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Rizzo V, Cicciarelli F, Galati F, Moffa G, Maroncelli R, Pasculli M, Pediconi F. Could breast multiparametric MRI discriminate between pure ductal carcinoma in situ and microinvasive carcinoma? Acta Radiol 2024; 65:565-574. [PMID: 38196268 DOI: 10.1177/02841851231225807] [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] [Indexed: 01/11/2024]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is often reclassified as invasive cancer in the final pathology report of the surgical specimen. It is of significant clinical relevance to acknowledge the possibility of underestimating invasive disease when utilizing preoperative biopsies for a DCIS diagnosis. In cases where such histologic upgrades occur, it is imperative to consider them in the preoperative planning process, including the potential inclusion of sentinel lymph node biopsy due to the risk of axillary lymph node metastasis. PURPOSE To assess the capability of breast multiparametric magnetic resonance imaging (MP-MRI) in differentiating between pure DCIS and microinvasive carcinoma (MIC). MATERIAL AND METHODS Between January 2018 and November 2022, this retrospective study enrolled patients with biopsy-proven DCIS who had undergone preoperative breast MP-MRI. We assessed various MP-MRI features, including size, morphology, margins, internal enhancement pattern, extent of disease, presence of peritumoral edema, time-intensity curve value, diffusion restriction, and ADC value. Subsequently, a logistic regression analysis was conducted to explore the association of these features with the pathological outcome. RESULTS Of 129 patients with biopsy-proven DCIS, 36 had foci of micro-infiltration on surgical specimens and eight were diagnosed with invasive ductal carcinoma (IDC). The presence of micro-infiltration foci was significantly associated with several MP-MRI features, including tumor size (P <0.001), clustered ring enhancement (P <0.001), segmental distribution (P <0.001), diffusion restriction (P = 0.005), and ADC values <1.3 × 10-3 mm2/s (P = 0.004). CONCLUSION Breast MP-MRI has the potential to predict the presence of micro-infiltration foci in biopsy-proven DCIS and may serve as a valuable tool for guiding therapeutic planning.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Middle Aged
- Retrospective Studies
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Aged
- Adult
- Diagnosis, Differential
- Multiparametric Magnetic Resonance Imaging/methods
- Neoplasm Invasiveness
- Breast/diagnostic imaging
- Breast/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Aged, 80 and over
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Affiliation(s)
- Veronica Rizzo
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Federica Cicciarelli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Roberto Maroncelli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Marcella Pasculli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
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Hickey BE, Lehman M. Partial breast irradiation versus whole breast radiotherapy for early breast cancer. Cochrane Database Syst Rev 2021; 8:CD007077. [PMID: 34459500 PMCID: PMC8406917 DOI: 10.1002/14651858.cd007077.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Breast-conserving therapy for women with breast cancer consists of local excision of the tumour (achieving clear margins) followed by radiotherapy (RT). Most true recurrences occur in the same quadrant as the original tumour. Whole breast radiotherapy (WBRT) may not protect against the development of a new primary cancer developing in other quadrants of the breast. In this Cochrane Review, we investigated the delivery of radiation to a limited volume of the breast around the tumour bed (partial breast irradiation (PBI)) sometimes with a shortened treatment duration (accelerated partial breast irradiation (APBI)). OBJECTIVES To determine whether PBI/APBI is equivalent to or better than conventional or hypofractionated WBRT after breast-conserving therapy for early-stage breast cancer. SEARCH METHODS On 27 August 2020, we searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and three trial databases. We searched for grey literature: OpenGrey (September 2020), reference lists of articles, conference proceedings and published abstracts, and applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) without confounding, that evaluated conservative surgery plus PBI/APBI versus conservative surgery plus WBRT. Published and unpublished trials were eligible. DATA COLLECTION AND ANALYSIS Two review authors (BH and ML) performed data extraction, used Cochrane's risk of bias tool and resolved