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Rakha EA, Quinn C, Masannat YA, Lee AHS, Tan PH, Karakatsanis A, Matrai ZT, Al Shaibani SHM, Gehani SA, Shaaban A, Khout H, Chagla L, Cserni G, Varga Z, Yong WF, Meattini I, Kulka J, Yang W, Tse GM, Pinder SE, Fox S, Dixon JM. Revisiting surgical margins for invasive breast cancer patients treated with breast conservation therapy - Evidence for adopting a 1 mm negative width. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108573. [PMID: 39243583 DOI: 10.1016/j.ejso.2024.108573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 09/09/2024]
Abstract
Clinical trials have demonstrated conclusively the non-inferiority of breast-conserving surgery followed by breast radiation therapy (BCT) compared with mastectomy for the treatment of early-stage invasive breast cancer (BC). The definition of the required surgical margin to ensure adequate removal of the cancer by BCT to obtain an acceptable low local recurrence (LR) rate remains controversial. Meta-analyses published by Houssami et al. in 2010 and 2014 demonstrated significantly lower LR rates for patients with a negative margin compared with those with positive (ink on tumour) or close (defined as ≤1 mm or ≤2 mm) margins. Neither meta-analysis addressed whether 'no ink on tumour' was adequate to define a negative margin because of a lack of data. Nevertheless, in 2014, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) with advice from pathologists reviewed these data together and published guidelines recommending that a margin of 'no ink on tumour' was sufficient to define a clear margin in BCT. Subsequently, clinical practice has varied with some national and international bodies endorsing 'no ink on tumour', whilst others have recommended a ≥1 mm margin as acceptable margins for BCT. A more recent meta-analysis conducted by Bundred and colleagues in 2022 did have sufficient data to compare 'no ink on tumour' and 1 mm and concluded that 1 mm rather than 'no ink on tumour', should be used as a minimum negative margin, and recommended that international guidelines be revised. The current review presents a balanced assessment of the evidence relating margin width and local recurrence after BCT. This review concludes that guidelines should consider re-defining a negative margin as ≥1 mm rather than 'no ink on tumour' in the context of BCT, recognising there will be variation to tailor therapy for any individual patient situation to ensure optimal patient care.
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Affiliation(s)
- Emad A Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Pathology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Pathology, Hamad Medical Corporation, Doha, Qatar.
| | - Cecily Quinn
- Irish National Breast Screening Programme and Department of Histopathology, St. Vincent's University Hospital, and School of Medicine, University College, Dublin, Ireland
| | - Yazan A Masannat
- Broomfield Breast Unit, Broomfield Hospital, Mid & South Essex NHS Trust, Chelmsford, CM1 7ET, England, UK; The London Breast Institute at Princess Grace Hospital, 42-52 Nottingham Place, London, W1U 5NY, England, UK
| | - Andrew H. S. Lee
- Pathology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Puay Hoon Tan
- Luma Medical Centre, Royal Square Medical Centre, Singapore, Singapore
| | - Andreas Karakatsanis
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Sweden
| | - Zoltan Tamas Matrai
- Surgical Department Breast Oncoplastic Unit, Hamad Medical Corporation, Doha, Qatar
| | | | - Salahddin A Gehani
- Surgical Department Breast Oncoplastic Unit, Hamad Medical Corporation, Doha, Qatar
| | - Abeer Shaaban
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Hazem Khout
- Department of Breast Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leena Chagla
- Breast Services, Mersey and West Lancashire Teaching Hospitals NHS Trust, UK
| | - Gábor Cserni
- Bács-Kiskun County Teaching Hospital, Department of Pathology, Kecskemét, Hungary. University of Szeged, Albert Szent-Györgyi Faculty of Medicine, Szeged, Hungary
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Wong Fuh Yong
- Division of Oncology, Singapore General Hospital, Singapore, Singapore
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Breast Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sarah E Pinder
- Guy's and St Thomas Hospitals/King's College London, London, UK
| | - Stephen Fox
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - J Michael Dixon
- Edinburgh Breast Unit, and Edinburgh University and Western General Hospital Edinburgh, UK
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Voets MM, Hassink NS, Veltman J, Slump CH, Koffijberg H, Siesling S. Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk. Breast Cancer Res Treat 2024; 205:313-322. [PMID: 38409613 PMCID: PMC11101519 DOI: 10.1007/s10549-024-07246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care. METHODS Patients with stage I-III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence. RESULTS In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1-1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1-2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often. CONCLUSIONS Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.
