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Orda Y, Shayakhmetov T, Baiturova S, Berikbol D, Otynshiyev R, Brimova A, Saktashev B, Baisalbayeva A, Samigatova A. Tomotherapy in synchronous and metachronous bilateral breast cancer: Clinical experience. J Appl Clin Med Phys 2024:e14367. [PMID: 38685589 DOI: 10.1002/acm2.14367] [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: 01/09/2024] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE OF STUDY The objective of this research is to present our firsthand experience and provide up-to-date data for the further study of cases involving simultaneous breast irradiation using helical Tomotherapy, ©Accuray Inc. METHODS The radical treatment options for bilateral breast cancer are surgery, chemotherapy, and radiation therapy. Being that radiotherapy for bilateral breast cancer is challenging due to limitations in the geometry of modern radiotherapy equipment, helical Tomotherapy was chosen as an appropriate technique of irradiation. The retrospective review focused on the records of patients who underwent bilateral irradiation of the breast or chest wall and regional lymph nodes using helical Tomotherapy. RESULTS Only four patients with bilateral breast cancer completed a radiation therapy course in our center from 2018 to 2023. Two patients underwent radical mastectomy with lymph node dissection on both sides before irradiation. For the other two patients, radical mastectomy was done after neoadjuvant chemotherapy. Acute radiation toxicity scoring was based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Only mild adverse effects, such as general weakness and slight skin irritation below Grade 3, were observed, with no instances of skin swelling, dryness, or pigmentation noted. Evaluation of late complications revealed tissue fibrosis in the area of the internal mammary nodes and respiratory failure with various severity. Complications and deterioration in the cardiovascular system were not observed during the follow-up period, which varied from 3 to 48 months. CONCLUSION Our results show the efficacy of using helical Tomotherapy considering positive outcomes, being that three out of four patients are in remission with low acute toxicity and late complications. There are a small number of articles describing bilateral breast cancer treatment with helical Tomotherapy. On this occasion, our data could contribute to the studies of tolerant doses for organs at risk and improve the parameters of treatment plans for bilateral breast cancer. Since the small sample of patients with bilateral breast cancer limits the study, a larger cohort of patients is essential to obtain statistically reliable results.
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Affiliation(s)
- Yernar Orda
- Medical Physics Department, UMIT International Oncological Center of Tomotherapy: Astana, Astana, Kazakhstan
| | - Tanzhas Shayakhmetov
- Medical Physics Department, UMIT International Oncological Center of Tomotherapy: Astana, Astana, Kazakhstan
| | - Saniya Baiturova
- Radiation Oncology Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Daulet Berikbol
- Radiation Oncology Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Rauan Otynshiyev
- Radiation Oncology Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Aigul Brimova
- Clinical Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Bolat Saktashev
- Clinical Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Ainur Baisalbayeva
- Research Management Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
| | - Ainur Samigatova
- Research Management Department, UMIT International Oncological Center of Tomotherapy, Astana, Kazakhstan
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Schulze AK, Hoskin TL, Moldoveanu D, Sturz JL, Boughey JC. Tumor Characteristics of Bilateral Breast Cancer Compared with Unilateral Breast Cancer. Ann Surg Oncol 2024; 31:947-956. [PMID: 37906382 DOI: 10.1245/s10434-023-14451-x] [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: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Bilateral breast cancer (BC) has an incidence of 1 to 3 %. This study aimed to describe the clinicopathologic characteristics and management of bilateral BC, estimate disease-free survival (DFS), and compare DFS with unilateral BC. METHODS A retrospective analysis was performed for patients who had bilateral invasive BC or unilateral invasive BC and contralateral ductal carcinoma in situ (DCIS) treated at Mayo Clinic Rochester from 2008 to 2022. A 4:1 matched cohort of patients with unilateral invasive BC was used for comparison. The groups were compared using Wilcoxon rank-sum or chi-square tests. Disease-free survival was analyzed using the Kaplan-Meier method and log-rank test, with Cox proportional hazards regression used for multivariable analysis. RESULTS The study identified 278 cases of bilateral breast cancer (177 cases of bilateral invasive cancer and 101 cases of unilateral invasive cancer with contralateral DCIS), representing 4.1 % of invasive BCs. Biologic subtype was concordant between sides in 79.8 % of the patients. Initial surgery was bilateral mastectomy for 76.6 %, bilateral lumpectomy for 20.5 %, and unilateral mastectomy with unilateral lumpectomy for 2.9 % of the patients. Pathogenic variants in breast cancer predisposition genes were present in 21.7 % of those tested. The patients who had bilateral BC presented with a higher cT category than the patients who had unilateral BC (p = 0.02), and a higher proportion presented with ILC (17.3 % vs 10.9 %; p = 0.004), estrogen receptor-positive (ER+) disease (89.2 % vs 84.2 %; p = 0.04), multicentric/multifocal disease (37.1 % vs 24.3 %; p < 0.001), breast cancer pathogenic variant (21.7 % vs 12.4 %; p = 0.02), and palpable presentation (48.2 % vs 40.8 %; p = 0.03). The patients with bilateral BC showed DFS similar to that for the unilateral BC cohort (p = 0.71). CONCLUSIONS Bilateral BCs most commonly are biologically concordant between sides. Bilateral BC presented more commonly with larger tumors, lobular histology, ER+ status, multicentricity or multifocality, pathogenic variant, and palpable disease. Bilateral BC is not associated with worse DFS than unilateral BC.
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Affiliation(s)
- Amy K Schulze
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dan Moldoveanu
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jenna L Sturz
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Kim H, Yoon TI, Kim S, Lee SB, Kim J, Chung IY, Ko BS, Lee JW, Son BH, Gwark S, Kim JK, Kim HJ. Survival After Development of Contralateral Breast Cancer in Korean Patients With Breast Cancer. JAMA Netw Open 2023; 6:e2333557. [PMID: 37707815 PMCID: PMC10502526 DOI: 10.1001/jamanetworkopen.2023.33557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Contralateral breast cancer (CBC) is the most frequently diagnosed primary cancer in patients with breast cancer. Although many studies have reported survival after the development of CBC, results have been inconsistent. Objective To investigate whether the development of CBC is associated with survival among patients with breast cancer. Design, Setting, and Participants This cohort study was conducted at the Asan Medical Center, Korea, among patients who were diagnosed with primary unilateral, nonmetastatic, stage 0 to III breast cancer between 1999 and 2013 and followed up through 2018. The median (IQR) follow-up was 107 (75-143) months. Patients were categorized into CBC and no-CBC groups by whether they developed CBC during the follow-up period. Data were analyzed from November 2021 to March 2023. Exposure Development of CBC. Main outcomes and measures Survival rates of CBC and no-CBC groups were compared using a time-dependent Cox proportional hazard model in the entire study population and in subgroup analyses by interval of CBC development and subtype of the primary breast cancer. Results Among 16 251 patients with breast cancer (all Asian, specifically Korean; mean [SD] age, 48.61 [10.06] years), 418 patients developed CBC. There was no significant difference in overall survival between CBC and no-CBC groups (hazard ratio, 1.166; 95% CI, 0.820-1.657). Patients who developed CBC within 1.5 years after the surgery of the primary breast cancer had a higher risk for overall death during the study period (hazard ratio, 2.014; 95% CI, 1.044-3.886), and those who developed CBC after 1.5 years showed no significant difference in survival compared with the no-CBC group. Patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (ERBB2, formerly HER2)-negative breast cancer had a higher risk for overall death in the CBC group (hazard ratio, 1.882; 95% CI, 1.143-3.098) compared with the no-CBC group. Conclusions and Relevance This study found that development of CBC in patients with breast cancer was not associated with survival but that early development of CBC after diagnosis of the primary breast cancer or development of CBC in patients with HR-positive/ERBB2-negative breast cancer was associated with survival. These results may provide valuable information for patients seeking advice on opting for contralateral prophylactic mastectomy.
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Affiliation(s)
- Hakyoung Kim
- Department of Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Tae In Yoon
- Division of Breast Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sungchan Gwark
- Department of Surgery, Ewha Woman’s University College of Medicine, Ewha Woman’s University Mokdong Hospital, Seoul, Republic of Korea
| | | | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Mishra A, Oberoi AS, Deo S, Sharma J, Gogia A, Sharma DN, Mathur S, Dhamija E. Bilateral Breast Cancer: Clinical Profile and Management. Indian J Surg Oncol 2023; 14:651-658. [PMID: 37900630 PMCID: PMC10611650 DOI: 10.1007/s13193-023-01731-x] [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: 07/28/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
There is paucity of literature regarding the demography, histopathology, management, and outcomes of bilateral breast cancer (BBC). We present our experience of treating 127 BBC with multimodality management. An audit of prospectively maintained computerized breast cancer database of the department of surgical oncology at a tertiary care center was performed. Demography, clinical profile, molecular sub-types, treatment patterns, and outcomes were analyzed. A total 127 patients presented with BBC between 1992 and 2019. Ninety-four had metachronous (MBBC) and 33 had synchronous breast cancer (SBBC). Most contralateral breast cancer (CBC) patients had early-stage breast cancer in comparison to the index side cancer (37% vs 32%). Ninety-four patients underwent bilateral mastectomy and only 18 patients underwent bilateral breast conservation. Seventy-one patients undergoing BCS and surgery for LABC were given postoperative radiotherapy. All patients received adjuvant chemo- and/or hormonal therapy both for index and CBC based on the stage and hormone receptor status. Thirty-three percent of patients had either locoregional or distant relapse. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) of the entire cohort were 86.6% and 68.4% respectively. There was no difference in the OS and DFS between SBBC and MBBC. The incidence of BBC is expected to increase with effective diagnostic and therapeutic interventions and improving survival. Patients require individualized treatment planning in a multidisciplinary treatment setting.
