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Mehta TS, Lourenco AP, Niell BL, Bennett DL, Brown A, Chetlen A, Freer P, Ivansco LK, Jochelson MS, Klein KA, Malak SF, McCrary M, Mullins D, Neal CH, Newell MS, Ulaner GA, Moy L. ACR Appropriateness Criteria® Imaging After Breast Surgery. J Am Coll Radiol 2022; 19:S341-S356. [PMID: 36436961 DOI: 10.1016/j.jacr.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Given that 20% to 40% of women who have percutaneous breast biopsy subsequently undergo breast surgery, knowledge of imaging women with a history of benign (including high-risk) disease or breast cancer is important. For women who had surgery for nonmalignant pathology, the surveillance recommendations are determined by their overall risk. Higher-than-average risk women with a history of benign surgery may require screening mammography starting at an earlier age before 40 and may benefit from screening MRI. For women with breast cancer who have undergone initial excision and have positive margins, imaging with diagnostic mammography or MRI can sometimes guide additional surgical planning. Women who have completed breast conservation therapy for cancer should get annual mammography and may benefit from the addition of MRI or ultrasound to their surveillance regimen. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tejas S Mehta
- Director of Diversity, Equity Inclusion and Population Health in Radiology, UMass Memorial Medical Center, Worchester, Massachusetts.
| | - Ana P Lourenco
- Panel Chair; Residency Program Director, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair; Section Chief of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Commission Government Relations Chair
| | - Debbie L Bennett
- Section Chief - Breast Imaging, Mallinckrodt Institute of Radiology/Washington University School of Medicine, Saint Louis, Missouri
| | - Ann Brown
- Assistant Section Chief, University of Cincinnati, Cincinnati, Ohio
| | - Alison Chetlen
- Vice Chair of Education, Division Chief Breast Imaging, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Phoebe Freer
- Section Chief, Breast Imaging, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah; ACR/SCBI Screening Leadership Group Inaugural Class
| | - Lillian K Ivansco
- Assistant Chief, Department of Radiology, Section Chief for Breast Imaging and Quality, Co-Chair, Breast Imaging Sourcing and Standards Team, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Maxine S Jochelson
- Chief of the Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians, North Carolina Chapter
| | - David Mullins
- Chief of Staff, Princeton Community Hospital, Princeton, West Virginia; American College of Surgeons
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York
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Vedoya GM, Galarza TE, Mohamad NA, Cricco GP, Martín GA. Non-tumorigenic epithelial breast cells and ionizing radiation cooperate in the enhancement of mesenchymal traits in tumorigenic breast cancer cells. Life Sci 2022; 307:120853. [PMID: 35926589 DOI: 10.1016/j.lfs.2022.120853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
Abstract
AIMS Radioresistance and recurrences are crucial hindrances in cancer radiotherapy. Fractionated irradiation can elicit a mesenchymal phenotype in irradiated surviving cells and a deep connection exists between epithelial mesenchymal transition, radioresistance, and metastasis. The aim of this study was to analyze the effect of the secretoma of irradiated non-tumorigenic mammary epithelial cells on surviving irradiated breast tumor cells regarding the gain of mesenchymal traits and migratory ability. MAIN METHODS MDA-MB-231 and MCF-7 breast cancer cells, irradiated or not, were incubated with conditioned media from MCF-10A non-tumorigenic epithelial breast cells, irradiated or not. After five days, we evaluated the expression and localization of epithelial and mesenchymal markers (by western blot and indirect immunofluorescence), cell migration (using transwells) and metalloproteinases activity (by zymography). We also assessed TGF-β1 content in conditioned media by immunoblot, and the effect of A83-01 (a selective inhibitor of TGF-β receptor I) and PP2 (a Src-family tyrosine kinase inhibitor) on nuclear Slug and cell migration. KEY FINDINGS Conditioned media from MCF-10A cells caused phenotypic changes in breast tumor cells with attainment or enhancement of mesenchymal traits mediated at least in part by the activation of the TGF-β type I receptor and a signaling pathway involving Src activation/phosphorylation. The effects were more pronounced mostly in irradiated tumor cells treated with conditioned media from irradiated MCF-10A. SIGNIFICANCE Our results suggest that non-tumorigenic epithelial mammary cells included in the irradiation field could affect the response to irradiation of post-surgery residual cancer cells enhancing EMT progression and thus modifying radiotherapy efficacy.
