1
|
Gentile D, Martorana F, Karakatsanis A, Caruso F, Caruso M, Castiglione G, Di Grazia A, Pane F, Rizzo A, Vigneri P, Tinterri C, Catanuto G. Predictors of mastectomy in breast cancer patients with complete remission of primary tumor after neoadjuvant therapy: A retrospective study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108732. [PMID: 39362047 DOI: 10.1016/j.ejso.2024.108732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 09/20/2024] [Accepted: 09/30/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Neoadjuvant therapy (NAT) should increase the rate of breast-conserving surgery (BCS) in non-metastatic breast cancer (BC) patients, especially in those achieving tumor shrinkage. Still, the conversion from a pre-planned mastectomy to BCS in patients responding to NAT is not a widespread standard. We aimed to identify factors influencing surgical choices in this setting. MATERIALS AND METHODS We retrospectively collected data of BC patients with complete remission of primitive tumor (ypT0) after NAT, treated with BCS or mastectomy in two Italian breast units. Predictors of mastectomy were explored using logistic regression. Distant recurrence and event-free survival were assessed in the BCS and mastectomy cohort. RESULTS 243 patients were included, 147 (60.5 %) treated with BCS and 96 (39.5 %) treated with mastectomy. In the mastectomy group, there were more centrally-located, multiple and larger tumors. At univariate regression analysis, central location, baseline tumor extension on ultrasound (US) and magnetic resonance imaging (MRI), multiple foci and clinical stage were significantly associated with the chance of receiving mastectomy. At multivariate analysis, only baseline focality on US and extension on MRI retained significance as predictors of mastectomy. Distant recurrence and event-free survival were significantly longer in patients undergoing BCS. CONCLUSION Baseline tumor extension and focality were the main predictors of mastectomy in patients with ypT0 after NAT. However, BCS did not negatively affect survival outcomes in our cohort. An effort should be made to avoid potentially unnecessary mastectomy in this population, aiming at minimizing surgery-associated toxicities and improving patients' quality of life.
Collapse
Affiliation(s)
- Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Federica Martorana
- University of Catania, Department of Clinical and Experimental Medicine, Catania, Italy; Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy.
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Uppsala University, Uppsala, Sweden; Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Francesco Caruso
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Michele Caruso
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | | | - Alfio Di Grazia
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Francesco Pane
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Antonio Rizzo
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Paolo Vigneri
- University of Catania, Department of Clinical and Experimental Medicine, Catania, Italy; Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Catanuto
- Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy; G.Re.T.A. Group for Reconstructive and Therapeutic Advancements Fondazione ETS, Naples, Italy
| |
Collapse
|
2
|
Ren J, Li Y, Zhou J, Yang T, Jing J, Xiao Q, Duan Z, Xiang K, Zhuang Y, Li D, Gao H. Developing machine learning models for personalized treatment strategies in early breast cancer patients undergoing neoadjuvant systemic therapy based on SEER database. Sci Rep 2024; 14:22055. [PMID: 39333608 PMCID: PMC11436944 DOI: 10.1038/s41598-024-72385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 09/06/2024] [Indexed: 09/29/2024] Open
Abstract
This study aimed to compare the long-term outcomes of breast-conserving surgery plus radiotherapy (BCS + RT) and mastectomy in early breast cancer (EBC) patients who received neoadjuvant systemic therapy (NST), and sought to construct and authenticate a machine learning algorithm that could assist healthcare professionals in formulating personalized treatment strategies for this patient population. We analyzed data from the Surveillance, Epidemiology, and End Results database on EBC patients undergoing BCS + RT or mastectomy post-NST (2010-2018). Employing propensity score matching (PSM) to minimize potential biases, we compared breast cancer-specific survival (BCSS) and overall survival (OS) between the two surgical groups. Additionally, we trained and validated six machine learning survival models and developed a cloud-based recommendation system for surgical treatment based on the optimal model. Among the 13,958 patients, 9028 (64.7%) underwent BCS + RT and 4930 (35.3%) underwent mastectomy. After PSM, there were 3715 patients in each group. Compared to mastectomy, BCS + RT significantly improved BCSS (p < 0.001) and OS (p < 0.001). Prognostic variables associated with BCSS were utilized to develop machine learning models. In both the training and validation cohorts, the random survival forest (RSF) model demonstrated superior predictive performance (0.847 and 0.795), not only outperforming other machine learning models, including Rpart (0.725 and 0.707), Xgboost (0.762 and 0.727), Glmboost (0.748 and 0.788), Survctree (0.764 and 0.766), and Survsvm (0.777 and 0.790), but also outperforming the classical COX model (0.749 and 0.782). Lastly, a web-based prediction tool was built to facilitate clinical application [ https://jhren.shinyapps.io/shinyapp1 ]. After adjusting other confounders, BCS + RT was associated with improved outcomes in patients with EBC after NST, compared to those who underwent mastectomy. Moreover, the RSF model, a reliable tool, can predict long-term outcomes for patients, providing valuable guidance for operative methods and postoperative follow-up.
Collapse
Affiliation(s)
- Jiahui Ren
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yili Li
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Zhou
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Yang
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jingfeng Jing
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Xiao
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongxu Duan
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Xiang
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuchen Zhuang
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Daxue Li
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China.
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Han Gao
- Breast and Thyroid Surgery Department, Chongqing Health Center for Women and Children, Chongqing, China.
- Breast and Thyroid Surgery Department, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
3
|
Ten Velde DE, Duijm LEM, van der Sangen MJC, Schipper RJ, Tjan-Heijnen VCG, Vreuls W, Strobbe LJA, Voogd AC. Long-term trends in incidence, characteristics and prognosis of screen-detected and interval cancers in women participating in the Dutch breast cancer screening programme. Br J Cancer 2024; 130:1561-1570. [PMID: 38467826 PMCID: PMC11059155 DOI: 10.1038/s41416-024-02633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND No studies are available in which changes over time in characteristics and prognosis of patients with interval breast cancers (ICs) and screen-detected breast cancers (SDCs) have been compared. The aim was to study these trends between 1995 and 2018. METHODS All women with invasive SDCs (N = 4290) and ICs (N = 1352), diagnosed in a southern mammography screening region in the Netherlands, were included and followed until date of death or 31 December 2022. RESULTS The 5-year overall survival rate of women with SDCs increased from 91.4% for those diagnosed in 1995-1999 to 95.0% for those diagnosed in 2013-2018 (P < 0.001), and from 74.8 to 91.6% (P < 0.001) in the same periods for those with ICs. A similar trend was observed for the 10-year survival rates. After adjustment for changes in tumour characteristics, the hazard ratio (HR) for overall survival was 0.47 (95% confidence interval (CI): 0.38-0.59) for women with SDCs diagnosed in the period 2013-2018, compared to the women diagnosed in the period 1995-1999. For the women with ICs this HR was 0.27 (95% CI: 0.19-0.40). CONCLUSION The prognosis of women with ICs has improved rapidly since 1995 and is now almost similar to that of women with SDCs.
Collapse
Affiliation(s)
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | | | | | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| |
Collapse
|
4
|
Baldassi B, Poladyan H, Shahi A, Maa-Hacquoil H, Rapley M, Komarov B, Stiles J, Freitas V, Waterston M, Aseyev O, Reznik A, Bubon O. Image quality evaluation for a clinical organ-targeted PET camera. Front Oncol 2024; 14:1268991. [PMID: 38590664 PMCID: PMC10999605 DOI: 10.3389/fonc.2024.1268991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction A newly developed clinical organ-targeted Positron Emission Tomography (PET) system (also known as Radialis PET) is tested with a set of standardized and custom tests previously used to evaluate the performance of Positron Emission Mammography (PEM) systems. Methods Imaging characteristics impacting standardized uptake value (SUV) and detectability of small lesions, namely spatial resolution, linearity, uniformity, and recovery coefficients, are evaluated. Results In-plane spatial resolution was measured as 2.3 mm ± 0.1 mm, spatial accuracy was 0.1 mm, and uniformity measured with flood field and NEMA NU-4 phantom was 11.7% and 8.3% respectively. Selected clinical images are provided as reference to the imaging capabilities under different clinical conditions such as reduced activity of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG) and time-delayed acquisitions. SUV measurements were performed for selected clinical acquisitions to demonstrate a capability for quantitative image assessment of different types of cancer including for invasive lobular carcinoma with comparatively low metabolic activity. Quantitative imaging performance assessment with phantoms demonstrates improved contrast recovery and spill-over ratio for this PET technology when compared to other commercial organ-dedicated PET systems with similar spatial resolution. Recovery coefficients were measured to be 0.21 for the 1 mm hot rod and up to 0.89 for the 5 mm hot rod of NEMA NU-4 Image Quality phantom. Discussion Demonstrated ability to accurately reconstruct activity in tumors as small as 5 mm suggests that the Radialis PET technology may be well suited for emerging clinical applications such as image guided assessment of response to neoadjuvant systemic treatment (NST) in lesions smaller than 2 cm. Also, our results suggest that, while spatial resolution greatly influences the partial volume effect which degrades contrast recovery, optimized count rate performance and image reconstruction workflow may improve recovery coefficients for systems with comparable spatial resolution. We emphasize that recovery coefficient should be considered as a primary performance metric when a PET system is used for accurate lesion size or radiotracer uptake assessments.