any disagreements through discussion, and assessed the certainty of the evidence for main outcomes using GRADE. Main outcomes were local recurrence-free survival, cosmesis, overall survival, toxicity (subcutaneous fibrosis), cause-specific survival, distant metastasis-free survival and subsequent mastectomy. We entered data into Review Manager 5 for analysis. MAIN RESULTS We included nine RCTs that enrolled 15,187 women who had invasive breast cancer or ductal carcinoma in-situ (6.3%) with T1-2N0-1M0 Grade I or II unifocal tumours (less than 2 cm or 3 cm or less) treated with breast-conserving therapy with negative margins. This is the second update of the review and includes two new studies and 4432 more participants. Local recurrence-free survival is probably slightly reduced (by 3/1000, 95% CI 6 fewer to 0 fewer) with the use of PBI/APBI compared to WBRT (hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 8 studies, 13,168 participants; moderate-certainty evidence). Cosmesis (physician/nurse-reported) is probably worse (by 63/1000, 95% CI 35 more to 92 more) with the use of PBI/APBI (odds ratio (OR) 1.57, 95% CI 1.31 to 1.87; 6 studies, 3652 participants; moderate-certainty evidence). Overall survival is similar (0/1000 fewer, 95% CI 6 fewer to 6 more) with PBI/APBI and WBRT (HR 0.99, 95% CI 0.88 to 1.12; 8 studies, 13,175 participants; high-certainty evidence). Late radiation toxicity (subcutaneous fibrosis) is probably increased (by 14/1000 more, 95% CI 102 more to 188 more) with PBI/APBI (OR 5.07, 95% CI 3.81 to 6.74; 2 studies, 3011 participants; moderate-certainty evidence). The use of PBI/APBI probably makes little difference (1/1000 less, 95% CI 6 fewer to 3 more) to cause-specific survival (HR 1.06, 95% CI 0.83 to 1.36; 7 studies, 9865 participants; moderate-certainty evidence). We found the use of PBI/APBI compared with WBRT probably makes little or no difference (1/1000 fewer (95% CI 4 fewer to 6 more)) to distant metastasis-free survival (HR 0.95, 95% CI 0.80 to 1.13; 7 studies, 11,033 participants; moderate-certainty evidence). We found the use of PBI/APBI in comparison with WBRT makes little or no difference (2/1000 fewer, 95% CI 20 fewer to 20 more) to mastectomy rates (OR 0.98, 95% CI 0.78 to 1.23; 3 studies, 3740 participants, high-certainty evidence). AUTHORS' CONCLUSIONS It appeared that local recurrence-free survival is probably worse with PBI/APBI; however, the difference was small and nearly all women remain free of local recurrence. Overall survival is similar with PBI/APBI and WBRT, and we found little to no difference in other oncological outcomes. Some late effects (subcutaneous fibrosis) may be worse with PBI/APBI and its use is probably associated with worse cosmetic outcomes. The limitations of the data currently available mean that we cannot make definitive conclusions about the efficacy and safety or ways to deliver PBI/APBI. We await completion of ongoing trials.
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Affiliation(s)
- Brigid E Hickey
- Radiation Oncology Raymond Terrace, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Margot Lehman
- School of Medicine, The University of Queensland, Brisbane, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion. JOURNAL OF ONCOLOGY 2020; 2020:3928976. [PMID: 32190051 PMCID: PMC7064828 DOI: 10.1155/2020/3928976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews.
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Li C, Du L, Ren Y, Liu X, Jiao Q, Cui D, Wen M, Wang C, Wei G, Wang Y, Ji A, Wang Q. SKP2 promotes breast cancer tumorigenesis and radiation tolerance through PDCD4 ubiquitination. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:76. [PMID: 30760284 PMCID: PMC6375223 DOI: 10.1186/s13046-019-1069-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
Background S-phase kinase-associated protein 2 (SKP2) is an oncogene and cell cycle regulator that specifically recognizes phosphorylated cell cycle regulator proteins and mediates their ubiquitination. Programmed cell death protein 4 (PDCD4) is a tumor suppressor gene that plays a role in cell apoptosis and DNA-damage response via interacting with eukaryotic initiation factor-4A (eIF4A) and P53. Previous research showed SKP2 may interact with PDCD4, however the relationship between SKP2 and PDCD4 is unclear. Methods To validate the interaction between SKP2 and PDCD4, mass spectrometric analysis and reciprocal co-immunoprecipitation (Co-IP) experiments were performed. SKP2 stably overexpressed or knockdown breast cancer cell lines were established and western blot was used to detect proteins changes before and after radiation. In vitro and in vivo experiments were performed to verify whether SKP2 