently with a higher number of involved nodes. The prognosis nomogram can predict the probability of recurrence patients within 3 or 5 years.
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Affiliation(s)
- Ning Liu
- Department of Pathology, Bao Di Hospital, Bao Di Clinical College of Tianjin Medical University, Tianjin, China
| | - Zhigang Yang
- Tianjin Baodi Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Xiaozhen Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Yun Niu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
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Walston S, Quick AM, Kuhn K, Rong Y. Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation. Technol Cancer Res Treat 2016; 16:22-32. [PMID: 26755749 DOI: 10.1177/1533034615624311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol. MATERIAL AND METHODS Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breath-hold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans. RESULTS Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose. CONCLUSION Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.
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Affiliation(s)
- Steve Walston
- 1 Department of Radiation Oncology, The James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allison M Quick
- 1 Department of Radiation Oncology, The James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Karla Kuhn
- 1 Department of Radiation Oncology, The James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yi Rong
- 2 Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Shen H, Zhao L, Wang L, Liu X, Liu X, Liu J, Niu F, Lv S, Niu Y. Postmastectomy radiotherapy benefit in Chinese breast cancer patients with T1-T2 tumor and 1-3 positive axillary lymph nodes by molecular subtypes: an analysis of 1369 cases. Tumour Biol 2015; 37:6465-75. [PMID: 26631044 DOI: 10.1007/s13277-015-4546-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/27/2015] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to examine the association between molecular subtype (MST) and prognosis and research the postmastectomy radiotherapy (PMRT) effect in T1-T2 tumors with 1-3 positive axillary lymph nodes (ALNs). This retrospective study studied breast cancer patients with T1-T2 tumors and 1-3 positive ALNs according to MST: Luminal A, Luminal B, human epidermal growth factor receptor-2 (Her-2) positive, and Triple negative. The impact of adjuvant PMRT in T1-T2 tumors with 1-3 positive ALNs was also assessed. This study included 1369 patients: 33.0 % Luminal A, 42.9 % Luminal B, 11.9 % Her-2 positive, and 12.2 % Triple negative. On univariate and multivariate analyses, MST was associated with locoregional relapse (LRR). Kaplan-Meier analysis showed that PMRT significantly decreased LRR risk (p = 0.017) and distant metastasis (DM) risk (p < 0.0001). In subgroup analysis, PMRT showed significant benefits of improvement in LRR in patients with younger age, positive lymphovascular invasion (LVI), and ratio of positive lymph nodes (LNs) >25 %. Moreover, the nomogram could more accurately predict LRR (c-index 0.75) in T1-2N1 breast cancer patients. MST associated with patient outcomes in breast cancer patients with T1-T2 tumors and 1-3 positive ALN. It makes sense to offer PMRT for patients aged<40 years old, LVI, 2 and 3 positive lymph nodes, and ratio of positive LNs >25 %.
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Affiliation(s)
- Honghong Shen
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Lin Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Li Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Xiaozhen Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Xia Liu
- Department of Oncology, General Hospital of Tianjin Medical University, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Junjun Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Fengting Niu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China
| | - Shuhua Lv
- Department of Pathology, Nankai University Affiliated Hospital, 190, Jie-Yuan Road, Hong Qiao District, Tianjin, 300121, China
| | - Yun Niu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin, 300060, China.
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Number of negative lymph nodes can predict survival of breast cancer patients with four or more positive lymph nodes after postmastectomy radiotherapy. Radiat Oncol 2014; 9:284. [PMID: 25511525 PMCID: PMC4278342 DOI: 10.1186/s13014-014-0284-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/02/2014] [Indexed: 12/03/2022] Open
Abstract
Background This study was conducted to assess the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients with four or more positive lymph nodes after postmastectomy radiotherapy (PMRT). Methods This retrospective study examined 605 breast cancer patients with four or more positive lymph nodes who underwent mastectomy. A total of 371 patients underwent PMRT. The prognostic value of the NLN count in patients with and without PMRT was analyzed. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. Results The median follow-up was 54 months, and the overall 8-year locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were 79.8%, 50.0%, 46.8%, and 57.9%, respectively. The optimal cut-off points for NLN count was 12. Univariate analysis showed that the number of NLNs, lymph node ratio (LNR) and pN stage predicted the LRFS of non-PMRT patients (p < 0.05 for all). Multivariate analysis showed that the number of NLNs was an independent prognostic factor affecting the LRFS, patients with a higher number of NLNs had a better LRFS (hazard ratio = 0.132, 95% confidence interval = 0.032-0.547, p =0.005). LNR and pN stage had no effect on LRFS. PMRT improved the LRFS (p < 0.001), DMFS (p = 0.018), DFS (p = 0.001), and OS (p = 0.008) of patients with 12 or fewer NLNs, but it did not any effect on survival of patients with more than 12 NLNs. PMRT improved the regional lymph node recurrence-free survival (p < 0.001) but not the chest wall recurrence-free survival (p = 0.221) in patients with 12 or fewer NLNs. Conclusions The number of NLNs can predict the survival of breast cancer patients with four or more positive lymph nodes after PMRT. Electronic supplementary material The online version of this article (doi:10.1186/s13014-014-0284-5) contains supplementary material, which is available to authorized users.
