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Song YC, Huang Z, Fang H, Tang Y, Jing H, Song YW, Jin J, Liu YP, Chen B, Tang Y, Qi SN, Lu NN, Li N, Li YX, Wang SL. Breast-conserving surgery versus mastectomy for treatment of breast cancer after neoadjuvant chemotherapy. Front Oncol 2023; 13:1178230. [PMID: 37496664 PMCID: PMC10368492 DOI: 10.3389/fonc.2023.1178230] [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: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background To compare recurrence and survival outcomes between breast-conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT). Methods The data of 730 patients who underwent NACT between 2000 and 2014 were retrospectively reviewed. A total of 104 (14.2%) patients received BCS and 626 (85.8%) received mastectomy. Locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were analyzed using the Kaplan-Meier method. The impact of BCS versus mastectomy on outcomes was assessed by multivariate Cox models. Inverse probability of treatment weighting (IPTW) was used to balance covariates between the two groups. Results The median follow-up of BCS and mastectomy groups were 86.5 and 87.4 months, respectively. There were significant differences in distribution of most baseline characteristics between two groups. Compared with those who underwent mastectomy, the patients with BCS had similar 5-year LRR, DM, and DFS rates, but had significantly higher 5-year BCSS (98.9% vs. 90.4%, P = 0.005) and OS (98.9% vs. 90.1%, P = 0.003) rates. Multivariate analysis also showed that BCS significantly improved BCSS (HR = 0.27, 95% CI: 0.08-0.85, P = 0.025) and OS (HR = 0.25, 95% CI: 0.08-0.79, P = 0.018). After IPTW adjustment, the LRR, DM, DFS, BCSS and OS between two groups had no significant differences. Conclusions The recurrence and survival outcomes are comparable with BCS and mastectomy. Thus, BCS is a safe treatment option for selected breast cancer patients after NACT.
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Affiliation(s)
- Yu-Chun Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhou Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital &Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chou HH, Chung WS, Ding RY, Kuo WL, Yu CC, Tsai HP, Shen SC, Chu CH, Lo YF, Chen SC. Factors affecting locoregional recurrence in breast cancer patients undergoing surgery following neoadjuvant treatment. BMC Surg 2021; 21:160. [PMID: 33757489 PMCID: PMC7988904 DOI: 10.1186/s12893-021-01158-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/15/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS). Locoregional recurrence (LRR) rate is still high after NAC. The aim of this study was to determine predictive factors for LRR in breast cancer patients in association with the operation types after NAC. METHODS Between 2005 and 2017, 1047 breast cancer patients underwent BCS or mastectomy after NAC in Chang Gung Memorial Hospital, Linkou. We obtained data regarding patient and tumor characteristics, chemotherapy regimens, clinical tumor response, tumor subtypes and pathological complete response (pCR), type of surgery, and recurrence. RESULTS The median follow-up time was 59.2 months (range 3.13-186.75 months). The mean initial tumor size was 4.89 cm (SD ± 2.95 cm). Of the 1047 NAC patients, 232 (22.2%) achieved pCR. The BCS and mastectomy rates were 41.3% and 58.7%, respectively. One hundred four patients developed LRR (9.9%). Comparing between patients who underwent BCS and those who underwent mastectomy revealed no significant difference in the overall LRR rate of the two groups, 8.8% in BCS group vs 10.7% in mastectomy group (p = 0.303). Multivariate analysis indicated that independent factors for the prediction of LRR included clinical N2 status, negative estrogen receptor (ER), and failure to achieve pCR. In subgroups of multivariate analysis, only negative ER was the independent factor to predict LRR in mastectomy group (p = 0.025) and hormone receptor negative/human epidermal growth factor receptor 2 positive (HR-/HER2 +) subtype (p = 0.006) was an independent factor to predict LRR in BCS patients. Further investigation according to the molecular subtype showed that following BCS, non-pCR group had significantly increased LRR compared with the pCR group, in HR-/HER2 + subtype (25.0% vs 8.3%, p = 0.037), and HR-/HER2- subtype (20.4% vs 0%, p = 0.002). CONCLUSION Clinical N2 status, negative ER, and failure to achieve pCR after NAC were independently related to the risk of developing LRR. Operation type did not impact on the LRR. In addition, the LRR rate was higher in non-pCR hormone receptor-negative patients undergoing BCS comparing with pCR patients.
