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Kleiman K, Yalniz C, Woodard S. Ultrafast MR imaging findings of 2 different subtypes in a male patient with bilateral breast cancer. Radiol Case Rep 2024; 19:1366-1370. [PMID: 38288048 PMCID: PMC10823031 DOI: 10.1016/j.radcr.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 01/31/2024] Open
Abstract
Bilateral breast cancer in males is an exceedingly rare diagnosis. In this case report, we will discuss the ultrafast sequence findings of a bilateral male breast cancer with different subtypes on his staging dynamic contrast enhanced (DCE) MRI with ultrafast technique. A 94-year-old male presented with bilateral palpable complaints in his breasts. Diagnostic mammography and ultrasound images demonstrated bilateral irregular masses with nipple retraction. Biopsies were performed and the histopathologic examination revealed invasive breast carcinoma of no special type in 1 breast and invasive micropapillary carcinoma in the other breast. Staging MRI with ultrafast sequence showed significant enhancement differences between 2 different subtypes, correlating with the different levels of tumor aggressiveness. Different ultrafast metrics, such as time-to-enhancement and maximum slope, may help to differentiate between several subtypes of breast cancer and serve as prognostic indicators. This case report discusses the application of ultrafast sequence in predicting breast cancer subtypes in a male patient with bilateral disease.
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Affiliation(s)
- Kyle Kleiman
- Edward Via College of Osteopathic Medicine, Carolinas Campus, 350 Howard St, Spartanburg, SC 29303, USA
| | - Ceren Yalniz
- Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
| | - Stefanie Woodard
- Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
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Schulze AK, Hoskin TL, Moldoveanu D, Sturz JL, Boughey JC. Tumor Characteristics of Bilateral Breast Cancer Compared with Unilateral Breast Cancer. Ann Surg Oncol 2024; 31:947-956. [PMID: 37906382 DOI: 10.1245/s10434-023-14451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Bilateral breast cancer (BC) has an incidence of 1 to 3 %. This study aimed to describe the clinicopathologic characteristics and management of bilateral BC, estimate disease-free survival (DFS), and compare DFS with unilateral BC. METHODS A retrospective analysis was performed for patients who had bilateral invasive BC or unilateral invasive BC and contralateral ductal carcinoma in situ (DCIS) treated at Mayo Clinic Rochester from 2008 to 2022. A 4:1 matched cohort of patients with unilateral invasive BC was used for comparison. The groups were compared using Wilcoxon rank-sum or chi-square tests. Disease-free survival was analyzed using the Kaplan-Meier method and log-rank test, with Cox proportional hazards regression used for multivariable analysis. RESULTS The study identified 278 cases of bilateral breast cancer (177 cases of bilateral invasive cancer and 101 cases of unilateral invasive cancer with contralateral DCIS), representing 4.1 % of invasive BCs. Biologic subtype was concordant between sides in 79.8 % of the patients. Initial surgery was bilateral mastectomy for 76.6 %, bilateral lumpectomy for 20.5 %, and unilateral mastectomy with unilateral lumpectomy for 2.9 % of the patients. Pathogenic variants in breast cancer predisposition genes were present in 21.7 % of those tested. The patients who had bilateral BC presented with a higher cT category than the patients who had unilateral BC (p = 0.02), and a higher proportion presented with ILC (17.3 % vs 10.9 %; p = 0.004), estrogen receptor-positive (ER+) disease (89.2 % vs 84.2 %; p = 0.04), multicentric/multifocal disease (37.1 % vs 24.3 %; p < 0.001), breast cancer pathogenic variant (21.7 % vs 12.4 %; p = 0.02), and palpable presentation (48.2 % vs 40.8 %; p = 0.03). The patients with bilateral BC showed DFS similar to that for the unilateral BC cohort (p = 0.71). CONCLUSIONS Bilateral BCs most commonly are biologically concordant between sides. Bilateral BC presented more commonly with larger tumors, lobular histology, ER+ status, multicentricity or multifocality, pathogenic variant, and palpable disease. Bilateral BC is not associated with worse DFS than unilateral BC.