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Affiliation(s)
- Guadalupe M Vedoya
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Laboratorio de Radioisótopos, Junín 956, C1113AAB Buenos Aires, Argentina
| | - Tamara E Galarza
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Laboratorio de Radioisótopos, Junín 956, C1113AAB Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Nora A Mohamad
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Laboratorio de Radioisótopos, Junín 956, C1113AAB Buenos Aires, Argentina
| | - Graciela P Cricco
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Laboratorio de Radioisótopos, Junín 956, C1113AAB Buenos Aires, Argentina
| | - Gabriela A Martín
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Laboratorio de Radioisótopos, Junín 956, C1113AAB Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Androgen Receptors in Resected Ductal Carcinoma In Situ of Breast: Novel Insights With Possible Implications for Testing and Targeted Endocrine Chemoprevention Trials. Appl Immunohistochem Mol Morphol 2019; 27:373-377. [PMID: 29489512 DOI: 10.1097/pai.0000000000000625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mammary ductal carcinoma in situ (DCIS) is classically treated by combinations of excision, radiation, and endocrine therapy, based upon the specific needs of individual patients. Estrogen receptor (ER) status is generally assessed by immunohistochemistry (IHC) in newly diagnosed cases of DCIS, and endocrine therapy in this setting is thought to be chemopreventive. The potential impact of androgens on mammary carcinogenesis has been studied in recent years, and several authors have proposed androgen receptor (AR) IHC testing and targeted antiandrogenic therapy in patients with locally advanced or metastatic triple-negative invasive breast cancer (ie, negative for ER and progesterone receptor and HER-2). Very little has been published on AR in DCIS. We report results of AR IHC on archival tissue blocks from 221 adult female patients, each of whom underwent definitive breast resection of DCIS. Of the 221 cases, 72 (33%) were shown to express AR in their DCIS at or above the 10% threshold often used for invasive carcinoma. AR expression was seen in all grades of DCIS. Of the 72 positive AR cases, 21 (29%) were ER negative, corresponding to 10% (21/221) of all patients. The majority of the AR-positive cases were high grade, and the most common histologic subtype in this subset was a solid growth pattern with apocrine features. Early data from clinical trials evaluating AR antagonists in invasive/metastatic triple-negative breast cancer suggest that some patients may benefit from androgen blockade. IHC testing and potential clinical trials of AR antagonists for chemoprevention in patients with AR-positive and ER-negative DCIS could be considered.
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Solin LJ. Management of Ductal Carcinoma In Situ (DCIS) of the Breast: Present Approaches and Future Directions. Curr Oncol Rep 2019; 21:33. [PMID: 30834994 DOI: 10.1007/s11912-019-0777-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast is commonly found in an asymptomatic woman on routine screening mammography. The purpose of this review is to describe current approaches to the management of DCIS as well as areas for future investigation. RECENT FINDINGS Randomized trials have demonstrated that adding radiation treatment after breast conservation surgery (lumpectomy; surgical excision) reduces the rate of ipsilateral local recurrence by about half, and that adding hormonal therapy reduces the rate of all breast cancer events (ipsilateral plus contralateral). Early clinical studies attempted to stratify the risk of recurrence using conventional clinical and pathologic features. More recent clinical studies have attempted to define prospectively patients with lower risk DCIS for whom omission of radiation treatment after lumpectomy is a reasonable option. Molecular profiling is a newer approach to define risk stratification for DCIS. Combining molecular profiling with clinical and pathologic features appears to be more accurate in defining and stratifying the risk of recurrence after lumpectomy. After lumpectomy for DCIS, risk stratification using clinical and pathologic characteristics, and more recently molecular profiling, can help guide clinical decision-making for the use of radiation treatment and hormonal therapy. Ongoing studies are evaluating the possibility of de-escalating therapy, and in some studies, even using core biopsy alone, without surgical excision.
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Affiliation(s)
- Lawrence J Solin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast. Cancer Treat Rev 2017; 55:163-172. [PMID: 28402908 DOI: 10.1016/j.ctrv.2017.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient.