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Affiliation(s)
- Madelon M Voets
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Noa S Hassink
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen Veltman
- Multi-Modality Medical Imaging, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Radiology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 9609 PP, Almelo, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
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Bundred JR, Michael S, Stuart B, Cutress RI, Beckmann K, Holleczek B, Dahlstrom JE, Gath J, Dodwell D, Bundred NJ. Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis. BMJ 2022; 378:e070346. [PMID: 36130770 PMCID: PMC9490551 DOI: 10.1136/bmj-2022-070346] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine if margin involvement is associated with distant recurrence and to determine the required margin to minimise both local recurrence and distant recurrence in early stage invasive breast cancer. DESIGN Prospectively registered systematic review and meta-analysis of literature. DATA SOURCES Medline (PubMed), Embase, and Proquest online databases. Unpublished data were sought from study authors. ELIGIBILITY CRITERIA Eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but <2 mm), and negative margins (≥2 mm). RESULTS 68 studies from 1 January 1980 to 31 December 2021, comprising 112 140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, P<0.001) and local recurrence (1.98, 1.66 to 2.36, P<0.001). Close margins were associated with increased distant recurrence (1.38, 1.13 to 1.69, P<0.001) and local recurrence (2.09, 1.39 to 3.13, P<0.001) compared with negative margins, after adjusting for receipt of adjuvant chemotherapy and radiotherapy. In five studies published since 2010, tumour on ink margins were associated with increased distant recurrence (2.41, 1.81 to 3.21, P<0.001) as were tumour on ink and close margins (1.44, 1.22 to 1.71, P<0.001) compared with negative margins. CONCLUSIONS Involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised. SYSTEMATIC REVIEW REGISTRATION CRD42021232115.
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Affiliation(s)
- James R Bundred
- Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Emergency Surgery, St James University Hospital, Leeds, UK
| | - Sarah Michael
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK
- Division of Cancer sciences, University of Manchester, Manchester, UK
| | - Beth Stuart
- Cancer Sciences, University of Southampton, Southampton, UK
| | - Ramsey I Cutress
- Cancer Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton, Southampton, UK
| | - Kerri Beckmann
- Cancer Epidemiology and Population Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Bernd Holleczek
- Division of Clinical Epidemiology Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
- Saarland Cancer Registry, Saarbrücken, Germany
| | - Jane E Dahlstrom
- ACT Pathology, Canberra Health Services and Australian National University Medical School, ACT, Australia
| | - Jacqui Gath
- Independent Cancer Patients' Voice, London, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nigel J Bundred
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK
- Division of Cancer sciences, University of Manchester, Manchester, UK
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Wang J, Tang H, Yin K, Li X, Xie X, Hughes KS. Second invasive breast cancers in patients treated with breast-conserving therapy. Eur J Surg Oncol 2021; 47:2492-2498. [PMID: 34134902 DOI: 10.1016/j.ejso.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/05/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Second breast cancers after breast-conserving therapy (BCT) include ipsilateral breast tumor recurrence (IBTR) and metachronous contralateral breast cancer (CBC). Each IBTR is further classified as true recurrence (TR) or new primary tumor (NP). We aim to compare survival outcomes of TR, NP and CBC, and explore the optimal treatments. METHODS 168,427 patients with primary breast cancer who underwent BCT between 1990 and 2005 were identified in the SEER database. The risks of IBTR and CBC were estimated by annual hazard rate. The breast cancer-specific survival (BCSS) were assessed using multivariable Cox regression analysis. RESULTS With median follow-up of 13 years after BCT, 5413 patients developed an IBTR and 4050 patients had a CBC. The risk of IBTR peaked between 10 and 15 years after BCT, while the risk of CBC distributed evenly. 45.9% of IBTRs were classified as a TR and 54.1% as an NP. The time interval from primary breast cancer to NP was longer than to TR and CBC (P < 0.001). Patients with TR had a poorer BCSS than NP (P = 0.003) and CBC (P = 0.002). There was no difference in BCSS between mastectomy and repeat BCT for treating TR (P = 0.584) or NP (P = 0.243). The BCSS of CBCs treated with BCT was better than mastectomy (P = 0.010). Chemotherapy didn't improve the survival of patients with TR (P = 0.058). However, TRs with grade III or negative hormone receptors benefited from chemotherapy significantly. CONCLUSION Patients with TR had a poorer BCSS than NP and CBC. Classifying IBTR may provide clinical significance for treatments.