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Affiliation(s)
- Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan.
| | - Wei-Shan Chung
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Rong-Yao Ding
- Colleges of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Wen-Ling Kuo
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hsiu-Pei Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Shih-Che Shen
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chia-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Shin-Cheh Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
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3
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Scheepens JCC, Veer LV', Esserman L, Belkora J, Mukhtar RA. Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability. Breast 2021; 56:61-69. [PMID: 33621798 PMCID: PMC7907889 DOI: 10.1016/j.breast.2021.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/29/2021] [Accepted: 02/06/2021] [Indexed: 12/26/2022] Open
Abstract
The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences. Contralateral prophylactic mastectomy rates have increased over the last 20 years. Patients may want CPM to reduce risk of contralateral breast cancer and mortality. Patients do not always have the tools available to make a well-informed decision. Patient and surgeon’s shared decision-making could optimize the use of CPM.
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Affiliation(s)
- Josien C C Scheepens
- University of California, San Francisco, Department of Laboratory Medicine, 2340 Sutter St., Box 0808, San Francisco, CA, 94115, USA
| | - Laura van 't Veer
- University of California, San Francisco, Department of Laboratory Medicine, 2340 Sutter St., Box 0808, San Francisco, CA, 94115, USA
| | - Laura Esserman
- University of California, San Francisco, Department of Surgery, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94143-1710, USA
| | - Jeff Belkora
- University of California, San Francisco, Institute for Health Policy Studies and Department of Surgery, 3333 California Street, Suite 265, San Francisco, CA, 94118, USA
| | - Rita A Mukhtar
- University of California, San Francisco, Department of Surgery, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94143-1710, USA.
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Froeling FEM, Casolino R, Pea A, Biankin AV, Chang DK. Molecular Subtyping and Precision Medicine for Pancreatic Cancer. J Clin Med 2021; 10:E149. [PMID: 33406790 PMCID: PMC7794969 DOI: 10.3390/jcm10010149] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/13/2020] [Accepted: 12/25/2020] [Indexed: 12/12/2022] Open
Abstract
Substantial progress in recent years has dramatically increased our knowledge of the molecular basis of cancer, revealing new potential therapeutic targets and paving the way for effective personalised medicine for the treatment of many tumour types. However, pancreatic cancer has been lagging behind in this success and continues to be one of the most lethal solid malignancies. Its molecular heterogeneity and the unselected design of the majority of clinical trials to date can in part explain the reason for our failure to make a significant change in the survival outcomes for patients with pancreatic cancer. A changing paradigm in drug development is required to validate the new molecular taxonomy and to rapidly translate preclinical discovery into clinical trials. Here, we review the molecular subtyping of pancreatic cancer, the challenges in identifying effective treatment regimens according to defined low-prevalence molecular subgroups and we illustrate a new model of translational therapeutic development that was established in the U.K. (Precision-Panc) as a potentially effective solution to improve outcomes for patients with pancreatic cancer.
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Affiliation(s)
- Fieke E. M. Froeling
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; (F.E.M.F.); (R.C.); (A.P.); (A.V.B.)
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; (F.E.M.F.); (R.C.); (A.P.); (A.V.B.)
- Department of Medicine, University and Hospital Trust of Verona of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Antonio Pea
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; (F.E.M.F.); (R.C.); (A.P.); (A.V.B.)
- Department of Surgery, University and Hospital Trust of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Andrew V. Biankin
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; (F.E.M.F.); (R.C.); (A.P.); (A.V.B.)
| | - David K. Chang
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; (F.E.M.F.); (R.C.); (A.P.); (A.V.B.)