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Scaperrotta G, Ferranti C, Capalbo E, Paolini B, Marchesini M, Suman L, Folini C, Mariani L, Panizza P. Performance and role of the breast lesion excision system (BLES) in small clusters of suspicious microcalcifications. Eur J Radiol 2015; 85:143-149. [PMID: 26724659 DOI: 10.1016/j.ejrad.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the diagnostic performance of the BLES as a biopsy tool in patients with ≤ 1 cm clusters of BIRADS 4 microcalcifications, in order to possibly avoid surgical excision in selected patients. MATERIALS This is a retrospective study of 105 patients undergone to stereotactic breast biopsy with the BLES. It excises a single specimen containing the whole mammographic target, allowing better histological assessment due to preserved architecture. RESULTS Our case series consists of 41 carcinomas (39%) and 64 benign lesions (61%). Cancer involved the specimen margins in 20/41 cases (48.8%) or was close to them (≤ 1 mm) in 14 cases (34.1%); margins were disease-free in only 7 DCIS (17.1%). At subsequent excision of 39/41 malignant cases, underestimation occurred for 5/32 DCIS (15.6%), residual disease was found in 15/39 cancers (38.5%) and no cancer in 19/39 cases (48.7%). For DCIS cases, no residual disease occurred for 66.7% G1-G2 cases and for 35.3% G3 cases (P=0.1556) as well as in 83.3%, 40.0% and 43.8% cases respectively for negative, close and positive BLES margins (P=0.2576). CONCLUSIONS The BLES is a good option for removal of small clusters of breast microcalcifications, giving better histological interpretation, lower underestimation rates and possibly reducing the need of subsequent surgical excision in selected patients.
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Affiliation(s)
- Gianfranco Scaperrotta
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Claudio Ferranti
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Capalbo
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Biagio Paolini
- Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Marchesini
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Suman
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Folini
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pietro Panizza
- Department of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, Tuck A, Sengupta S, Elavathil L, Jani PA, Bonin M, Chang MC, Robertson SJ, Slodkowska E, Fong C, Anderson JM, Jamshidian F, Miller DP, Cherbavaz DB, Shak S, Paszat L. A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone. Breast Cancer Res Treat 2015; 152:389-98. [PMID: 26119102 PMCID: PMC4491104 DOI: 10.1007/s10549-015-3464-6] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/08/2015] [Indexed: 12/16/2022]
Abstract
Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX® DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.
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Affiliation(s)
- Eileen Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada,
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Nam JM, Ahmed KM, Costes S, Zhang H, Onodera Y, Olshen AB, Hatanaka KC, Kinoshita R, Ishikawa M, Sabe H, Shirato H, Park CC. β1-Integrin via NF-κB signaling is essential for acquisition of invasiveness in a model of radiation treated in situ breast cancer. Breast Cancer Res 2014; 15:R60. [PMID: 23883667 PMCID: PMC3978561 DOI: 10.1186/bcr3454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/04/2013] [Accepted: 07/25/2013] [Indexed: 01/05/2023] Open
Abstract
Introduction Ductal carcinoma in situ (DCIS) is characterized by non-invasive cancerous cell growth within the breast ducts. Although radiotherapy is commonly used in the treatment of DCIS, the effect and molecular mechanism of ionizing radiation (IR) on DCIS are not well understood, and invasive recurrence following radiotherapy remains a significant clinical problem. This study investigated the effects of IR on a clinically relevant model of Akt-driven DCIS and identified possible molecular mechanisms underlying invasive progression in surviving cells. Methods We measured the level of phosphorylated-Akt (p-Akt) in a cohort of human DCIS specimens by immunohistochemistry (IHC) and correlated it with recurrence risk. To model human DCIS, we used Akt overexpressing human mammary epithelial cells (MCF10A-Akt) which, in three-dimensional laminin-rich extracellular matrix (lrECM) and in vivo, form organotypic DCIS-like lesions with lumina expanded by pleiomorphic cells contained within an intact basement membrane. In a population of cells that survived significant IR doses in three-dimensional lrECM, a malignant phenotype emerged creating a model for invasive recurrence. Results P-Akt was up-regulated in clinical DCIS specimens and was associated with recurrent disease. MCF10A-Akt cells that formed DCIS-like structures in three-dimensional lrECM showed significant apoptosis after IR, preferentially in the luminal compartment. Strikingly, when cells that survived IR were repropagated in three-dimensional lrECM, a malignant phenotype emerged, characterized by invasive activity, up-regulation of fibronectin, α5β1-integrin, matrix metalloproteinase-9 (MMP-9) and loss of E-cadherin. In addition, IR induced nuclear translocation and binding of nuclear factor-kappa B (NF-κB) to the β1-integrin promoter region, associated with up-regulation of α5β1-integrins. Inhibition of NF-κB or β1-integrin signaling abrogated emergence of the invasive activity. Conclusions P-Akt is up-regulated in some human DCIS lesions and is possibly associated with recurrence. MCF10A-Akt cells form organotypic DCIS-like lesions in three-dimensional lrECM and in vivo, and are a plausible model for some forms of human DCIS. A population of Akt-driven DCIS-like spheroids that survive IR progresses to an invasive phenotype in three-dimensional lrECM mediated by β1-integrin and NF-κB signaling.
