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Zhang S, Yang H, Xu Y, Wang S. Do we need reshape rTNM staging system for ipsilateral breast tumor recurrence of breast cancer? A population-based, propensity score matched cohort study. Breast Cancer Res Treat 2024; 206:637-651. [PMID: 38727889 DOI: 10.1007/s10549-024-07340-8] [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: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The aim of the study was to explore the role of recurrent TNM (rTNM) staging in predicting prognosis for ipsilateral breast tumor recurrence (IBTR) and determine the optimal treatment strategy for IBTR. METHOD IBTR cases were identified from the Surveillance, Epidemiology, and End Results (SEER) database spanning the years 2000-2018. Cox proportional hazards analysis was performed to examine factors associated with overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) was employed to match IBTR with primary early breast cancer (EBC) based on clinicopathological characteristics. Investigations into the impact of different therapies were also included. RESULTS Of the 4375 IBTR cases included in the study, the 5-year OS was 87.1%, 71.6% and 58.7% in rTNM stages I, II and III, respectively. After PSM, while IBTR patients had worse survival to primary EBC patients, prognosis of IBTR for different rTNM stage always closely aligned with the corresponding stage of primary EBC. Repeat breast-conserving surgery (BCS) with radiation therapy was equivalent to mastectomy with respect to OS and BCSS. Chemotherapy was favorable for OS and BCSS in estrogen receptor (ER)-negative IBTR or IBTR occurring within a 60-month interval. CONCLUSIONS rTNM staging system has an outstanding prognostic value for survival outcome of patients with IBTR, and IBTR and primary EBC may have potentially analogous features in the context of TNM staging. BCS plus radiation therapy may be an alternative. IBTR cases who have experienced recurrence with short intervals and with ER-negative tumors might benefit from chemotherapy.
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Affiliation(s)
- Shuwei Zhang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Yaqian Xu
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China.
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Uomori T, Horimoto Y, Ueki Y, Ishizuka Y, Onagi H, Hayashi T, Watanabe J, Shikama N. Efficacy of radiation therapy in Japanese patients with positive margins after breast-conserving surgery. Jpn J Clin Oncol 2024; 54:556-561. [PMID: 38251759 DOI: 10.1093/jjco/hyad196] [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: 10/06/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Additional surgical resection is recommended after breast-conserving surgery if the surgical margin is pathologically positive. However, in clinical practice, radiation therapy is sometimes used instead for several reasons. Irradiation may be appropriate for some patients, but real-world data is still insufficient to establish it as standard treatment. We retrospectively investigated the status of local control in patients who received irradiation for positive margins. METHODS We investigated 85 patients with positive margins after curative partial mastectomy who were treated with irradiation instead of additional excision during the period 2006-2013. The patients received whole-breast irradiation (43.2-50 Gy) using photon beams and additional tumour-bed boost (8.1-16 Gy) using electron beams. Intrabreast tumour recurrence was defined as secondary cancer within the ipsilateral conserved breast. Surgical margin was defined as positive if tumour cell exposure was pathologically confirmed on the margin. RESULTS Seven patients (8.2%) developed intrabreast tumour recurrence during a mean observation period of 119 months. As to components of positive margin, 76 cases were positive for an intraductal component, of which seven (9.2%) developed intrabreast tumour recurrence. Meanwhile, all nine cases positive for an invasive component were free from intrabreast tumour recurrence. Two of the intrabreast tumour recurrence cases seemed to develop new lesions rather than recurrence, considering tumour location. The cumulative incidence of intrabreast tumour recurrence over 10 years was 6.1%. Limited to true recurrence, intrabreast tumour recurrence incidence was 4.9%. CONCLUSION Our real-world data supports irradiation as an alternative to additional surgical intervention for positive margins after breast-conserving surgery and offers a basis for further research.