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
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Hamy AS, Darrigues L, Laas E, De Croze D, Topciu L, Lam GT, Evrevin C, Rozette S, Laot L, Lerebours F, Pierga JY, Osdoit M, Faron M, Feron JG, Laé M, Reyal F. Prognostic value of the Residual Cancer Burden index according to breast cancer subtype: Validation on a cohort of BC patients treated by neoadjuvant chemotherapy. PLoS One 2020; 15:e0234191. [PMID: 32579551 PMCID: PMC7313974 DOI: 10.1371/journal.pone.0234191] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction The Residual Cancer Burden (RCB) quantifies residual disease after neoadjuvant chemotherapy (NAC). Its predictive value has not been validated on large cohorts with long-term follow up. The objective of this work is to independently evaluate the prognostic value of the RCB index depending on BC subtypes (Luminal, HER2-positive and triple negative (TNBCs)). Methods We retrospectively evaluated the RCB index on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between RCB index and relapse-free survival (RFS), overall survival (OS) among the global population, after stratification by BC subtypes. Results 717 patients were included (luminal BC (n = 222, 31%), TNBC (n = 319, 44.5%), HER2-positive (n = 176, 24.5%)). After a median follow-up of 99.9 months, RCB index was significantly associated with RFS. The RCB-0 patients displayed similar prognosis when compared to the RCB-I group, while patients from the RCB-II and RCB-III classes were at increased risk of relapse (RCB-II versus RCB-0: HR = 3.25 CI [2.1–5.1] p<0.001; RCB-III versus RCB-0: HR = 5.6 CI [3.5–8.9] p<0.001). The prognostic impact of RCB index was significant for TNBC and HER2-positive cancers; but not for luminal cancers (Pinteraction = 0.07). The prognosis of RCB-III patients was poor (8-years RFS: 52.7%, 95% CI [44.8–62.0]) particularly in the TNBC subgroup, where the median RFS was 12.7 months. Conclusion RCB index is a reliable prognostic score. RCB accurately identifies patients at a high risk of recurrence (RCB-III) with TNBC or HER2-positive BC who must be offered second-line adjuvant therapies.
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Affiliation(s)
- Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lauren Darrigues
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Enora Laas
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Diane De Croze
- Department of Tumor Biology, Institut Curie, Saint-Cloud, France
| | - Lucian Topciu
- Department of Tumor Biology, Institut Curie, Paris, France
| | - Giang-Thanh Lam
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Clemence Evrevin
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Sonia Rozette
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lucie Laot
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Marie Osdoit
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Matthieu Faron
- Department of biostatistics and epidemiology, INSERM 1018 CESP Oncostat team, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Guillaume Feron
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
| | - Marick Laé
- Department of Tumor Biology, Institut Curie, Paris, France
| | - Fabien Reyal
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Department of Surgery, Faculté de Médecine Descartes, Université Paris, Institut Curie, Paris, France
- * E-mail:
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Krug D, Lederer B, Seither F, Nekljudova V, Ataseven B, Blohmer JU, Costa SD, Denkert C, Ditsch N, Gerber B, Hanusch C, Heil J, Hilfrich J, Huober JB, Jackisch C, Kümmel S, Paepke S, Schem C, Schneeweiss A, Untch M, Debus J, von Minckwitz G, Kühn T, Loibl S. Post-Mastectomy Radiotherapy After Neoadjuvant Chemotherapy in Breast Cancer: A Pooled Retrospective Analysis of Three Prospective Randomized Trials. Ann Surg Oncol 2019; 26:3892-3901. [PMID: 31350646 DOI: 10.1245/s10434-019-07635-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of locoregional radiotherapy (RT) after neoadjuvant chemotherapy (NACT) and mastectomy in breast cancer patients is currently unclear. Several publications have suggested that patients with a favorable response to NACT might not benefit from RT after mastectomy. METHODS A retrospective analysis of three prospective randomized NACT trials was performed. Information on the use of RT was available for 817 breast cancer patients with non-inflammatory breast cancer who underwent mastectomy after NACT within the