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Affiliation(s)
- Jin Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China; Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xing Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Patterns in detection of recurrence among patients treated for breast cancer. Breast Cancer Res Treat 2020; 184:365-373. [DOI: 10.1007/s10549-020-05847-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022]
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Aagaard Rasmussen L, Jensen H, Flytkjær Virgilsen L, Jellesmark Thorsen LB, Vrou Offersen B, Vedsted P. A validated algorithm for register-based identification of patients with recurrence of breast cancer-Based on Danish Breast Cancer Group (DBCG) data. Cancer Epidemiol 2019; 59:129-134. [PMID: 30743224 DOI: 10.1016/j.canep.2019.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/20/2018] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cancer recurrence is not routinely and completely registered in Danish national health registers, which challenges register-based research. The aim of this study was to develop and validate a register-based algorithm to identify patients with recurrence of breast cancer (BC). METHODS We conducted a cohort study based on data from Danish national health registers and used the Danish National Patient Register and the Danish National Pathology Register as sources to identify BC recurrence. We used data from the Danish Breast Cancer Group (DBCG) validated against medical records on recurrence status and recurrence date for 471 women with early stage unilateral BC as the gold standard of BC recurrence to assess the accuracy of the algorithm to identify BC recurrence. RESULTS The algorithm displayed a sensitivity of 97.3% (95% confidence interval (CI): 93.2-99.3), a specificity of 97.2% (95% CI: 94.8-98.7) and a positive predictive value of 94.4% (95% CI: 89.2-97.3). The concordance correlation coefficient for the agreement between recurrence dates generated by the algorithm and the gold standard was 0.97 (95% CI: 0.96-0.98), and the date was estimated within +/-30 days of the gold standard in 66% of the patients and within +/-60 days in 76% of the patients. CONCLUSION The developed algorithm almost perfectly identified BC recurrence and with reasonable timing compared to the gold standard.
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Affiliation(s)
- Linda Aagaard Rasmussen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Line Flytkjær Virgilsen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Lise Bech Jellesmark Thorsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark; Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark; Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Bartholins Allé 2, 8000 Aarhus C, Denmark
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Hammer J, Geinitz H, Nieder C, Track C, Thames HD, Seewald DH, Petzer AL, Helfgott R, Spiegl KJ, Heck D, Bräutigam E. Risk Factors for Local Relapse and Inferior Disease-free Survival After Breast-conserving Management of Breast Cancer: Recursive Partitioning Analysis of 2161 Patients. Clin Breast Cancer 2019; 19:58-62. [DOI: 10.1016/j.clbc.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/01/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022]
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Berg M, Lorenzen EL, Jensen I, Thomsen MS, Lutz CM, Refsgaard L, Nissen HD, Offersen BV. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial. Acta Oncol 2018; 57:113-119. [PMID: 29205080 DOI: 10.1080/0284186x.2017.1406139] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The potential benefits from respiratory gating (RG) compared to free-breathing (FB) regarding target coverage and dose to organs at risk for breast cancer patients receiving post-operative radiotherapy (RT) in the DBCG HYPO multicentre trial are reported. MATERIAL AND METHODS Patients included in the DBCG HYPO trial were randomized between 50 Gy in 25 fractions (normofractionated) versus 40 Gy in 15 fractions (hypofractionated). A tangential forward field-in-field dose planning technique was used to cover the clinical target volume (CTV) with the intent to limit dose to the left anterior descending coronary artery (LADCA) to 20 Gy and 17 Gy in the normo- and hypofractionated arms, respectively. Treatment plan data for 1327 patients from four Danish centres was retrospectively analyzed. FB right-sided patients served as control group for the left-sided patients regarding CTV V95% (relative volume receiving at least 95% of the prescribed dose), mean heart dose (MHD) and mean lung dose (MLD). RESULTS Median CTV V95% was for FB right-sided, FB left-sided and RG left-sided patients 94.6, 92.6 and 94.7% for normofractionated therapy, respectively, and 94.6, 91.8 and 94.4% for hypofractionated therapy and did not differ significantly for RG left-sided plans compared to FB right-sided in either study arm. CTV V95% was significantly lower for FB versus RG for left-sided plans in both arms. Median MHD was 0.7, 1.8 and 1.5 Gy (normofractionated therapy) versus 0.6, 1.5 and 1.2 Gy (hypofractionated therapy), respectively. The corresponding median MLD was 9.0, 8.3 and 7.3 Gy versus 7.3, 6.4 and 5.8 Gy, respectively. CONCLUSIONS RG for left-sided breast cancer patients ensured similar CTV V95% as for FB right-sided patients. MLD was lower for RG due to the increased lung volume. MHD was generally low due to strict protocol-defined maximum dose to LADCA, but for left-sided patients RG led to significantly lower MHD.