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Affiliation(s)
- Toshitaka Uomori
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiya Horimoto
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Breast Surgery and Oncology, Tokyo Medical University, 6-1-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Yuko Ueki
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yumiko Ishizuka
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroko Onagi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takuo Hayashi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Junichiro Watanabe
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Naoto Shikama
- Faculty of Medicine, Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Eom YH, Yoon CI, Kang YJ, Jeon YW. Prognostic factors after isolated ipsilateral local and regional recurrence in HER2-negative luminal breast cancer: a multi-center retrospective study. World J Surg Oncol 2023; 21:105. [PMID: 36967374 PMCID: PMC10041698 DOI: 10.1186/s12957-023-02991-1] [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: 11/23/2022] [Accepted: 03/18/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Although the incidence of isolated ipsilateral local and regional recurrence (IILRR) in human epidermal growth factor 2 (HER2)-negative luminal breast cancer is low, it is important because of its potential risk of distant metastasis and breast cancer related mortality. The aim of this study was to investigate prognostic factor and survival of IILRR using a large multi-center cohort. METHODS Data on patients with HER2-negative luminal breast cancer between 2005 and 2015 were retrieved. The endpoint was IILRR rate, post-recurrence progression-free survival (P-PFS), and post-recurrence overall survival (P-OS). Prognostic factors for progression and overall survival (OS) after IILRR were assessed by multivariate analysis. RESULTS Eighty (2.37%) patients experienced IILRR. Of them, 27 (33.7%) experienced a disease progression, including 23 (85.2%) who had distant metastasis. The median DFS was 48.5 months (range, 4-138 months). In 72.5% of cases, the first IILRR occurred after 3 years. Estimated 5-year P-PFS rates were 86.2%, 69.7%, 69.0%, 42.7%, and 82.2% for patients with age < 40 at diagnosis (p = 0.015), T1 stage (p = 0.012), stage I (p < 0.001), lymphovascular invasion (p = 0.003), and patients with post-recurrence endocrine therapy (p < 0.001), respectively. The 5-year Kaplan-Meier P-OS rate for patients was 81.4%. Post-recurrence endocrine therapy was independent factor for progression (HR: 0.176, p < 0.001) and OS (HR: 0.080, p < 0.001). CONCLUSIONS Although there is no standardized treatment for IILRR yet, endocrine therapy after local resection plays a more important role in improving prognosis than chemotherapy or radiotherapy in HER2-negative luminal breast cancer.
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Affiliation(s)
- Yong Hwa Eom
- Division of Breast Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Ik Yoon
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Kang
- Division of Breast Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ye Won Jeon
- Division of Breast Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Gyeonggi-do, Korea.
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The clinical relevance of various methods of classifying ipsilateral breast tumour recurrence as either true local recurrence or new primary. Breast Cancer Res Treat 2022; 195:249-262. [PMID: 35939185 DOI: 10.1007/s10549-022-06680-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/06/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Describes the relevance of -various classification methods for ipsilateral breast tumour recurrence (IBTR) as either true recurrence (TR) or new primary (NP) on both disease-specific survival (DSS) and distant metastasis-free survival (DMFS). METHOD Two hundred and thirty-four of 4359 women undergoing breast-conserving therapy experienced IBTR. We compared the impact of four known classification methods and two newly created classification methods. RESULTS For three of the methods, a better DSS was observed for NP compared to TR with the hazard ratio (HR) ranging from 0.5 to 0.6. The new Twente method classification, comprising all classification criteria of three known methods, and the new Morphology method, using only morphological criteria, had the best HR and confidence interval with a HR 0.5 (95% CI 0.2-1.0) and a HR 0.5 (95% CI 0.3-1.1), respectively. For DMFS, the HR for NP compared to TR ranged from 0.6 to 0.9 for all six methods. The new Morphology method and the Twente method noted the best HR and confidence intervals with a HR 0.6 (95% CI 0.3-1.1) and a HR 0.6 (95% CI 0.4-1.2), respectively. CONCLUSION IBTR classified as TR or NP has a prognostic value for both DSS and DMFS, but depends on the classification method used. Developing and validating a generally accepted form of classification are imperative for using TR and NP in clinical practice.