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Affiliation(s)
- Ashutosh Mishra
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | | | - Jyoti Sharma
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - D. N. Sharma
- Department of Radiation Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | - Ekta Dhamija
- Department of Radiology, AIIMS, New Delhi, India
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Hamy AS, Abécassis J, Driouch K, Darrigues L, Vandenbogaert M, Laurent C, Zaccarini F, Sadacca B, Delomenie M, Laas E, Mariani O, Lam T, Grandal B, Laé M, Bieche I, Vacher S, Pierga JY, Brain E, Vallot C, Hotton J, Richer W, Rocha D, Tariq Z, Becette V, Meseure D, Lesage L, Vincent-Salomon A, Filmann N, Furlanetto J, Loibl S, Dumas E, Waterfall JJ, Reyal F. Evolution of synchronous female bilateral breast cancers and response to treatment. Nat Med 2023; 29:646-655. [PMID: 36879128 PMCID: PMC10033420 DOI: 10.1038/s41591-023-02216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/10/2023] [Indexed: 03/08/2023]
Abstract
Synchronous bilateral breast cancer (sBBC) occurs after both breasts have been affected by the same germline genetics and environmental exposures. Little evidence exists regarding immune infiltration and response to treatment in sBBCs. Here we show that the impact of the subtype of breast cancer on levels of tumor infiltrating lymphocytes (TILs, n = 277) and on pathologic complete response (pCR) rates (n = 140) differed according to the concordant or discordant subtype of breast cancer of the contralateral tumor: luminal breast tumors with a discordant contralateral tumor had higher TIL levels and higher pCR rates than those with a concordant contralateral tumor. Tumor sequencing revealed that left and right tumors (n = 20) were independent regarding somatic mutations, copy number alterations and clonal phylogeny, whereas primary tumor and residual disease were closely related both from the somatic mutation and from the transcriptomic point of view. Our study indicates that tumor-intrinsic characteristics may have a role in the association of tumor immunity and pCR and demonstrates that the characteristics of the contralateral tumor are also associated with immune infiltration and response to treatment.
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Affiliation(s)
- Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
| | - Judith Abécassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
- INRIA, Université Paris-Saclay, CEA, Palaiseau, France
| | - Keltouma Driouch
- Pharmacogenomics Unit, Department of Genetics, PSL University, Institut Curie, Paris, France
| | - Lauren Darrigues
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
| | - Mathias Vandenbogaert
- Translational Research Department, Institut Curie Research Center, PSL University, Paris, France
- INSERM U830, Institut Curie, PSL University, Paris, France
| | - Cecile Laurent
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
| | - Francois Zaccarini
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
| | - Benjamin Sadacca
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
- INSERM U830, Institut Curie, PSL University, Paris, France
| | - Myriam Delomenie
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
| | - Enora Laas
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
| | - Odette Mariani
- Biological Resource Center, Department of Pathology, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Paris, France
| | - Thanh Lam
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France
| | - Marick Laé
- Biological Resource Center, Department of Pathology, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Paris, France
- Department of Pathology, Centre Henri Becquerel, INSERM U1245, UNIROUEN, University of Normandie, Rouen, France
| | - Ivan Bieche
- Pharmacogenomics Unit, Department of Genetics, PSL University, Institut Curie, Paris, France
- INSERM U1016, Faculty of Pharmaceutical and Biological Sciences, Université de Paris Cité, Paris, France
| | - Sophie Vacher
- Pharmacogenomics Unit, Department of Genetics, PSL University, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Celine Vallot
- Translational Research Department, Institut Curie Research Center, PSL University, Paris, France
- CNRS UMR3244, Institut Curie, PSL University, Paris, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Wilfrid Richer
- Translational Research Department, Institut Curie Research Center, PSL University, Paris, France
- Translational Immunotherapy Team, INSERM U932, Institut Curie, PSL University, Paris, France
| | - Dario Rocha
- Translational Immunotherapy Team, INSERM U932, Institut Curie, PSL University, Paris, France
| | - Zakia Tariq
- Pharmacogenomics Unit, Department of Genetics, PSL University, Institut Curie, Paris, France
| | - Veronique Becette
- Biological Resource Center, Department of Pathology, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Paris, France
| | - Didier Meseure
- Department of Diagnostic and Theranostic Medicine, Institut Curie, University Paris-Sciences et Lettres, Paris, France
| | - Laetitia Lesage
- Department of Diagnostic and Theranostic Medicine, Institut Curie, University Paris-Sciences et Lettres, Paris, France
| | - Anne Vincent-Salomon
- Department of Diagnostic and Theranostic Medicine, Institut Curie, University Paris-Sciences et Lettres, Paris, France
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Centre for Haematology and Oncology/Bethanien, Frankfurt am Main, Germany
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France
| | - Joshua J Waterfall
- Translational Research Department, Institut Curie Research Center, PSL University, Paris, France.
- INSERM U830, Institut Curie, PSL University, Paris, France.
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, Paris, INSERM, U932 Immunity and Cancer, Institut Curie, Université de Paris, Paris, France.
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université de Paris Cité, Paris, France.
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Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat 2022; 194:137-148. [PMID: 35488092 DOI: 10.1007/s10549-022-06532-4] [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: 11/15/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Lobular carcinoma in situ (LCIS) confers increased cancer risk in either breast, but it remains unclear if this population is at increased risk for bilateral breast cancer (BC) development. Here we report bilateral BC incidence among women with a history of LCIS. METHODS Women with classic-type LCIS diagnosed from 1980 to 2017 who developed unilateral BC (UBC) or bilateral BC were identified. Bilateral BC was categorized as synchronous (bilateral BC diagnosed < 6 months apart; SBBC) or metachronous (bilateral BC diagnosed ≥ 6 months apart; MBBC). Five-year incidence rates of bilateral BC among this population were evaluated. Comparisons were made to identify factors associated with bilateral BC. RESULTS At 7 years' median follow-up, 249/1651 (15%) women with LCIS developed BC; 34 with bilateral BC (2%). There were no clinicopathologic feature differences between those with UBC and bilateral BC. SBBC occurred in 18 without significant differences versus UBC. Among 211 with UBC and a contralateral breast at risk, 16 developed MBBC at a median follow-up of 3 years. MBBC patients were less likely to receive endocrine therapy and more likely to receive chemotherapy versus UBC. Tumor histology was not associated with MBBC. Estimated 5-year MBBC risk was 6.4%. Index estrogen/progesterone receptor positivity and endocrine therapy were the only factors associated with MBBC risk. CONCLUSION Bilateral BC occurred in 2% of women with LCIS history at median follow-up of 7 years. Similar to the general BC population, a decrease in MBBC is seen among women with a history of LCIS who develop hormone receptor-positive disease and those who receive endocrine therapy, highlighting the protective effects of this treatment.
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7
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Bloom JA, Sekigami Y, Young R, Macera L, Russell CA, Cao Y, Buchsbaum RJ, Naber SP, Chatterjee A. Discordance in Oncotype DX Breast Recurrence Score ® Results for Bilateral Breast Cancer. Ann Surg Oncol 2021; 28:8711-8716. [PMID: 34241750 DOI: 10.1245/s10434-021-10387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Oncotype DX Breast Recurrence Score® assay is a clinically useful tool to determine the benefit of chemotherapy in the treatment of early-stage, hormone-receptor-positive breast cancer. Bilateral breast cancer (BBC) is found in ~ 5% of patients with breast cancer, and data regarding discordance of Oncotype DX results between BBC defined by current TAILORx subgroups are limited. Our goals are to study the rate of Oncotype DX discordance between BBC and investigate whether such differences can affect chemotherapy treatment discussions. METHODS Patients with BBC were identified in US samples submitted to Genomic Health for 21-gene testing between January 2019 and July 2020. The risk categories were defined as 0-25 and 26-100 as well as 0-17, 18-30, and 31-100 for all patients. Subgroup analysis was also performed for node-negative women age ≤ 50 years with Recurrence Score results of 0-15, 16-20, 21-25, and 26-100. RESULTS 944 BBC patients with known nodal status (702 node negative, 242 node positive) were identified and included. Among node-negative patients aged > 50 years, the rate of discordance in Recurrence Score by group (0-25 and 26-100) was 4.2% (n = 598). For node-negative patients aged ≤ 50 years, the risk group was discordant in < 3% when considering the risk grouping of 0-25 and 26-100. However, upon subgroup analysis based on TAILORx analysis, the rate of discordance was 48.1% in these younger patients (n = 104). CONCLUSIONS This study shows that a clinically relevant rate of discordance in Oncotype DX results in patients with BBC may impact medical decision-making regarding chemotherapy.
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Affiliation(s)
- Joshua A Bloom
- Department of Surgery, Tufts Medical Center, Boston, MA, USA.
| | - Yurie Sekigami
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Lisa Macera
- Exact Sciences Corporation, Redwood City, CA, USA
| | | | - Yu Cao
- Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Rachel J Buchsbaum
- Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Stephen P Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
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8
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Gadea J, Ortiz I, Roncero R, Alastuey I, Mestre F, Aymar N, Maturana JE, Garcia C, Mateu L, Pardo J. Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes. Clin Transl Oncol 2021; 23:1915-1922. [PMID: 33830442 PMCID: PMC8026808 DOI: 10.1007/s12094-021-02600-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 11/20/2022]
Abstract
Background and purpose Synchronous bilateral breast cancer (SBBC) accounts for 1–3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT). Materials and methods From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60–64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0. Results 34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average Dmean for the heart was: Group A: 5.0 Gy (4.6–5.5), Group B: 4.4 Gy (4.1–5.4), Group C: 4.8 Gy (4.5–5.1) and Group D: 5.3 Gy (4.4–5.6). For the lungs, the inter-patient average Dmean was: Group A: 10.8 Gy (9.8–12.2), Group B: 11.5 Gy (11.3–12), Group C: 9.8 Gy (9.3–10.5) and Group D: 10.5 Gy (10–11.3). Conclusions This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory.