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Kim H, Noh JM, Choi DH, Lee J, Nam SJ, Lee JE, Park W, Huh SJ. Excision alone for small size ductal carcinoma in situ of the breast. Breast 2014; 23:586-90. [PMID: 24969239 DOI: 10.1016/j.breast.2014.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/31/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022] Open
Abstract
This study was performed to determine the risk of tumor recurrence after local excision alone in patients with small size (≤1 cm) ductal carcinoma in situ (DCIS) of the breast. We have treated 107 patients who had DCIS measuring ≤1 cm with margin widths of ≥0.3 cm with excision alone per institutional protocol. With a median follow-up time of 58 months, 4 patients developed ipsilateral breast tumor recurrence (IBTR). Two of the 4 recurrences were invasive, whereas 2 were DCIS. The 5-year rate of IBTR was 6.1%. The patients with resection margin of <1.0 cm had significantly higher rate of IBTR than the patients with resection margin of ≥1.0 cm (23.1% vs. 1.5% at 5-year, p < 0.01). In conclusion, radiotherapy is necessary in the patients with resection margin of <1.0 cm after excision alone because of the substantial risk of IBTR.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
| | - Jihye Lee
- Department of Radiation Oncology, Ewha Womans University Medical Center, South Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - Won Park
- Department of Radiation Oncology, Ewha Womans University Medical Center, South Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Ewha Womans University Medical Center, South Korea
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Souchon R, Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Wenz F, Sauer R. DEGRO practical guidelines: radiotherapy of breast cancer II. Strahlenther Onkol 2013; 190:8-16. [DOI: 10.1007/s00066-013-0502-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hagen KR, Zeng X, Lee MY, Tucker Kahn S, Harrison Pitner MK, Zaky SS, Liu Y, O'Regan RM, Deng X, Saavedra HI. Silencing CDK4 radiosensitizes breast cancer cells by promoting apoptosis. Cell Div 2013; 8:10. [PMID: 23886499 PMCID: PMC3733890 DOI: 10.1186/1747-1028-8-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background The discovery of molecular markers associated with various breast cancer subtypes has greatly improved the treatment and outcome of breast cancer patients. Unfortunately, breast cancer cells acquire resistance to various therapies. Mounting evidence suggests that resistance is rooted in the deregulation of the G1 phase regulatory machinery. Methods To address whether deregulation of the G1 phase regulatory machinery contributes to radiotherapy resistance, the MCF10A immortalized human mammary epithelial cell line, ER-PR-Her2+ and ER-PR-Her2- breast cancer cell lines were irradiated. Colony formation assays measured radioresistance, while immunocytochemistry, Western blots, and flow cytometry measured the cell cycle, DNA replication, mitosis, apoptosis, and DNA breaks. Results Molecular markers common to all cell lines were overexpressed, including cyclin A1 and cyclin D1, which impinge on CDK2 and CDK4 activities, respectively. We addressed their potential role in radioresistance by generating cell lines stably expressing small hairpin RNAs (shRNA) against CDK2 and CDK4. None of the cell lines knocked down for CDK2 displayed radiosensitization. In contrast, all cell lines knocked down for CDK4 were significantly radiosensitized, and a CDK4/CDK6 inhibitor sensitized MDA-MB-468 to radiation induced apoptosis. Our data showed that silencing CDK4 significantly increases radiation induced cell apoptosis in cell lines without significantly altering cell cycle progression, or DNA repair after irradiation. Our results indicate lower levels of phospho-Bad at ser136 upon CDK4 silencing and ionizing radiation, which has been shown to signal apoptosis. Conclusion Based on our data we conclude that knockdown of CDK4 activity sensitizes breast cancer cells to radiation by activating apoptosis pathways.