Collapse
Affiliation(s)
- Brandon Baldassi
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
| | | | - Anirudh Shahi
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
| | | | - Madeline Rapley
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
| | | | - Justin Stiles
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
| | - Vivianne Freitas
- Department of Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | - Olexiy Aseyev
- Department of Medical Oncology, Thunder Bay Regional Health Sciences Center, Thunder Bay, ON, Canada
| | - Alla Reznik
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
- Radialis Inc., Thunder Bay, ON, Canada
| | - Oleksandr Bubon
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
- Radialis Inc., Thunder Bay, ON, Canada
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| |
Collapse
|
5
|
Pons L, Hernández L, Urbizu A, Osorio P, Rodríguez-Martínez P, Castella E, Muñoz A, Sanz C, Arnaldo L, Felip E, Quiroga V, Tapia G, Margelí M, Fernandez PL. Pre- and Post-Neoadjuvant Clinicopathological Parameters Can Help in the Prognosis and the Prediction of Response in HER2+ and Triple Negative Breast Cancer. Cancers (Basel) 2023; 15:3068. [PMID: 37370679 DOI: 10.3390/cancers15123068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Neoadjuvant treatment (NAT) is one of the most widely used options for HER2+ and triple negative (TN) early breast cancer (BC). Since around half of the patients treated with NAT do not achieve a pathologically complete response (pCR), biomarkers to predict resistance are urgently needed. The correlation of clinicopathological factors with pCR was studied in 150 patients (HER2 = 81; TN = 69) and pre- and post-NAT differences in tumour biomarkers were compared. Low estrogen receptor (ER) expression, high tumour-infiltrating lymphocytes (TILs) and low cT-stage were associated with pCR in HER2+ tumours (p = 0.022; p = 0.032 and p = 0.005, respectively). Furthermore, ER expression was also associated with residual cancer burden (RCB; p = 0.046) in the HER2+ subtype. Similarly, pre-NAT, low progesterone receptor expression (PR; 1-10%) was associated with higher RCB (p < 0.001) in TN tumours. Only clinical and pathological T-stage (cpT-stage) had prognostic capacity in HER2+ tumours, whereas pre-NAT cpT-stage and post-NAT TILs had this capacity for the prognosis of TN tumours. We conclude that ER and PR expression may help predict response to NAT in HER2 and TN BC and should be taken into account in residual tumours. Also, changes observed in the phenotype after NAT suggest the need to reevaluate biomarkers in surviving residual tumour cells.
Collapse
Affiliation(s)
- Laura Pons
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Laura Hernández
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Aintzane Urbizu
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Paula Osorio
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Paula Rodríguez-Martínez
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Eva Castella
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Ana Muñoz
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Carolina Sanz
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Laura Arnaldo
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Eudald Felip
- Medical Oncology Department, Catalan Institute of Oncology, B-ARGO Groups, Institut Germans Trias i Pujol (IGTP), 18916 Badalona, Spain
| | - Vanesa Quiroga
- Medical Oncology Department, Catalan Institute of Oncology, B-ARGO Groups, Institut Germans Trias i Pujol (IGTP), 18916 Badalona, Spain
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Mireia Margelí
- Medical Oncology Department, Catalan Institute of Oncology, B-ARGO Groups, Institut Germans Trias i Pujol (IGTP), 18916 Badalona, Spain
| | - Pedro Luis Fernandez
- Department of Pathology, Germans Trias i Pujol Universitary Hospital, Institut Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
- Faculty of Medicine and Health Sciences, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| |
Collapse
|
6
|
García-Calvo L, Martí Álvarez C, Gutiérrez AH, García AB, Muñoz RA, Sánchez-Méndez JI. Sentinel Node Biopsy in Patients With Breast Carcinoma Without Axillary Involvement at Diagnosis Receiving Primary Systemic Therapy. Clin Breast Cancer 2023:S1526-8209(23)00140-4. [PMID: 37331894 DOI: 10.1016/j.clbc.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Primary systemic therapy (PST) has acquired great importance in breast cancer (BC) in the last few years. In this scenario, even if it is accepted to perform SLNB before PST, most of the guidelines remark the advantages of this practice after it, such as avoiding another surgery to the patient, a rapid start of the treatment and no need of axillary dissection in cases of pathologic complete response (pCR). Nevertheless, the lack of knowledge of the initial axillary state and the need to practice axillary dissection with any axillary disease are claimed to be some other disadvantages. There are no randomized studies yet that can conclude the optimal timing of SLNB in PST, so for the moment we may settle for our common practice. PATIENTS AND METHODS We studied all the cases attended in the Breast Unit that joined the inclusion criteria between 2011 and 2019 in our hospital and we compared the group with SLNB before PST with the group with SLNB after PST in terms of unnecessary axillary dissection and description features. RESULTS We included 223 female patients diagnosed with BC and without clinical nor radiological axillary disease (cN0), who had received NAC and SLNB performed before or after it. We observed a higher proportion of high-grade histological tumors (G3), tumors with aggressive phenotypes (Basal like and Her 2 enriched), and younger women in the group of SLNB before NAC compared with the SLNB after NAC group (P < .01). Despite this, we did not find any difference in the number of positive SLNBs or in the number of ALND performed between the 2 groups. We found a higher proportion of ALND with all the lymph node (LN) negatives in the SLNB before NAC group. CONCLUSION Taking into account that in the observation period we did not use ACOSOG Z0011 criteria with all the SLNBs, we figure out what would have been the real results nowadays following these criteria. In this scenario we conclude that patients with luminal phenotype seemed to benefit from practicing SLNB before NAC in terms of avoiding axillary dissections. We could not make any conclusion in the rest of the phenotypes. However, prospective studies are needed to confirm if this affirmation could be proved.
Collapse
Affiliation(s)
- Laura García-Calvo
- Department of Gynecology and Obstetrics, Breast Pathology Unit, Campo Grande Hospital, Valladolid, Spain.
| | - Covadonga Martí Álvarez
- Department of Gynecology and Obstetrics, Breast Pathology Unit, La Paz University Hospital, Madrid, Spain
| | - Alicia Hernández Gutiérrez
- Universidad Autónoma Department, Madrid, Spain; Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; Gynecology and Obstetrics Department, Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Rocío Arnedo Muñoz
- Gynecology and Obstetrics Department, Rey Juan Carlos University Hospital, Madrid, Spain
| | - José I Sánchez-Méndez
- Department of Gynecology and Obstetrics, Breast Pathology Unit, La Paz University Hospital, Madrid, Spain; Universidad Autónoma Department, Madrid, Spain; Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| |
Collapse
|
7
|
Kataoka A, Sawaki M, Horisawa N, Kotani H, Yoshimura A, Hattori M, Adachi Y, Sugino K, Endo Y, Ozaki Y, Sasaki E, Hosoda W, Iwata H. The Absence of Cancer in the Location of a Breast Tissue Marker After Neoadjuvant Chemotherapy may Predict Pathological Complete Response with High Accuracy: Results from a Phase II Trial. Ann Surg Oncol 2023; 30:3224-3232. [PMID: 36754946 DOI: 10.1245/s10434-023-13199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND It is difficult to determine pathological complete response (pCR) before surgery in clinical complete response (cCR) cases by imaging alone. We designed a prospective study to evaluate whether a breast tissue marker placed in a tumor before neoadjuvant chemotherapy (NAC) can predict a pCR, possibly removing the need for surgery. METHODS We recruited patients with primary invasive breast cancer assigned to undergo curative surgery and possible NAC. A breast marker (UltraClip®) was placed in the primary tumor before standard NAC. We evaluated the probability of no cancer in the marker but cancer in removed specimens from a cCR group. RESULTS A total of 102 patients were enrolled. Patients were categorized by cancer stage and subtypes. Seventy-two patients (70.6%) received standard NAC; 23 (34.3%) attained cCR, of whom pCR was obtained in 12 (52.2%). The probability of no cancer in the marker's location but cancer in the removed specimens was 4.3% (95% confidence interval, 0.1-21.9). The false-negative rate was 9.1% (1/11), and the negative predictive value was 92.3% (12/13). In only one case, no cancer was found in the marker's location, but cancer cells were present in the removed specimen. CONCLUSIONS The absence of cancer in the location of a breast tissue marker after NAC predicted pCR with high accuracy. Therefore, the rebiopsy of a marker's location might mean surgery is unnecessary.