inhibits cell apoptosis and promotes DNA-damage response via PDCD4 suppression. SMIP004 was used to test the effect of radiotherapy combined with SKP2 inhibitor. Results We found that SKP2 remarkably promoted PDCD4 phosphorylation, ubiquitination and degradation. SKP2 promoted cell proliferation, inhibited cell apoptosis and enhanced the response to DNA-damage via PDCD4 suppression in breast cancer. SKP2 and PDCD4 showed negative correlation in human breast cancer tissues. Radiotherapy combine with SKP2 inhibitor SMIP004 showed significant inhibitory effects on breast cancer cells in vitro and in vivo. Conclusions We identify PDCD4 as an important ubiquitination substrate of SKP2. SKP2 promotes breast cancer tumorigenesis and radiation tolerance via PDCD4 degradation. Radiotherapy combine with SKP2-targeted adjuvant therapy may improve breast cancer patient survival in clinical medicine. Electronic supplementary material The online version of this article (10.1186/s13046-019-1069-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ce Li
- School of Pharmaceutical Sciences, Shandong University, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Lutao Du
- Department of Clinical Laboratory, The Second Hospital of Shandong University, 247 Beiyuan Street, Tianqiao District, Jinan, 250033, Shandong, China
| | - Yidan Ren
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, 264209, Shandong, China
| | - Xiaoyan Liu
- Department of Human Anatomy and Key Laboratory of Experimental Teratology, Ministry of Education, Shandong University School of Medicine, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Qinlian Jiao
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, 264209, Shandong, China
| | - Donghai Cui
- Department of Human Anatomy and Key Laboratory of Experimental Teratology, Ministry of Education, Shandong University School of Medicine, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Mingxin Wen
- Department of Human Anatomy and Key Laboratory of Experimental Teratology, Ministry of Education, Shandong University School of Medicine, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Chuanxin Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, 247 Beiyuan Street, Tianqiao District, Jinan, 250033, Shandong, China
| | - Guangwei Wei
- Department of Human Anatomy and Key Laboratory of Experimental Teratology, Ministry of Education, Shandong University School of Medicine, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Yunshan Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, 247 Beiyuan Street, Tianqiao District, Jinan, 250033, Shandong, China
| | - Aiguo Ji
- School of Pharmaceutical Sciences, Shandong University, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China.
| | - Qin Wang
- Department of Anesthesiology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China.
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Harowicz M, Saha A, Grimm LJ, Marcom PK, Marks JR, Hwang ES, Mazurowski MA. Can algorithmically assessed MRI features predict which patients with a preoperative diagnosis of ductal carcinoma in situ are upstaged to invasive breast cancer? J Magn Reson Imaging 2017; 46:1332-1340. [PMID: 28181348 PMCID: PMC5910028 DOI: 10.1002/jmri.25655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess the ability of algorithmically assessed magnetic resonance imaging (MRI) features to predict the likelihood of upstaging to invasive cancer in newly diagnosed ductal carcinoma in situ (DCIS). MATERIALS AND METHODS We identified 131 patients at our institution from 2000-2014 with a core needle biopsy-confirmed diagnosis of pure DCIS, a 1.5 or 3T preoperative bilateral breast MRI with nonfat-saturated T1 -weighted MRI sequences, no preoperative therapy before breast MRI, and no prior history of breast cancer. A fellowship-trained radiologist identified the lesion on each breast MRI using a bounding box. Twenty-nine imaging features were then computed automatically using computer algorithms based on the radiologist's annotation. RESULTS The rate of upstaging of DCIS to invasive cancer in our study was 26.7% (35/131). Out of all imaging variables tested, the information measure of correlation 1, which quantifies spatial dependency in neighboring voxels of the tumor, showed the highest predictive value of upstaging with an area under the curve (AUC) = 0.719 (95% confidence interval [CI]: 0.609-0.829). This feature was statistically significant after adjusting for tumor size (P < 0.001). CONCLUSION Automatically assessed MRI features may have a role in triaging which patients with a preoperative diagnosis of DCIS are at highest risk for occult invasive disease. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1332-1340.