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Baek SY, Kim J, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH, Lee SB. Clinical Course and Predictors of Subsequent Recurrence and Survival of Patients With Ipsilateral Breast Tumor Recurrence. Cancer Control 2022; 29:10732748221089412. [PMID: 35414226 PMCID: PMC9016529 DOI: 10.1177/10732748221089412] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the clinical course and long-term outcomes of patients with
ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery
(BCS) and identify independent prognostic factors for further
recurrence. Methods In this retrospective study, we reviewed the records of 327 patients who
experienced IBTR after undergoing BCS for breast cancer at Asan Medical
Center during 1990–2013. Overall survival (OS) after IBTR and cumulative
incidence rates of recurrences after IBTR were calculated. The association
of clinicopathological factors with survival and the development of further
recurrence after IBTR was determined in multivariate analysis. Results At a median follow-up of 127.7 months, 97 patients experienced recurrence
after IBTR. The 5-year and 10-year cumulative incidence rates of recurrence
after IBTR were 32% and 41%, respectively. The 5-year and 10-year OS rates
after IBTR were 86.6% and 70.3%, respectively. In multivariate analysis,
hormone receptor negativity was associated with decreases in OS after IBTR
(hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.18–6.78). Patients
with longer disease-free interval (DFI) had decreased risks of second
recurrence (HR .99, 95% CI .99–1.00), and second locoregional recurrence
(LRR) (HR .98, 95% CI .97–.99). Lymphovascular invasion (LVI) of IBTR was
associated with increased recurrence rates (second recurrence-free survival,
HR 3.58, 95% CI 2.16–5.94; second LRR free survival, HR 5.21, 95% CI
2.77–9.78; second distant metastasis-free survival, 2.11, 95% CI 1.04–4.30)
and lower survival rates (OS after IBTR, HR 4.64, 95% CI 2.23–9.67). Conclusions Despite subsequent recurrences during long-term follow-up, the survival rates
after IBTR remained high. Patients with hormone receptor-negative tumors,
shorter DFI, and tumors that present LVI of IBTR had higher risks for
recurrence and poor survival rates after IBTR. The study findings may help
in understanding the course and prognosis of IBTR patients and identifying
high-risk IBTR to establish management strategies.
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Affiliation(s)
- Soo Yeon Baek
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, 65526University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Sener SF. Outcomes from ipsilateral breast tumor recurrence after breast conserving surgery and whole breast irradiation for breast cancer. Am J Surg 2021; 223:445-446. [PMID: 34384586 DOI: 10.1016/j.amjsurg.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Stephen F Sener
- Los Angeles County+University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
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7
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Goulding A, Asmar L, Wang Y, Tole S, Barke L, Widner J, Leonard C. Outcomes After Accelerated Partial Breast Irradiation in Women With Triple Negative Subtype and Other "High Risk" Variables Categorized as Cautionary in The ASTRO Guidelines. Front Oncol 2021; 11:617439. [PMID: 33777758 PMCID: PMC7993056 DOI: 10.3389/fonc.2021.617439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a primary objective clinical outcome of ipsilateral breast recurrence following accelerated partial breast irradiation (APBI) in women with triple negative and other high risk breast cancer (as described in 2017 ASTRO guidelines) (i.e., age 40–49, size 2.1–3.0 cm, estrogen receptor negative and invasive lobular breast cancer). Secondary objectives of axillary and regional failure as well as overall survival are also reported. Methods and Material Patients from two clinical trials (NCT01185145, NCT01185132) were treated with 38.5 Gy IMRT or 3D-CRT APBI w/3.85 Gy fraction/BID fractionation for 10 fractions. Triple negative and other high risk patients (n=269) were compared to a total of 478 low risk patients which ASTRO defined as “suitable” for APBI. High risk patients, for the purpose of this study, were defined as those who possess one or more high risk criteria: triple negative (n=30), tumor size >2 cm <3 cm (n=50), HER 2+ (n=54), age range 40–50 years (n=120), ER- (n=43), and ILC histology (n=52). Results Median follow up was 4.0 years for all patients. No significant difference was found for this high-risk cohort at 5 years for ipsilateral breast, or regional recurrences. Axillary recurrence was significantly adversely impacted by triple negative and ER- statuses (p=0.01, p=0.04). There were significant correlations between triple negative type and axillary recurrence on multivariate analysis (p=0.03). Overall survival for all patients was unaffected by any of the high-risk categories. Conclusion The data from this study suggests that women possessing high risk features are at no more meaningful risk for recurrence than other patients considered to be acceptable for APBI treatment. However, the finding of axillary recurrence in patients with triple negative breast cancer does warrant a degree of caution in proceeding with accelerated partial breast irradiation technique in this patient group.