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Affiliation(s)
- Martin Berg
- Department of Medical Physics, Vejle Hospital, Vejle, Denmark
| | - Ebbe L. Lorenzen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Ingelise Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - Mette S. Thomsen
- Department of Medical Physics, Aarhus University Hospital, Denmark Aarhus
| | | | - Lasse Refsgaard
- Department of Medical Physics, Vejle Hospital, Vejle, Denmark
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Grau C, Høyer M, Poulsen PR, Muren LP, Korreman SS, Tanderup K, Lindegaard JC, Alsner J, Overgaard J. Rethink radiotherapy - BIGART 2017. Acta Oncol 2017; 56:1341-1352. [PMID: 29148908 DOI: 10.1080/0284186x.2017.1371326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kari Tanderup
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Laurberg T, Overgaard J. Intrinsic subtype characterization of local recurrences and new contralateral primary tumors in patients with low risk breast cancer. Influence of age and primary surgery. Acta Oncol 2017; 56:1644-1647. [PMID: 28885116 DOI: 10.1080/0284186x.2017.1360514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tinne Laurberg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Bonzano E, Guenzi M, Corvò R. A Successful Therapeutic Challenge: Local Reirradiation of Breast Cancer with a Single Dose of 18 Gy Intraoperative Radiation Therapy (IORT). Cureus 2017; 9:e1376. [PMID: 28744423 PMCID: PMC5519315 DOI: 10.7759/cureus.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
After standard treatment of primary breast cancer, local relapse can develop in a previously irradiated region. The decision to refer a patient for a second radiotherapy must be thoroughly evaluated due to the increased risk of side effects. We report a case of a 43-year-old Caucasian female with a history of left breast lumpectomy and radiation treatment in 1990 for an invasive ductal carcinoma who presented with a locoregional recurrence 19 years later. After careful evaluation, the patient has undergone a second breast-conserving surgery and successful reirradiation with 18 Gy single dose of intraoperative radiation therapy (IORT).
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Affiliation(s)
- Elisabetta Bonzano
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
| | - Marina Guenzi
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
| | - Renzo Corvò
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
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Women with breast cancer report substantially more disease- and treatment-related side or late effects than registered by clinical oncologists: a cross-sectional study of a standard follow-up program in an oncological department. Breast Cancer Res Treat 2017; 164:727-736. [PMID: 28536950 DOI: 10.1007/s10549-017-4301-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Follow-up after breast cancer treatment is standard due to the risk of development of new primary cancers and recurrent disease. The aim of the present study was to evaluate a standard follow-up program in an oncological department by assessing: (1) Symptoms or signs of new primary cancer or recurrent disease, (2) Disease- and treatment-related physical and psychosocial side or late effects, and (3) relevant actions by oncology staff. MATERIALS AND METHODS In a cross-sectional study, 194 women who came for follow-up visit after treatment for primary surgery were included. The clinical oncologists registered symptoms and signs of recurrent disease or new primary cancer. Side or late effects were both assessed by patient and the clinical oncologists. RESULTS Loco-regional or distant signs of recurrent disease were suspected in eight (5%) patients. Further examinations revealed no disease recurrence. Most patients (93%) reported some degree of side or late effects. Statistically significant more side or late effects were reported by the women (average: 6.9) than registered by the clinical oncologists (average: 2.4), p < 0.001. The three most often patient-reported side or late effects were hot flushes (35%), fatigue (32%), and sleep disturbance (31%). CONCLUSION None of the scheduled or additional visits resulted in detection of recurrent disease. Furthermore, the majority of patients reported side or late effects. Statistically significant more women reported side or late effects than registered by the clinical oncologists. This suggests the need for rethinking of the follow-up programs with more emphasis upon side or late effects of the treatment.