Collapse
Affiliation(s)
- Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuka Endo
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Waki Hosoda
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
8
|
Assessment of diffusion-weighted MRI in predicting response to neoadjuvant chemotherapy in breast cancer patients. Sci Rep 2023; 13:614. [PMID: 36635514 PMCID: PMC9837175 DOI: 10.1038/s41598-023-27787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
To compare region of interest (ROI)-apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) measurements and Ki-67 proliferation index before and after neoadjuvant chemotherapy (NACT) for breast cancer. 55 women were enrolled in this prospective single-center study, with a final population of 47 women (49 cases of invasive breast cancer). ROI-ADC measurements were obtained on MRI before and after NACT and were compared to histological findings, including the Ki-67 index in the whole study population and in subgroups of "pathologic complete response" (pCR) and non-pCR. Nineteen percent of women experienced pCR. There was a significant inverse correlation between Ki-67 index and ROI-ADC before NACT (r = - 0.443, p = 0.001) and after NACT (r = - 0.614, p < 0.001). The mean Ki-67 index decreased from 45.8% before NACT to 18.0% after NACT (p < 0.001), whereas the mean ROI-ADC increased from 0.883 × 10-3 mm2/s before NACT to 1.533 × 10-3 mm2/s after NACT (p < 0.001). The model for the prediction of Ki67 index variations included patient age, hormonal receptor status, human epidermal growth factor receptor 2 status, Scarff-Bloom-Richardson grade 2, and ROI-ADC variations (p = 0.006). After NACT, a significant increase in breast cancer ROI-ADC on diffusion-weighted imaging was observed and a significant decrease in the Ki-67 index was predicted. Clinical trial registration number: clinicaltrial.gov NCT02798484, date: 14/06/2016.
Collapse
|
9
|
Sabatino V, Pignata A, Valentini M, Fantò C, Leonardi I, Campora M. Assessment and Response to Neoadjuvant Treatments in Breast Cancer: Current Practice, Response Monitoring, Future Approaches and Perspectives. Cancer Treat Res 2023; 188:105-147. [PMID: 38175344 DOI: 10.1007/978-3-031-33602-7_5] [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: 01/05/2024]
Abstract
Neoadjuvant treatments (NAT) for breast cancer (BC) consist in the administration of chemotherapy-more rarely endocrine therapy-before surgery. Firstly, it was introduced 50 years ago to downsize locally advanced (inoperable) BCs. NAT are now widespread and so effective to be used also at the early stage of the disease. NAT are heterogeneous in terms of therapeutic patterns, class of used drugs, dosage, and duration. The poly-chemotherapy regimen and administration schedule are established by a multi-disciplinary team, according to the stage of disease, the tumor subtype and the age, the physical status, and the drug sensitivity of BC patients. Consequently, an accurate monitoring of treatment response can provide significant clinical advantages, such as the treatment de-escalation in case of early recognition of complete response or, on the contrary, the switch to an alternative treatment path in case of early detection of resistance to the ongoing therapy. Future is going toward increasingly personalized therapies and the prediction of individual response to treatment is the key to practice customized care pathways, preserving oncological safety and effectiveness. To gain such goal, the development of an accurate monitoring system, reproducible and reliable alone or as part of more complex diagnostic algorithms, will be promising.
Collapse
Affiliation(s)
- Vincenzo Sabatino
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy.
| | - Alma Pignata
- Breast Center, Spedali Civili Hospital, ASST, Brescia, Italy
| | - Marvi Valentini
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Carmen Fantò
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Irene Leonardi
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Michela Campora
- Pathology Department, Santa Chiara Hospital, APSS, Trento, Italy
| |
Collapse
|
10
|
Wang H, Lu Y, Li Y, Li S, Zhang X, Geng C. Nomogram for Early Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy in Breast Cancer Combining Both Clinicopathological and Imaging Indicators. Curr Probl Cancer 2022; 46:100914. [PMID: 36351312 DOI: 10.1016/j.currproblcancer.2022.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
To construct a nomogram for early prediction of pathological complete response (pCR) in patients with breast cancer (BC) after neoadjuvant chemotherapy (NAC). A total of 257 patients with BC from the fourth hospital of Hebei Medical University were included in the study. The patients were divided into training (n = 128) and validation groups (n = 129). Variables were screened using univariate and multivariate logistic regression analyses, and the nomogram model was set up based on the training group. The training and validation groups were validated using the receiver operating characteristic (ROC) curves and calibration plots. The diagnostic value of the nomogram was evaluated using decision curve analysis (DCA). Indicators such as hormone receptor status, clinical TNM stage, and change rate in apparent diffusion coefficient of breast magnetic resonance imaging after two NAC cycles were used for nomogram construction. The calibration plots showed high consistency between nomogram-predicted and actual pCR probabilities in the training and validation groups. The areas under the curve of the ROC curve with discrimination ability were 0.942 and 0.921 in the training and validation groups, respectively. This showed an excellent discrimination ability of our nomogram for pCR prediction. Further, DCA showed favorable diagnostic value in our model. The nomogram may be instructive to clinicians for early prediction of pCR and helpful to adjust the treatment program on time in neoadjuvant management.
Collapse
Affiliation(s)
- Haoqi Wang
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuyang Lu
- Thyroid and Breast Department, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yilun Li
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Sainan Li
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xi Zhang
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cuizhi Geng
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| |
Collapse
|
11
|
Panico C, Ferrara F, Woitek R, D’Angelo A, Di Paola V, Bufi E, Conti M, Palma S, Cicero SL, Cimino G, Belli P, Manfredi R. Staging Breast Cancer with MRI, the T. A Key Role in the Neoadjuvant Setting. Cancers (Basel) 2022; 14:cancers14235786. [PMID: 36497265 PMCID: PMC9739275 DOI: 10.3390/cancers14235786] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among women worldwide. Neoadjuvant chemotherapy (NACT) indications have expanded from inoperable locally advanced to early-stage breast cancer. Achieving a pathological complete response (pCR) has been proven to be an excellent prognostic marker leading to better disease-free survival (DFS) and overall survival (OS). Although diagnostic accuracy of MRI has been shown repeatedly to be superior to conventional methods in assessing the extent of breast disease there are still controversies regarding the indication of MRI in this setting. We intended to review the complex literature concerning the tumor size in staging, response and surgical planning in patients with early breast cancer receiving NACT, in order to clarify the role of MRI. Morphological and functional MRI techniques are making headway in the assessment of the tumor size in the staging, residual tumor assessment and prediction of response. Radiomics and radiogenomics MRI applications in the setting of the prediction of response to NACT in breast cancer are continuously increasing. Tailored therapy strategies allow considerations of treatment de-escalation in excellent responders and avoiding or at least postponing breast surgery in selected patients.
Collapse
Affiliation(s)
- Camilla Panico
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Correspondence:
| | - Francesca Ferrara
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Ramona Woitek
- Medical Image Analysis and AI (MIAAI), Danube Private University, 3500 Krems, Austria
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
- Cancer Research UK Cambridge Centre, Cambridge CB2 0RE, UK
| | - Anna D’Angelo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Valerio Di Paola
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Simone Palma
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefano Lo Cicero
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giovanni Cimino
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paolo Belli
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Manfredi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
12
|
Effectiveness of Virtual Reality Vs Guides imagery on mood changes in cancer patients receiving chemotherapy treatment: A crossover trial. Eur J Oncol Nurs 2022; 61:102188. [DOI: 10.1016/j.ejon.2022.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022]
|
13
|
Diagnostic precision of breast MRI in prediction of pathological complete response: is it influenced by the presence of metallic markers? Eur J Radiol 2022; 154:110453. [DOI: 10.1016/j.ejrad.2022.110453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
|
14
|
Pilger TL, Ortolani AJM, Reis FJCDR. Physiotherapy in the prevention and treatment of upper limb complications in women with breast cancer. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i2.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Breast cancer is the one that most affects the female population in Brazil and the world. Upper limb complications are common after cancer treatment, including conservative procedures. Old studies have already shown the effectiveness of physiotherapy in the rehabilitation of these complications. However, currently, physiotherapeutic care must be initiated from the diagnosis of the disease. Pre-rehabilitation prepares the patient to receive cancer treatment and promotes a reduction in rehabilitation time. Rehabilitation decreased the axillary cord by 57%, increased the range of motion (ROM) by 45º for flexion and 70º for shoulder abduction, the incidence of lymphedema was 11%, and there was a decrease of 3.4 points concerning pain on the Visual Scale Analog (EVA). The physical therapist should work with breast cancer to diagnose, prevent, and rehabilitate after cancer treatment, promoting functionality and quality of life for patients with breast cancer.
