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González-Viguera J, Martínez-Pérez E, Pérez-Montero H, Arangüena M, Guedea F, Gutiérrez-Miguélez C. Hype or hope? A review of challenges in balancing tumor control and treatment toxicity in breast cancer from the perspective of the radiation oncologist. Clin Transl Oncol 2024; 26:561-573. [PMID: 37505372 DOI: 10.1007/s12094-023-03287-2] [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: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
The aim of this article is to discuss the challenges and new strategies in managing breast cancer patients, with a specific focus on radiation oncology and the importance of balancing oncologic outcomes with quality of life and post-treatment morbidity. A comprehensive literature review was conducted to identify advances in the management of breast cancer, exploring de-escalation strategies, hypofractionation schemes, predictors and tools for reducing toxicity (radiation-induced lymphocyte apoptosis, deep inspiration breath-hold, adaptive radiotherapy), enhancer treatments (hyperthermia, immunotherapy) and innovative diagnostic modalities (PET-MRI, omics). Balancing oncologic outcomes with quality of life and post-treatment morbidity is crucial in the era of personalized medicine. Radiotherapy plays a critical role in the management of breast cancer patients. Large randomized trials are necessary to generalize some practices and cost remains the main obstacle for many innovations that are already applicable.
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Affiliation(s)
- Javier González-Viguera
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Evelyn Martínez-Pérez
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marina Arangüena
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Dai L, Cui H, Bao Y, Hu L, Zhou Z, Lin S, Zhang X, Wu H, Kang H, Ma X. Prognostic effect of radiotherapy in breast cancer patients underwent immediate reconstruction after mastectomy. Front Oncol 2022; 12:1010088. [PMID: 36408183 PMCID: PMC9667104 DOI: 10.3389/fonc.2022.1010088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/20/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION It is still unclear whether radiotherapy affects the long-term survival of breast cancer (BC) patients after immediate breast reconstruction (IBR). This study aims to evaluate the actual prognostic impact of radiotherapy on BC patients undergoing IBR, and to construct survival prediction models to predict the survival benefit of radiotherapy. METHODS Data on eligible BC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk models were used to assess breast cause-specific death (BCSD) and non-breast cancer cause-specific death (NBCSD). Kaplan-Meier curve, Cox risk regression model and forest map were used to evaluate and demonstrate overall survival (OS) and breast cancer-specific survival (BCSS). Survival prediction nomograms were used to predict OS and BCSS probabilities. RESULTS A total of 22,218 patients were selected, 24.9% received radiotherapy and 75.1% were without radiotherapy. Competing risk models showed that whether BCSD or NBCSD, the cumulative long-term risk of death in the radiotherapy group was higher than that in the non-radiotherapy group. The Kaplan-Meier curve showed that patients with different lymph node metastasis had different radiotherapy benefits. Multivariate stratified analysis showed that radiotherapy after autologous reconstruction was associated with poor BCSS in patients with stage N0, and radiotherapy after autologous reconstruction and combined reconstruction improved OS and BCSS in patients with stage N3. The C-indexes of nomogram (between 0.778 and 0.847) and calibration curves showed the good prediction ability of survival prediction model. CONCLUSIONS Radiotherapy can improve OS and BCSS in N3 stage BC patients undergoing immediate autologous reconstruction after mastectomy. The practical nomograms can be used to predict OS and BCSS of patients with or without radiotherapy, which is helpful for individualized treatment.