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Affiliation(s)
- J Gadea
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.
| | - I Ortiz
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.,Institut d´Investigació Sanitaria Illes Balears, IdISBA, Palma de Mallorca, Spain
| | - R Roncero
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain
| | - I Alastuey
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.,Institut d´Investigació Sanitaria Illes Balears, IdISBA, Palma de Mallorca, Spain
| | - F Mestre
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.,Institut d´Investigació Sanitaria Illes Balears, IdISBA, Palma de Mallorca, Spain
| | - N Aymar
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.,Institut d´Investigació Sanitaria Illes Balears, IdISBA, Palma de Mallorca, Spain
| | - J E Maturana
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain
| | - C Garcia
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain
| | - L Mateu
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain
| | - J Pardo
- Hospital Universitari Son Espases, Radiation Oncology Department, Carretera de Valldemossa, 79, 07020, Palma de Mallorca (Islas Baleares), Spain.,Institut d´Investigació Sanitaria Illes Balears, IdISBA, Palma de Mallorca, Spain.,Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Spain
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9
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Kuhl CK, Lehman C, Bedrosian I. Imaging in Locoregional Management of Breast Cancer. J Clin Oncol 2020; 38:2351-2361. [PMID: 32442068 PMCID: PMC7343437 DOI: 10.1200/jco.19.03257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Constance Lehman
- Breast Imaging Section, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, Division of Surgery, University of Texas MD Anderson Cancer, Center, Houston, TX
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10
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Multiple Bilateral Circumscribed Breast Masses Detected at Imaging: Review of Evidence for Management Recommendations. AJR Am J Roentgenol 2019; 214:276-281. [PMID: 31825259 DOI: 10.2214/ajr.19.22061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Historically, management recommendations for multiple bilateral circumscribed breast masses encountered with breast imaging have varied. This article reviews the evidence and provides best-practice recommendations for managing these masses. CONCLUSION. Meticulous imaging technique and interpretation are required to correctly diagnose multiple bilateral circumscribed breast masses. Radiologists should classify such masses identified at mammography, digital breast tomosynthesis, or bilateral whole-breast sonography as benign and recommend annual follow-up. Elucidating the significance of these masses on MRI, contrast-enhanced mammography, or nuclear breast imaging requires further study.
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11
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Debruhl ND, Lee SJ, Mahoney MC, Hanna L, Tuite C, Gatsonis CA, Lehman C. MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer: 2-Year Follow-up. JOURNAL OF BREAST IMAGING 2019; 2:50-55. [PMID: 32055797 DOI: 10.1093/jbi/wbz053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/27/2022]
Abstract
Objective The American College of Radiology Imaging Network Trial 6667 showed that MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast cancer diagnosis, based on 1-year follow-up. This study is a continuation of the trial that evaluates the diagnostic accuracy of MRI for contralateral breast cancer after 2 years of follow-up. Methods In total, 969 women with a diagnosis of unilateral breast cancer and no clinical or imaging abnormalities in the contralateral breast underwent breast MRI. The cancer status of all participants was monitored for 2 years after the initial MRI. Follow-up included documentation of any clinical, imaging, or interventional procedures performed. A study participant was considered positive for cancer if she had a tissue diagnosis of in situ or invasive breast cancer in the contralateral breast within 730 days of her initial MRI. Results Three additional cancers were diagnosed in the study population in the second year of the trial. The diagnostic yield for MRI for the 2-year period was 3% (31/969). After 2 years of follow-up, breast MRI has a sensitivity of 86% and specificity of 88% for detection of contralateral breast cancer. Its negative predictive value was 99%, and its positive predictive value was 22%. These values did not change significantly from the 1-year data. Conclusion A negative contralateral breast MRI has a very high and reliable negative predictive value over 2 years, and, therefore, is helpful in managing and counseling patients during the period of initial diagnosis and early treatment.
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Affiliation(s)
- Nanette D Debruhl
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Su-Ju Lee
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH
| | - Mary C Mahoney
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH
| | - Lucy Hanna
- Brown University, Center for Statistical Sciences, Department of Biostatistics, Providence, RI
| | | | - Constantine A Gatsonis
- Brown University, Center for Statistical Sciences, Department of Biostatistics, Providence, RI
| | - Constance Lehman
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA
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12
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Patel S, Anand M. Dual Gynecological Malignancies: A Case Series from Tertiary Care Center. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Valli M, Cima S, Gaudino D, Cartolari R, Deantonio L, Frapolli M, Daniele D, Pesce GA, Martucci F, Azinwi NC, Bosetti D, Presilla S, Richetti A. Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience. Clin Transl Oncol 2019; 21:1492-1498. [DOI: 10.1007/s12094-019-02077-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
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14
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Lohana P, Button J, Young D, Hart A, Weiler-Mithoff E. Functional recovery after bilateral extended autologous latissimus dorsi breast reconstruction: A prospective observational study. J Plast Reconstr Aesthet Surg 2019; 72:1060-1066. [PMID: 31053451 DOI: 10.1016/j.bjps.2019.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/10/2018] [Accepted: 01/06/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of unilateral extended autologous latissimus dorsi (EALD) flap harvest and axillary surgery on shoulder function has been well described, but the impact of bilateral EALD flap harvest has not been clearly defined nor is it clear whether reconstructions should be synchronous or staged. METHODS In this prospective observational study, patients undergoing bilateral EALD breast reconstruction (February 2003-December 2009) completed the disability, arm, shoulder and hand (DASH) questionnaire preoperatively and at five post-operative timepoints. Intensive shoulder physiotherapy was offered to those whose DASH score was >30 at 6 weeks or >20 at 12 weeks post-operatively. RESULTS Sixty patients underwent bilateral EALD flap breast reconstruction (51 synchronous, 9 metachronous). Patients with pre-existing shoulder pathology (n = 1) and those who failed to return any post-operative DASH questionnaire (n = 10) were excluded from initial DASH analysis. However, these eleven patients were included in a separate analysis as an intention-to-treat analysis. Statistical analysis was performed using non-parametric, Friedman test and multiple comparison model. Forty-nine patients' DASH scores were analysed. DASH score initially increased after surgery and then returned to functionally normal within 3-6 months (median DASH: preoperative = 1 vs 6 weeks post-operation = 26, p = <0.001; vs 3 months = 19, p = <0.001; vs 6 months = 13, p = <0.001); thereafter, the scores remained less than 12 (p = <0.001). Median DASH score after synchronous reconstruction was not higher than that after metachronous reconstructions, although the metachronous sample size was small. CONCLUSION With appropriate patient selection and intensive physiotherapy, bilateral EALD breast reconstruction does not appear to cause significant long-term impairment of shoulder function, and patients can now be counselled about the likely timecourse of shoulder recovery. There seems no reason to stage bilateral reconstruction to reduce shoulder morbidity.
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Affiliation(s)
- Parkash Lohana
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
| | - Jane Button
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow G1 1NH, UK
| | - Andrew Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK; Centre for Cell Engineering, College of Medical Veterinary & Life Sciences, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Eva Weiler-Mithoff
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
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15
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Zhou C, Hainsworth B, Sydney M, Lee M, Ormsby Z, Haggers M, Chase JG. Structural health monitoring of tissue mechanics for non-invasive diagnosis of breast cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1515/auto-2018-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
A hysteresis loop analysis (HLA) method for breast cancer diagnosis based on a non-invasive digital imaging elasto-tomography (DIET) screening system is evaluated using data from 3 clinical trial patients, comprising 2 healthy breasts and 4 breasts with cancer. The identified mechanical nominal stiffness with ∼2x higher values compared to healthy tissue stiffness localized the correct cancerous area (CA) or tumor location, matching the mammography detection for all 4 breasts with cancer. The difference in identified stiffness varies across different frequencies and individuals. However, the identified stiffness for all healthy breasts and/or health tissue regions are consistent across frequencies, avoiding false positive diagnosis. The overall approach can be implemented automatically without requiring a skilled operator, thus reducing the screening cost.
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Affiliation(s)
- Cong Zhou
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Brent Hainsworth
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Maxwell Sydney
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | - Michael Lee
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
| | | | | | - J. Geoffrey Chase
- Department of Mechanical Engineering , 2496 University of Canterbury , Private Bag 4800 , Christchurch , New Zealand
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16
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Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography. Eur J Radiol 2018; 108:215-221. [PMID: 30396659 DOI: 10.1016/j.ejrad.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.