Collapse
|
15
|
Hottat NA, Badr DA, Lecomte S, Besse-Hammer T, Jani JC, Cannie MM. Value of diffusion-weighted MRI in predicting early response to neoadjuvant chemotherapy of breast cancer: comparison between ROI-ADC and whole-lesion-ADC measurements. Eur Radiol 2022; 32:4067-4078. [PMID: 35015127 DOI: 10.1007/s00330-021-08462-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/20/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of the study was to assess DWI with ROI-ADC and WL-ADC measurements in early response after NAC in breast cancer. METHODS Between January 2016 and December 2019, 55 women were enrolled in this prospective single-center study. MRI was performed at three time points for each patient: before treatment (MRI 1: DW and DCE MRI), after one cycle of NAC (MRI 2: noncontrast DW MRI), and after completion of NAC before surgery (MRI 3: DW and DCE MRI). ROI-ADC and WL-ADC measurements were obtained on MRI and were compared to histology findings and to the RCB class. Patients were categorized as having pCR or non-pCR. RESULTS Among 48 patients, 9 experienced pCR. An increase of ROI-ADC between MRI 1 and 2 of more than 47.5% had a sensitivity of 88.9% and a specificity of 63.4% in predicting pCR, whereas WL-ADC did not predict pCR. An increase of ROI-ADC between MRI 1 and 2 of more than 47.5% had a sensitivity of 83.3% and a specificity of 64.9% in predicting radiologic complete response. An increase of WL-ADC between MRI 1 and 2 of more than 25.5% had a sensitivity of 83.3% and a specificity of 75.5% in predicting radiologic complete response. CONCLUSION After one cycle of NAC, a significant increase in breast tumor ROI-ADC at DWI predicted complete pathologic and radiologic responses. KEY POINTS • An increase of WL-ADC between MRI 1 and 2 of more than 25.5% had a sensitivity of 83.3% and a specificity of 75.5% in predicting radiologic complete response. • An increase of ROI-ADC between MRI 1 and 2 of more than 47.5% had a sensitivity of 88.9% and a specificity of 63.4% in predicting pCR, and a sensitivity of 83.3% and a specificity of 64.9% in predicting radiologic complete response. • A significant increase in breast tumor ROI-ADC at DWI predicted complete pathologic and radiologic responses.
Collapse
Affiliation(s)
- Nathalie A Hottat
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium. .,Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Lecomte
- Department of Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Tatiana Besse-Hammer
- Department of Clinical Research Unit University, Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium.,Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
16
|
de Mooij CM, Mitea C, Mottaghy FM, Smidt ML, van Nijnatten TJA. Value of 18F-FDG PET/CT for predicting axillary pathologic complete response following neoadjuvant systemic therapy in breast cancer patients: emphasis on breast cancer subtype. EJNMMI Res 2021; 11:116. [PMID: 34807395 PMCID: PMC8609064 DOI: 10.1186/s13550-021-00861-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Neoadjuvant systemic therapy (NST) is a widely accepted initial treatment modality that can lead to pathologic downstaging of the axillary disease burden in breast cancer patients. Axillary response as well as baseline 18F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography with computed tomography (PET/CT) differ between breast cancer subtypes. The value of baseline 18F-FDG PET/CT in predicting axillary response to NST is not yet established, possibly since breast cancer subtype was not taken into account. The purpose of this study was to investigate the value of baseline 18F-FDG PET/CT in predicting axillary response to NST with a specific emphasis on subtype. Methods PET-parameters derived from the primary tumor as well as the most FDG-avid axillary lymph node were measured on baseline 18F-FDG PET/CT. Overall imaging findings were compared with the gold standard of histopathology of the axillary surgery specimen. Analyses for ER-positive/HER2-negative were performed separately from HER2-positive and TN patients. In addition, separate analyses for clinically node-positive patients were performed. Results Sixty-six patients with 69 primary tumors were included in this study. Thirty-three axillae contained ER-positive/HER2-negative, 16 HER2-positive, and 20 TN breast cancer. No significant difference in PET-parameters between patients with axillary residual disease and axillary pathologic complete response were found for ER-positive/HER2-negative breast cancer. In the combined HER2-positive/TN subgroup, the SUVmax was significantly lower in patients without residual axillary disease in both the entire cohort and in patients with clinically node-positive disease. In this combined subgroup, a cut-off of 4.89 SUVmax measured on the most FDG-avid axillary lymph node could predict residual axillary disease with a sensitivity, specificity, PPV, and NPV of 90%, 69%, 53%, and 95%, respectively. Conclusions Predicting axillary response following NST with baseline 18F-FDG PET/CT can be performed when focusing on breast cancer subtypes. The easily computed PET-parameter SUVmax can predict axillary response in HER2-positive and TN breast cancer. This study adds to the accumulating evidence that studies investigating the value of 18F-FDG PET/CT in breast cancer should always take subtypes into account. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00861-z.
Collapse
Affiliation(s)
- Cornelis M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. .,Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Cristina Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
17
|
Ye P, Duan H, Zhao Z, Fang S. A Practical Predictive Model Based on Ultrasound Imaging and Clinical Indices for Estimation of Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer. Cancer Manag Res 2021; 13:7783-7793. [PMID: 34675673 PMCID: PMC8519354 DOI: 10.2147/cmar.s331384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Clinical responses of neoadjuvant chemotherapy (NACT) are associated with prognosis in patients with breast cancer. The selection of suitable variables for the prediction of clinical responses remains controversial. Herein, we developed a predictive model based on ultrasound imaging and clinical indices to identify patients most likely to benefit from NACT. Patients and Methods We recruited a total of 225 consecutive patients who underwent NACT followed by surgery and axillary lymph node dissection at the Sixth Hospital of Ning Bo City of Zhe Jiang Province between January 1, 2018, and March 31, 2021. All patients had been diagnosed with breast cancer following the clinical examination. First, we created a training cohort of patients who underwent NACT+surgery (N=180) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+ surgery (N=45). Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to NACT; these were then incorporated into the nomogram. Results Multivariate logistic regression analysis identified several significant differences as to clinical responses of NACT, including neutrophil–lymphocyte ratio (NLR), body mass index (BMI), pulsatility index (PI), resistance index (RI), blood flow, Ki67, histological type, molecular subtyping, and tumor size. The performance of the nomogram score exhibited a robust C-index of 0.89 (95% confidence interval [CI]: 0.83 to 0.95) in the training cohort and a high C-index of 0.87 (95% CI: 0.81 to 0.93) in the validation cohort. Clinical impact curves showed that the nomogram had a good predictive ability. Conclusion We successfully established an accurate and optimized nomogram incorporated ultrasound imaging and clinical indices that could be used preoperatively to predict clinical responses of NACT. This model can be used to evaluate the risk of clinical responses to NACT and therefore facilitate the choice of personalized therapy.
