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Sun D, Lu G, Liang F, Zhang W, Zeng T, Ling Y, Peng H, Xia T, Hu M, Chen X. Intraoperative radiotherapy: An alternative to whole-breast external beam radiotherapy in the management of highly selective breast cancer: A SEER database analysis. Cancer Med 2024; 13:e7458. [PMID: 39157891 PMCID: PMC11331247 DOI: 10.1002/cam4.7458] [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: 03/30/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE This study aimed to verify if intraoperative radiotherapy (IORT) can achieve the same survival outcome as whole-breast external beam radiotherapy (EBRT) in early breast cancer after breast-conserving surgery (BCS), and to explore the suitable candidates that can safely receive IORT after BCS. METHODS Eligible post-BCS patients who received IORT or EBRT were included in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2018. Risk factors that affected 5-year overall survival (OS) or breast cancer specific survival (BCSS) were identified by Cox proportional hazards regression analysis. Clinical characteristics, OS, and BCSS were comparatively analyzed between the two treatment modalities. RESULTS The survival analysis after propensity score matching confirmed that patients who received IORT (n = 2200) had a better 5-year OS than those who received EBRT (n = 2200) (p = 0.015). However, the two groups did not differ significantly in 5-year BCSS (p = 0.381). This feature persisted even after multivariate analyses that took into account numerous clinical characteristics. Although there was no significant difference in BCSS between different subgroups of patients treated with IORT or EBRT, patients over 55 years of age, with T1, N0, non-triple negative breast cancers, hormone receptor-positive, and histologic grade II showed a better OS after receiving IORT. CONCLUSION In low-risk, early-stage breast cancer, IORT was not inferior to EBRT considering 5-year BCSS and OS. Considering the equivalent clinical outcome but less radiotoxicity, IORT might be a reasonable alternative to EBRT in highly selective patients undergoing BCS.
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Affiliation(s)
- Dexun Sun
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Guanhua Lu
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Fenmei Liang
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Tao Zeng
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Yun Ling
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Haojie Peng
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Ting Xia
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Meilin Hu
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Xinxin Chen
- Department of Breast SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
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Sheffield KM, Peachey JR, Method M, Grimes BR, Brown J, Saverno K, Sugihara T, Cui ZL, Lee KT. A real-world US study of recurrence risks using combined clinicopathological features in HR-positive, HER2-negative early breast cancer. Future Oncol 2022; 18:2667-2682. [PMID: 35611679 DOI: 10.2217/fon-2022-0310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To assess invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, HER2-negative early breast cancer with combined clinicopathological criteria from monarchE, a phase III study of abemaciclib. Methods: US electronic health records were used to compare outcomes between high-risk (≥4 lymph nodes, or 1-3 lymph nodes and grade 3, tumor ≥5 cm, or Ki-67 ≥20%) versus nonhigh-risk groups using Kaplan-Meier methods and Cox regression models. Results: The high-risk group (n = 557) was at higher risk for IDFS and DRFS events than the nonhigh-risk group (n = 3471). IDFS events (hazard ratio: 3.07; 95% CI: 2.45-3.83) and DRFS events (hazard ratio: 3.15; 95% CI: 2.49-3.97) were significantly higher for the high-risk group. Conclusion: Risk of recurrence was three-times greater in the high-risk group, highlighting the need for better therapies.