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Affiliation(s)
- Katie R Hagen
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Xiangbin Zeng
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Mi-Young Lee
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Shannon Tucker Kahn
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | | | - Sandra S Zaky
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, USA
| | - Ruth M O'Regan
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, USA
| | - Xingming Deng
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
| | - Harold I Saavedra
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, USA
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Cutuli B, Lemanski C, Le Blanc-Onfroy M, de Lafontan B, Cohen-Solal-Le-Nir C, Fondrinier É, Mignotte H, Giard S, Charra-Brunaud C, Auvray H, Gonzague-Casabianca L, Quétin P, Fay R. Local recurrence after ductal carcinoma in situ breast conserving treatment. Analysis of 195 cases. Cancer Radiother 2013; 17:196-201. [DOI: 10.1016/j.canrad.2013.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 11/20/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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13
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Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, Cherbavaz DB, Shak S, Page DL, Sledge GW, Davidson NE, Ingle JN, Perez EA, Wood WC, Sparano JA, Badve S. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013; 105:701-10. [PMID: 23641039 PMCID: PMC3653823 DOI: 10.1093/jnci/djt067] [Citation(s) in RCA: 350] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND For women with ductal carcinoma in situ (DCIS) of the breast, the risk of developing an ipsilateral breast event (IBE; defined as local recurrence of DCIS or invasive carcinoma) after surgical excision without radiation is not well defined by clinical and pathologic characteristics. METHODS The Oncotype DX breast cancer assay was performed for patients with DCIS treated with surgical excision without radiation in the Eastern Cooperative Oncology Group (ECOG) E5194 study. The association of the prospectively defined DCIS Score (calculated from seven cancer-related genes and five reference genes) with the risk of developing an IBE was analyzed using Cox regression. All statistical tests were two-sided. RESULTS There were 327 patients with adequate tissue for analysis. The continuous DCIS Score was statistically significantly associated with the risk of developing an IBE (hazard ratio [HR] = 2.31, 95% confidence interval [CI] = 1.15 to 4.49; P = .02) when adjusted for tamoxifen use (prespecified primary analysis) and with invasive IBE (unadjusted HR = 3.68, 95% CI = 1.34 to 9.62; P = .01). For the prespecified DCIS risk groups of low, intermediate, and high, the 10-year risks of developing an IBE were 10.6%, 26.7%, and 25.9%, respectively, and for an invasive IBE, 3.7%, 12.3%, and 19.2%, respectively (both log rank P ≤ .006). In multivariable analyses, factors associated with IBE risk were DCIS Score, tumor size, and menopausal status (all P ≤ .02). CONCLUSIONS The DCIS Score quantifies IBE risk and invasive IBE risk, complements traditional clinical and pathologic factors, and provides a new clinical tool to improve selecting individualized treatment for women with DCIS who meet the ECOG E5194 criteria.
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Affiliation(s)
- Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
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Duggal S, Julian TB. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ. J Natl Cancer Inst 2013; 105:681-3. [PMID: 23641041 DOI: 10.1093/jnci/djt098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aguiar FN, Mendes HN, Cirqueira CS, Bacchi CE, Carvalho FM. Basal cytokeratin as a potential marker of low risk of invasion in ductal carcinoma in situ. Clinics (Sao Paulo) 2013; 68:638-43. [PMID: 23778411 PMCID: PMC3654300 DOI: 10.6061/clinics/2013(05)010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/17/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Biological markers that predict the development of invasive breast cancer are needed to improve personalized therapy for patients diagnosed with ductal carcinoma in situ. We investigated the role of basal cytokeratin 5/6 in the risk of invasion in breast ductal carcinoma in situ. METHODS We constructed tissue microarrays using 236 ductal carcinoma in situ samples: 90 pure samples (group 1) and 146 samples associated with invasive carcinoma (group 2). Both groups had similar nuclear grades and were obtained from patients of similar ages. The groups were compared in terms of estrogen (ER) and progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) expression, cytokeratin 5/6 immunostaining, human epidermal growth factor receptor 1 (EGFR) membrane staining and molecular subtype, as indicated by their immunohistochemistry profiles. RESULTS ER/PR-negative status was predictive of invasion, whereas HER2 superexpression and cytokeratin 5/6-positive status were negatively associated with invasion. Among the high-grade ductal carcinoma in situ cases, a triple-positive profile (positive for estrogen receptor, progesterone receptor, and HER2) and cytokeratin 5/6 expression by neoplastic cells were negatively associated with invasion. In the low-grade ductal carcinoma in situ subgroup, only cytokeratin 5/6 expression exhibited a negative association with the probability of invasion. CONCLUSION The immunohistochemical expression of cytokeratin 5/6 by ductal carcinoma in situ epithelial cells may provide clinically useful information regarding the risk of progression to invasive disease.