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17
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Wadasadawala T, Lewis S, Parmar V, Budrukkar A, Gupta S, Nair N, Shet T, Badwe R, Sarin R. Bilateral Breast Cancer After Multimodality Treatment: A Report of Clinical Outcomes in an Asian Population. Clin Breast Cancer 2018; 18:e727-e737. [DOI: 10.1016/j.clbc.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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18
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Mortality after contralateral breast cancer in Denmark. Breast Cancer Res Treat 2018; 171:489-499. [PMID: 29948403 DOI: 10.1007/s10549-018-4846-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE How a second breast cancer diagnosis affects survival in comparison with unilateral breast cancer (UBC) is unclear. Prognostic factors for contralateral breast cancer (CBC) are also not well established. We aimed to investigate the survival pattern after CBC with particular focus on time between first and second breast cancer diagnosis and age at CBC diagnosis. METHODS Within the nationwide Danish Breast Cancer Cooperative Group database, we identified 68,466 breast cancer patients diagnosed during 1978-2012. Patients who subsequently developed CBC were identified in a previously established database (N = 3004). Patients were followed for breast cancer-specific death in the Danish Register of Causes of Death until 2015. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard regression models. Cumulative breast cancer mortality from date of CBC was estimated using the Aalen-Johansen method. RESULTS Compared with UBC patients, the rate of dying from breast cancer was more than twofold higher following a CBC diagnosis, after adjustment for age, period, tumor characteristics, and treatment of the first breast cancer (HR 2.48; 95% CI 2.31-2.66). Short time interval (< 5 years) was associated with higher breast cancer-specific mortality after CBC among patients < 70 years at CBC diagnosis compared with longer time intervals, but not among patients ≥ 70 years at CBC diagnosis. CONCLUSION Breast cancer-specific mortality rates were markedly higher after compared with before a CBC diagnosis. We found higher breast cancer-specific mortality after CBC associated with a short interval between diagnoses among patients diagnosed with CBC before age 70 years.
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19
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Including internal mammary lymph nodes in radiation therapy for synchronous bilateral breast cancer: an international survey of treatment technique and clinical priorities. Breast Cancer Res Treat 2018; 171:471-475. [PMID: 29869775 DOI: 10.1007/s10549-018-4848-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to understand the international standard practice for radiation therapy treatment techniques and clinical priorities for institutions including the internal mammary lymph nodes (IMLNs) in the target volume for patients with synchronous bilateral breast cancer. METHODS An international survey was developed to include questions that would provide awareness of favored treatment techniques, treatment planning and delivery resource requirements, and the clinical priorities that may lead to the utilization of preferred treatment techniques. RESULTS Of the 135 respondents, 82 indicated that IMLNs are regularly included in the target volume for radiation therapy (IMLN-inclusion) when the patient is otherwise generally indicated for regional nodal irradiation. Of the 82 respondents that regularly include IMLNs, five were removed as those respondents do not treat this population synchronously. Of the 77 respondents, institutional standard of care varied significantly, though VMAT (34%) and combined static photon and electron fields (21%) were the most commonly utilized techniques. Respondents did preferentially select target volume coverage (70%) as the most important clinical priority, followed by normal tissue sparing (25%). CONCLUSION The results of the survey indicate that the IMLN-inclusion for radiation therapy has not yet been comprehensively adopted. As well, no consensus on best practice for radiation therapy treatment techniques has been reached.
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20
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Raber B, Bea VJ, Bedrosian I. How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Surgical Oncologist. Magn Reson Imaging Clin N Am 2018; 26:281-288. [PMID: 29622133 DOI: 10.1016/j.mric.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
MR imaging is now readily available for surgeons to incorporate into their practice, thus, begging the question, is this new modality clinically useful? Current literature and expert opinion are reviewed concerning the implementation of breast MR imaging to clinical management of breast cancer. Although breast MR imaging is acknowledged to be highly sensitive in detection of breast cancer, its routine application to surgical practice remains controversial because these gains in sensitivity have not been demonstrated to translate into improved long-term patient outcomes. Current clinical trials and the future of breast MR imaging are also discussed.
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Affiliation(s)
- Benjamin Raber
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA
| | - Vivian J Bea
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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21
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Motuzyuk I, Sydorchuk O, Kovtun N, Palian Z, Kostiuchenko Y. Analysis of Trends and Factors in Breast Multiple Primary Malignant Neoplasms. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018. [PMID: 29531473 PMCID: PMC5843092 DOI: 10.1177/1178223418759959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The study aims to evaluate the current state and tendencies in multiple primary breast cancer incidence, behavior, and treatment in Ukraine. Methods A total of 2032 patients who received special treatment at the Department of Breast Tumors and Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 were included in the study. Among them, there were 195 patients with multiple primary malignant neoplasms: 54.9% patients with synchronous cancer and 45.1% patients with metachronous cancer. The average age of patients was 46.6 years, and the percentage of postmenopausal women was 63.1%. Among patients with synchronous cancer, there were 56.1% patients with only breast localizations and 43.9% with combination of breast and other localizations, and among patients with metachronous cancer, there were 46.6% patients with only breast localizations and 53.4% with combination of breast and other localizations. All the patients were evaluated in terms of aggressiveness of the disease, survival rates, as well as risk factors and treatment options. Results A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chernobyl accident under the age of 30 years (P < .01). The clinical course of disease in patients with synchronous cancer is worse and prognostically unfavorable compared with metachronous cancer (P < .01). The course of the disease in patients who underwent mastectomy is worse compared with patients who underwent breast-conserving surgery (P < .01). Plastic and reconstructive surgery in patients with synchronous cancer was proven to be reasonable in terms of increase in survival (P < .01). Conclusions The patients with multiple primary breast cancer should have attentive management and treatment. Multidisciplinary team should concern all the risk factors and provide the most sufficient option of management. This is crucial to continue research in this oncological area.
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Affiliation(s)
- Igor Motuzyuk
- Department of Oncology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Oleg Sydorchuk
- Department of Oncology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natalia Kovtun
- Chiltern Clinical Research Ukraine LLC, Kyiv, Ukraine.,Department of Statistics and Demography, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Zinaida Palian
- Department of Statistics and Demography, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
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van Bommel RMG, Voogd AC, Nederend J, Setz-Pels W, Louwman MWJ, Strobbe LJ, Venderink D, Tjan-Heijnen VCG, Duijm LEM. Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography. Breast 2018; 38:101-106. [PMID: 29306176 DOI: 10.1016/j.breast.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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Jacob LA, Anand A, Lakshmaiah KC, Babu GK, Lokanatha D, Suresh Babu MS, Lokesh KN, Rudresha AH, Rajeev LK, Koppaka D. Clinicopathological Profile and Treatment Outcomes of Bilateral Breast Cancer: A Study from Tertiary Cancer Center in South India. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_56_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Bilateral breast cancer (BBC) is a rare clinical entity with limited data regarding clinicopathological aspects and treatment guidelines. Materials and Methods: This was an observational study of patients diagnosed with BBC from August 2012 to July 2014. Synchronous breast cancers (SBCs) was defined as two tumors diagnosed within an interval of 6 months and metachronous breast cancer (MBC) as second cancer diagnosed after 6 months. Results: Out of 750 breast cancer patients seen during a 2-year period, 35 had BBC. Ten patients were diagnosed as SBC whereas 25 patients as MBC. Among patients with MBC, the average time for development of contralateral breast cancer was 5 years. In 8 patients, the contralateral breast cancer was detected mammography whereas rest 27 patients were detected by clinical breast examination. At a median follow-up of 24 months, 23 (66%) patients were disease free, 9 (26%) patients had disease relapse, and 3 (8%) patients succumbed to the progressive disease. Conclusions: Every patient with breast cancer should be regularly followed up with clinical breast examination at a more frequent interval. The role of frequent clinical breast examination appears more than mammography especially beyond 5 years for early detection of contralateral breast cancer.
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Affiliation(s)
- Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Abhishek Anand
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Govind K. Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Dasappa Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - M.C. Suresh Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Kadabur N. Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - L K. Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Deepak Koppaka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Iyer P, Radhakrishnan V, Ananthi B, Selvaluxmy G, Sridevi V. Synchronous Bilateral Breast Cancer: Clinical Features, Pathology and Survival Outcomes from a Tertiary Cancer Center. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sejdinaj F, Yang W, Zhu W, Zhang H. Breast-conserving therapy: An alternative to optimal cosmetic outcome and comparable prognosis in synchronous bilateral breast cancer. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fabjola Sejdinaj
- Department of General Surgery, Zhongshan Hospital; Fudan University; Shanghai China
| | - Weige Yang
- Department of General Surgery, Zhongshan Hospital; Fudan University; Shanghai China
| | - Wei Zhu
- Department of General Surgery, Zhongshan Hospital; Fudan University; Shanghai China
| | - Hongwei Zhang
- Department of General Surgery, Zhongshan Hospital; Fudan University; Shanghai China
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Fiorentino A, Mazzola R, Naccarato S, Giaj-Levra N, Fersino S, Sicignano G, Tebano U, Ricchetti F, Ruggieri R, Alongi F. Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetric modulated arc therapy and simultaneous integrated boost. Radiol Med 2017; 122:464-471. [PMID: 28224401 DOI: 10.1007/s11547-017-0741-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the present retrospective analysis was to evaluate dosimetric parameters, feasibility and outcome for Synchronous Bilateral Breast Cancer (SBBC) patients treated with adjuvant radiotherapy (RT) by Volumetric Modulated Arc Therapy (VMAT). METHODS From September 2011 to April 2016, 1100 Breast Cancer (BC) patients were referred to our institution to receive adjuvant breast RT, and those with SBBC were selected for the present analysis. A total of 16 patients were identified. A total dose of 50 Gy in 25 fractions was prescribed to the Planning Target Volume of the whole bilateral breast (PTVBN) with or without the supraclavicular and infraclavicular nodes, while a total dose of 60 Gy in 25 fractions was prescribed to the surgical bed (PTVboost). Several V xGy and Dx% parameters were analyzed for the PTVs, together with Conformity and Homogeneity indexes (CI, HI), and for the critical Organs at risk (OARs), lungs and heart first. RESULTS With a median follow-up of 24 months, no acute or late side effects more than grade 2 were observed. All patients are alive without any sign of disease. For target dose coverage, our observed inter-patients averages (±1 sd) were V 95% Dp = 96.7 ± 1.6% (96.3 ± 1.8%) to the left (right) PTVBN, V 95% Dp = 98.6 ± 2.7% (99.4 ± 0.9%) to the left (right) PTVboost, and D 2% = 64.4 ± 1.8 Gy (65.0 ± 2.0 Gy) to the left (right) PTVboost, respectively. With regard to the heart, the inter-patient average of D mean was 8.3 ± 3.3 Gy. For the lungs, the inter-patient average of D mean, V 5 Gy and V 20 Gy were 11.8 ± 2.3 Gy, 78.9 ± 15.3% and 15.7 ± 5%, respectively. CONCLUSIONS The present retrospective analysis showed the feasibility, tolerability and safety of VMAT in the treatment of SBBC patients. Further studies are necessary to confirm these preliminary data.