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Affiliation(s)
- Anabel Goulding
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
| | - Lina Asmar
- Statistics, Linasmar Consulting, Houston, TX, United States
| | - Yunfei Wang
- Statistics, Linasmar Consulting, Houston, TX, United States
| | - Shannon Tole
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
| | - Lora Barke
- Radiology, Invision Sally Jobe, Greenwood Village, CO, United States
| | - Jodi Widner
- Surgery, SurgOne, Greenwood Village, CO, United States
| | - Charles Leonard
- Radiation Oncology, Rocky Mountain Cancer Centers, Denver, CO, United States
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Sagona A, Gentile D, Anghelone CAP, Barbieri E, Marrazzo E, Antunovic L, Franceschini D, Tinterri C. Ipsilateral Breast Cancer Recurrence: Characteristics, Treatment, and Long-Term Oncologic Results at a High-Volume Center. Clin Breast Cancer 2020; 21:329-336. [PMID: 33431329 DOI: 10.1016/j.clbc.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Salvage mastectomy is considered the treatment of choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast-conserving surgery (BCS) is feasible. The purpose of this study was to describe the characteristics of IBCR patients, to compare the 2 therapeutic options in terms of long-term outcomes, and to identify independent factors that may predict the type of treatment. PATIENTS AND METHODS A total of 309 IBCR patients who underwent either repeat BCS or mastectomy were identified. All the analyzed patients with IBCR had true recurrence. RESULTS Repeat BCS and salvage mastectomy were performed in 143 and 166 patients, respectively. Age < 65 years (59.6% vs 37.1% if age ≥ 65 years; odds ratio, 2.374; 95% confidence interval, 0.92-5.24; P = .018) and disease-free interval < 24 months (15.7% vs 10.5% if disease-free interval ≥ 24 months; odds ratio, 2.705; 95% confidence interval, 1.42-5.97; P = .007) were found to significantly increase the probability of receipt of mastectomy. Disease-free survival rates at 3, 5, and 10 years were 79.2%, 68.2%, and 36.9%; and 77.2%, 65.9%, and 55.3% in patients receiving repeat BCS or mastectomy, respectively (P = .842). Overall survival rates at 3, 5, and 10 years were 95.4%, 91.4%, and 68.5%; and 87.3%, 69.3%, and 57.9%, respectively, in patients receiving repeat BCS or mastectomy (P = .018). CONCLUSION Salvage mastectomy should not be considered the only treatment option for IBCR. A second BCS can still be evaluated and proposed to IBCR patients, with acceptable locoregional control and survival. The risk of poor long-term prognosis after mastectomy should be shared with the patient.