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Affiliation(s)
- Amy K Schulze
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dan Moldoveanu
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jenna L Sturz
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Wang J, Chen H, Koenig J, Wu Y, Bedrosian I, Arun B, Ding Q, Khazai L, Resetkova E, Huo L, Sneige N, Albarracin C. Discordance of Oncotype DX scores in synchronous bilateral and unilateral multifocal breast cancers. Breast Cancer Res Treat 2024; 203:73-83. [PMID: 37751078 DOI: 10.1007/s10549-023-07119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Oncotype DX, a 21-gene expression profiling test, has become standard of care in the management of estrogen receptor (ER)-positive breast cancer. In multifocal tumors, it is unclear whether testing of the different foci is necessary. We evaluated the concordance of Oncotype DX recurrence scores (RS) between 2 tumor foci in synchronous bilateral or unilateral multifocal tumors and characterized pathological predictors of discordance. METHODS We reviewed 713 ER+, HER2- primary invasive breast cancer patients with Oncotype RS and identified 17 bilateral synchronous patients (34 tumors) and 13 unilateral multifocal patients (26 tumors) with available Oncotype RS on all foci. Discordance in Oncotype RS between synchronous tumors was recorded and associations with clinicopathologic features including tumor size, histology, Nottingham histologic grade, progesterone receptor staining, and Ki67 index were analyzed. RESULTS Bilateral synchronous tumors were present in older patients (median age 59 years) and had larger tumor (median size 17 mm) and more discordant histology (10/17, 59%) as compared to unilateral multifocal tumors (median age 49 years, p < 0.01; median tumor size 12 mm, p = 0.01; discordant histology 2/13, 15%, p = 0.03). Oncotype RS were discordant in 47% (8/17) of bilateral and 54% (7/13) of unilateral multifocal tumors. Concordant Oncotype RS was associated with similar histologic grade and Ki67 index in 78% (7/9) of bilateral and 100% (6/6) of multifocal tumors. In contrast, only 25% (2/8) of bilateral (p = 0.06) and 14% (1/7) of unilateral multifocal (p < 0.01) cases with discordant Oncotype RS had concordant histology grades and Ki67 levels. In synchronous tumors with discordant Oncotype RS and Ki67 index, all (4/4) foci with higher RS had higher Ki67 index. CONCLUSION Discordance of Oncotype RS is common in both bilateral and unilateral multifocal breast cancer and is likely associated with discordant histologic grade or Ki67.
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Affiliation(s)
- Jing Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, G1.3617B, Houston, TX, 77030, USA.
| | - Jenna Koenig
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laila Khazai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Resetkova
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nour Sneige
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Constance Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, G1.3617A, Houston, TX, 77030, USA.
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Zhang JQ, Dos Anjos CH, Sevilimedu V, Crown A, Amoroso KA, Pilewskie ML, Robson ME, Gemignani ML. Association of Moderate-Risk Breast Cancer Genes with Contralateral Prophylactic Mastectomy and Bilateral Disease. Ann Surg Oncol 2023; 30:6990-6999. [PMID: 37661222 PMCID: PMC11005956 DOI: 10.1245/s10434-023-14141-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/23/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The impact of ATM, CHEK2, and PALB2, the three most prevalent moderate-risk breast cancer genes, on surgical decision making is not well known. METHODS Our retrospective study included patients with resectable non-metastatic breast cancer who underwent multigene panel testing between July 2014 and January 2020 with at least one genetic alteration (pathogenic or variant of uncertain significance [VUS] in ATM [n = 49], CHEK [n = 57], or PALB2 [n = 27]). Our objectives were to determine the rate of contralateral prophylactic mastectomy (CPM) and the rate of bilateral breast cancer. Univariable analyses (UVA) and multivariable analyses (MVA) were performed to identify factors associated with CPM and bilateral breast cancer. RESULTS The rate of CPM was 39% (n = 49/127), with 54% (n = 25/46) of patients with a pathogenic mutation and 30% (n = 24/81) of patients with a VUS choosing CPM. On MVA, premenopausal status (odds ratio [OR] 3.46) and a pathogenic alteration (OR 3.01) were associated with increased use of CPM. Bilateral disease was noted in 16% (n = 22/138). Patients with pathogenic mutations had a 22% (n = 11/51) incidence of bilateral breast cancer, while patients with VUS had a 13% (n = 11/87) incidence, although this was not statistically significant on UVA or MVA. On MVA, premenopausal status was associated with a decreased risk of bilateral disease (OR 0.33, p = 0.022). During follow-up, a breast cancer event occurred in 16% (n = 22/138). CONCLUSIONS Our study identified a high rate of CPM among those with ATM, CHEK2, and PALB2 alterations, including VUS. Further studies are needed to clarify reasons for CPM among patients with moderate-risk alterations.