Collapse
Affiliation(s)
- Pingping Ye
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
| | - Hongbo Duan
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
| | - Zhenya Zhao
- Department of Imaging, The First Hospital of Ningbo City of Zhejiang Province, Ningbo, 315010, People's Republic of China
| | - Shibo Fang
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
| |
Collapse
|
18
|
Koelbel V, Pfob A, Schaefgen B, Sinn P, Feisst M, Golatta M, Gomez C, Stieber A, Bach P, Rauch G, Heil J. Vacuum-Assisted Breast Biopsy After Neoadjuvant Systemic Treatment for Reliable Exclusion of Residual Cancer in Breast Cancer Patients. Ann Surg Oncol 2021; 29:1076-1084. [PMID: 34581923 PMCID: PMC8724060 DOI: 10.1245/s10434-021-10847-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022]
Abstract
Background About 40 % of women with breast cancer achieve a pathologic complete response in the breast after neoadjuvant systemic treatment (NST). To identify these women, vacuum-assisted biopsy (VAB) was evaluated to facilitate risk-adaptive surgery. In confirmatory trials, the rates of missed residual cancer [false-negative rates (FNRs)] were unacceptably high (> 10%). This analysis aimed to improve the ability of VAB to exclude residual cancer in the breast reliably by identifying key characteristics of false-negative cases. Methods Uni- and multivariable logistic regressions were performed using data of a prospective multicenter trial (n = 398) to identify patient and VAB characteristics associated with false-negative cases (no residual cancer in the VAB but in the surgical specimen). Based on these findings FNR was exploratively re-calculated. Results In the multivariable analysis, a false-negative VAB result was significantly associated with accompanying ductal carcinoma in situ (DCIS) in the initial diagnostic biopsy [odds ratio (OR), 3.94; p < 0.001], multicentric disease on imaging before NST (OR, 2.74; p = 0.066), and age (OR, 1.03; p = 0.034). Exclusion of women with DCIS or multicentric disease (n = 114) and classication of VABs that did not remove the clip marker as uncertain representative VABs decreased the FNR to 2.9% (3/104). Conclusion For patients without accompanying DCIS or multicentric disease, performing a distinct representative VAB (i.e., removing a well-placed clip marker) after NST suggests that VAB might reliably exclude residual cancer in the breast without surgery. This evidence will inform the design of future trials evaluating risk-adaptive surgery for exceptional responders to NST.
Collapse
Affiliation(s)
- Vivian Koelbel
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schaefgen
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Gomez
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Bach
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Joerg Heil
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
19
|
Chung HL, Le-Petross HT, Leung JWT. Imaging Updates to Breast Cancer Lymph Node Management. Radiographics 2021; 41:1283-1299. [PMID: 34469221 DOI: 10.1148/rg.2021210053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Metastatic lymph node involvement in breast cancer is a key determinant of the overall stage of disease and prognosis. Historically, lymph node status was determined by surgery first, with adjuvant treatments determined based on the results of the final surgical pathologic analysis. While this sequence is still applicable in many cases, neoadjuvant systemic treatment (NST) is increasingly being administered as the initial treatment. In cases that demonstrate good therapeutic response to drug therapies, NST may permit the option to perform less radical surgeries subsequently. Current breast cancer treatment has become multidisciplinary, with overlapping roles from the different disciplines. As surgery may be postponed, imaging and image-guided lymph node interventions have gained importance as the primary means of lymph node assessment. Imaging enables evaluation of all regional nodal basins, including locations where surgery is not usually performed. By differentiating limited versus extensive nodal involvement, imaging findings help determine whether initial treatment should be surgical or medical. If medical treatment with NST is indicated, imaging is performed to monitor the in vivo nodal response to drug therapy and ultimately to help determine the surgical technique to perform on the basis of the final imaging findings after NST. The authors discuss the imaging features of nodal metastases and the indications and techniques for the various image-guided procedures. The relative usefulness and shortcomings of the various imaging examinations are reviewed to discuss how they can be applied when biopsy results are not available. The role of imaging in the multidisciplinary team approach is emphasized based on past clinical trials of lymph node management and recent evolving knowledge of breast cancer staging. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Hannah L Chung
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Huong T Le-Petross
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Jessica W T Leung
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| |
Collapse
|
20
|
Masood S. Prediction and assessment of response to neo-adjuvant chemotherapy in breast cancer: The responsibilities of breast pathologists. Breast J 2021; 27:629-630. [PMID: 34331376 DOI: 10.1111/tbj.14274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| |
Collapse
|
21
|
Lee TL, Wei PY, Yang MH, Chang PMH, Wang LW, Tai SK. Tongue conservation treatment for oral tongue squamous cell carcinoma with induction chemotherapy, surgery, and risk-adapted adjuvant therapy: A phase II trial. Cancer Rep (Hoboken) 2021; 5:e1456. [PMID: 34051137 PMCID: PMC8842695 DOI: 10.1002/cnr2.1456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess the feasibility of tongue conservation treatment with induction chemotherapy (ICT), tongue conservation surgery, and risk-adapted postoperative adjuvant therapy in oral tongue squamous cell carcinoma (OTSCC). METHODS Patients with newly diagnosed OTSCC cT2-4 N0-2 M0 were recruited. The ICT with a regimen of docetaxel, cisplatin, and oral tegafur/uracil (DCU) was administrated every 21 days. After the first cycle of ICT (DCU1), patients with a more than 30% decrease in the longest diameter of primary tumor underwent a second cycle of ICT (DCU2). Tongue conservation surgery was performed after ICT, and risk-adapted adjuvant therapy was organized based on pathological features. RESULTS From July 2011 to December 2015, a total of 23 patients were enrolled, 87% of whom were classified as stage III-IV. Clinical responders to DCU1 and DCU2 were determined in 90.5% (19/21) and 88.2% (15/17) of patients. Tongue conservation surgery was performed in 16 responders to ICT. Only one patient had a positive margin (6.3%), and a complete pathologic response was achieved in eight patients (50%). Only one patient developed local recurrence after a median follow-up of 58.6 months (range, 7.9-105.2). The 5-year overall survival (0% vs. 87.5%, P = 0.001) and disease-specific survival (0% vs. 93.3%, P = 0.000) were significantly different between the DCU1 nonresponders and responders. CONCLUSION Tongue conservation treatment with ICT, followed by conservation surgery and risk-adapted adjuvant therapy, is feasible for patients with OTSCC who are good responders to ICT. However, the outcomes of nonresponders are dismal. Further study in a larger patient population is warranted.
Collapse
Affiliation(s)
- Tsung-Lun Lee
- Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Yin Wei
- Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Muh-Hwa Yang
- Infection and Immunity Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Oncology, Division of Medical Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peter Mu-Hsin Chang
- Oncology, Division of Medical Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Wei Wang
- Oncology, Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Department of Otolaryngology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.,Infection and Immunity Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
22
|
Granzier RWY, Ibrahim A, Primakov SP, Samiei S, van Nijnatten TJA, de Boer M, Heuts EM, Hulsmans FJ, Chatterjee A, Lambin P, Lobbes MBI, Woodruff HC, Smidt ML. MRI-Based Radiomics Analysis for the Pretreatment Prediction of Pathologic Complete Tumor Response to Neoadjuvant Systemic Therapy in Breast Cancer Patients: A Multicenter Study. Cancers (Basel) 2021; 13:cancers13102447. [PMID: 34070016 PMCID: PMC8157878 DOI: 10.3390/cancers13102447] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/23/2022] Open
Abstract
This retrospective study investigated the value of pretreatment contrast-enhanced Magnetic Resonance Imaging (MRI)-based radiomics for the prediction of pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients. A total of 292 breast cancer patients, with 320 tumors, who were treated with neo-adjuvant systemic therapy and underwent a pretreatment MRI exam were enrolled. As the data were collected in two different hospitals with five different MRI scanners and varying acquisition protocols, three different strategies to split training and validation datasets were used. Radiomics, clinical, and combined models were developed using random forest classifiers in each strategy. The analysis of radiomics features had no added value in predicting pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients compared with the clinical models, nor did the combined models perform significantly better than the clinical models. Further, the radiomics features selected for the models and their performance differed with and within the different strategies. Due to previous and current work, we tentatively attribute the lack of improvement in clinical models following the addition of radiomics to the effects of variations in acquisition and reconstruction parameters. The lack of reproducibility data (i.e., test-retest or similar) meant that this effect could not be analyzed. These results indicate the need for reproducibility studies to preselect reproducible features in order to properly assess the potential of radiomics.