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Affiliation(s)
- Alba Fiorentino
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - Stefania Naccarato
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Sergio Fersino
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Gianluisa Sicignano
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Umberto Tebano
- Radiation Oncology School, University of Padua, Padua, Italy
| | - Francesco Ricchetti
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Ruggero Ruggieri
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
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Motuzyuk I, Sydorchuk O, Kovtun N, Kostiuchenko Y. Synchronous and metachronous breast cancer in Ukraine. Breast Dis 2017; 37:83-93. [PMID: 29504518 DOI: 10.3233/bd-170285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study aims to describe the current state of multiple primary malignant neoplasms (MPMNs) breast cancer patients management, evaluate the predictive impact of different factors, optimise approaches to diagnosis and treatment of these patients and improve their life quality. METHODS The study included 2,032 patients who received special treatment at the Department of Breast Tumours and it Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 within an open randomized controlled trial. The sample included 195 patients with synchronous cancer or metachronous breast cancer. RESULTS A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chornobyl accident. The clinical course of disease in patients with synchronous breast cancer is worse and prognostically unfavourable comparing to metachronous one. The influence on clinical course of disease of primary localization, type of settlement, blood group and Rh factor, type of special treatment, and age in patients with synchronous and metachronous cancer was not statistically proven. The impact of operative intervention scope in patients with synchronous and metachronous breast cancer was statistically proven, i.e. the course of the underlying disease in patients who underwent mastectomy is worse comparing to patients who underwent conservative surgery. Plastic and reconstructive surgery in patients with synchronous cancer was statistically proven in this study as reasonable. The influence of local recurrence rates on overall survival in patients with synchronous cancer was proven. However, the influence of local recurrence rates in patients with metachronous cancer was not statistically proven. CONCLUSIONS There should be paid a great attention to synchronous and metachronous breast cancer patients in order to find and provide the best options of their management. This is crucial to continue researches in this field of oncology.
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Affiliation(s)
- Igor Motuzyuk
- Oncology Department, Bogomolets National Medical University, 03022, Kyiv, Ukraine
| | - Oleg Sydorchuk
- Oncology Department, Bogomolets National Medical University, 03022, Kyiv, Ukraine
| | - Natalia Kovtun
- Chiltern Clinical Research Ukraine LLC, Department of Statistics and Demography, Taras Schevchenko National University of Kyiv, Kyiv, Ukraine
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Park YJ, Kim MJ, Moon HJ, Kim EK, Yoon JH. Whole-breast US following mammography and breast MRI in newly diagnosed breast cancer patients: can it be more than just a guidance tool for biopsy? Clin Radiol 2016; 72:425.e1-425.e7. [PMID: 27712905 DOI: 10.1016/j.crad.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/03/2016] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the role of ultrasound (US) following magnetic resonance imaging (MRI) and mammography in patients with newly diagnosed breast cancers by assessing the additional cancer detection rate of US. MATERIAL AND METHODS Two hundred and twenty-five women who had undergone 225 MRI examinations followed by US were included. An US-detected additional cancer was defined as a lesion detected using breast US that had not been detected by MRI, and which was shown to be malignant at histopathology. The rate of additional cancer detection, incidence of additional malignancies, positive predictive value (PPV), and false-positive (FP) rate were analysed. Factors associated with an increase in the additional cancer detection rate were analysed. RESULTS The additional cancer detection rate was 0% (0/225) for the ipsilateral breast and 0.9% (2/225) for the contralateral breast, and the PPVs were 0% (0/5) and 100% (2/2), respectively. The overall TP:FP ratio was 0.4 (2:5). The additional cancer detection rate was higher for cases with moderate and severe background parenchymal enhancement than cases with minimal and mild background parenchymal enhancement (p=0.003). The additional cancer detection rate for cases with moderate and severe background parenchymal enhancement was 5.7% (2/35) for the contralateral breast (p=0.003). CONCLUSION Preoperative breast US following MRI and mammography can help clinicians screen for contralateral cancers with an additional detection rate of 0.9%. Moreover, whole-breast US might be a useful contralateral screening modality in cases with moderate or marked parenchymal enhancement on breast MRI.
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Affiliation(s)
- Y J Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - M J Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - H J Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - E-K Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J H Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kaidar-Person O, Kostich M, Zagar TM, Jones E, Gupta G, Mavroidis P, Das SK, Marks LB. Helical tomotherapy for bilateral breast cancer: Clinical experience. Breast 2016; 28:79-83. [DOI: 10.1016/j.breast.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 01/01/2023] Open
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Contribution of FDG PET/CT for the Optimization of the Management of Additional Lesions Detected on Local Staging Breast MRI. AJR Am J Roentgenol 2016; 206:891-900. [DOI: 10.2214/ajr.15.14656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ibrahim NY, Sroor MY, Darwish DO. Impact of bilateral breast cancer on prognosis: synchronous versus metachronous tumors. Asian Pac J Cancer Prev 2015; 16:1007-10. [PMID: 25735321 DOI: 10.7314/apjcp.2015.16.3.1007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. MATERIALS AND METHODS Between 2005 and 2009 we identified 110 cases of bilateral breast cancer (BBC) ; 49 patients had synchronous (duration between the occurrence of carcinoma in both breasts was less than 12 months) and 61 had metachronous (duration was more than one year with no ipsilateral local recurrence). We compared the patient characteristics including age, menopausal status, clinical stage, tumor size, histological classification, lymph node status, and hormone receptor and Her-2 status. We also compared the treatment given and overall and disease free survival (DFS) of both groups. RESULTS Synchronous cases tend to present more aggressively than metachronous cases and age at first presentation adversely affects survival. The 5 year overall survival was 78.7% for metachronous and 60% for synchronous. Patients with positive hormonal status had better five year disease free survival in metachronous compared to synchronous cases, at 76% and 63%, respectively. Age at first presentation >45years had better DFS (65%) compared to those with age ≤45 years (52%) at 5 years follow up. CONCLUSIONS Patients with synchronous breast cancer may have worse prognosis. Young age and hormone receptor negative were risk factors in our study. Close follow up and early detection of contralateral breast cancer is mandatory.
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Affiliation(s)
- Noha Y Ibrahim
- Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr El-Aini School of Medicine, Cairo University, Cairo, Egypt E-mail :
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Liederbach E, Wang CH, Lutfi W, Kantor O, Pesce C, Winchester DJ, Yao K. Survival Outcomes and Pathologic Features Among Breast Cancer Patients Who Have Developed a Contralateral Breast Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S412-21. [DOI: 10.1245/s10434-015-4835-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 11/18/2022]
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Padmanabhan N, Subramanyan A, Radhakrishna S. Synchronous Bilateral Breast Cancers. J Clin Diagn Res 2015; 9:XC05-XC08. [PMID: 26500995 DOI: 10.7860/jcdr/2015/14880.6511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bilateral breast cancer (BBC) is not an uncommon entity in contemporary breast clinics. Improved life expectancy after breast cancer treatment and routine use of contra-lateral breast mammography has led to increased incidence of BBC. Our study objective was to define the epidemiological and tumour characteristics of BBC in India. MATERIALS AND METHODS A total of 1251 breast cancer patients were treated during the period January 2007 to March 2015 and 30 patients were found to have BBC who constituted the study population (60 tumour samples). Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC). Analyses of patient and tumour characteristics were done in this prospective data base of BBC patients. RESULTS Median patient age was 66 years (range 39-85). Majority of the patients had SBC (n=28) and in 12 patients the second tumour was clinically occult and detected only by mammography of the contra-lateral breast. The second tumour was found at lower tumour size compared to the first in 73% of cases and was negative for axillary metastasis in 80% of cases (24/30). Infiltrating ductal carcinoma was the commonest histological type (n=51) and majority of the tumours were ER/PR positive (50/60). Her2 was overexpressed in 13 tumours (21%). Over 70% (22/30) of patients had similar histology in both breasts and amongst them grade concordance was present in about 69% (15/22) of patients. Concordance rates of ER, PR and Her2 statuses were 83%, 80% and 90% respectively. Bilateral mastectomy was the commonest surgery performed in 80% of the patients followed by bilateral breast conservation in 13%. At the end of study period, 26 patients were alive and disease free. Median survival was 29 months (range 3-86 months). CONCLUSION In most patients with BBC, the second tumour is identified at an early stage than index tumours supporting the importance of contralateral breast cancer screening at the time of primary diagnosis and during follow-up. BBC occurs more frequently in old age group and majority of these tumours are estrogen dependent. There is good pathological concordance between the index tumour and the contralateral breast cancer.