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Wenz F, Sperk E, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Fussl C, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer IV: radiotherapy following mastectomy for invasive breast cancer. Strahlenther Onkol 2014; 190:705-14. [PMID: 24888511 DOI: 10.1007/s00066-014-0687-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. METHODS The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio >20 %, resection margins <3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size >2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. RESULTS The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, >3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. CONCLUSION PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present.
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Affiliation(s)
- Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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Janus A, Plank A, Middleton M. Influence of Individualized Stabilization on the Consistency of Supraclavicular Fossa Positioning in Breast Radiation Therapy: A Retrospective Study. J Med Imaging Radiat Sci 2014; 45:210-217. [PMID: 31051971 DOI: 10.1016/j.jmir.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/29/2014] [Accepted: 05/10/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The accurate stabilization of breast patients who are also undergoing supraclavicular fossa treatment is essential and can be challenging. Discrepancy in setup error for these patients often lies with the position of the clavicle in relationship with other anatomic structures. This study was performed to assess how individualized stabilization can improve patient's stability and reproducibility. METHODS Thirty patients stabilized with an individualized vacfix located on a Civco wing board (Civco Medical Solutions, Kalona, IA) were compared with 30 patients stabilized in the traditional manner on a Civco breast board (Civco Medical Solutions). Each of these patients underwent daily imaging using the Varian Clinac iX On-board Imaging System (Varian Medical Systems, Palo Alto, CA), and image mismatch data for each session were collected. Additionally, the relationship between the clavicle and vertebrae was assessed for each stabilization solution on a daily basis. Statistical analysis of this data was then performed using a mixed effects approach to take account of data grouping by patient specifically for the displacement error in each direction. RESULTS The use of an individualized vacfix decreased the overall systematic and random setup errors and displayed a reduction in the standard deviation of setup error. Patients positioned using breast board stabilization with the clavicle as the match method were exposed in the longitudinal direction to a systematic error of a 95% confidence interval (CI) of 2.6-4.5 mm and a random error of a 95% CI of 2.7-3.2 mm. This was significantly reduced for vacfix stabilization with a systematic error of a 95% CI of 1.2-2.3 mm and a random error of a 95% CI of 1.8-2.3 mm. These data amount to a reduction of the systematic error by 40% (P = .02) and a random error by 25% (P = .003) when using the vacfix method compared with the breast board. The data displaying the relationship between the clavicle and other anatomy within the treatment volume appear to be more consistent with the individualized vacfix approach. CONCLUSIONS Reproducible and consistent stabilization for the breast/supraclavicular fossa technique is vital in terms of ensuring accurate patient position. Analysis of the setup error for clavicle and spinous process matching strongly indicates a reduction in both the systematic and random setup error achieved by the vacfix. This illustrates the increased stability and reproducibility of patient positioning when an individualized vacfix is used.