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Affiliation(s)
- Jennifer Q Zhang
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Kimberly A Amoroso
- Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa L Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E Robson
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mishra A, Oberoi AS, Deo S, Sharma J, Gogia A, Sharma DN, Mathur S, Dhamija E. Bilateral Breast Cancer: Clinical Profile and Management. Indian J Surg Oncol 2023; 14:651-658. [PMID: 37900630 PMCID: PMC10611650 DOI: 10.1007/s13193-023-01731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
There is paucity of literature regarding the demography, histopathology, management, and outcomes of bilateral breast cancer (BBC). We present our experience of treating 127 BBC with multimodality management. An audit of prospectively maintained computerized breast cancer database of the department of surgical oncology at a tertiary care center was performed. Demography, clinical profile, molecular sub-types, treatment patterns, and outcomes were analyzed. A total 127 patients presented with BBC between 1992 and 2019. Ninety-four had metachronous (MBBC) and 33 had synchronous breast cancer (SBBC). Most contralateral breast cancer (CBC) patients had early-stage breast cancer in comparison to the index side cancer (37% vs 32%). Ninety-four patients underwent bilateral mastectomy and only 18 patients underwent bilateral breast conservation. Seventy-one patients undergoing BCS and surgery for LABC were given postoperative radiotherapy. All patients received adjuvant chemo- and/or hormonal therapy both for index and CBC based on the stage and hormone receptor status. Thirty-three percent of patients had either locoregional or distant relapse. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) of the entire cohort were 86.6% and 68.4% respectively. There was no difference in the OS and DFS between SBBC and MBBC. The incidence of BBC is expected to increase with effective diagnostic and therapeutic interventions and improving survival. Patients require individualized treatment planning in a multidisciplinary treatment setting.
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Affiliation(s)
- Ashutosh Mishra
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | | | - Jyoti Sharma
- Department of Surgical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - D. N. Sharma
- Department of Radiation Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | | | - Ekta Dhamija
- Department of Radiology, AIIMS, New Delhi, India
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Bharati A, Rath S, Khurana R, Rastogi M, Mandal SR, Gandhi AK, Hadi R, Srivastava AK, Mishra SP. Dosimetric Comparision of Coplanar versus Noncoplanar Volumetric Modulated Arc Therapy for Treatment of Bilateral Breast Cancers. J Med Phys 2023; 48:252-258. [PMID: 37969151 PMCID: PMC10642589 DOI: 10.4103/jmp.jmp_36_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction The purpose of this study was to compare the dosimetric parameters of volumetric modulated arc therapy (VMAT) treatment plans using coplanar and noncoplanar beams in patients with bilateral breast cancer/s (BBCs) in terms of organ at risk sparing and target volume coverage. The hypothesis was to test whether VMAT with noncoplanar beams can result in lesser dose delivery to critical organs such as heart and lung, which will result in lesser overall toxicity. Materials and Methods Data of nine BBC cases treated at our hospital were retrieved. Computed tomography simulation data of these cases was used to generate noncoplanar VMAT plans and the parameters were compared with standard VMAT coplanar plans. Contouring was done using radiation therapy oncology group guidelines. Forty-five Gray in 25 fractions was planned followed by 10 Gy in five fractions boost in breast conservation cases. Results No significant difference in planning target volume (PTV) coverage was found for the right breast/chestwall (P = 0.940), left breast/chestwall (P = 0.872), and in the total PTV (P = 0.929). Noncoplanar beams resulted in better cardiac sparing in terms of Dmean heart. The difference in mean dose was >1 Gy (8.80 ± 0.28 - 7.28 ± 0.33, P < 0.001). The Dmean, V20 and V30 values for total lung slightly favor noncoplanar beams, although there was no statistically significant difference. The average monitor units (MUs) were similar for coplanar plans (1515 MU) and noncoplanar plans (1455 MU), but the overall treatment time was higher in noncoplanar plans due to more complex setup and beam arrangement. For noncoplanar VMAT plans, the mean conformity index was slightly better although the homogeneity indices were similar. Conclusion VMAT plans with noncoplanar beam arrangements had significant dosimetric advantages in terms of sparing of critical organs, that is Dmean of heart doses with almost equivalent lung doses and equally good target coverage. Larger studies with clinical implications need to be considered to validate this data.
