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Liu J, Zhu Z, Hua Z, Lin W, Weng Y, Lin J, Mao H, Lin L, Chen X, Guo J. Radiotherapy refusal in breast cancer with breast-conserving surgery. Radiat Oncol 2023; 18:130. [PMID: 37543579 PMCID: PMC10403910 DOI: 10.1186/s13014-023-02297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/14/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Although radiotherapy after breast-conserving surgery has been the standard treatment for breast cancer, some people still refuse to undergo radiotherapy. The aim of this study is to identify risk factors for refusal of radiotherapy after breast-conserving surgery. METHODS To investigate the trend of refusing radiotherapy after breast-conserving surgery in patients with breast cancer using the Surveillance, Epidemiology, and End Results database. The patients were divided into radiotherapy group and radiotherapy refusal group. Survival results were compared using a multivariate Cox risk model adjusted for clinicopathological variables. Multivariate logistic regression was used to analyze the influencing factors of patients refusing radiotherapy after breast-conserving surgery and a nomogram model was established. RESULTS The study included 87,100 women who underwent breast-conserving surgery for breast cancer between 2010 and 2015. There were 84,948 patients (97.5%) in the radiotherapy group and 2152 patients (2.5%) in the radiotherapy refusal group. The proportion of patients who refused radiotherapy after breast-conserving surgery increased from 2.1% in 2010 to 3.1% in 2015. The Kaplan-Meier survival curve showed that radiotherapy can improve overall survival (p < 0.001) and breast cancer specific survival (p < 0.001) in the patients with breast-conserving surgery. The results of multivariate logistic regression showed that age, income, marital status, race, grade, stage, subtype and chemotherapy were independent factors associated with the refusal of radiotherapy. CONCLUSIONS Postoperative radiotherapy can improve the benefits of breast-conserving surgery. Patients with old age, low income, divorce, white race, advanced stage, and no chemotherapy were more likely to refuse radiotherapy.
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Affiliation(s)
- Jiameng Liu
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Zhanlin Zhu
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Zhipeng Hua
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Weijie Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Yiyin Weng
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Juli Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Hehui Mao
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Lifen Lin
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China
| | - Xuming Chen
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China.
| | - Jujiang Guo
- Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China.
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Gentile D, Sagona A, Barbieri E, Antunovic L, Franceschini D, Losurdo A, Fernandes B, Tinterri C. Breast conserving surgery versus salvage mastectomy for ipsilateral breast cancer recurrence: a propensity score matching analysis. Updates Surg 2021; 74:479-489. [PMID: 34181187 DOI: 10.1007/s13304-021-01122-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/21/2021] [Indexed: 01/01/2023]
Abstract
Salvage mastectomy is regarded as the treatment of first choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast conserving surgery (BCS) is feasible. The purpose of this study was to compare the long-term oncological outcomes of IBCR patients who had undergone either mastectomy or second BCS, performing a propensity score matching (PSM) analysis to reduce the selection bias. All the consecutive patients with IBCR were retrospectively reviewed and divided into two different groups of treatment: repeat BCS versus salvage mastectomy. The propensity score predicting the probability of surgical treatment was determined for each patient and a 1:1 matching was performed. Disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and breast cancer-specific survival (BCSS) were analyzed and compared between the two groups. A total of 309 patients underwent surgical treatment for IBCR. After PSM, 108 patients treated with repeat BCS and 108 patients treated with salvage mastectomy were included in the analysis. There was no significant difference in terms of DFS between patients with IBCR receiving repeat BCS or salvage mastectomy (p = 0.167). However, patients with IBCR undergoing second BCS had significantly better DDFS, OS, and BCSS compared to salvage mastectomy (p < 0.001). Salvage mastectomy should not be considered the optimal treatment for IBCR and it does not seem to improve prognosis compared to repeat conserving surgery. Second BCS for IBCR is a safe option with encouraging long-term oncological outcomes and should be proposed to all patients, when technically feasible.
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Affiliation(s)
- Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, , Milan, Italy.
| | - Andrea Sagona
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Lidija Antunovic
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Agnese Losurdo
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Bethania Fernandes
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, , Milan, Italy
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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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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: 38] [Impact Index Per Article: 7.6] [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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Ahmed K, Asaduzzaman S, Bashar MI, Hossain G, Bhuiyan T. Association Assessment among Risk Factors and Breast Cancer in a Low Income Country: Bangladesh. Asian Pac J Cancer Prev 2016; 16:7507-12. [PMID: 26625753 DOI: 10.7314/apjcp.2015.16.17.7507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the low incoming country Bangladesh, breast cancer is second most common neoplasm and is increasing at an alarming rate among females. Lack of awareness and illiteracy are contributory factors for late presentation and therefore mortality. PURPOSE To examine associations of different factors with breast cancer mortality and to raise awareness among the women of society in Bangladesh. MATERIALS AND METHODS This descriptive case-control study was conducted on 160 participants from April 2011 till July 2014. Through a valid questionnaire covering personal and family history, data were collected by face to face interview. For analyzing correlations among factors with breast cancer data, binary logistic regression, Pearson's χ2- value, odd ratios and p-value tests were conducted with SPSS version 20. RESULTS The mean age of the patients was 43.0 (SD= ± 11.12). In ascending order the leading significant factors were hormone therapy (p<0.0000, OR=4.897), abortion (p<0.0001, OR=3.452), early start menarche (p<0.0002, OR=3.500), family history (p<0.0022, OR=3.235), and late menopause (p<0.0093, OR=3.674) with both χ2 test and logistic regression analyses. Non-significant factors were cancer experience, fatty food habits, marital status and taking alcohol. CONCLUSIONS Regarding the investigation of this study, significant and insignificant factor's correlation visualization with breast cancer will be helpful to increase awareness among Bangladeshi women as well as all over the world.
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Affiliation(s)
- Kawsar Ahmed
- Department of Information and Communication Technology, Mawlana Bhashani Science and Technology University, Tangail, Baangladesh E-mail :
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