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Affiliation(s)
- Michael Harowicz
- Department of Radiology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Ashirbani Saha
- Department of Radiology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Lars J. Grimm
- Department of Radiology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - P. Kelly Marcom
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeffrey R. Marks
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - E. Shelley Hwang
- Department of Surgical Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Maciej A. Mazurowski
- Department of Radiology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Duke University Medical Physics Program, Durham, North Carolina, USA
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Mattingly AE, Ma Z, Smith PD, Kiluk JV, Khakpour N, Hoover SJ, Laronga C, Lee MC. Early Postoperative Complications after Oncoplastic Reduction. South Med J 2017; 110:660-666. [PMID: 28973708 DOI: 10.14423/smj.0000000000000706] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Breast-conserving surgery with adjuvant radiation therapy (BCT) has been established as safe oncologically. Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast conservation to improve cosmetic outcomes. We evaluated the risk factors associated with complications after oncoplastic breast reduction. METHODS A single-institution, institutional review board-approved, retrospective review of electronic medical records of female patients with breast cancer who underwent oncoplastic breast reduction from 2008 to 2014. A review of electronic medical records collected relevant medical history, clinical and pathological information, and data on postoperative complications within 6 months stratified into major or minor complications. Categorical variables analyzed with the χ2 exact method; continuous variables were analyzed with the Wilcoxon rank sum test exact method. RESULTS We identified 59 patients; 4 required re-excision for positive margins, and 1 moved on to completion mastectomy. The overall complication rate was 33.9% (n = 20): 12 major (20.3%) and 8 minor (13.6%). Of the continuous variables (age, body mass index, and tissue removed), increased age was associated with minor complications (P = 0.02). Among the categorical variables (stratified body mass index, prior breast surgery, hypertension, diabetes mellitus, hyperlipidemia, vascular disease, pulmonary disease, and stratified weight of tissue removed), none were associated with overall or major complications. Pulmonary disease was associated with minor complications (P = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no statistically significant increase in complications. CONCLUSIONS The overall complication rate after oncoplastic breast reduction was markedly higher than that in nationally published data for breast-conserving surgery. The complication rate resembled more closely the complication rate after bilateral mastectomy with immediate reconstruction. No risk factors were associated with major or overall complications. Age and pulmonary disease were associated with minor complications. Patients should be selected and counseled appropriately when considering oncoplastic breast reduction.
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Affiliation(s)
- Anne E Mattingly
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - Zhenjun Ma
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - Paul D Smith
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - John V Kiluk
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - Nazanin Khakpour
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - Susan J Hoover
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - Christine Laronga
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
| | - M Catherine Lee
- From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida
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He XM, Zou DH. The association of young age with local recurrence in women with early-stage breast cancer after breast-conserving therapy: a meta-analysis. Sci Rep 2017; 7:11058. [PMID: 28894168 PMCID: PMC5593910 DOI: 10.1038/s41598-017-10729-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of this meta-analysis is to determine the relationship between young age and local recurrence in patients with early-stage breast cancer after breast-conserving therapy. Eligible studies were retrieved from various electronic databases. Among the 19 studies included, 14 studies were analyzed for 5-year local recurrence rate and 8 studies for 10-year local recurrence rate using random effects models. Both results showed that young patients were at higher risk of local recurrence compared to old patients (5-year: RR = 2.64, 95% CI (1.94–3.60); 10-year: RR = 2.37, 95% CI (1.57–3.58)). Harbord’s modified test showed the presence of publication bias in both 5- and 10-year local recurrence rates (P = 0.019 and P = 0.01, respectively). While the Trim and Fill analysis showed that the presence of publication bias did not affect the overall outcome of the 5-year local recurrence rate (RR = 2.21, 95% CI (1.62, 3.02)), it significantly affected the effect size of the 10-year local recurrence rate (RR = 1.47, 95% CI (0.96, 2.27)). Young age is a significant risk factor for local recurrence developed within 5 years of breast-conserving therapy in patients with early-stage breast cancer. Further high-quality studies are needed to elucidate the relationship between young age and the risk of local recurrence developed within 10 years.
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Affiliation(s)
- Xiang-Ming He
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - De-Hong Zou