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Affiliation(s)
- Avinav Bharati
- Department of Radiation Oncology, NCI-AIIMS, New Delhi, India
| | - Satyajeet Rath
- Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Rohini Khurana
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | | | - Ajeet Kumar Gandhi
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Rahat Hadi
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Anoop K. Srivastava
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Luís C, Fernandes R, Dias J, Pereira D, Firmino-Machado J, Baylina P, Fernandes R, Soares R. Bilateral breast cancer and the influence of body mass index in clinicopathological features and overall survival. Breast Dis 2023; 42:407-414. [PMID: 38108338 DOI: 10.3233/bd-230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Breast cancer (BC) and obesity are two closely associated pathologies with increasing incidence and mortality rates. Bilateral Breast Cancer (BBC) displays a low incidence rate within BC and obesity represents a major risk factor. OBJECTIVE The aim of this study is to analyzed BBC clinicopathological features distribution and determine the potential influence of obesity in BBC in these same features and overall survival. METHODS Clinicopathological information was obtained from 42 cases of women with BBC diagnosed in IPO-Porto. To evaluate the frequency distribution of the clinicopathological data, a chi-square goodness of fit test was performed for BBC cases. A chi-square test of independence was applied for BMI stratification. Cox regression was performed for overall survival. Statistical significance was set at p-value < 0.05. RESULTS Distribution of BBC clinicopathological features was found to be statistically significant in family history (p-value < 0.001), BBC type (p-value < 0.001), stage (p-value = 0.005), differentiation grade (p-value < 0.001), receptor expression (p-value < 0.001) and histological type (p-value = 0.031). In comparison to the statistical expected results, we observed an increased cases of absence of family history and less cases of metachronous BBC. Histological types between tumours of BBC were mostly concordant. All cases presented concordant receptor expression. Analysis stratified by BMI revealed that obese women were diagnosed later, although without statistical significance. All obese women presented poor differentiation grade (n = 6). Overweight patients display a tendency to a better overall survival with lower tumour stages and lower differentiation grades. CONCLUSIONS Our results reveal the same receptor expression between contralateral tumours. Also, most tumours share the same histological type. When stratified by BMI, we observed a tendency for overweight women to have improved overall survival.
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Affiliation(s)
- Carla Luís
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
| | | | - João Dias
- Portuguese Oncology Institute of Porto, Porto, Portugal
| | | | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, University of Porto, Porto, Portugal
- Departamento de Ciências Médicas, University of Aveiro, Aveiro, Portugal
- Centro Académico Clínico Egas Moniz, Aveiro, Portugal
| | - Pilar Baylina
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
- School of Health, Polytechnic of Porto, Porto, Portugal
| | - Rúben Fernandes
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Fernando Pessoa Hospital-School, Porto, Portugal
| | - Raquel Soares
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Inovação e Investigação em Saúde, University of Porto, Porto, Portugal
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Balasubramanian S, Shobana MK. A Dosimetric and Radiobiological Comparison of Intensity Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Helical Tomotherapy Planning Techniques in Synchronous Bilateral Breast Cancer. Asian Pac J Cancer Prev 2022; 23:4233-4241. [PMID: 36580006 PMCID: PMC9971452 DOI: 10.31557/apjcp.2022.23.12.4233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The present investigation intends to identify the optimal radiotherapy treatment plan for synchronous bilateral breast cancer (SBBC) using dosimetric and radiobiological indexes for three techniques, namely, helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT). METHODS Twenty SBBC treated female patients treatment planning data (average age of 52.5 years) were used as the sample for the present study. Three different plans were created using 50 Gy in a 25 fraction dose regime. Poisson, Niemierko, and LKB models were applied for calculating normal tissue complication probability (NTCP) and tumour control probability (TCP). RESULT The target average dose comparison between IMRT with HT and VMAT with HT was highly substantial (P=0.001). The percentage of TCP for IMRT, VMAT, and HT in the Poisson model were 93.70±0.28, 94.68±0.30, and 94.34±0.57, respectively (p<0.05). The dose maximum was lower for the whole lung in the HT plan, with an average dose of 49.31Gy±3.9 (p<0.009). The NTCP values of both Niemierko and LKB models were lower for the heart, lungs, and liver for the IMRT plan. CONCLUSION The sparing of organs at risk was higher in the HT plan dosimetrically, and the TCP was higher in the three techniques. The comparison between the three techniques shows that the IMRT and HT techniques could be considered for treating SBBC.