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Affiliation(s)
- Amanda Janus
- Radiation Oncology Queensland, Toowoomba and Cairns, Queensland, Australia.
| | - Ashley Plank
- Oncology Research Australia, Toowoomba and Cairns, Queensland, Australia
| | - Mark Middleton
- Radiation Oncology Queensland, Toowoomba and Cairns, Queensland, Australia
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Moo TA, McMillan R, Lee M, Stempel M, Ho A, Patil S, El-Tamer M. Impact of molecular subtype on locoregional recurrence in mastectomy patients with T1-T2 breast cancer and 1-3 positive lymph nodes. Ann Surg Oncol 2014; 21:1569-74. [PMID: 24488216 DOI: 10.1245/s10434-014-3488-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postmastectomy radiation (PMRT) in T1-T2 tumors with 1-3 positive axillary lymph nodes (ALNs) is controversial. Impact of molecular subtype (MST) on locoregional recurrence (LRR) and PMRT benefit is uncertain. We examined the association between MST and LRR, recurrence-free survival (RFS), and overall survival (OS), in T1-T2 tumors with 1-3 positive ALNs. METHODS From an institutional database, we identified mastectomy patients with 1-3 positive ALNs between 1995 and 2006. Patients who received neoadjuvant chemotherapy, had T3-T4 tumors, or ≥4 positive ALNs were excluded. MST was defined as: hormone receptor (HR)+/HER2-(luminal A/B), HR+/HER2+(luminal HER2), HR-/HER2+(HER2), and HR-/HER2-(basal). Kaplan-Meier method and Cox regression analysis were used to examine association between MST and LRR, RFS, and OS. RESULTS This study included 884 patients (700 no PMRT, 141 PMRT): 72.8 % luminal A/B, 7.8 % luminal HER2, 6.8 % HER2, and 12.6 % basal. Median follow-up was 6.3 years; 39 LRRs occurred. Luminal A/B subtype had the smallest tumors (p = 0.03), lowest intraductal component (p = 0.01), histologic grade (p < 0.0001), lymphovascular invasion (LVI) (p = 0.008), and multifocality/multicentricity (p = 0.02). On univariate analyses, there was no association between MST and LRR. MST was associated with RFS and OS; the basal and HER2 subtype had the lowest RFS (p = 0.0002) and OS (p < 0.0001). On multivariate analysis, only age ≤50 years (p = 0.003) and presence of LVI (p = 0.0003) were predictive of LRR; MST was not (p = 0.38). CONCLUSION In patients with T1-T2 breast cancer and 1-3 positive lymph nodes who did not receive PMRT, MST was not an independent predictor of LRR and may not be useful in selecting PMRT candidates in that group.
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Affiliation(s)
- Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Differentiate among the various techniques available to reconstructive breast surgeons. 2. Perform a comprehensive assessment of the breast reconstruction candidate. 3. Gain knowledge about the indications and contraindications for different breast reconstructive procedures. 4. Understand the complications inherent in different reconstructive breast procedures. 5. Summarize the long-term objective and subjective implications of surgery. SUMMARY This article was prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is structured to outline the care of the patient with the postmastectomy breast deformity.
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La Verde N, Moretti A, Farina G, Dazzani MC, Gamucci T, Borgonovo K, Botta M, Salesi N, Zuradelli M, Pavese I, Barbieri E, Cretella E, Saladino T, Varese P, Traverso ES, Addamo G, Ciccarese M, Rispoli AI, Pellegrino A, Mentuccia L, Girelli S, Piva S, Maio MD. Eribulin in cutaneous breast cancer metastasis treatment: clinical activity and symptom control. Future Oncol 2013; 9:1841-8. [DOI: 10.2217/fon.13.216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This observational study evaluated the behavior and outcome of cutaneous breast cancer metastasis treated with eribulin. Patients & methods: From November 2012 to January 2013, oncologists completed a database with patient, tumor and treatment characteristics from 14 Italian cancer centers. Skin lesions were assessed by Response Evaluation Criteria In Solid Tumors and cutaneous symptoms by present/absent criteria. Results: A total of 23 metastatic breast cancer patients with skin metastasis who were treated with eribulin were analyzed. After treatment, 43% of patients exhibited a partial response, 35% stable disease and 22% progressive disease. Regarding only the skin response, 26% obtained a complete response, 22% a partial response, 39% stable disease and 13% progressive disease. We found an improvement in symptoms, infiltration and ulceration. With a median follow-up of 6 months, median progression-free survival was 4.3 months and median overall survival was 9.1 months. Conclusion: The response rate of skin metastasis to eribulin treatment was coherent with systemic responses. The good clinical response in most patients reflected symptom improvement.