Collapse
Affiliation(s)
- Renée W. Y. Granzier
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Correspondence: ; Tel.: +31-43-388-1575
| | - Abdalla Ibrahim
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liège and GIGA CRC-In Vivo Imaging, University of Liège, 4000 Liege, Belgium
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital RWTH Aachen University, 52074 Aachen, Germany
| | - Sergey P. Primakov
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Sanaz Samiei
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| | - Thiemo J. A. van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| | - Maaike de Boer
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Esther M. Heuts
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
| | - Frans-Jan Hulsmans
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands;
| | - Avishek Chatterjee
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Philippe Lambin
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marc B. I. Lobbes
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands;
| | - Henry C. Woodruff
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein L. Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| |
Collapse
|
23
|
De Luca A, Frusone F, Buzzacchino F, Amabile MI, Taffurelli M, Del Mastro L, Rutgers EJT, Sacchini V, Caruso F, Minelli M, Fortunato L. First Surgical National Consensus Conference of the Italian Breast Surgeons association (ANISC) on breast cancer management in neoadjuvant setting: Results and summary. Eur J Surg Oncol 2021; 47:1913-1919. [PMID: 33972142 DOI: 10.1016/j.ejso.2021.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022] Open
Abstract
RATIONALE On October 15th, 2020, the first Surgical National Consensus Conference on neoadjuvant chemotherapy (NACT) was promoted by the Italian Association of Breast Surgeons (ANISC). METHOD The Consensus Conference was entirely held online due to anti-Covid-19 restrictions and after an introductory four lectures held by national and international experts in the field, a total of nine questions were presented and a digital "real-time" voting system was obtained. A consensus was reached if 75% or more of all panelists agreed on a given question. RESULTS A total of 202 physicians, from 76 different Italian Breast Centers homogeneously distributed throughout the Italian country, participated to the Conference. Most participants were surgeons (75%). Consensus was reached for seven out of the nine considered topics, including management of margins and lymph nodes at surgery, and there was good correspondence between the 32 "Expert Panelists" and the "Participants" to the Conference. Consensus was not achieved regarding the indications to NACT for high-grade luminal-like breast tumors, and the need to perform an axillary lymph node dissection in case of micrometastases in the sentinel lymph node after NACT. CONCLUSIONS NACT is a topic of major interest among surgeons, and there is need to develop shared guidelines. While a Consensus was obtained for most issues presented at this Conference, controversies still exist regarding indications to NACT in luminal B-like tumors and management of lymph node micrometastases. There is need for clinical studies and analysis of large databases to improve our knowledge on this subject.
Collapse
Affiliation(s)
- Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Frusone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
| | - Mario Taffurelli
- IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, Breast Unit, and Department of Internal Medicine and Medical Specialties (DIMI), Genova, Italy
| | - Emiel J T Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Francesco Caruso
- Department of Oncological Surgery, Humanitas Catanese Center of Oncology, Catania, Italy
| | - Mauro Minelli
- Division of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Lucio Fortunato
- Breast Centre, San Giovanni-Addolorata Hospital, Rome, Italy.
| |
Collapse
|
24
|
Is mastectomy with immediate reconstruction safe for patients undergoing neoadjuvant chemotherapy? A nationwide study from Korean Breast Cancer Society. Breast Cancer 2021; 28:874-883. [PMID: 33586091 DOI: 10.1007/s12282-021-01223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In this study, we compared the prognoses of patients who underwent mastectomy with immediate breast reconstruction (IBR) after neoadjuvant chemotherapy with those who underwent mastectomy. METHODS This retrospective study included 87,995 patients who were surgically treated for primary breast cancer between 2008 and 2014. We compared the three groups of patients who were divided based on the following surgeries: breast-conserving surgery (BCS), mastectomy, and mastectomy with IBR. RESULTS Of the 3295 patients who were treated with neoadjuvant chemotherapy, 482 patients achieved a pathological complete response (pCR) and 2813 patients did not (non-pCR). In survival analysis of the pCR patients, the 5-year Overall Survival (5 yr OS) between those who underwent mastectomy with IBR and mastectomy (P = 0.639) In the non-pCR group, 5 yr OS of the mastectomy with IBR group was 90.0%, while those of the mastectomy group was 84.4% in patients with clinical stage II (P = 0.032). In a multivariate analysis by Cox regression method revealed that the prognoses of the patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy group in both groups (the pCR group and the non-pCR group). CONCLUSION In the pCR group, the prognoses of patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy. In the non-pCR group, women in the mastectomy with IBR group had shown worse prognoses than the mastectomy group in advanced clinical stage. Appropriate operation should be determined depending on the status of individualized patients.
Collapse
|
25
|
Impact of Postmastectomy Radiotherapy on Locoregional Control and Disease-Free Survival in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy. JOURNAL OF ONCOLOGY 2021; 2021:6632635. [PMID: 33564308 PMCID: PMC7850833 DOI: 10.1155/2021/6632635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
Background The impact of postmastectomy radiotherapy (PMRT) in patients receiving neoadjuvant chemotherapy (NAC) is unclear. The purpose of this study is to identify the patients who may benefit from PMRT. Methods We retrospectively analysed patients with clinical stage II-III breast cancer who underwent NAC and modified radical mastectomy at our centre from 2007 to 2015. We investigated the relationship amongst locoregional recurrence rate (LRR), disease-free survival (DFS), and clinical pathological characters. Results A total of 554 patients were analysed in this study. The median follow-up time was 65 months. Amongst the patients, 58 (10.5%) had locoregional recurrence, 138 (24.9%) had distant metastasis, and 72 (13.0%) patients died. The 5-year cumulative incidence of LRR and DFS was 9.2% and 74.2%, respectively. A total of 399 (72%) patients received PMRT and 155 (28%) did not. The 5-year LRR of the patients with PMRT (7.3% vs. 14.1%, P=0.01) decreased significantly. We found that PMRT was an independent prognostic factor of LRR and DFS. Patients with the persistent involvement of 1–3 lymph nodes (ypN1) and more than 4 positive lymph nodes (ypN2-3) had a better outcome after PMRT than those without. However, the LRR and DFS of patients with negative lymph nodes at the time of surgery (ypN0) and who received PMRT showed no significant benefits. Amongst all patients with the three molecular subtypes of breast cancer, patients with triple-negative breast cancer had the highest pathological complete response rate but the worst prognosis (P=0.001). Conclusion Results showed that PMRT significantly reduced the LRR of patients with clinical stage II-III breast cancer after receiving NAC and mastectomy. YpN0 patients derived no local control or survival benefit after receiving PMRT, whereas those with ypN1 and ypN2-3 could obviously benefit from PMRT.
Collapse
|
26
|
Simons JM, Jacobs JG, Roijers JP, Beek MA, Boonman-de Winter LJM, Rijken AM, Gobardhan PD, Wijsman JH, Tetteroo E, Heijns JB, Yick CY, Luiten EJT. Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study. Breast Cancer Res Treat 2021; 185:441-451. [PMID: 33073303 PMCID: PMC7867515 DOI: 10.1007/s10549-020-05966-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE The extended role of breast-conserving surgery (BCS) in the neoadjuvant setting may raise concerns on the oncologic safety of BCS compared to mastectomy. This study compared long-term outcomes after neoadjuvant chemotherapy (NAC) between patients treated with BCS and mastectomy. METHODS All breast cancer patients treated with NAC from 2008 until 2017 at the Amphia Hospital (the Netherlands) were included. Disease-free and overall survival were compared between BCS and mastectomy with survival functions. Multivariable Cox proportional hazard regression was performed to determine prognostic variables for disease-free survival. RESULTS 561 of 612 patients treated with NAC were eligible: 362 (64.5%) with BCS and 199 (35.5%) with mastectomy. Median follow-up was 6.8 years (0.9-11.9). Mastectomy patients had larger tumours and more frequently node-positive or lobular cancer. Unadjusted five-year disease-free survival was 90.9% for BCS versus 82.9% for mastectomy (p = .004). Unadjusted five-year overall survival was 95.3% and 85.9% (p < .001), respectively. In multivariable analysis, clinical T4 (cT4) (HR 3.336, 95% CI 1.214-9.165, p = .019) and triple negative disease (HR 5.946, 95% CI 2.703-13.081, p < .001) were negative predictors and pathologic complete response of the breast (HR 0.467, 95% CI 0.238-0.918, p = .027) and axilla (HR 0.332, 95% CI 0.193-0.572, p = .001) were positive predictors for disease-free survival. Mastectomy versus BCS was not a significant predictor for disease-free survival when adjusted for the former variables (unadjusted HR 2.13 (95%CI: 1.4-3.24), adjusted HR 1.31 (95%CI: 0.81-2.13)). In the BCS group, disease-free and overall survival did not differ significantly between cT1, cT2 or cT3 tumours. CONCLUSION BCS does not impair disease-free and overall survival in patients treated with NAC. Tumour biology and treatment response are significant prognostic indicators.