GeparTrio, GeparQuattro, and GeparQuinto-trials. RT was administered to 676 of these patients (82.7%). RESULTS The 5-year cumulative incidence of locoregional recurrence (LRR) was 15.2% (95% confidence interval [CI] 9.0-22.8%) in patients treated without RT and 11.3% in patients treated with RT (95% CI 8.7-14.3%). In the multivariate analysis, RT was associated with a lower risk of LRR (hazard ratio 0.51, 95% CI 0.27-1.0; p = 0.05). This effect was shown especially in patients with cT3/4 tumors, as well as in patients who were cN+ before neoadjuvant therapy, including those who converted to ypN0 after neoadjuvant therapy. In the bivariate analysis, disease-free survival was significantly worse in patients who received RT, however this was not confirmed in the multivariate analysis. CONCLUSIONS Our results suggest that RT reduces the LRR rates in breast cancer patients who receive a mastectomy after NACT without an improvement in DFS. Prospective randomized controlled trials such as the National Surgical Adjuvant Breast and Bowel Project B-51/RTOG 1304 trial will analyze whether RT has any benefit in patients who have a favorable response after NACT.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany. .,Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | | | | | | | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | | | - Serban Dan Costa
- Universitätsklinikum Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany
| | - Carsten Denkert
- Institute for Pathology, Philipps-University Marburg, Marburg, Germany
| | - Nina Ditsch
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Bernd Gerber
- Department of Gynecology and Obstetrics, University Hospital, Rostock, Germany
| | - Claus Hanusch
- Rotkreuzklinikum München, Frauenklinik, Munich, Germany
| | - Joerg Heil
- Breast Unit, University Hospital, University of Heidelberg, Heidelberg, Germany
| | | | - Jens B Huober
- Universitätsklinikum Ulm, Universitätsfrauenklinik, Ulm, Germany
| | - Christian Jackisch
- Sana Klinikum Offenbach, Klinik für Gynäkologie und Geburtshilfe, Offenbach, Germany
| | | | - Stefan Paepke
- Klinikum rechts der Isar TU München, Frauenklinik und Poliklinik, Munich, Germany
| | | | | | - Michael Untch
- Helios Klinikum Berlin-Buch, Klinik für Gynäkologie und Geburtshilfe, Berlin, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | | | - Thorsten Kühn
- Department for Gynecology and Obstetrics, Interdisciplinary Breast Center, Esslingen, Germany
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7
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Chou HH, Kuo WL, Yu CC, Tsai HP, Shen SC, Chu CH, Yu MC, Lo YF, Dabora MA, Chang HK, Lin YC, Ueng SH, Chen SC. Impact of age on pathological complete response and locoregional recurrence in locally advanced breast cancer after neoadjuvant chemotherapy. Biomed J 2019; 42:66-74. [PMID: 30987708 PMCID: PMC6468039 DOI: 10.1016/j.bj.2018.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) is the standard approach for downstaging of locally advanced breast cancer and can improve breast conservation rates. A pathological complete response (pCR) after NAC associated with favorable long-term outcomes has been described. There is still a high locoregional recurrence (LRR) rate after NAC and the influence of age on LRR after NAC is unclear. This study analyzed the relationship between age and LRR after NAC. Methods Two hundred and sixty-three patients with invasive breast cancer who received NAC followed by mastectomy or breast conserving surgery (BCS) were enrolled. Concurrent weekly epirubicin and docetaxel was the NAC regimen. Results Twenty-nine patients (11%) achieved a pCR after NAC. In univariate analysis, age <50 years, luminal B (HER2 positive) subtype, HER2 overexpression subtype, and triple-negative subtype were factors to predict a pCR. In multivariate analysis, age <50 years, luminal B (HER2 positive) type, HER2 overexpression, and triple-negative subtype were the independent factors to predict a pCR. No patients in the pCR group developed LRR compared with 31 patients in the non-pCR group. Eleven patients (6.9%) in the younger group (age <50 years) developed LRR compared with 20 patients (19.4%) in the older group (age ≥50 years). In multivariate analysis, younger age (<50 years) was the only independent prognostic factor for a LRR-free survival. Conclusion Younger age can predict a pCR and is an independent prognostic factor for LRR in locally advanced breast cancer patients after NAC as concurrent epirubicin and docetaxel.