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Affiliation(s)
- Nicla La Verde
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Anna Moretti
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Gabriella Farina
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Maria Chiara Dazzani
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, Localita’ San Marciano, 03039 Sora (FR), Italy
| | - Karen Borgonovo
- Medical Oncology, AO Treviglio, Piazzale Ospedale, 1 Treviglio (BG), Italy
| | - Mario Botta
- Santo Spirito Hospital, ASL AL, Viale Giolitti 2, Casale Monferrato, Italy
| | - Nello Salesi
- UOC Oncologia, Ospedale S.M. Goretti, ASL Latina, via Canova, 3, Latina, Italy
| | - Monica Zuradelli
- Humanitas Cancer Center, Rozzano, Via Manzoni 56, Rozzano, Italy
| | - Ida Pavese
- UOC Oncologia Ospedale San Pietro Fatebenefratelli, via Cassia 60, Rome, Italy
| | - Elena Barbieri
- AO Universitaria di Bologna Policlinico San Orsola-Malpighi – Istituto di Oncologia F. Addarii, Via G. Ercolani 4/2, 40138 Bologna, Italy
| | - Elisabetta Cretella
- Oncologia Medica – Comprensorio Sanitario di Bolzano, Via Lorenz Böhler 5, Bolzano, Italy
| | - Tiziana Saladino
- UO Oncologia, Ospedale Provinciale, via Santa Lucia, Macerata, Italy
| | - Paola Varese
- Ospedale Civile, Oncology Department, Via Ruffini, 22 15076 Ovada (AL), Italy
| | | | - Gianfranco Addamo
- Division of Medical Oncology, Ospedale Civile ‘G Borea’, Via G. Borea 56, Sanremo, Italy
| | | | - Anna Iolanda Rispoli
- Oncology Unit, Universital Hospital Careggi, Largo Brambilla, 3, 50134 Firenze, Italy
| | - Arianna Pellegrino
- UOC Oncologia Ospedale San Pietro Fatebenefratelli, via Cassia 60, Rome, Italy
| | - Lucia Mentuccia
- Medical Oncology Unit, Localita’ San Marciano, 03039 Sora (FR), Italy
| | - Serena Girelli
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Sheila Piva
- Department of Oncology, AO Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, Milan, Italy
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, G. Pascale Foundation, Via Mariano Semmola, 162, Napoli, Italy
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Benevento R, Vicidomini A, Sorrentino VP, Renzulli M, Di Nardo D, Canonico S, Santoriello A. Electrochemotherapy of head and neck cancer in elderly patients: a preliminary report. BMC Surg 2013. [PMCID: PMC3847356 DOI: 10.1186/1471-2482-13-s1-a5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Moo TA, McMillan R, Lee M, Stempel M, Patil S, Ho A, El-Tamer M. Selection Criteria for Postmastectomy Radiotherapy in T1–T2 Tumors with 1 to 3 Positive Lymph Nodes. Ann Surg Oncol 2013; 20:3169-74. [DOI: 10.1245/s10434-013-3117-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 11/18/2022]
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Kreienberg R, Albert US, Follmann M, Kopp IB, Kühn T, Wöckel A. Interdisciplinary GoR level III Guidelines for the Diagnosis, Therapy and Follow-up Care of Breast Cancer: Short version - AWMF Registry No.: 032-045OL AWMF-Register-Nummer: 032-045OL - Kurzversion 3.0, Juli 2012. Geburtshilfe Frauenheilkd 2013; 73:556-583. [PMID: 24771925 PMCID: PMC3963234 DOI: 10.1055/s-0032-1328689] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - U.-S. Albert
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik
für Gynäkologie, Gynäkologische Endokrinologie und Onkologie,
Marburg
| | - M. Follmann
- Deutsche Krebsgesellschaft e. V., Bereich Leitlinien,
Berlin
| | - I. B. Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, c/o
Philipps-Universität, Marburg
| | - T. Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe,
Esslingen
| | - A. Wöckel
- Universitätsklinikum Ulm, Klinik für Frauenheilkunde und Geburtshilfe,
Ulm
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Benevento R, Santoriello A, Perna G, Canonico S. Electrochemotherapy of cutaneous metastastes from breast cancer in elderly patients: a preliminary report. BMC Surg 2012; 12 Suppl 1:S6. [PMID: 23173816 PMCID: PMC3499246 DOI: 10.1186/1471-2482-12-s1-s6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The management of cutaneous metastases often represents a challenge because they may be widespread and may recur after radiotherapy or chemotherapy; breast cancer accounts for 51% of the total cases of cutaneous metastases. When surgical excision of chest wall recurrences is not possible and other local treatments such as radiotherapy or radiotherapy with hyperthermia fail, topical chemotherapy and electrochemotherapy (ECT) might be taken into account. ECT is a new local treatment of solid tumors which can be defined as the local potentiation, by means of permeabilizing electric pulses, of the antitumor activity