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Park YH, Senkus-Konefka E, Im SA, Pentheroudakis G, Saji S, Gupta S, Iwata H, Mastura MY, Dent R, Lu YS, Yin Y, Smruti BK, Toyama T, Malwinder S, Lee SC, Tseng LM, Kim JH, Kim TY, Suh KJ, Cardoso F, Yoshino T, Douillard JY. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with early breast cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS. Ann Oncol 2020; 31:451-469. [PMID: 32081575 DOI: 10.1016/j.annonc.2020.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 12/27/2022] Open
Abstract
In view of the planned new edition of the most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of primary breast cancer published in 2015, it was decided at the ESMO Asia Meeting in November 2018, by both the ESMO and the Korean Society of Medical Oncology (KSMO), to convene a special face-to-face guidelines meeting in 2019 in Seoul. The aim was to adapt the latest ESMO 2019 guidelines to take into account the ethnic and geographical differences associated with the treatment of early breast cancer in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with early breast cancer representing the oncology societies of Korea (KSMO), China (CSCO), India (ISMPO) Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence, and was independent of both the current treatment practices, and the drug availability and reimbursement situations, in the individual participating Asian countries.
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Affiliation(s)
- Y H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - E Senkus-Konefka
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - S-A Im
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - S Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - S Gupta
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - H Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - M Y Mastura
- Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - R Dent
- Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Y-S Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Y Yin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - B K Smruti
- Medical Oncology, Lilavati Hospital and Research Centre and Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - T Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Malwinder
- Sri Kota Specialist Medical Centre, Selangor, Malaysia
| | - S C Lee
- Department of Haematology-Oncology, National University, Cancer Institute, Singapore, (NCIS) National University Health System, Singapore, Singapore
| | - L-M Tseng
- Department of Surgery, Taipei-Veterans General Hospital, Taipei, Taiwan
| | - J H Kim
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - T-Y Kim
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - K J Suh
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Sinnadurai S, Kwong A, Hartman M, Tan EY, Bhoo-Pathy NT, Dahlui M, See MH, Yip CH, Taib NA, Bhoo-Pathy N. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open 2018; 3:48-55. [PMID: 30734015 PMCID: PMC6354186 DOI: 10.1002/bjs5.50111] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/07/2018] [Indexed: 01/01/2023] Open
Abstract
Background Mastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early‐stage breast cancer in Asian settings. Survival in women treated with breast‐conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared. Methods Young women (aged less than 50 years) newly diagnosed with stage I or II (T1–2 N0–1 M0) breast cancer in four hospitals in Malaysia, Singapore and Hong Kong in 1990–2012 were included. Overall survival (OS) was compared for patients treated by BCS and those who had a mastectomy. Propensity score analysis was used to account for differences in demographic, tumour and treatment characteristics between the groups. Results Some 63·5 per cent of 3536 women underwent mastectomy. Over a 15‐year period, only a modest increase in rates of BCS was observed. Although BCS was significantly associated with favourable prognostic features, OS was not significantly different for BCS and mastectomy; the 5‐year OS rate was 94·9 (95 per cent c.i. 93·5 to 96·3) and 92·9 (91·7 to 94·1) per cent respectively. Inferences remained unchanged following propensity score analysis (hazard ratio for BCS versus mastectomy: 0·81, 95 per cent c.i. 0·64 to 1·03). Conclusion The prevalence of young women with breast cancer treated by mastectomy remains high in Asian countries. Patients treated with BCS appear to survive as well as those undergoing mastectomy.
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Affiliation(s)
- S Sinnadurai
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - A Kwong
- Department of Surgery University of Hong Kong Pokfulam Hong Kong
| | - M Hartman
- Division of General Surgery (Breast Surgery) National University Hospital Singapore
| | - E Y Tan
- Department of General Surgery Tan Tock Seng Hospital Singapore
| | - N T Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - M Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - M H See
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - C H Yip
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - N A Taib
- Department of Surgery, University Malaya Medical Centre University of Malaya Kuala Lumpur Malaysia
| | - N Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
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Bhoo-Pathy N, Verkooijen HM, Wong FY, Pignol JP, Kwong A, Tan EY, Aishah Taib N, Nei WL, Ho GF, Tan B, Chan P, Lee SC, Hartman M, Yip CH, Dent R. Prognostic role of adjuvant radiotherapy in triple-negative breast cancer: A historical cohort study. Int J Cancer 2015; 137:2504-12. [PMID: 26018878 DOI: 10.1002/ijc.29617] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 12/22/2022]
Abstract
The value of adjuvant radiotherapy in triple-negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N = 1,138) were included. Survival between patients receiving mastectomy only, breast-conserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23-96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node-negative disease. The majority of patients received adjuvant chemotherapy (n = 861, 76%) comprising predominantly anthracycline-based regimes. In 775 women with T1-2, N0-1, M0 TNBCs, 5-year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8-98.8%), followed by BCT (90.8%, 95% CI: 85.0-94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4-88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3-4, N2-3, M0 TNBCs, BCT was associated with highest 5-year RSR (94.1%, 95% CI: 81.3-99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3-70.1%), and mastectomy only (58.6%, 95% CI: 43.5-71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.