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Affiliation(s)
- Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsiu-Pei Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Cheh Shen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Hsien-Kun Chang
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Neoadjuvant chemotherapy for breast cancer-background for the indication of locoregional treatment. Strahlenther Onkol 2018; 194:797-805. [PMID: 29974132 DOI: 10.1007/s00066-018-1329-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023]
Abstract
Neoadjuvant chemotherapy (NACT) has been widely adopted into the multidisciplinary management of breast cancer. The prognostic impact of treatment response has been clearly demonstrated. However, the impact of treatment response on the indication for adjuvant radiotherapy is unclear. This review summarizes important implications of NACT and treatment response on the risk of recurrence and locoregional multidisciplinary management from the standpoint of radiation oncology.
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9
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Sun Y, Liao M, He L, Zhu C. Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8367. [PMID: 29069026 PMCID: PMC5671859 DOI: 10.1097/md.0000000000008367] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 08/16/2017] [Accepted: 09/28/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The application of breast-conserving surgery (BCS) on patients with locally advanced breast cancer (LABC) with good response to neoadjuvant chemotherapy (NACT) still remains controversial. The objective in this study is to analyze the safety of BCS in the management of LABC in patients with good response to NACT. METHODS We searched the electronic databases of Medline (Pubmed) and Cochrane Library for reports on local recurrence (LR), regional recurrence (RR), distant recurrence (DR), 5-year disease-free survival (DFS) or 5-year overall survival (OS) in patients with LABC receiving BCS or mastectomy (MT) and with good response to NACT. Based on the research results, we conducted a meta-analysis using Review Manager 5.3. RESULTS Our study showed that 16 studies with a combined total of 3531 patients, of whom 1465 patients underwent BCS, whereas 2066 patients underwent MT. There was no significant heterogeneity among these studies (Q statistic: P = .88; I = 0%). Patients with good response to NACT showed no significant difference in LR and RR [odd ratio (OR) = 0.83; 95% confidence interval (CI): 0.60-1.15; P = .26; OR = 0.56; 95% CI: 0.33-0.93; P = .03], while we figured out a lower DR (OR = 0.51; 95% CI: 0.42-0.63; P < .01), a higher DFS (OR = 2.35; 95% CI: 1.84 to 3.01, P < .01) and a higher OS (OR = 2.12; 95% CI: 1.51 to 2.98, P < .01) in BCS compared with MT. CONCLUSION This meta-analysis concluded that BCS was a safe surgery for patients with LABC and had good response to NACT.
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Affiliation(s)
| | - Mingjuan Liao
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Chenfang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, 200011, China
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10
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Shen Z, Chen YH, Chen Y, Chen Y, Lv Z, Gao HC. A case of IV degree on acute radiation dermatitis in China. Int J Surg Case Rep 2017; 32:19-21. [PMID: 28214397 PMCID: PMC5312647 DOI: 10.1016/j.ijscr.2017.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022] Open
Abstract
This report investigates the nursing procedure of a case of adjuvant therapy of rectal cancer on IV degree of acute radiation dermatitis patients in the penis and scrotum junction. The lesion degree gradually increased. Fixation of the dressing was difficult in the penis and scrotum junction. The concept of wet healing with new dressings was used in patient. The silver ion dressings were used in inhibiting infection, and the wound was covered by the rimmed foam dressings. When it comes to the shaping period, water gel transparent paste was applied instead to cover the wound. The patient was just into the surgical treatment in the wound healed after six days.