of a non permeating anticancer drug with high intrinsic cytotoxicity. Methods This prospective observational study took place throughout March 2010 to October 2011. Twelve consecutive elderly patients (1 man and 11 women, median age of 76 years) with regional or distant skin or subcutaneous metastases from breast cancer, with or without visceral disease, were included in the study. Patient enrollment was carried out according to the ESOPE criteria. Bleomycin administration was followed by the application of brief electric pulses to each tumor nodule within 8 min after intravenous infusion of the drug. Electric currents were delivered by means of a 2–3 cm long needle electrode according to lesion size. All treatments were performed using the CliniporatorTM device. Results We observed Complete Response(CR) in 75.3% (107 metastases), Partial Response(PR) in 17% (24 metastases), no change in 7.7% (11 metastases) . No serious ECT-related adverse events were reported; adverse events consisted of pain in the treated area one to two days after treatment (1 patient, 8.3%) and ulceration of treated area (1 patient, 8.3%). Conclusion ECT could be suggested as a primary local therapy in patients not suitable for surgical removal of the primary tumor, and clinicians should not hesitate to use it even in the elderly.
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Affiliation(s)
- Raffaella Benevento
- Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy
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Sersa G, Cufer T, Paulin SM, Cemazar M, Snoj M. Electrochemotherapy of chest wall breast cancer recurrence. Cancer Treat Rev 2012; 38:379-86. [DOI: 10.1016/j.ctrv.2011.07.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/12/2011] [Accepted: 07/25/2011] [Indexed: 12/21/2022]
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Abstract
Care of the older woman with early breast cancer is of particular importance to both the oncologist and geriatrician because of both the prevalence of the disease in this population as well as the subtleties necessary in individualizing treatment decisions. In general, older women are able to tolerate many of the same modalities of treatment for early breast cancer as younger women, but special consideration must be given to future life expectancy, comorbidities, and other elements that might be identified using a CGA. Both short-term and long-term side effects of cancer therapies can be clinically important in the older woman, and appropriate screening and support for these toxicities are necessary.
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Affiliation(s)
- Ari VanderWalde
- Clinical Research Senior Medical Scientist, Global Development- Oncology, Amgen, Thousand Oaks, California
| | - Arti Hurria
- Associate Professor and Director of Cancer and Aging Program, Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Sioka C, Exarchopoulos T, Tasiou I, Tzima E, Fotou N, Capizzello A, Ragos V, Tsekeris P, Fotopoulos A. Myocardial perfusion imaging with (99 m)Tc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study. Radiat Oncol 2011; 6:151. [PMID: 22067743 PMCID: PMC3222615 DOI: 10.1186/1748-717x-6-151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/08/2011] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin - single photon emission computer tomography (T-SPECT). Materials and methods We studied 46 BC female patients (28 patients with left and 18 patients with right BC) treated with postoperative RT compared to a control group of 85 age-matched females. The median time of RT to SPECT was 40 months (6-263). Results Abnormalities in the summed stress score (SSS) were found in 54% of left BC patients, 44.4% of right BC patients, and 32.9% of controls. In left BC patients there were significantly more SSS abnormalities compared to controls (4.0 ± 3.5 vs 2.6 ± 2.0, p = 0.05) and possible trend of increased abnormalities of right BC patients (3.7 ± 3.0 vs 2.6 ± 2.0, p = 0.14). Multiple regression analysis showed more abnormalities in the MPI of left BC patients compared to controls (SSS, p = 0.0001); Marginal toxicity was also noted in right BC patients (SSS, p = 0.045). No additional toxicity was found in patients that received adjuvant cardiotoxic chemotherapy. All T-SPECT abnormalities were clinically silent. Conclusion The study suggests that radiation therapy to BC patients result in MPI abnormalities but without apparent clinical consequences.
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Affiliation(s)
- Chrissa Sioka
- Department of Nuclear Medicine, University Hospital of Ioannina, Greece.
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