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Affiliation(s)
- Andrea Sagona
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Damiano Gentile
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Erika Barbieri
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Emilia Marrazzo
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Lidija Antunovic
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Corrado Tinterri
- Breast Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
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Yu CC, Kuo WL, Shen SC, Chou HH, Lo YF, Yu MC, Chen SC. Prognostic study for isolated local recurrence operated with salvage excision in hormone-receptor-positive patients with invasive breast cancer after primary breast surgery. Biomed J 2020; 43:83-93. [PMID: 32200960 PMCID: PMC7090316 DOI: 10.1016/j.bj.2019.07.002] [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: 09/01/2018] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to identify the factors that predict distant recurrence and survival outcome after patients with primary positive hormone receptor-positive (HR+) invasive breast cancer undergo complete excision for isolated local recurrence (ILR). Methods From January 2000 to December 2009, we performed a retrospective review of our database and identified 51 patients with HR + invasive breast cancer who underwent complete excision for ILR as a component of salvage therapy. The distant metastasis-free survival (DMFS) and overall survival (OS) from the time of ILR were calculated using the Kaplan–Meier method, and a Cox regression model was used for multivariate analysis. Results Of the 51 cases of ILR, 28 were of ipsilateral breast tumor recurrence and 23 were of chest wall recurrence. By receiver operating characteristic curve analyses, the cut-off time point for time to ILR was determined to be 29 months. According to time to ILR (≤29 vs. >29 months) and primary tumor size (≤2 vs. >2 cm), patients were divided into four risk groups as variables for analysis. On multivariate analysis, two independent prognostic factors for DMFS and OS after ILR were identified: risk groups (ILR≤29 months with primary tumor size >2 cm vs. ILR>29 months with primary tumor size ≤ 2 cm, HR = 8.53 for DMFS and HR = 11.18 for OS) and primary tumor grade (2/3 vs. 1, HR = 6.10 for DMFS and 4.27 for OS). Conclusion We demonstrated that poor DMFS and OS are associated with high risk group defined as short time to ILR (≤29 months) with primary tumor size (>2 cm) and higher primary tumor grade (2/3) among patients with HR + invasive breast cancer treated with complete excision for ILR. Therapeutic strategies for ILR based on hormone therapy with new agents should be explored in future prospective studies, especially for patients with poor outcome.
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Affiliation(s)
- Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Lin Kuo
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Che Shen
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Huan Chou
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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10
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Walstra CJEF, Schipper RJ, Poodt IGM, van Riet YE, Voogd AC, van der Sangen MJC, Nieuwenhuijzen GAP. Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: A systematic review. Eur J Surg Oncol 2019; 45:1317-1327. [PMID: 30795956 DOI: 10.1016/j.ejso.2019.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/27/2019] [Accepted: 02/06/2019] [Indexed: 12/23/2022] Open
Abstract
The standard of care for patients with an ipsilateral breast tumour recurrence (IBTR) after breast-conserving therapy (BCT) is a salvage mastectomy. However, there is growing interest in the feasibility of repeat BCT for these patients. This systematic review contains the latest insights on BCT options for patients with an IBTR after initial BCT. A PubMed literature search was performed for articles on BCT options for IBTR after primary lumpectomy followed by radiotherapy. Weighted estimates were calculated for 5- and 10-year local control, distant metastasis-free and overall survival rates. Secondary outcomes were toxicity, cosmesis and quality of life. In total, 34 studies were eligible for analysis, of which 5 reported on repeat breast-conserving surgery (BCS) alone, 10 with mixed populations (BCS ± RT and/or mastectomy), 18 on repeat BCS followed by re-irradiation (whole-breast or partial) and one on quality of life. The weighted estimates for 5-year overall survival for repeat BCS and repeat BCS followed by reirradiation were 77% and 87%, respectively. Five-year local control was 76% for repeat BCS alone and 89% for repeat BCS followed by re-irradiation. Grade III-IV toxicity rates after re-irradiation varied from 0 to 21%, whereas the cosmesis was excellent-good in 29-100% of patients and unacceptable in 0-18%. Repeat BCS followed by re-irradiation, with either whole breast or partial breast re-irradiation, seems a feasible alternative to mastectomy in case of IBTR, in selected patients. Toxicity rates are low and the cosmetic outcome is good, but the size and follow-up of the published patient series is limited.