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Affiliation(s)
- Zhen Shen
- Department of Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130041, China
| | - Ya-Hong Chen
- Department of Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130041, China.
| | - Yue Chen
- Department of Drug, Jilin University School of Pharmaceutical Sciences, Changchun, 130021, China
| | - Yan Chen
- Department of Drug, Jilin University School of Pharmaceutical Sciences, Changchun, 130021, China
| | - Zhe Lv
- Department of Drug, Jilin University School of Pharmaceutical Sciences, Changchun, 130021, China
| | - Hai-Cheng Gao
- Department of Drug, Jilin University School of Pharmaceutical Sciences, Changchun, 130021, China.
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11
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Golshan M, Cirrincione CT, Sikov WM, Carey LA, Berry DA, Overmoyer B, Henry NL, Somlo G, Port E, Burstein HJ, Hudis C, Winer E, Ollila DW. Impact of neoadjuvant therapy on eligibility for and frequency of breast conservation in stage II-III HER2-positive breast cancer: surgical results of CALGB 40601 (Alliance). Breast Cancer Res Treat 2016; 160:297-304. [PMID: 27704226 DOI: 10.1007/s10549-016-4006-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It had been previously shown that patients who receive neoadjuvant systemic therapy (NST) are more likely to undergo breast-conserving therapy (BCT) than those who have primary surgery. However, the frequency with which patients who are not BCT-eligible prior to NST convert to BCT-eligible with treatment is unknown. To document this conversion rate in a subset of patients expected to have a high clinical response rate to NST, we studied surgical assessment and management of patients enrolled on a randomized neoadjuvant trial for stage II-III HER2-positive breast cancer (HER2 + BC)(CALGB 40601). METHODS The treating surgeon assessed BCT candidacy based on clinico-radiographic criteria both before and after NST. Definitive breast surgical management was at surgeon and patient discretion. We sought to determine (1) the conversion rate from BCT-ineligible to BCT-eligible (2) the percentage of BCT-eligible patients who chose breast conservation, and (3) the rate of successful BCT. We also evaluated surgeon-determined factors for BCT-ineligibility and the correlation between BCT eligibility and pathologic complete response (pCR). RESULTS Of 292 patients with pre- and post-NST surgical assessments, 59 % were non-BCT candidates at baseline. Of the 43 % of these patients who converted with NST, 67 % opted for BCT, with an 80 % success rate. NST increased the BCT-eligible rate from 41 to 64 %. Common factors cited for BCT-ineligibility prior to NST including tumor size (56 %) and probable poor cosmetic outcome (26 %) were reduced by 67 and 75 %, respectively, with treatment, while multicentricity, the second most common factor (33 %), fell by only 16 %. Since 23 % of the BCT-eligible patients chose mastectomy, BCT was the final surgical procedure in just 40 % of the patients. Patients considered BCT-eligible both at baseline and after NST had a pCR rate of 55 %, while patients who were BCT-ineligible prior to NST had the same pCR rate (44 %) whether they converted to BCT-eligible or not. CONCLUSIONS Many patients with HER2 + BC deemed ineligible for BCT at baseline can be converted to BCT-eligible with NST; excluding patients with multicentric disease substantially increases that percentage. In converted patients who opt for BCT, the success rate is similar to that of patients considered BCT-eligible at baseline. Whether a BCT-ineligible patient converts to BCT eligibility or not does not appear to affect the likelihood of achieving a pCR. Despite the efficacy of NST in this patient cohort, only 40 % of patients had successful BCT; further research into why BCT-eligible patients often opt for mastectomy is needed.