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Affiliation(s)
- Naveen Padmanabhan
- Registrar, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai-35, India
| | - Annapurneswari Subramanyan
- Chief of Surgical Pathology, Department of Surgical Pathology, Apollo Speciality Hospitals , Chennai-35, India
| | - Selvi Radhakrishna
- Senior Consultant, Department of Breast surgery and Oncoplastic Breast surgeon, Apollo Speciality Hospitals , Chennai-35, India
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Jobsen JJ, van der Palen J, Ong F, Riemersma S, Struikmans H. Bilateral breast cancer, synchronous and metachronous; differences and outcome. Breast Cancer Res Treat 2015; 153:277-83. [DOI: 10.1007/s10549-015-3538-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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O'Brien JA, Ho A, Wright GP, Stempel M, Patil S, Krause K, Morrow M, Gemignani ML. Breast-Conserving Surgery in Bilateral Breast Cancer. Ann Surg Oncol 2015; 22:3389-96. [PMID: 26265365 DOI: 10.1245/s10434-015-4746-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bilateral breast cancer (BBC) may present as synchronous (SBC) or metachronous breast cancer (MBC). Optimal surgical management of BBC patients is not well-defined. In this study, we report on histopathology, treatment, and outcomes in BBC patients. METHODS Upon Institutional Review Board approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999 and 2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed, and factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease, tumor considered too large for BCS, and a patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs (binary variables) or the paired t test (continuous variables) were used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival (OS). RESULTS A total of 203 BBC patients (119 SBC, 84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and molecular profiles. Overall, 57% of MBC patients underwent breast-conserving surgery (BCS) at initial diagnosis versus 34% of patients with SBC. BCS contraindications were similar in both groups: 16 (34%) MBC patients and 28 (36%) SBC patients. Kaplan-Meier OS estimates at 5 and 10 years were 86 and 78% for MBC, and 87 and 77% for SBC patients, respectively. CONCLUSIONS OS was excellent for both the MBC and SBC groups. Contraindications to BCS did not differ between groups. However, patients with SBC were less likely to undergo BCS compared with patients with MBC at the time of initial diagnosis.
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Affiliation(s)
- Julie A O'Brien
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bilateral breast cancer following augmentation mammaplasty with polyacrylamide hydrogel injection: A case report. Oncol Lett 2015; 9:2687-2693. [PMID: 26137129 DOI: 10.3892/ol.2015.3116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 02/13/2015] [Indexed: 11/05/2022] Open
Abstract
Breast cancer occurring following injection with polyacrylamide hydrogel (PAMG) for augmentation mammaplasty is rare. The present study reports the case of a 43-year-old female presenting with bilateral breast cancer 10 years after augmentation mammaplasty with PAMG injection and no family history of breast cancer. A 5.5×6.0-cm mass in the right breast with multiple intumescent axillary lymph nodes was revealed and a palpable mass of ~1.0 cm was identified in the outer upper quadrant of the left breast. Multiple smaller nodules were observed in the pulmonary field. Pathological examination revealed invasive lobular grade II carcinoma in both breasts with ER(+++), PR(+++), C-erbB2(-), Top-2(+), in the right breast and ER(++), PR(++), c-erb-B2(-), Top-2(+) in the left. Preoperative chemotherapy, modified radical bilateral mastectomy with axillary clearance, postoperative chemotherapy, and an oophorectomy were conducted, followed by treatment with Arimedex® until the present date A number of valuable insights can be garnered from this case. First, close follow-up is required for female patients who receive an injection of PAMG for augmentation mammaplasty in order to achieve an early diagnosis and to intervene in any incidences of breast cancer. Second, the differential diagnosis of dual primary carcinoma versus metastatic breast cancer is important and may be aided by the use of molecular technology. Third, it remains difficult to determine gene expression values for the prediction of chemotherapy sensitivity. Thus, discrimination between primary and secondary carcinomas is the principle barrier for identifying an appropriate treatment strategy when a patient is diagnosed with bilateral breast cancer.
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Bilateral Breast Radiation Delivered with Static Angle Tomotherapy (TomoDirect): Clinical Feasibility and Dosimetric Results of a Single Patient. TUMORI JOURNAL 2015; 101:e4-8. [DOI: 10.5301/tj.5000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/20/2022]
Abstract
We herein report on a case of synchronous bilateral breast cancer patient undergoing adjuvant intensity-modulated whole breast with static angle tomotherapy (TomoDirect). The patient was treated with a hypofractionated schedule employing a simultaneous integrated boost approach. Radiotherapy schedule was 45 Gy/20 fractions (2.25 Gy daily) to the bilateral whole breast and 50 Gy/20 fractions (2.5 Gy daily) to the 2 lumpectomy cavities. Treatment was delivered over 4 weeks. Dosimetric results were robust with consistent target coverage and adequate normal tissue avoidance. Treatment was generally well-tolerated and acute toxicity profile was mild. The present report highlights the promising clinical feasibility of TomoDirect for bilateral breast irradiation.
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Davies KR, Cantor SB, Brewster AM. Better contralateral breast cancer risk estimation and alternative options to contralateral prophylactic mastectomy. Int J Womens Health 2015; 7:181-7. [PMID: 25678823 PMCID: PMC4324540 DOI: 10.2147/ijwh.s52380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The incidence of contralateral prophylactic mastectomy (CPM) has increased among women with breast cancer, despite uncertain survival benefit and a declining incidence of contralateral breast cancer (CBC). Patient-related reasons for undergoing CPM include an overestimation of the risk of CBC, increased cancer worry, and a desire to improve survival. We summarize the existing literature on CBC risk and outcomes and the clinical benefit of CPM among women with unilateral breast cancer who have a low-to-moderate risk of developing a secondary cancer in the contralateral breast. Published studies were retrieved from the MEDLINE database with the keywords "contralateral breast cancer" and "contralateral prophylactic mastectomy". These include observational studies, clinical trials, survival analyses, and decision models examining the risk of CBC, the clinical and psychosocial effects of CPM, and other treatment strategies to reduce CBC risk. Studies that have evaluated CBC risk estimate it to be approximately 0.5% annually on average. Patient-related factors associated with an increased risk of CBC include carriers of BRCA1/2 mutations, young age at breast cancer, and strong family history of breast cancer in the absence of a BRCA1/2 mutation. Although CPM reduces the risk of CBC by approximately 94%, it may not provide a significant gain in overall survival and there is conflicting evidence that it improves disease-free survival among women with breast cancer regardless of estrogen receptor (ER) status. Therefore, alternative strategies such as the use of tamoxifen or aromatase inhibitors, which reduce the risk of CBC by approximately 50%, should be encouraged for eligible women with ER-positive breast cancers. Future research is needed to evaluate the impact of decision and educational tools that can be used for personalized counseling of patients regarding their CBC risk, the uncertain role of CPM, and alternative CBC risk reduction strategies.
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Affiliation(s)
- Kalatu R Davies
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wadasadawala T, Visariya B, Sarin R, Upreti RR, Paul S, Phurailatpam R. Use of tomotherapy in treatment of synchronous bilateral breast cancer: dosimetric comparison study. Br J Radiol 2015; 88:20140612. [PMID: 25605345 DOI: 10.1259/bjr.20140612] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Synchronous malignancy in both breasts is a rare incidence. The present study aims at dosimetric comparison of conventional bitangential radiotherapy (RT) technique with conventional [field-in-field (FIF)] and rotational [Helical TomoTherapy(®) and TomoDirect™ (TD); Accuray Inc., Sunnyvale, CA] intensity-modulated RT for patients with synchronous bilateral breast cancer (SBBC). METHODS CT data sets of 10 patients with SBBC were selected for the present study. RT was planned for all patients on both sides to whole breast and/or chest wall using the above-mentioned techniques. Six females with breast conservation on at least one side also had a composite plan along with tumour bed (TB) boost using sequential electrons for bitangential and FIF techniques or sequential helical tomotherapy (HT) boost (for TD) or simultaneous integrated boost (SIB) for HT. RESULTS All techniques produced acceptable target coverage. The hotspot was significantly lower with FIF technique and HT but higher with TD. For the organs at risk doses, HT resulted in significant reduction of the higher dose volumes. Similarly, TD resulted in significant reduction of the mean dose to the heart and total lung by reducing the lower dose volumes. All techniques of delivering boost to the TB were comparable in terms of target coverage. HT-SIB markedly reduced mean doses to the total lung and heart by specifically lowering the higher dose volumes. CONCLUSION This study demonstrates the cardiac and pulmonary sparing ability of tomotherapy in the setting of SBBC. ADVANCES IN KNOWLEDGE This is the first study demonstrating feasibility of treatment of SBBC using tomotherapy.
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Affiliation(s)
- T Wadasadawala
- 1 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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Kadioğlu H, Özbaş S, Akcan A, Soyder A, Soylu L, Koçak S, Cantürk NZ, Tükenmez M, Müslümanoğlu M. Comparison of the histopathology and prognosis of bilateral versus unilateral multifocal multicentric breast cancers. World J Surg Oncol 2014; 12:266. [PMID: 25143016 PMCID: PMC4247688 DOI: 10.1186/1477-7819-12-266] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 08/06/2014] [Indexed: 11/30/2022] Open
Abstract
Background Multiple breast cancers may present with different clinical and biological characteristics. The data indicate that multifocal (MF), multicentric (MC), and bilateral synchronous (BS) breast cancers (BC) are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases. However, a comparison of these multiple breast cancers has not been covered in the literature. The aim of this study was to describe the histopathological characteristics of patients suffering from MF, MC, and BS breast carcinoma and to compare their prognoses. Methods Retrospective data for MF, MC, and BS breast carcinoma patients treated in five different breast cancer units in Turkey between 2003 and 2012 were collected. MF and MC cancers were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. Results There were 507 patients (271 MF, 147 MC, and 89 BS) treated in this time period. BS breast carcinoma patients were younger than the other groups (44.83 ± 9.6, 47.27 ± 11.6, and 51.11 ± 11.8 years for BS, MF, and MC breast carcinoma patients, respectively). MFBC and MCBC patients in this study were younger than the ages reported in Western literature, but this result was similar to the ages reported in Eastern literature. The five-year survival rates and recurrence rates were not statistically different among groups (P = 0.996 and P = 0.263, respectively). According to univariate analyses, tumor size, histological grade, and lymph node status were statistically significant factors that affected survival. However, only lymph node involvement was significant for survival according to multivariate analyses. Conclusions The clinical significance of MF, MC, and BS breast cancers is still unclear and their influence on prognosis is controversial. Disease-free and overall survival rates of BS breast cancers might be similar to MF and MC breast cancers.