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Affiliation(s)
| | | | - Michael Method
- Eli Lilly and Company, Indianapolis, IN 46225, USA.,ImmunoGen, Waltham, MA 02451, USA
| | | | | | - Kim Saverno
- Eli Lilly and Company, Indianapolis, IN 46225, USA.,US Medical Affairs, Incyte Corporation, Wilmington, DE 19803, USA
| | | | | | - Kimberley T Lee
- Departments of Breast Oncology and Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Lai X, Han W, Zhang H, Hou J, Wang G, Luo X, Li X, Wang Q, Zhang Y, Wang H, Li Y. Prognostic role of radiotherapy in low-risk elderly breast cancer patients after breast-conserving surgery: a cohort study. Gland Surg 2022; 11:847-859. [PMID: 35694094 PMCID: PMC9177274 DOI: 10.21037/gs-22-235] [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: 03/02/2022] [Accepted: 04/28/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND Previous research suggested that radiotherapy (RT) had a small absolute benefit in patients with low-risk breast cancer over the age of 65. To reduce the patient's treatment burden and cost, as well as the damage to normal tissue, this study sought to explore the prognostic role of RT after breast-conserving surgery (BCS) in elderly patients. METHODS Patients who were aged ≥65 years, stage T1N0M0, and estrogen receptor/progesterone receptor positive (ER+/PR+) were included in this study. Age, marital status, histology, race, grade, human epidermal growth factor receptor 2 (HER2), subtype, treatment method, and survival were also collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. We compared overall survival (OS) and breast cancer-specific survival (BCSS) before and after propensity score matching (PSM) in the patients who underwent BCS with or without RT. Kaplan-Meier method and Cox proportional hazards regression analyses were used in our study. RESULTS The data of 3,623 patients were analyzed in this study. Among them, 2,851 (78.69%) patients had received RT. The multivariate analyses before PSM showed that RT resulted in better OS [hazard ratio (HR) 0.51, 95% confidence interval (CI): 0.42-0.62, P<0.001], and BCSS (HR 0.40, 95% CI: 0.27-0.58, P<0.001). The multivariate analyses after PSM (n=1,538) confirmed that patients who received RT (n=769) had a longer survival time than those who did not (n=769) (OS: HR 0.73, 95% CI: 0.57-0.95, P=0.018; and BCSS: HR 0.57, 95% CI: 0.35-0.93, P=0.025). The survival analysis showed that patients receiving RT had a better OS (P=0.028) and BCSS (P=0.016) than those who did not receive RT. However, there were no significant differences in patients' OS and BCSS with or without RT across the different age subgroups (P>0.05). CONCLUSIONS In our study, patients who received RT had a longer survival time. However, the age subgroup analysis showed that RT did not have any survival benefit in elderly patients with T1N0M0 and ER+/PR+ breast cancer. Furthermore, at the age of 65-69 years, the P value for OS approached 0.05, which suggests that the decision to administer RT in this patient group should be made based on each patient's condition.
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Affiliation(s)
- Xiaolian Lai
- Guizhou University Medical College, Guiyang, China
- Department of Central Laboratory, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Wei Han
- Center for Rehabilitative Auditory Research, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Hanqun Zhang
- Department of Oncology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Jing Hou
- Department of Breast Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Guanghui Wang
- Department of Breast Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Xiaoqing Luo
- Department of Oncology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Xin Li
- Department of Oncology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Qi Wang
- Department of Occupational Health and Occupational Diseases, College of Public Health, Zhengzhou University, Zhengzhou, China
- China Canada Medical and Health Science Association, Toronto, Canada
| | - Yi Zhang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Hua Wang
- Department of Breast Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Li
- Department of Oncology, Guizhou Provincial People’s Hospital, Guiyang, China
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Cerimele F, Tagliati C, Salvatori F, Baldassarre S, Di Martino A, Calamita V, Pressanti GL, Mingliang Y, Giuseppetti GM, Giovagnoni A. Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size. Breast Dis 2021; 41:45-49. [PMID: 34397397 DOI: 10.3233/bd-201072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). RESULTS Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.
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Affiliation(s)
- Federico Cerimele
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | - Fabio Salvatori
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Silvia Baldassarre
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | - Ying Mingliang
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Tagliati C, Lanni G, Cerimele F, Di Martino A, Calamita V, Lucidi Pressanti G, Mingliang Y, Giuseppetti GM, Argalia G, Giovagnoni A. Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report. Breast Dis 2021; 40:283-286. [PMID: 34092581 DOI: 10.3233/bd-201080] [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] [Indexed: 11/15/2022]
Abstract
We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.
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Affiliation(s)
- Corrado Tagliati
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Giuseppe Lanni
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Federico Cerimele
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Antonietta Di Martino
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Valentina Calamita
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Gabriella Lucidi Pressanti
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Ying Mingliang
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Giulio Argalia
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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