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Affiliation(s)
| | | | - Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Yvonne E van Riet
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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11
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Laas E, Hamy AS, Michel AS, Panchbhaya N, Faron M, Lam T, Carrez S, Pierga JY, Rouzier R, Lerebours F, Feron JG, Reyal F. Impact of time to local recurrence on the occurrence of metastasis in breast cancer patients treated with neoadjuvant chemotherapy: A random forest survival approach. PLoS One 2019; 14:e0208807. [PMID: 30673703 PMCID: PMC6344020 DOI: 10.1371/journal.pone.0208807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background We studied the relationship between time to ipsilateral breast tumor recurrence (IBTR) and distant metastasis-free survival (DMFS) in patients with breast cancer treated by neoadjuvant chemotherapy (NAC). Methods Between 2002 and 2012, 1199 patients with primary breast cancer were treated with NAC. Clinical, radiological and pathological data were retrieved from medical records. Multivariate analysis was performed with the random survival forest (RSF) method, to evaluate the relationship between time to local recurrence and DMFS. Results Time to IBTR, local recurrence and molecular subtype were the factors most strongly associated with DMFS. In the total population, DMFS increased linearly with recurrence time, up to 50 months. For recurrences after 50 months, DMFS was similar for all times to recurrence. Considering molecular subtypes separately, the threshold was similar for the TNBC subtype (50 months), but appeared to occur later for the luminal and HER2-positive subtypes (75 months). Conclusion A threshold of 50 months seems to differentiate between early and late recurrences and could be used to guide the medical management of local breast tumour recurrences.
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Affiliation(s)
- Enora Laas
- Department of Surgery, Institut Curie, Paris, France
| | - Anne-Sophie Hamy
- Residual Tumour & Response to Treatment Laboratory, RT2Lab, PSL Research University, Translational Research Department, Institut Curie, Paris, France
- INSERM, U932 Immunity and Cancer, Paris, France
| | | | | | - Matthieu Faron
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Thanh Lam
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Carrez
- Department of Surgery, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris, France
- Paris Descartes University, Paris, France
| | - Roman Rouzier
- Department of Surgery, Institut Curie, Paris, France
| | | | | | - Fabien Reyal
- Department of Surgery, Institut Curie, Paris, France
- Residual Tumour & Response to Treatment Laboratory, RT2Lab, PSL Research University, Translational Research Department, Institut Curie, Paris, France
- INSERM, U932 Immunity and Cancer, Paris, France
- * E-mail:
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12
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Isolated ipsilateral local recurrence of breast cancer: predictive factors and prognostic impact. Breast Cancer Res Treat 2018; 173:111-122. [PMID: 30238274 DOI: 10.1007/s10549-018-4944-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Tumour features associated with isolated invasive breast cancer (BC) ipsilateral local recurrence (ILR) after breast conservative treatment (BCT) and consequences on overall survival (OS) are still debated. Our objective was to investigate these points. METHODS Patients were retrospectively identified from a cohort of patients who underwent BCT for invasive BC in 16 cancer centres. End-points were ILR rate and OS. The impact of ILR on OS was assessed by multivariate analysis (MVA) for all patients and according to endocrine receptors (ERs) and grade or tumour subtypes. RESULTS Of 15,570 patients, ILR rate was 3.1%. Cumulative ILR rates differed according to ERs/grade (ERs+/Grade2: HR 1.42, p = 0.010; ERs+/Grade3: HR 1.41, p = 0.067; ERs-: HR 2.14, p < 0.0001), endocrine therapy (HR 2.05, p < 0.0001) and age < 40-years old (HR 2.28, p = 0.005) in MVA. When MVA was adjusted on tumour subtype, the latter was the only independent factor. OS-after-ILR was significantly different according to ILR-free intervals (HR 4.96 for ILR-free interval between 2 and 5-years and HR 9.00 when < 2-years, in comparison with ≥ 5-years). CONCLUSION ERs/Grade status, lack of endocrine therapy and tumour subtypes predict isolated ILR risk in patients treated with BCT. Short ILR-free-intervals represent a strong pejorative factor for OS. These results may help selecting initial treatment as well as tailoring ILR systemic chemotherapy.