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
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Cooke AL, Diaz-Abele J, Hayakawa T, Buchel E, Dalke K, Lambert P. Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year—A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy. Int J Radiat Oncol Biol Phys 2017; 99:165-172. [DOI: 10.1016/j.ijrobp.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/19/2017] [Accepted: 05/01/2017] [Indexed: 11/12/2022]
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Tamoxifen with radiotherapy compared with Tamoxifen alone in elderly women with early-stage breast cancer treated with breast conserving surgery: A systematic review and meta-analysis. Radiother Oncol 2017; 123:1-9. [DOI: 10.1016/j.radonc.2017.02.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/23/2022]
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Abstract
BACKGROUND Breast-conserving therapy for women with breast cancer consists of local excision of the tumour (achieving clear margins) followed by radiotherapy (RT). RT is given to sterilize tumour cells that may remain after surgery to decrease the risk of local tumour recurrence. Most true recurrences occur in the same quadrant as the original tumour. Whole breast radiotherapy (WBRT) may not protect against the development of a new primary cancer developing in other quadrants of the breast. In this Cochrane review, we investigated the delivery of radiation to a limited volume of the breast around the tumour bed (partial breast irradiation (PBI)) sometimes with a shortened treatment duration (accelerated partial breast irradiation (APBI)). OBJECTIVES To determine whether PBI/APBI is equivalent to or better than conventional or hypo-fractionated WBRT after breast-conserving therapy for early-stage breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group Specialized Register (4 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 5), MEDLINE (January 1966 to 4 May 2015), EMBASE (1980 to 4 May 2015), CINAHL (4 May 2015) and Current Contents (4 May 2015). We searched the International Standard Randomised Controlled Trial Number Register (5 May 2015), the World Health Organization's International Clinical Trials Registry Platform (4 May 2015) and ClinicalTrials.gov (17 June 2015). We searched for grey literature: OpenGrey (17 June 2015), reference lists of articles, several conference proceedings and published abstracts, and applied no language restrictions. SELECTION CRITERIA Randomized controlled trials (RCTs) without confounding, that evaluated conservative surgery plus PBI/APBI versus conservative surgery plus WBRT. Published and unpublished trials were eligible. DATA COLLECTION AND ANALYSIS Two review authors (BH and ML) performed data extraction and used Cochrane's 'Risk of bias' tool, and resolved any disagreements through discussion. We entered data into Review Manager 5 for analysis. MAIN RESULTS We included seven RCTs and studied 7586 women of the 8955 enrolled.Local recurrence-free survival appeared worse for women receiving PBI/APBI compared to WBRT (hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.11 to 2.35; six studies, 6820 participants, low-quality evidence). Cosmesis (physician-reported) appeared worse with PBI/APBI (odds ratio (OR) 1.51, 95% CI 1.17 to 1.95, five studies, 1720 participants, low-quality evidence). Overall survival did not differ with PBI/APBI (HR 0.90, 95% CI 0.74 to 1.09, five studies, 6718 participants, high-quality evidence).Late radiation toxicity (subcutaneous fibrosis) appeared worse with PBI/APBI (OR 6.58, 95% CI 3.08 to 14.06, one study, 766 participants, moderate-quality evidence). Acute skin toxicity appeared reduced with PBI/APBI (OR 0.04, 95% CI 0.02 to 0.09, two studies, 608 participants). Telangiectasia (OR 26.56, 95% CI 3.59 to 196.51, 1 study, 766 participants) and radiological fat necrosis (OR 1.58, 95% CI 1.02 to 2.43, three studies, 1319 participants) appeared worse with PBI/APBI. Late skin toxicity (OR 0.21, 95% CI 0.01 to 4.39, two studies, 608 participants) and breast pain (OR 2.17, 95% CI 0.56 to 8.44, one study, 766 participants) appeared not to differ with PBI/APBI.'Elsewhere primaries' (new primaries in the ipsilateral breast) appeared more frequent with PBI/APBI (OR 3.97, 95% CI 1.51 to 10.41, three studies, 3009 participants).We found no clear evidence of a difference for the comparison of PBI/APBI with WBRT for the outcomes of: cause-specific survival (HR 1.08, 95% CI 0.73 to 1.58, five studies, 6718 participants, moderate-quality evidence), distant metastasis-free survival (HR 0.94, 95% CI 0.65 to 1.37, four studies, 3267 participants, moderate-quality evidence), relapse-free survival (HR 1.36, 95% CI 0.88 to 2.09, three studies, 3811 participants), loco-regional recurrence-free survival (HR 1.80, 95% CI 1.00 to 3.25, two studies, 3553 participants) or mastectomy rates (OR 1.20, 95% CI 0.77 to 1.87, three studies, 4817 participants, low-quality evidence). Compliance was met: more than 90% of the women in all studies received the RT they were assigned to receive. We found no data for the outcomes of costs, quality of life or consumer preference. AUTHORS' CONCLUSIONS It appeared that local recurrence and 'elsewhere primaries' (new primaries in the ipsilateral breast) are increased with PBI/APBI (the difference was small), but we found no evidence of detriment to other oncological outcomes. It appeared that cosmetic outcomes and some late effects were worse with PBI/APBI but its use was associated with less acute skin toxicity. The limitations of the data currently available mean that we cannot make definitive conclusions about the efficacy and safety or ways to deliver of PBI/APBI. We await completion of ongoing trials.