Collapse
Affiliation(s)
- Janine M Simons
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands.
| | - Julien G Jacobs
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Joost P Roijers
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Maarten A Beek
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | | | - Arjen M Rijken
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Paul D Gobardhan
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Jan H Wijsman
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Eric Tetteroo
- Department of Radiology, Amphia Hospital, Breda, The Netherlands
| | - Joan B Heijns
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - C Y Yick
- Department of Pathology, Amphia Hospital, Breda, The Netherlands
| | - Ernest J T Luiten
- Department of Surgical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| |
Collapse
|
27
|
Pu S, Wang K, Liu Y, Liao X, Chen H, He J, Zhang J. Nomogram-derived prediction of pathologic complete response (pCR) in breast cancer patients treated with neoadjuvant chemotherapy (NCT). BMC Cancer 2020; 20:1120. [PMID: 33213397 PMCID: PMC7678042 DOI: 10.1186/s12885-020-07621-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient. Combining multiple potential efficacy-related factors to build a model may improve the accuracy of prediction. This study intends to explore the clinical and biological factors in breast cancer patients receiving NCT and to establish a nomogram that can predict the pathologic complete response (pCR) rate of NCT. METHODS We selected 165 breast cancer patients receiving NCT from July 2017 to May 2019. Using pretreatment biopsy materials, immunohistochemical studies to assess estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression. The correlation between biological markers and pCR was analyzed. These predictors were used to develop a binary logistic regression model with cross-validation and to show the established predictive model with a nomogram. RESULTS The nomogram for pCR based on lymphovascular invasion, anemia (hemoglobin≤120 g/L), ER, Ki67 expression levels and NCT regimen had good discrimination performance (area under the curve [AUC], 0.758; 95% confidence interval [CI], 0.675-0.841) and calibration coordination. According to the Hosmer-Lemeshow test, the calibration chart showed satisfactory agreement between the predicted and observed probabilities. The final prediction accuracy of cross-validation was 76%. CONCLUSIONS We developed a nomogram based on multiple clinical and biological covariations that can provide an early prediction of NCT response and can help to quickly assess the individual benefits of NCT.
Collapse
Affiliation(s)
- Shengyu Pu
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China
| | - Ke Wang
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China
| | - Yang Liu
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China
| | - Xiaoqin Liao
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China
| | - Heyan Chen
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China
| | - Jianjun He
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China.
| | - Jian Zhang
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi Province, China.
| |
Collapse
|
28
|
Stafford A, Williams A, Edmiston K, Cocilovo C, Cohen R, Bruce S, Yoon-Flannery K, De La Cruz L. Axillary Response in Patients Undergoing Neoadjuvant Endocrine Treatment for Node-Positive Breast Cancer: Systematic Literature Review and NCDB Analysis. Ann Surg Oncol 2020; 27:4669-4677. [PMID: 32909130 PMCID: PMC7480656 DOI: 10.1245/s10434-020-08905-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
Background Several studies have proven that neoadjuvant endocrine therapy (NET) has a similar beneficial therapeutic effect in estrogen-positive (ER+) breast cancer (BC) with improved breast conservation rate in patients undergoing NET versus neoadjuvant chemotherapy (NAC). The impact of axillary complete pathologic response (pCR) is less clear. We evaluate the impact of NET on axillary downstaging and surgical management. Methods Using the National Cancer Database (NCDB), we identified all patients with node positive (N+), ER+, HER2− BC undergoing NET and performed a systemic review of literature using PRISMA guidelines. Results The literature review identified 1479 clinically N+ patients in four studies, 148 of whom had axillary pCR (10.0%). In the two studies of patients with invasive lobular carcinoma (ILC), 7.8% (69/883) of clinically N+ patients had axillary pCR. The NCDB query identified 4580 female patients with clinically N+ ER+ HER2− BC who underwent NET from 2010 to 2016 with mean age of 61.4 years. Patients who achieved a pCR were more likely to have N1 disease (p 0.008), moderately differentiated tumors (p 0.003), and ductal histology (p 0.04). There was no statistically significant difference in race, comorbidity score, education, income, hospital setting, or clinical tumor stage. Of the 4580 total patients, 663 (14.48%) had an axillary pCR (pN0) after NET, and 3917 (85.52%) remained pN+. Conclusions We found that patients who underwent NET for N+ disease had a higher axillary pCR than previously reported (10%) in smaller studies. Although NET is not a common treatment option for women with N+ ER+ HER2− BC, it may be a suitable option for axillary downstaging, which is currently underutilized. Electronic supplementary material The online version of this article (10.1245/s10434-020-08905-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Arielle Stafford
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA
| | - Austin Williams
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Kirsten Edmiston
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA
| | - Costanza Cocilovo
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA
| | - Robert Cohen
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA
| | - Sara Bruce
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA
| | - Kahyun Yoon-Flannery
- Comprehensive Breast Center, Jefferson Health New Jersey, Sewell, NJ, USA.,Department of Surgery, Rowan SOM, Stratford, NJ, USA
| | - Lucy De La Cruz
- Division of Breast Surgery, Department of Surgery, Inova Health System, Schar Cancer Institute, Fairfax, VA, USA.
| |
Collapse
|
29
|
Whisenant JG, Williams JM, Kang H, Arlinghaus LR, Abramson RG, Abramson VG, Fakhoury K, Chakravarthy AB, Yankeelov TE. Quantitative Comparison of Prone and Supine PERCIST Measurements in Breast Cancer. ACTA ACUST UNITED AC 2020; 6:170-176. [PMID: 32548293 PMCID: PMC7289244 DOI: 10.18383/j.tom.2020.00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Positron emission tomography (PET) is typically performed in the supine position. However, breast magnetic resonance imaging (MRI) is performed in prone, as this improves visibility of deep breast tissues. With the emergence of hybrid scanners that integrate molecular information from PET and functional information from MRI, it is of great interest to determine if the prognostic utility of prone PET is equivalent to supine. We compared PERCIST (PET Response Criteria in Solid Tumors) measurements between prone and supine FDG-PET in patients with breast cancer and the effect of orientation on predicting pathologic complete response (pCR). In total, 47 patients were enrolled and received up to 6 cycles of neoadjuvant therapy. Prone and supine FDG-PET were performed at baseline (t0; n = 46), after cycle 1 (t1; n = 1) or 2 (t2; n = 10), or after all neoadjuvant therapy (t3; n = 19). FDG uptake was quantified by maximum and peak standardized uptake value (SUV) with and without normalization to lean body mass; that is, SUVmax, SUVpeak, SULmax, and SULpeak. PERCIST measurements were performed for each paired baseline and post-treatment scan. Receiver operating characteristic analysis for the prediction of pCR was performed using logistic regression that included age and tumor size as covariates. SUV and SUL metrics were significantly different between orientation (P < .001), but were highly correlated (P > .98). Importantly, no differences were observed with the PERCIST measurements (P > .6). Overlapping 95% confidence intervals for the receiver operating characteristic analysis suggested no difference at predicting pCR. Therefore, prone and supine PERCIST in this data set were not statistically different.
Collapse
Affiliation(s)
- Jennifer G Whisenant
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jason M Williams
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lori R Arlinghaus
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN
| | - Richard G Abramson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Vandana G Abramson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Kareem Fakhoury
- Department of Radiation Oncology, University of Colorado Cancer Center-Anschutz Medical Campus, Aurora, CO
| | - A Bapsi Chakravarthy
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN; and
| | - Thomas E Yankeelov
- Oden Institute for Computational Engineering and Sciences; Livestrong Cancer Institutes; Department of Biomedical Engineering; Department of Diagnostic Medicine; and Department of Oncology, The University of Texas, Austin, TX
| |
Collapse
|
30
|
De-escalation of axillary surgery in breast cancer patients treated in the neoadjuvant setting: a Dutch population-based study. Breast Cancer Res Treat 2020; 180:725-733. [PMID: 32180074 PMCID: PMC7103007 DOI: 10.1007/s10549-020-05589-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/06/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE An overall trend is observed towards de-escalation of axillary surgery in patients with breast cancer. The objective of this study was to evaluate this trend in patients treated with neoadjuvant systemic therapy (NST). METHODS Patients with cT1-4N0-3 breast cancer treated with NST (2006-2016) were selected from the Netherlands Cancer Registry. Patients were classified by clinical node status (cN) and type of axillary surgery. Uni- and multivariable logistic regression analyses were performed to determine the clinicopathological factors associated with performing ALND in cN+ patients. RESULTS A total of 12,461 patients treated with NST were identified [5830 cN0 patients (46.8%), 6631 cN+ patients (53.2%)]. In cN0 patients, an overall increase in sentinel lymph node biopsy (SLNB) only (not followed by ALND) was seen from 11% in 2006 to 94% in 2016 (p < 0.001). SLNB performed post-NST increased from 33 to 62% (p < 0.001). In cN+ patients, an overall decrease in ALND was seen from 99% in 2006 to 53% in 2016 (p < 0.001). Age (OR 1.01, CI 1.00-1.02), year of diagnosis (OR 0.47, CI 0.44-0.50), HER2-positive disease (OR 0.62, CI 0.52-0.75), clinical tumor stage (T2 vs. T1 OR 1.32, CI 1.06-1.65, T3 vs. T1 OR 2.04, CI 1.58-2.63, T4 vs. T1 OR 6.37, CI 4.26-9.50), and clinical nodal stage (N3 vs. N1 OR 1.65, CI 1.28-2.12) were correlated with performing ALND in cN+ patients. CONCLUSIONS ALND decreased substantially over the past decade in patients treated with NST. Assessment of long-term prognosis of patients in whom ALND is omitted after NST is urgently needed.