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13
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Narod SA, Sopik V. Is invasion a necessary step for metastases in breast cancer? Breast Cancer Res Treat 2018; 169:9-23. [PMID: 29353366 PMCID: PMC5882625 DOI: 10.1007/s10549-017-4644-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/23/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through several stages, including an in situ stage prior to an invasive stage, and thereafter (in some cases) disseminates to the lymph nodes and distant organs. METHODS We review the cancer literature of the last 50 years which relates to the prevention of invasive breast cancer (through radiotherapy or surgery) and reductions in the mortality for breast cancer. RESULTS For both invasive cancers and DCIS, the literature indicates that prevention of in-breast invasive recurrences does not prevent death from breast cancer. Moreover, the presence of residual cancer cells in the breast after breast-conserving surgery does not compromise the cure rate. CONCLUSION We propose an alternate (parallel) model of breast cancer wherein there is a small pool of cancer stem cells which have metastatic potential from their inception and which disseminate synchronously through several routes-to the breast stroma, to the lymph nodes and to distant organs. Cancer cells which disseminate to the breast give rise to cells which make up the bulk of the tumour mass but these are not the source of the distant metastases.
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Affiliation(s)
- Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, M5S 1B2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Victoria Sopik
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, M5S 1B2, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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14
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Clement Z, McLeay W, Hoffmann C, Shin P, Kiu A, Eaton M. Role of radiotherapy in women over the age of 65 after breast conserving surgery for breast cancer: A 5-year retrospective study. Breast Dis 2018; 37:197-205. [PMID: 30124442 DOI: 10.3233/bd-180340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/OBJECTIVE This study aimed to analyse the local recurrence (LR) and breast cancer related mortality (BCRM) in older women who underwent breast-conserving surgery (BCS) with and without adjuvant radiotherapy (XRT). METHODS This retrospective study included a total of 299 women who underwent BCS for early breast carcinoma, between the years of 2007 and 2011. Predictive risk factors, local recurrence (LR) and breast cancer related mortality (BCRM) were assessed with a mean follow-up period of 84 months. RESULTS Women over the age of 65 in the XRT and No-XRT groups showed similar incidence of LR (5.8% vs 5%, p = 0.838). Women over 65 years old with XRT had a higher rate of BCRM (5.8% vs 0%, p = 0.05). Resection margins >5 mm had a lower rate of BCRM (HR 0.395, p = 0.05). Women under the age of 65, invasive ductal carcinoma, grade-3 tumours, HER-2 positive, triple negative, lympho-vascular invasion, axillary lymph node positivity, high breast density on mammography were associated with increased risk of LR and BCRM. CONCLUSIONS XRT in women over the age of 65 did not decrease the risk of LR. Adjuvant XRT in older women should be offered to selective patients with high risk patient and tumour factors.
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Affiliation(s)
| | | | | | - Peter Shin
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Andrew Kiu
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Michael Eaton
- Department of Surgery, Flinders University School of Medicine, Adelaide, SA, Australia
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15
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Zingarello A, Mazouni C, Rivera S, Mokdad-Adi M, Pistilli B. Prognostic assessment and systemic treatments of invasive local relapses of hormone receptor-positive breast cancer. Breast 2017; 35:162-168. [PMID: 28755621 DOI: 10.1016/j.breast.2017.07.013] [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: 04/07/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022] Open
Abstract
The rate of local recurrences, after breast-conserving surgery or mastectomy for hormone receptor-positive (HR+) breast cancer, has dramatically changed in last decades, due to advances in surgical and radiation techniques and a more extensive use of adjuvant systemic treatments. However, the occurrence of local recurrences remains a major predictor for distant metastasis and is responsible for increased cancer-specific death. It has been estimated that 1 in 4 HR+ and HR-ipsilateral breast recurrences leads to widespread metastatic disease, with an annual mortality rate of 10% in the first 5 years. Nevertheless, very few studies have been conducted to evaluate the optimal care of purely HR+ local relapses of breast cancer, after surgical removal. In this review we have highlighted the available knowledge on prognostic assessment and systemic treatment for women experiencing local relapses of HR+ breast cancers, underlying unsolved questions and controversial clinical aspects.
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Affiliation(s)
- Anna Zingarello
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France; Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Meriem Mokdad-Adi
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
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