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Affiliation(s)
- Luyao Dai
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hanxiao Cui
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yuanhang Bao
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Liqun Hu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zhangjian Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shuai Lin
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xin Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hao Wu
- School of Basic Medical Sciences, Xi’an Key Laboratory of Immune Related Diseases, Xi’an Jiaotong University, Xi’an, Shaanxi, China,*Correspondence: Hao Wu, ; Huafeng Kang, ; Xiaobin Ma,
| | - Huafeng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,*Correspondence: Hao Wu, ; Huafeng Kang, ; Xiaobin Ma,
| | - Xiaobin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China,*Correspondence: Hao Wu, ; Huafeng Kang, ; Xiaobin Ma,
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Dai L, Cui H, Bao Y, Hu L, Zhou Z, Wang M, Lin S, Wu H, Kang H, Ma X. The relationship between immediate postmastectomy reconstruction modalities and survival benefits in patients with triple negative breast cancer. Cancer Med 2022; 12:2782-2794. [PMID: 36106621 PMCID: PMC9939230 DOI: 10.1002/cam4.5166] [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: 03/19/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Immediate postmastectomy reconstruction for breast cancer has been widely used due to its unique esthetic and psychological effects. However, no other population-based study has investigated the effects of different reconstruction types on the survival in patients with triple negative breast cancer (TNBC). METHODS We selected patients who met the eligibility criteria from the Surveillance, Epidemiology, and End Results cancer registry (N = 9760). We then assessed the effect of different reconstructive surgical approaches (implant, autologous, implant and autologous combined reconstruction) on the overall survival (OS) and breast cancer-specific survival (BCSS) by using the Kaplan-Meier survival curve and Cox proportional hazard regression analyses. The nomograms were used to predict OS and BCSS. And the competitive risk model was used to assess breast cancer-specific death (BCSD) and non-breast cancer-specific death (NBCSD). RESULTS Statistical analysis suggested that the three reconstruction methods had better OS and BCSS with lower hazard than mastectomy alone (log-rank test, p < 0.05). Multivariate stratified analysis showed that patients aged 40-60 years had the greatest improvement in OS (Adjusted hazard ratio [AHR], 0.646; 95% Confidence Interval [CI], 0.439-0.950; p = 0.026) with combined reconstruction. BCSS could be improved only by implant reconstruction (AHR, 0.672; 95% CI, 0.514-0.878; p = 0.004). In addition, autologous reconstruction (AHR, 0.570; 95% CI, 0.350-0.929; p = 0.024) and implant reconstruction (AHR, 0.538; 95% CI, 0.339-0.853; p = 0.008) improved OS in patients >60 years of age. The survival prediction model quantified the survival benefits of TNBC patients undergoing different surgeries. Moreover, the C-indexes showed the good predictive ability of the nomograms. CONCLUSIONS Our results suggest that for TNBC patients, there is a survival benefit of immediate postmastectomy reconstruction compared with mastectomy alone. Among them, implant reconstruction has the most obvious advantage.
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Affiliation(s)
- Luyao Dai
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hanxiao Cui
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yuanhang Bao
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Liqun Hu
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Zhangjian Zhou
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Meng Wang
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Shuai Lin
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hao Wu
- School of Basic Medical Sciences, Xi'an Key Laboratory of Immune Related DiseasesXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Huafeng Kang
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Xiaobin Ma
- Department of OncologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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Vakaet V, Van Hulle H, Van de Vijver K, Hilderson I, Naert E, De Neve W, Vandorpe J, Hendrix A, Göker M, Depypere H, Vergauwen G, Van den Broecke R, De Visschere P, Braems G, Vandecasteele K, Denys H, Veldeman L. Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial. Breast 2022; 62:10-15. [PMID: 35091184 PMCID: PMC8800131 DOI: 10.1016/j.breast.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Neo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT. MATERIAL AND METHODS Twenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy. RESULTS 20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196-253) compared to the control group (mean 237, range 211-268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications. CONCLUSION This pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.
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Affiliation(s)
- Vincent Vakaet
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
| | - Hans Van Hulle
- Dept. of Human Structure and Repair, Ghent University, Belgium.
| | - Koen Van de Vijver
- Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium.
| | | | - Eline Naert
- Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | | | - Jo Vandorpe
- Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium.
| | - An Hendrix
- Dept. of Human Structure and Repair, Ghent University, Belgium.
| | - Menekse Göker
- Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Herman Depypere
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | | | - Rudy Van den Broecke
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Pieter De Visschere
- Dept. of Diagnostic Sciences, Ghent University, Belgium; Dept. of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium.
| | - Geert Braems
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium.
| | - Katrien Vandecasteele
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
| | - Hannelore Denys
- Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | - Liv Veldeman
- Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium.
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