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The Benefit of Pro Re Nata Antiemetics Provided With Guideline-Consistent Antiemetics in Delayed Nausea Control. Cancer Nurs 2017; 41:E49-E57. [PMID: 28418944 DOI: 10.1097/ncc.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed nausea after chemotherapy remains a symptom of interest. Clinicians often provide additional and/or pro re nata (p.r.n.) antiemetics with guideline-consistent antiemetics in an attempt to achieve further symptom control. Whether the usage of additional and/or p.r.n. antiemetics provide added benefit remains as a question. OBJECTIVE The purpose of this study was to determine the benefit of providing additional antiemetics and/or p.r.n. antiemetics with guideline-consistent antiemetics in the control of nausea, functioning, and quality of life (QOL). METHODS A secondary data analysis of 143 breast cancer patients who received guideline-consistent antiemetics for anthracycline and cyclophosphamide chemotherapy was conducted. Instruments included vomiting frequency and nausea intensity items of the Multinational Association of Supportive Care in Cancer Antiemesis Tool and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. RESULTS Providing p.r.n. antiemetics alleviated the incidence of significant nausea (intensity, ≥3) in the delayed phase. The experience of nausea contributed to symptom incidence in the next phase and cycle. The intensity of delayed nausea demonstrated a moderate negative correlation with physical and role functioning and global health/QOL. CONCLUSION Providing patients with strategies to further control nausea (p.r.n. antiemetics) in addition to guideline-consistent antiemetics is recommended for practice. Because the nausea experience contributes to symptom incidence in the next phase and cycle and because the nausea intensity demonstrated a significant relationship with function and global health/QOL, proactive supportive approaches are strongly recommended. IMPLICATIONS FOR PRACTICE Delayed nausea control may be improved by adhering to guideline-consistent antiemetics and using p.r.n. antiemetics. Delayed nausea control would contribute to patients' functioning and QOL.
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Giacchetti S, Hamy AS, Delaloge S, Brain E, Berger F, Sigal-Zafrani B, Mathieu MC, Bertheau P, Guinebretière JM, Saghatchian M, Lerebours F, Mazouni C, Tembo O, Espié M, Reyal F, Marty M, Asselain B, Pierga JY. Long-term outcome of the REMAGUS 02 trial, a multicenter randomised phase II trial in locally advanced breast cancer patients treated with neoadjuvant chemotherapy with or without celecoxib or trastuzumab according to HER2 status. Eur J Cancer 2017; 75:323-332. [PMID: 28279941 DOI: 10.1016/j.ejca.2017.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The REMAGUS-02 multicenter randomised phase II trial showed that the addition to neoadjuvant chemotherapy (NAC) of trastuzumab in patients with localised HER2-positive breast cancer (BC) increased the pathological complete response (pCR) rate and that the addition of celecoxib in HER2-negative cases did not increase the pCR rate. We report here the long-term follow-up results for disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS From 2004 to 2007, 340 stage II-III BC patients were randomly assigned to receive neoadjuvant EC-T (four cycles of epirubicin-cyclophosphamide followed by four cycles of docetaxel) +/- celecoxib in HER2-negative cases (n = 220) and ± trastuzumab in HER2-positive cases (n = 120). From September 2005, all patients with HER2-positive BC received adjuvant T (n = 106). RESULTS Median follow-up was nearly 8 years (94.4 months, 20-127 m). In the HER2-negative subgroup, addition of celecoxib was not associated with a DFS benefit. Favourable factors were smaller tumour size, expression of progesterone receptor status (PgR) and pCR. In the HER2-positive population, neoadjuvant trastuzumab was not associated with a DFS benefit. Axillary pCR was the only prognostic factor associated with DFS in this group [HR = 0.44, 95% CI = 0.2-0.97], p = 0.035]. To note, DFS and OS were significantly higher in the HER2-positive than in HER2-negative BC patients (HR = 0.58 [0.36-0.92], p = 0.021). CONCLUSION Celecoxib combined with NAC provided neither pCR nor survival benefit in patients with HER2-negative BC. Absence of PgR is a major prognostic factor. Neoadjuvant trastuzumab increased pCR rates without translation into a DFS or OS benefit compared with adjuvant trastuzumab only. Axillary pCR could be a more relevant surrogate of survival than in the breast in HER2-positive population. A retrospective comparison shows that patients with HER2-positive tumours have a better outcome than HER2-negative BC patients showing the impact of trastuzumab on the natural history of BC.
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Affiliation(s)
- Sylvie Giacchetti
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France.
| | - Anne-Sophie Hamy
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France
| | - Suzette Delaloge
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France
| | | | | | | | - Philippe Bertheau
- AP-HP, Hôpital Saint-Louis, Pathology Department, University Paris Diderot, Paris, France
| | | | - Mahasti Saghatchian
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | | | - Chafouny Mazouni
- Department of Surgery, Gustave Roussy, Cancer Center Villejuif, France
| | - Olivier Tembo
- Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | - Marc Espié
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France
| | - Fabien Reyal
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France; Department of Surgery, Institut Curie, Paris, France
| | - Michel Marty
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France; Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | | | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France; Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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