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Affiliation(s)
- Brigid E Hickey
- Princess Alexandra HospitalRadiation Oncology Mater Service31 Raymond TerraceBrisbaneQueenslandAustralia4101
- The University of QueenslandSchool of MedicineBrisbaneAustralia
| | - Margot Lehman
- The University of QueenslandSchool of MedicineBrisbaneAustralia
- Princess Alexandra HospitalRadiation Oncology UnitGround Floor, Outpatients FIpswich Road, WoollangabbaBrisbaneQueenslandAustralia4102
| | - Daniel P Francis
- Queensland University of TechnologySchool of Public Health and Social WorkVictoria Park RoadBrisbaneQueenslandAustralia4059
| | - Adrienne M See
- Princess Alexandra HospitalRadiation Oncology Mater Service31 Raymond TerraceBrisbaneQueenslandAustralia4101
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Onitilo AA, Engel JM, Stankowski RV, Doi SAR. Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy. Clin Med Res 2015; 13:65-73. [PMID: 25487237 PMCID: PMC4504664 DOI: 10.3121/cmr.2014.1245] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/14/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Evidence suggests superiority of breast conserving surgery (BCS) plus radiation over mastectomy alone for treatment of early stage breast cancer. Whether the superiority of BCS plus radiation is related to the surgical approach itself or to the addition of adjuvant radiation therapy following BCS remains unclear. MATERIALS AND METHODS We conducted a retrospective cohort study of women with breast cancer diagnosed from 1994-2012. Data regarding patient and tumor characteristics and treatment specifics were captured electronically. Kaplan-Meier survival analyses were performed with inverse probability of treatment weighting to reduce selection bias effects in surgical assignment. RESULTS Data from 5335 women were included, of which two-thirds had BCS and one-third had mastectomy. Surgical decision trends changed over time with more women undergoing mastectomy in recent years. Women who underwent BCS versus mastectomy differed significantly regarding age, cancer stage/grade, adjuvant radiation, chemotherapy, and endocrine treatment. Overall survival was similar for BCS and mastectomy. When BCS plus radiation was compared to mastectomy alone, 3-, 5-, and 10-year overall survival was 96.5% vs 93.4%, 92.9% vs 88.3% and 80.9% vs 67.2%, respectively. CONCLUSION These analyses suggest that survival benefit is not related only to the surgery itself, but that the prognostic advantage of BCS plus radiation over mastectomy may also be related to the addition of adjuvant radiation therapy. This conclusion requires prospective confirmation in randomized trials.
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Affiliation(s)
- Adedayo A Onitilo
- Department of Hematology/Oncology, Marshfield Clinic-Weston Center, Weston, Wisconsin, USA School of Population Health, University of Queensland, Brisbane, Australia
| | - Jessica M Engel
- Department of Hematology/Oncology, Marshfield Clinic Cancer Care, Stevens Point, Wisconsin, USA
| | | | - Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Australia
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Abstract
This article reviews the surgical options for breast cancer with emphasis on factors that influence decision making and the data that have driven changes in clinical practice.
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Affiliation(s)
- Jessica Salmans LaCross
- Jessica Salmans LaCross is an instructor at Baylor College of Medicine and practices in Baylor's Michael E. DeBakey Department of Surgery, both in Houston, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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Liu FF, Shi W, Done SJ, Miller N, Pintilie M, Voduc D, Nielsen TO, Nofech-Mozes S, Chang MC, Whelan TJ, Weir LM, Olivotto IA, McCready DR, Fyles AW. Identification of a Low-Risk Luminal A Breast Cancer Cohort That May Not Benefit From Breast Radiotherapy. J Clin Oncol 2015; 33:2035-40. [PMID: 25964246 DOI: 10.1200/jco.2014.57.7999] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the prognostic and predictive value of intrinsic subtyping by using immunohistochemical (IHC) biomarkers for ipsilateral breast relapse (IBR) in participants in an early breast cancer randomized trial of tamoxifen with or without breast radiotherapy (RT). PATIENTS AND METHODS IHC analysis of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), cytokeratin 5/6, epidermal growth factor receptor, and Ki-67 was conducted on 501 of 769 available blocks. Patients were classified as luminal A (n = 265), luminal B (n = 165), or high-risk subtype (luminal HER2, n = 22; HER2 enriched, n = 13; basal like, n = 30; or triple-negative nonbasal, n = 6). Median follow-up was 10 years. RESULTS Classification by subtype was prognostic for IBR (10-year estimates: luminal A, 5.2%; luminal B, 10.5%; high-risk subtypes, 21.3%; P < .001). Luminal subtypes seemed to derive less benefit from RT (luminal A hazard ratio [HR], 0.40; luminal B HR, 0.51) than high-risk subtypes (HR, 0.13); however, the overall subtype-treatment interaction term was not significant (P = .26). In an exploratory analysis of women with clinical low-risk (age older than 60 years, T1, grade 1 or 2) luminal A tumors (n = 151), 10-year IBR was 3.1% versus 11.8% for the high-risk cohort (n = 341; P = .0063). Clinical low-risk luminal A patients had a 10-year IBR of 1.3% with tamoxifen versus 5.0% with tamoxifen plus RT (P = .42). Multivariable analysis showed that RT (HR, 0.31; P < .001), clinical risk group (HR, 2.2; P = .025), and luminal A subtype (HR, 0.25; P < .001) were significantly associated with IBR. CONCLUSION IHC subtyping was prognostic for IBR but was not predictive of benefit from RT. Further studies may validate the exploratory finding of a low-risk luminal A group who may be spared breast RT.