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Affiliation(s)
- Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - William M Sikov
- Program in Women's Oncology, Women and Infants Hospital of Rhode Island and Alpert Medical School of Brown University, Providence, RI, USA
| | - Lisa A Carey
- Department of Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald A Berry
- Alliance Statistics and Data Center, M D Anderson Cancer Center, Houston, TX, USA
| | - Beth Overmoyer
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Nora L Henry
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - George Somlo
- Department of Medical Oncology, City of Hope Medical Center, Los Angeles, CA, USA
| | - Elisa Port
- Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Harold J Burstein
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Clifford Hudis
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eric Winer
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - David W Ollila
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Peled AW, Wang F, Foster RD, Alvarado M, Ewing CA, Sbitany H, Esserman LJ. Expanding the Indications for Total Skin-Sparing Mastectomy: Is It Safe for Patients with Locally Advanced Disease? Ann Surg Oncol 2015; 23:87-91. [PMID: 26170194 DOI: 10.1245/s10434-015-4734-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Indications for total skin-sparing mastectomy (TSSM) continue to expand. Although initially used only for early-stage breast cancer, TSSM currently is offered in many centers to patients with locally advanced disease. However, despite this practice change, limited data on oncologic outcomes in this population have been reported. METHODS A retrospective review of a prospectively collected database of all patients undergoing TSSM and immediate reconstruction from 2005 to 2013 was performed. The outcomes for patients with stage 2b and stage 3 cancer were included in the analysis. The primary outcomes included the development of locoregional or distant recurrences. RESULTS Of 753 patients undergoing TSSM, 139 (18 %) presented with locally advanced disease. Of these 139 patients, 25 (18 %) had stage 2b disease, and 114 (82 %) had stage 3 disease. Most of the patients (97 %) received chemotherapy (77 % neoadjuvant, 20 % adjuvant), whereas 3 % received adjuvant hormonal therapy alone. Of the neoadjuvant patients, 13 (12 %) had a pathologic complete response (pCR) to treatment. During a mean follow-up period of 41 months (range 4-111 months), seven patients (5 %) had a local recurrence, 21 patients (15.1 %) had a distant recurrence, and three patients (2.2 %) had simultaneous local and distant recurrences. None of the local recurrences occurred in the preserved nipple-areolar complex skin. CONCLUSIONS Patients with locally advanced breast cancer are most at risk for distant rather than local recurrence, even after TSSM. When used in conjunction with appropriate multimodal therapy, TSSM is not associated with an increased risk for local recurrence in this population, even in the setting of low pCR rates.
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Affiliation(s)
- Anne Warren Peled
- Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Frederick Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Robert D Foster
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Alvarado
- Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA
| | - Cheryl A Ewing
- Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA
| | - Hani Sbitany
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Laura J Esserman
- Division of Breast Surgery, Department of Surgery, UCSF Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA.
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13
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Read RL, Flitcroft K, Snook KL, Boyle FM, Spillane AJ. Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer. ANZ J Surg 2015; 85:315-20. [DOI: 10.1111/ans.12975] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca L. Read
- Breast and Surgical Oncology; Poche Centre; North Sydney New South Wales Australia
- Department of Surgery; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Kathy Flitcroft
- Breast and Surgical Oncology; Poche Centre; North Sydney New South Wales Australia
| | - Kylie L. Snook
- Breast and Surgical Oncology; Poche Centre; North Sydney New South Wales Australia
- Medical Oncology; Mater Hospital; North Sydney New South Wales Australia
- Department of Surgery; Hornsby Hospital; Hornsby New South Wales Australia
| | - Frances M. Boyle
- Medical Oncology; Mater Hospital; North Sydney New South Wales Australia
- Medical Oncology; The University of Sydney; Sydney New South Wales Australia
| | - Andrew J. Spillane
- Breast and Surgical Oncology; Poche Centre; North Sydney New South Wales Australia
- Department of Surgery; Royal North Shore Hospital; St Leonards New South Wales Australia
- Medical Oncology; Mater Hospital; North Sydney New South Wales Australia
- Department of Surgery; The University of Sydney; Sydney New South Wales Australia
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14
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Mittendorf EA, Bedrosian I. Breast cancer biology: implications for local-regional therapy. Ann Surg Oncol 2014; 21:2820-2. [PMID: 24752612 DOI: 10.1245/s10434-014-3730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Elizabeth A Mittendorf
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA,
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