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Affiliation(s)
- Fernando N Aguiar
- Faculdade de Medicina da Universidade de São Paulo, Department of Pathology, São Paulo/SP, Brazil
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Romestaing P. Cancers canalaires in situ de moins de 5mm : pas de radiothérapie postopératoire. ACTA ACUST UNITED AC 2012; 40:387-9. [DOI: 10.1016/j.gyobfe.2012.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Brawarsky P, Neville BA, Fitzmaurice GM, Hassett MJ, Haas JS. Use of annual mammography among older women with ductal carcinoma in situ. J Gen Intern Med 2012; 27:500-5. [PMID: 22005943 PMCID: PMC3326107 DOI: 10.1007/s11606-011-1918-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/03/2011] [Accepted: 09/26/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND As ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer, ongoing annual mammography is important for cancer control, yet little is known about racial/ethnic and other disparities in use among older women with DCIS. METHODS SEER-Medicare data was used to identify women age 65-85 years, diagnosed with DCIS from 1992 to 2005 and treated with surgery, but not bilateral mastectomy. We examined factors associated with receipt of an initial mammogram within 1 year of treatment and subsequent annual mammograms for 3 and 5 years. We examined whether follow-up care, by a primary care physician or cancer specialist, or neighborhood characteristics mediated disparities in mammography use. RESULTS Overall, 91.3% of women had an initial mammogram. After adjustment, blacks and Hispanics were less likely than whites to receive an initial mammogram (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.55-0.99 and OR 0.65, CI 0.46-0.93, respectively, as were women of lower socioeconomic status (SES), women who had a mastectomy or breast conserving surgery without radiation therapy, and women who did not have a physician visit. Overall rates of annual mammography decreased over time. Disparities by SES, initial treatment type, and physician visit did not diminish over time. Physician visits had a modest effect on reducing initial racial/ethnic disparities. CONCLUSIONS Annual mammography among women age 65 to 85 with DCIS declines as women get further from diagnosis. Interventions should focus on reducing disparities in the use of initial surveillance mammography, and increasing surveillance over time.
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Affiliation(s)
- Phyllis Brawarsky
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120-1613 USA
| | - Bridget A. Neville
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Garrett M. Fitzmaurice
- Laboratory for Psychiatric Biostatistics, McLean Hospital and Harvard Medical School, Belmont, USA
| | - Michael J. Hassett
- Center for Outcomes and Policy Research, Dana Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - Jennifer S. Haas
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120-1613 USA
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Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, Mamounas EP, Julian TB, Geyer CE, Costantino JP, Land SR, Wolmark N. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 2012; 30:1268-73. [PMID: 22393101 DOI: 10.1200/jco.2010.34.0141] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen. PATIENTS AND METHODS Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n = 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n = 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years). RESULTS ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P < .001) and overall follow-up (HR, 0.60; P = .003), which remained significant in multivariable analysis (overall HR, 0.64; P = .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone. CONCLUSION Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.
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Affiliation(s)
- D Craig Allred
- National Surgical Adjuvant Breast and Bowel Project, Washington University School of Medicine, Department of Pathology and Immunology, 660 Euclid Campus Box 8118, St Louis, MO 63110, USA.
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Solin LJ. Selecting Individualized Treatment for Patients With Ductal Carcinoma in Situ of the Breast: The Search Continues. J Clin Oncol 2012; 30:577-9. [DOI: 10.1200/jco.2011.39.6929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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