Collapse
|
31
|
Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg 2019; 269:432-442. [PMID: 30312200 PMCID: PMC6369968 DOI: 10.1097/sla.0000000000003075] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: The aim of this study was to perform a systematic review and meta-analysis to assess the accuracy of different surgical axillary staging procedures compared with ALND. Summary of Background Data: Optimal axillary staging after neoadjuvant systemic therapy (NST) in node-positive breast cancer is an area of controversy. Several less invasive procedures, such as sentinel lymph node biopsy (SLNB), marking axillary lymph node with radioactive iodine seed (MARI), and targeted axillary dissection (a combination of SLNB and a MARI-like procedure), have been proposed to replace the conventional axillary lymph node dissection (ALND) with its concomitant morbidity. Methods: PubMed and Embase were searched for studies comparing less invasive surgical axillary staging procedures to ALND to identify axillary burden after NST in patients with pathologically confirmed node-positive breast cancer (cN+). A meta-analysis was performed to compare identification rate (IFR), false-negative rate (FNR), and negative predictive value (NPV). Results: Of 1132 records, 20 unique studies with 2217 patients were included in quantitative analysis: 17 studies on SLNB, 1 study on MARI, and 2 studies on a combination procedure. Overall axillary pathologic complete response rate was 37%. For SLNB, pooled rates of IFR and FNR were 89% and 17%. NPV ranged from 57% to 86%. For MARI, IFR was 97%, FNR 7%, and NPV 83%. For the combination procedure, IFR was 100%, FNR ranged from 2% to 4%, and NPV from 92% to 97%. Conclusion: Axillary staging by a combination procedure consisting of SLNB with excision of a pre-NST marked positive lymph node appears to be most accurate for axillary staging after NST. More evidence from prospective multicenter trials is needed to confirm this.
Collapse
|
32
|
He L, Wu Q, Xiong J, Su Z, Zhang B, Song Y. Do early HER2-overexpression breast cancer patients benefit from undergoing neoadjuvant trastuzumab and mastectomy? A meta-analysis. Cancer Manag Res 2019; 11:8043-8054. [PMID: 31507328 PMCID: PMC6718741 DOI: 10.2147/cmar.s208319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/21/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose To assess the overall survival (OS) of early human epidermal growth factor receptor 2 (HER2)-enriched breast cancer patients after receiving neoadjuvant trastuzumab (NAT) compared to adjuvant trastuzumab (AT) treatment and the difference in local-regional relapse (LRR) rate with this tumor and treatment between women after mastectomy and women after breast-conserving therapy (BCT). Methods Articles were retrieved from PubMed, Embase, Web of Science, and Cochrane Library. A pooled odds ratio (OR) with a 95% confidential interval (CI) was calculated. The StataSE version 12.0 software was employed for meta-analysis. Results Twelve available clinical studies containing 2366 subjects were included. The OS of NAT compared with that of AT was not significantly different (pooled OR=1.04; 95% CI, 0.47–2.33). There was a significantly lower LRR rate for patients with mastectomy compared to those with BCT (pooled OR=0.58; 95% CI, 0.38–0.89); however, subgroup analysis revealed that the significant advantage of LRR for mastectomy compared to BCT was only represented in women without trastuzumab treatment (pooled OR=0.52; 95% CI, 0.31–0.88) compared to those who received trastuzumab treatment (pooled OR=0.71; 95% CI, 0.34–1.49). Conclusion Early stage HER2-overexpression breast cancer patients benefit with an equivalent OS from NAT treatment compared to AT. Patients who underwent mastectomy and BCT experienced a similar LRR rate if they received anti-HER2 targeted therapy of trastuzumab, but the LRR rate was discernibly reduced in patients who received mastectomy compared to BCT if they did not also receive trastuzumab treatment. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/NZW1HV69ESk
Collapse
Affiliation(s)
- Lin He
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Qian Wu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Jing Xiong
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Zhumin Su
- Department of Neurology, The People's Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Biyuan Zhang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| |
Collapse
|
33
|
Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J, Boccardo F, Boddington C, Bogaerts J, Bonadonna G, Bradley R, Brain E, Braybrooke J, Broet P, Bryant J, Burrett J, Cameron D, Clarke M, Coates A, Coleman R, Coombes RC, Correa C, Costantino J, Cuzick J, Danforth D, Davidson N, Davies C, Davies L, Di Leo A, Dodwell D, Dowsett M, Duane F, Evans V, Ewertz M, Fisher B, Forbes J, Ford L, Gazet JC, Gelber R, Gettins L, Gianni L, Gnant M, Godwin J, Goldhirsch A, Goodwin P, Gray R, Hayes D, Hill C, Ingle J, Jagsi R, Jakesz R, James S, Janni W, Liu H, Liu Z, Lohrisch C, Loibl S, MacKinnon L, Makris A, Mamounas E, Mannu G, Martín M, Mathoulin S, Mauriac L, McGale P, McHugh T, Morris P, Mukai H, Norton L, Ohashi Y, Olivotto I, Paik S, Pan H, Peto R, Piccart M, Pierce L, Poortmans P, Powles T, Pritchard K, Ragaz J, Raina V, Ravdin P, Read S, Regan M, Robertson J, Rutgers E, Scholl S, Slamon D, Sölkner L, Sparano J, Steinberg S, Sutcliffe R, Swain S, Taylor C, Tutt A, Valagussa P, van de Velde C, van der Hage J, Viale G, von Minckwitz G, Wang Y, Wang Z, Wang X, Whelan T, Wilcken N, Winer E, Wolmark N, Wood W, Zambetti M, Zujewski JA. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 2018; 19:27-39. [PMID: 29242041 PMCID: PMC5757427 DOI: 10.1016/s1470-2045(17)30777-5] [Citation(s) in RCA: 649] [Impact Index Per Article: 108.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. METHODS We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). FINDINGS Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4-8·6]; rate ratio 1·37 [95% CI 1·17-1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92-1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95-1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94-1·15]; p=0·45). INTERPRETATION Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. FUNDING Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.
Collapse
|
34
|
Variation in use of neoadjuvant chemotherapy in patients with stage III breast cancer: Results of the Dutch national breast cancer audit. Breast 2017; 36:34-38. [DOI: 10.1016/j.breast.2017.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
|
35
|
Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer. J Contemp Brachytherapy 2017; 8:492-496. [PMID: 28115954 PMCID: PMC5241379 DOI: 10.5114/jcb.2016.64512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/17/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT) with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT) including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT). The BT dose of 15 Gy (1 Gy/pulse/h) was given on the following day after surgery. Results No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%), subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years), among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96%) and 87% (95% CI: 80-94%), respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97%) and 89% (95% CI: 82-96%), respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91%) evaluable patients. Conclusions Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation of primary diagnosis.
Collapse
|
36
|
Masood S. Neoadjuvant chemotherapy in breast cancers. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:480-491. [PMID: 27885165 PMCID: PMC5373271 DOI: 10.1177/1745505716677139] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
Abstract
With advances in science and technology, there are more innovations in the approach to management of patients with breast cancer. Neoadjuvant chemotherapy that is designed to be used prior to surgical removal of a tumor has received significant attention. Currently, neoadjuvant chemotherapy is offered to patients with locally advanced breast cancer and also those breast cancer patients who may benefit from size reduction before conservation therapy. There is now sufficient evidence that if neoadjuvant chemotherapy leads to complete pathologic response, the patient will enjoy a better outcome. Therefore, assessment of the degree of response to neoadjuvant chemotherapy has a major impact on patient selection and the follow-up management of each patient and defines patient outcome.
Collapse
MESH Headings
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Female
- Humans
- Mastectomy
- Mastectomy, Segmental
- Neoadjuvant Therapy/methods
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Treatment Outcome
- Tumor Burden
Collapse
Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- UF Health Breast Center, University of Florida Health-Jacksonville, Jacksonville, FL, USA
| |
Collapse
|