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Affiliation(s)
- Hüseyin Kadioğlu
- Department of General Surgery, Bezmialem Vakif University, Istanbul Adnan Menderes Bulvarı Vatan Caddesi, 34093 Fatih/İstanbul, Turkey.
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Kim J, Han W, Moon HG, Ahn SK, Shin HC, You JM, Chang JM, Cho N, Moon WK, Park IA, Noh DY. Low rates of additional cancer detection by magnetic resonance imaging in newly diagnosed breast cancer patients who undergo preoperative mammography and ultrasonography. J Breast Cancer 2014; 17:167-73. [PMID: 25013439 PMCID: PMC4090320 DOI: 10.4048/jbc.2014.17.2.167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/24/2014] [Indexed: 01/29/2023] Open
Abstract
Purpose We evaluated the efficacy of breast magnetic resonance imaging (MRI) for detecting additional malignancies in breast cancer patients newly diagnosed by breast ultrasonography and mammography. Methods We retrospectively reviewed the records of 1,038 breast cancer patients who underwent preoperative mammography, bilateral breast ultrasonography, and subsequent breast MRI between August 2007 and December 2010 at single institution in Korea. MRI-detected additional lesions were defined as those lesions detected by breast MRI that were previously undetected by mammography and ultrasonography and which would otherwise have not been identified. Results Among the 1,038 cases, 228 additional lesions (22.0%) and 30 additional malignancies (2.9%) were detected by breast MRI. Of these 228 lesions, 109 were suspected to be malignant (Breast Imaging-Reporting and Data System category 4 or 5) on breast MRI and second-look ultrasonography and 30 were pathologically confirmed to be malignant (13.2%). Of these 30 lesions, 21 were ipsilateral to the main lesion and nine were contralateral. Fourteen lesions were in situ carcinomas and 16 were invasive carcinomas. The positive predictive value of breast MRI was 27.5% (30/109). No clinicopathological factors were significantly associated with additional malignant foci. Conclusion Breast MRI was useful in detecting additional malignancy in a small number of patients who underwent ultrasonography and mammography.
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Affiliation(s)
- Jisun Kim
- Division of Breast-Endocrine Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | | | - Hee-Chul Shin
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jee-Man You
- Department of Surgery, Sun General Hospital, Daejeon, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - In-Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
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Synchronous and metachronous breast malignancies: a cross-sectional retrospective study and review of the literature. BIOMED RESEARCH INTERNATIONAL 2014; 2014:250727. [PMID: 24877073 PMCID: PMC4022260 DOI: 10.1155/2014/250727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/22/2014] [Indexed: 11/17/2022]
Abstract
Objective. There is increasing interest in patients with metachronous (MBC) and synchronous breast cancer (SBC). The objective of this study was to evaluate the occurrence and outcome of MBCs and SBCs. Methods. A retrospective study on women operated in our department for breast cancer between 2002 and 2005 was carried out. Patients were divided into three groups: women with MBC, SBC, and unilateral breast cancer (UBC). Moreover, we performed a meta-analysis of the English literature about multiple breast cancers between 2000 and 2011 taking into consideration their prevalence and overall survival (OS). Results. We identified 584 breast cancer patients: 16 women (3%) presented SBC and 40 MBC (7%, second cancer after 72-month follow-up IQR 40–145). Although the meta-analysis showed significant OS differences between MBC or SBC and UBC, we did not observe any significant OS difference among the three groups of our population. Anyway, we found a significant worse disease-free survival in MBC than UBC and a significant higher prevalence of radical surgery in MBC and SBC than UBC. Conclusions. Despite the low prevalence of MBC and SBC, the presence of a long time risk of MBC confirms the crucial role of ipsi- and contralateral mammographies in the postoperative follow-up.
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Chen JJ, Wang Y, Xue JY, Chen Y, Chen YL, Xiao Q, Yang WT, Shao ZM, Wu J. A clinicopathological study of early-stage synchronous bilateral breast cancer: a retrospective evaluation and prospective validation of potential risk factors. PLoS One 2014; 9:e95185. [PMID: 24736632 PMCID: PMC3988153 DOI: 10.1371/journal.pone.0095185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/24/2014] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the present study was to investigate potential risk factors for synchronous bilateral breast cancer sBBC). Methods A retrospective analysis was performed of patients diagnosed and treated with operable bilateral breast cancer (BBC) between June 2007 and December 2011. Risk factors for sBBC were evaluated in this cohort and further validated in a prospective observational validation analysis of patients between January 2012 and December 2012. Patients treated with operable unilateral breast cancer during the same period were used as a control group. Results A total of 11,247 patients with primary breast cancer underwent operations at the Fudan University Shanghai Cancer Center between June 2007 and December 2012. The incidence of sBBC was 1.6%. The age at diagnosis (HR = 2.4, 95% C.I.: 1.4–4.0, p = 0.001), presence of sclerosing adenosis (HR = 11.8, 95% C.I.: 5.3–26.3, p<0.001), lobular carcinoma component involvement (HR = 5.6, 95% C.I.: 2.6–12.1, p<0.001), and family history of first-degree relatives with breast cancer (HR = 2.0, 95% C.I.: 1.1–3.4, p<0.001) were independent risk factors for sBBC. A subsequent validation study failed to confirm the significance of family history. No significant difference on survival was found between patients with early-stage sBBC and control cases. Conclusions Patients with the presence of sclerosing in the affected breast, and lobular carcinoma component involvement may be at high risk for developing sBBC. This study supports the hypothesis that the host-carcinoma biological relationship, especially for the tumor microenvironment, played a critical role in the carcinogenesis of sBBC.
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Affiliation(s)
- Jia-jian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing-yan Xue
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-ling Chen
- Department of Ultrasound, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qin Xiao
- Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-tao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi-min Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Xing Y, Meng Q, Sun L, Chen X, Cai L. Survival analysis of patients with unilateral and bilateral primary breast cancer in Northeast China. Breast Cancer 2014; 22:536-43. [PMID: 24510639 DOI: 10.1007/s12282-014-0517-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous reports have shown that patients with bilateral primary breast cancer (BPBC) had comparable or moderately poor survival compared with patients experiencing unilateral primary breast cancer (UPBC). However, studies are conflicting in their analyses of correlations between survival and clinicopathological and prognostic characteristics in BPBC patients. The aim of our study was to compare the clinicopathological features and prognoses of BPBC and UPBC patients in Heilongjiang Province, northeast China. METHODS We retrospectively reviewed the records of 2,695 patients who underwent modified radical mastectomy or lumpectomy from 2005 to 2008 in the Tumor Hospital of Harbin Medical University. Eighty-one patients (3.0 %) had BPBC and 2,614 patients had UPBC. Multivariate analysis was performed using Cox's proportional hazards model. RESULTS There were significant differences between patients with BPBC and UPBC in the age of onset (referring to the age when the first tumor in BPBC was diagnosed), T stage, menopause status (referring to the age when the second tumor in BPBC was diagnosed), and breast cancer family history. The overall 5-year survival of patients with BPBC was 70.1 % compared with 87.1 % for patients with UPBC (p = 0.004). Furthermore, multivariate analysis showed that HER-2 status, menopause status, and mammary disease history were significant factors affecting survival among the patients with BPBC. CONCLUSIONS Our results confirmed previous findings that BPBC patients had moderately poor survival. However, when T stages were matched, BPBC patients had a survival rate similar to UPBC patients. Premenopause status, HER-2 positivity and family history of breast cancer were major risk factors for BPBC.
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Affiliation(s)
- Ying Xing
- The Fourth Department of Medicine Oncology, The Tumor Hospital of Harbin Medical University, Haping Road 150, Harbin, 150040, China
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Baker B, Morcos B, Daoud F, Sughayer M, Sughayyer M, Shabani H, Salameh H, Almasri M. Histo-biological comparative analysis of bilateral breast cancer. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2013. [PMID: 24062258 DOI: 10.1007/s12032-013-0711-8.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bilateral breast cancer occurs in approximately 7% of surviving breast cancer patients. However, a dilemma exists concerning the notion of whether this represents a de novo second primary tumor versus a breast metastasis. We analyzed 81 patients with bilateral breast cancer, 47 (58%) synchronous tumors and 34 (42%) metachronous tumors. Additionally, charts were reviewed for age, family history, full histology data and biological receptors. We found there were no significant differences in concordance between the first and second primary tumors (in both synchronous and metachronous bilateral breast cancer) with respect to histology; grade; T-category; N-category; ER, PR and HER-2 status. In addition, there was no significant difference in the strength of correlation between ER and PR in the first and secondary primary tumors. Our findings suggest that the differentiation of the origin of contralateral breast cancer based on routine histological and biological concordance is inconclusive. Furthermore, the dilemma will continue to exist until additional molecular approaches are applied routinely for research purposes to resolve the debate.