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Affiliation(s)
- Fei-Fei Liu
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Wei Shi
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Susan J Done
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Naomi Miller
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Melania Pintilie
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - David Voduc
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Torsten O Nielsen
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Sharon Nofech-Mozes
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Martin C Chang
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Timothy J Whelan
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Lorna M Weir
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Ivo A Olivotto
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - David R McCready
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada
| | - Anthony W Fyles
- Fei-Fei Liu, Anthony W. Fyles, Wei Shi, Susan J. Done, Naomi Miller, Melania Pintilie, and David R. McCready, Princess Margaret Cancer Centre/University Health Network; Sharon Nofech-Mozes, Sunnybrook Odette Cancer Center; Martin C. Chang, Mt. Sinai Hospital, University of Toronto, Toronto; Timothy J. Whelan, Juravinski Cancer Centre, McMaster University, Hamilton, ON; David Voduc, Torsten O. Nielsen, and Lorna M. Weir, British Columbia Cancer Agency, Vancouver; and Ivo A. Olivotto, British Columbia Cancer Agency, Victoria, BC, Canada.
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14
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Freedman GM. Current Guidelines for Acceptable Surgical Margins in Breast Conservation Therapy. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0084-3] [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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Pleijhuis R, Timmermans A, De Jong J, De Boer E, Ntziachristos V, Van Dam G. Tissue-simulating phantoms for assessing potential near-infrared fluorescence imaging applications in breast cancer surgery. J Vis Exp 2014:51776. [PMID: 25286185 DOI: 10.3791/51776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Inaccuracies in intraoperative tumor localization and evaluation of surgical margin status result in suboptimal outcome of breast-conserving surgery (BCS). Optical imaging, in particular near-infrared fluorescence (NIRF) imaging, might reduce the frequency of positive surgical margins following BCS by providing the surgeon with a tool for pre- and intraoperative tumor localization in real-time. In the current study, the potential of NIRF-guided BCS is evaluated using tissue-simulating breast phantoms for reasons of standardization and training purposes. Breast phantoms with optical characteristics comparable to those of normal breast tissue were used to simulate breast conserving surgery. Tumor-simulating inclusions containing the fluorescent dye indocyanine green (ICG) were incorporated in the phantoms at predefined locations and imaged for pre- and intraoperative tumor localization, real-time NIRF-guided tumor resection, NIRF-guided evaluation on the extent of surgery, and postoperative assessment of surgical margins. A customized NIRF camera was used as a clinical prototype for imaging purposes. Breast phantoms containing tumor-simulating inclusions offer a simple, inexpensive, and versatile tool to simulate and evaluate intraoperative tumor imaging. The gelatinous phantoms have elastic properties similar to human tissue and can be cut using conventional surgical instruments. Moreover, the phantoms contain hemoglobin and intralipid for mimicking absorption and scattering of photons, respectively, creating uniform optical properties similar to human breast tissue. The main drawback of NIRF imaging is the limited penetration depth of photons when propagating through tissue, which hinders (noninvasive) imaging of deep-seated tumors with epi-illumination strategies.