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Affiliation(s)
- Nirmala Bhoo-Pathy
- Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,National Clinical Research Centre, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Helena M Verkooijen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fuh-Yong Wong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ava Kwong
- Breast Surgery Division, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ern-Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Wen-Long Nei
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Gwo-Fuang Ho
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Benita Tan
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Patrick Chan
- Department of Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Soo-Chin Lee
- Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Cheng-Har Yip
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Rebecca Dent
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
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Brar P, Jain S, Singh I. Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS. Indian J Surg Oncol 2011; 2:126-32. [PMID: 22693405 DOI: 10.1007/s13193-011-0078-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 07/11/2011] [Indexed: 11/26/2022] Open
Abstract
ALND is part of primary management of breast cancer. In spite of complications it causes, its use in prognostication and planning adjuvant treatment in carcinoma breast is unquestioned. Prospective study was conducted on 100 patients of EBC [clinical stage I&II]. 50 underwent MRM, 50 WLE&AC. Patients were asked to rate on likert scale various symptoms on follow up. Multivariate regression analysis was carried out between pain, numbness, limitation of shoulder or arm motion, arm swelling, infection and age, BSA, clinical status of axilla, no. of LNs removed, no. of positive LNs, co-morbidities, chemotherapy, radiotherapy, hormone therapy, type of surgery. 60% patients reported one or more symptoms. Numbness, pain were reported by 39% each, arm swelling by 25%, limitation of arm movement by 16%, infection by 11%. Symptoms were mild in majority. On regression analyses numbness was associated with EBRT, co-morbidity, type of operation (p value- <0.01, <0.01, <0.05), pain had no significant association, swelling with EBRT, no. of LNs positive for metastases, co-morbidity, type of operation (p value- <0.01, <0.05, <0.05, <0.01), limitation of arm motion with no. of positive LNs (p value < 0.01), infection with no. of positive LNs, co-morbidity (p value <0.05, <0.05). There was no statistically significant difference in reporting of symptoms by patients in two groups. ALND caused morbidity in majority of patients but few reported severe symptoms and interference with daily activities.
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Oncoplastic Breast Surgery: A Global Perspective on Practice, Availability, and Training. World J Surg 2008; 32:2570-7. [DOI: 10.1007/s00268-008-9635-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Back M, Ahern V, Delaney G, Graham P, Steigler A, Wratten C. Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer. ACTA ACUST UNITED AC 2005; 49:39-43. [PMID: 15727608 DOI: 10.1111/j.1440-1673.2005.01392.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.
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Affiliation(s)
- M Back
- Department of Radiation Oncology, The Newcastle Mater Misericordiae Hospital, Newcastle.
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Guerrero M, Li XA. Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning. Phys Med Biol 2003; 48:3307-26. [PMID: 14620060 DOI: 10.1088/0031-9155/48/20/004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher T(pot) is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer: alpha = 0.3 Gy(-1), alpha/beta = 10 Gy and sub-lethal damage repair time T(rep) = 1 h (mono-exponential behaviour is assumed). This set of parameters is consistent with in vitro experiments and with previously reported analyses. Using this set of parameters, we have found that most of the studies, using BCS plus whole breast RT and a boost to the tumour bed, have EUDs ranging from 60-70 Gy. No correlation is found between BED and the local recurrence rate. The treatments of BCS plus brachytherapy alone have a wide range of EUD (30-50 Gy), which is significantly lower than the treatments with whole breast EBRT plus a boost of the tumour bed. The studies with different fractionation schemes for whole breast EBRT also show a significant variation of EUD. Carefully designed clinical studies with large numbers of patients are required to determine clinically the relative effectiveness of these treatment variations. The derived LQ parameter set based on clinical data is consistent with in vitro experiments and previous studies. As demonstrated in the present work, these radiobiological parameters can be potentially useful in radiotherapy treatment planning for early breast cancer, e.g., in comparing biological effectiveness of different radiotherapy modalities, different fractionation schemes and in designing new treatment strategies.
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Affiliation(s)
- M Guerrero
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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