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Affiliation(s)
- Bilal Baker
- Department of Surgical Oncology, King Hussein Cancer Center, KHCC, Queen Rania Al Abdullah Street, Amman, 11941, Jordan,
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Baker B, Morcos B, Daoud F, Sughayer M, Sughayyer M, Shabani H, Salameh H, Almasri M. Histo-biological comparative analysis of bilateral breast cancer. Med Oncol 2013; 30:711. [PMID: 24062258 DOI: 10.1007/s12032-013-0711-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/22/2013] [Indexed: 01/07/2023]
Abstract
Bilateral breast cancer occurs in approximately 7% of surviving breast cancer patients. However, a dilemma exists concerning the notion of whether this represents a de novo second primary tumor versus a breast metastasis. We analyzed 81 patients with bilateral breast cancer, 47 (58%) synchronous tumors and 34 (42%) metachronous tumors. Additionally, charts were reviewed for age, family history, full histology data and biological receptors. We found there were no significant differences in concordance between the first and second primary tumors (in both synchronous and metachronous bilateral breast cancer) with respect to histology; grade; T-category; N-category; ER, PR and HER-2 status. In addition, there was no significant difference in the strength of correlation between ER and PR in the first and secondary primary tumors. Our findings suggest that the differentiation of the origin of contralateral breast cancer based on routine histological and biological concordance is inconclusive. Furthermore, the dilemma will continue to exist until additional molecular approaches are applied routinely for research purposes to resolve the debate.
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Affiliation(s)
- Bilal Baker
- Department of Surgical Oncology, King Hussein Cancer Center, KHCC, Queen Rania Al Abdullah Street, Amman, 11941, Jordan,
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Sandberg MEC, Alkner S, Hartman M, Eloranta S, Rydén L, Ploner A, Adami HO, Hall P, Czene K. Influence of radiotherapy for the first tumor on aggressiveness of contralateral breast cancer. Int J Cancer 2013; 132:2388-94. [PMID: 23034813 DOI: 10.1002/ijc.27890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 09/07/2012] [Indexed: 11/10/2022]
Abstract
We aimed to investigate if characteristics of contralateral breast cancer (CBC) are influenced by adjuvant radiotherapy for the first breast cancer. Using information from population-based registers and medical records, we analyzed two cohorts comprising all women with CBC diagnosed >3 months after their first cancer (809 patients in Stockholm 1976-2005 and 750 patients in South Sweden 1977-2005). We used Poisson regression to calculate risk of distant metastasis after CBC, comparing patients treated and not treated with radiotherapy for the first cancer. Logistic regression was used to estimate odds ratio (OR) of more aggressive tumor characteristics in the second cancer, compared to the first. For patients with CBC in Stockholm with <5 years between the cancers radiotherapy for the first cancer conferred a nearly doubled risk of distant metastasis [incidence rate ratio (IRR) = 1.91; 95% confidence interval (CI): 1.27-2.88], compared to those not treated with radiotherapy. This was replicated in the South Swedish cohort [IRR = 2.12 (95% CI: 1.40-3.23)]. In Stockholm, we found an increased odds that, following radiotherapy, a second cancer was of more advanced TNM-stage [OR 2.16 (95% CI 1.13-4.11)] and higher histological grade [OR = 2.00 (95% CI 1.08-3.72)] compared to the first, for patients with CBC with <5 years between the cancers. No effect on any of the investigated outcomes was seen for patients diagnosed with CBC >5 years from the first cancer. In conclusion, patients diagnosed with CBC within 5 years had worse prognosis and more aggressive tumor characteristics of the second cancer, if they had received radiotherapy for their first cancer, compared to no radiotherapy.
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Affiliation(s)
- Maria E C Sandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Liang X, Li D, Geng W, Cao X, Xiao C. The prognosis of synchronous and metachronous bilateral breast cancer in Chinese patients. Tumour Biol 2013; 34:995-1004. [PMID: 23296702 DOI: 10.1007/s13277-012-0636-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022] Open
Abstract
This study was undertaken to determine the differences in the clinicopathology and survival between synchronous bilateral breast cancer (sBBC) and metachronous bilateral breast cancer (mBBC). Additionally, we analyzed the risk factors for single tumors to develop as sBBC or mBBC. Of the 190 bilateral breast cancer (BBC) cases, 84 cases were sBBC and 106 were mBBC. We defined sBBC as two tumors that developed within 12 months, while mBBC was defined as two tumors that developed over more than 12 months. The peak age of onset of the first mBBC tumors was significantly younger than that of sBBC tumors (p = 0.001). There was a higher concordance rate of ER/ER positivity and PR/PR positivity in the first and second tumors of sBBC than mBBC. The two sBBC breast cancers had relatively similar hormone conditions because of the low rate of ER and PR transformation from positive to negative or vice versa. We determined that patients who presented with extracapsular extension (p = 0.008) and ER positivity (p = 0.001) tend to have synchronous cancers, while patients with 3+ HER2 were more likely to develop metachronous tumors. The prognosis for mBBC was better than that for sBBC when the survival time of mBBC was measured from the initial observation of the first tumors.
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Affiliation(s)
- Xinrui Liang
- The First Department of Breast Cancer, China Tianjin Breast Cancer Prevention, Treatment and Research center, Tianjin Medical University Cancer Institute and Hospital, West Beihuanhu Rd, Tianjin, 300060, People's Republic of China
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Reiner AS, John EM, Brooks JD, Lynch CF, Bernstein L, Mellemkjær L, Malone KE, Knight JA, Capanu M, Teraoka SN, Concannon P, Liang X, Figueiredo JC, Smith SA, Stovall M, Pike MC, Haile RW, Thomas DC, Begg CB, Bernstein JL. Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women's Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol 2012; 31:433-9. [PMID: 23269995 DOI: 10.1200/jco.2012.43.2013] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To fully characterize the risk of contralateral breast cancer (CBC) in patients with breast cancer with a family history who test negative for BRCA1 and BRCA2 mutations. PATIENTS AND METHODS From our population-based case-control study comparing women with CBC to women with unilateral breast cancer (UBC), we selected women who tested negative for BRCA1 and BRCA2 mutations (594 patients with CBC/1,119 control patients with UBC). Rate ratios (RRs) and 95% CIs were estimated to examine the association between family history of breast cancer and risk of asynchronous CBC. Age- and family history-specific 10-year cumulative absolute risks of CBC were estimated. RESULTS Family history of breast cancer was associated with increased CBC risk; risk was highest among young women (< 45 years) with first-degree relatives affected at young ages (< 45 years; RR, 2.5; 95% CI, 1.1 to 5.3) or women with first-degree relatives with bilateral disease (RR, 3.6; 95% CI, 2.0 to 6.4). Women diagnosed with UBC before age 55 years with a first-degree family history of CBC had a 10-year risk of CBC of 15.6%. CONCLUSION Young women with breast cancer who have a family history of breast cancer and who test negative for deleterious mutations in BRCA1 and BRCA2 are at significantly greater risk of CBC than other breast cancer survivors. This risk varies with diagnosis age, family history of CBC, and degree of relationship to an affected relative. Women with a first-degree family history of bilateral disease have risks of CBC similar to mutation carriers. This has important implications for the clinical management of patients with breast cancer with family history of the disease.
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Affiliation(s)
- Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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50
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Lee TF, Ting HM, Chao PJ, Wang HY, Shieh CS, Horng MF, Wu JM, Yeh SA, Cho MY, Huang EY, Huang YJ, Chen HC, Fang FM. Dosimetric advantages of generalised equivalent uniform dose-based optimisation on dose-volume objectives in intensity-modulated radiotherapy planning for bilateral breast cancer. Br J Radiol 2012; 85:1499-506. [PMID: 23091290 PMCID: PMC3500793 DOI: 10.1259/bjr/24112047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 03/08/2012] [Accepted: 03/19/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We compared and evaluated the differences between two models for treating bilateral breast cancer (BBC): (i) dose-volume-based intensity-modulated radiation treatment (DV plan), and (ii) dose-volume-based intensity-modulated radiotherapy with generalised equivalent uniform dose-based optimisation (DV-gEUD plan). METHODS The quality and performance of the DV plan and DV-gEUD plan using the Pinnacle(3) system (Philips, Fitchburg, WI) were evaluated and compared in 10 patients with stage T2-T4 BBC. The plans were delivered on a Varian 21EX linear accelerator (Varian Medical Systems, Milpitas, CA) equipped with a Millennium 120 leaf multileaf collimator (Varian Medical Systems). The parameters analysed included the conformity index, homogeneity index, tumour control probability of the planning target volume (PTV), the volumes V(20 Gy) and V(30 Gy) of the organs at risk (OAR, including the heart and lungs), mean dose and the normal tissue complication probability. RESULTS Both plans met the requirements for the coverage of PTV with similar conformity and homogeneity indices. However, the DV-gEUD plan had the advantage of dose sparing for OAR: the mean doses of the heart and lungs, lung V(20) (Gy), and heart V(30) (Gy) in the DV-gEUD plan were lower than those in the DV plan (p<0.05). CONCLUSIONS A better result can be obtained by starting with a DV-generated plan and then improving it by adding gEUD-based improvements to reduce the number of iterations and to improve the optimum dose distribution. Advances to knowledge The DV-gEUD plan provided superior dosimetric results for treating BBC in terms of PTV coverage and OAR sparing than the DV plan, without sacrificing the homogeneity of dose distribution in the PTV.
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Affiliation(s)
- T-F Lee
- Medical Physics & Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.
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