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Affiliation(s)
- Rick Pleijhuis
- Department of Surgery, University Medical Center Groningen
| | | | | | - Esther De Boer
- Department of Surgery, University Medical Center Groningen
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Abstract
BACKGROUND Breast conserving therapy for women with breast cancer consists of local excision of the tumour (achieving clear margins) followed by radiation therapy (RT). RT is given to sterilize tumour cells that may remain after surgery to decrease the risk of local tumour recurrence. Most true recurrences occur in the same quadrant as the original tumour. Whole breast RT may not protect against the development of a new primary cancer developing in other quadrants of the breast. In this Cochrane Review, we investigated the role of delivering radiation to a limited volume of the breast around the tumour bed (partial breast irradiation: PBI) sometimes with a shortened treatment duration (accelerated partial breast irradiation: APBI). OBJECTIVES To determine whether PBI/APBI is equivalent to or better than conventional or hypofractionated WBRT after breast conservation therapy for early-stage breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group Specialised Register (07 November 2013), CENTRAL (2014, Issue 3), MEDLINE (January 1966 to 11 April 2014), EMBASE (1980 to 11 April 2014), CINAHL (11 April 2014) and Current Contents (11 April 2014). Also we searched the International Standard Randomised Controlled Trial Number Register, the World Health Organization's International Clinical Trials Registry Platform (07 November 2013) and US clinical trials registry (www.clinicaltrials.gov) (22 April 2014). We searched for grey literature: Open Grey (23 April 2014), reference lists of articles, a number of conference proceedings and published abstracts, and did not apply any language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) without confounding and evaluating conservative surgery plus PBI/APBI versus conservative surgery plus whole breast RT. We included both published and unpublished trials. DATA COLLECTION AND ANALYSIS Three review authors (ML, DF and BH) performed data extraction and resolved any disagreements through discussion. We entered data into Review Manager for analysis. BH and ML assessed trials, graded the methodological quality using Cochrane's Risk of Bias tool and resolved any disagreements through discussion. MAIN RESULTS We included four RCTs that had 2253 women. Two older trials examined RT techniques which do not reflect current practice and one trial had a short follow-up. We downgraded the quality of the evidence for our key outcomes due to risk of bias. Taken together with other GRADE recommendations, the quality of evidence for our outcomes was very low to low. For the comparison of partial breast irradiation/accelerated breast irradiation (PBI/APBI) with whole breast irradiation (WBRT), local recurrence-free survival appeared worse (Hazard Ratio (HR) 1.74, 95% confidence interval (CI) 1.23 to 2.45; three trials, 1140 participants, very low quality evidence). Cosmesis appeared improved with PBI/APBI in a single trial (OR 0.40, 95% CI 0.23 to 0.72; one trial, 241 participants, very low quality evidence), but late toxicity (telangiectasia OR 4.41, 95% CI 3.21 to 6.05; very low quality evidence, 708 participants) and subcutaneous fibrosis (OR 4.27, 95% CI 3.04 to 6.01; one trial, 710 participants, very low quality evidence) appeared increased in another trial. We found no clear evidence of a difference for the comparison of PBI/APBI versus WBRT for the outcomes of: overall survival (HR 0.99, 95% CI 0.83 to 1.18; three trials, 1140 participants, very low quality evidence), cause-specific survival (HR 0.95, 95% CI 0.74 to 1.22; two trials, 966 participants, low evidence quality), distant metastasis-free survival (HR 1.02, 95% CI 0.81 to 1.28; 1140 participants, low quality evidence), subsequent mastectomy rate (OR 0.20, 95% CI 0.01 to 4.21; 258 participants, low quality evidence) and relapse-free survival (HR 0.99, 95% CI 0.53 to 1.85; 258 participants, low quality evidence). We found no data for the outcomes of acute toxicity, new ipsilateral breast primaries, costs, quality of life or consumer preference. AUTHORS' CONCLUSIONS The limitations of the data currently available mean that we cannot make definitive conclusions about the efficacy and safety or ways to deliver of PBI/APBI. We await completion of ongoing trials.
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Affiliation(s)
- Margot Lehman
- Radiation Oncology Unit, Princess Alexandra Hospital, Ground Floor, Outpatients F, Ipswich Road, Woollangabba, Brisbane, Queensland, Australia, 4102
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Abstract
Breast cancer and osteoporosis are common diagnoses in women. Breast cancer survival has improved due to earlier detection and improved treatments. As most breast cancers are estrogen receptor positive, treatment is often aimed at altering the hormonal environment. Both pre and postmenopausal women undergoing these therapies are at risk for bone loss. The patient's health care team ought to have an awareness of the potential for breast cancer treatments to accelerate bone loss. Women with early stage breast cancer are treated with curative intent and, therefore, maintaining bone health is important and is part of the survivorship care to ensure an optimal quality of life.
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Affiliation(s)
- Palak Choksi
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Health System, 24 Frank Lloyd Wright Drive, Lobby C, Ann Arbor, MI, 48106, USA,
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van de Water W, Bastiaannet E, Scholten AN, Kiderlen M, de Craen AJM, Westendorp RGJ, van de Velde CJH, Liefers GJ. Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2013; 21:786-94. [DOI: 10.1245/s10434-013-3374-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Indexed: 11/18/2022]
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Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Controversies and Current Indications for Use. Curr Treat Options Oncol 2012. [DOI: 10.1007/s11864-012-0213-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Bai Y, Ye M, Cao H, Ma X, Xu Y, Wu B. Economic evaluation of radiotherapy for early breast cancer after breast-conserving surgery in a health resource-limited setting. Breast Cancer Res Treat 2012; 136:547-57. [DOI: 10.1007/s10549-012-2268-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 12/22/2022]
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