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Affiliation(s)
- S Balasubramanian
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Vellore (632014), India. ,Department of Radiation Oncology, Max Super Speciality Hospital, Ghaziabad (201012), India.
| | - MK Shobana
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Vellore (632014), India. ,For Correspondence:
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Li Y, Chen L, Lv J, Chen X, Zeng B, Chen M, Guo W, Lin Y, Yu L, Hou J, Li J, Zhou P, Zhang W, Li S, Jin X, Cai W, Zhang K, Huang Y, Wang C, Fu F. Clinical application of artificial neural network (ANN) modeling to predict BRCA1/2 germline deleterious variants in Chinese bilateral primary breast cancer patients. BMC Cancer 2022; 22:1125. [PMID: 36324133 PMCID: PMC9628090 DOI: 10.1186/s12885-022-10160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bilateral breast cancer (BBC), as well as ovarian cancer, are significantly associated with germline deleterious variants in BRCA1/2, while BRCA1/2 germline deleterious variants carriers can exquisitely benefit from poly (ADP-ribose) polymerase (PARP) inhibitors. However, formal genetic testing could not be carried out for all patients due to extensive use of healthcare resources, which in turn results in high medical costs. To date, existing BRCA1/2 deleterious variants prediction models have been developed in women of European or other descent who are quite genetically different from Asian population. Therefore, there is an urgent clinical need for tools to predict the frequency of BRCA1/2 deleterious variants in Asian BBC patients balancing the increased demand for and cost of cancer genetics services. METHODS The entire coding region of BRCA1/2 was screened for the presence of germline deleterious variants by the next generation sequencing in 123 Chinese BBC patients. Chi-square test, univariate and multivariate logistic regression were used to assess the relationship between BRCA1/2 germline deleterious variants and clinicopathological characteristics. The R software was utilized to develop artificial neural network (ANN) and nomogram modeling for BRCA1/2 germline deleterious variants prediction. RESULTS Among 123 BBC patients, we identified a total of 20 deleterious variants in BRCA1 (8; 6.5%) and BRCA2 (12; 9.8%). c.5485del in BRCA1 is novel frameshift deleterious variant. Deleterious variants carriers were younger at first diagnosis (P = 0.0003), with longer interval between two tumors (P = 0.015), at least one medullary carcinoma (P = 0.001), and more likely to be hormone receptor negative (P = 0.006) and HER2 negative (P = 0.001). Area under the receiver operating characteristic curve was 0.903 in ANN and 0.828 in nomogram modeling individually (P = 0.02). CONCLUSION This study shows the spectrum of the BRCA1/2 germline deleterious variants in Chinese BBC patients and indicates that the ANN can accurately predict BRCA deleterious variants than conventional statistical linear approach, which confirms the BRCA1/2 deleterious variants carriers at the lowest costs without adding any additional examinations.
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Affiliation(s)
- Yan Li
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Lili Chen
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Jinxing Lv
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China ,grid.54549.390000 0004 0369 4060Sichuan Cancer Center, School of Medicine, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, 610000 Chengdu, China
| | - Xiaobin Chen
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Bangwei Zeng
- grid.411176.40000 0004 1758 0478Nosocomial Infection Control Branch, Fujian Medical University Union Hospital, Fuzhou, Fujian Province China
| | - Minyan Chen
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Wenhui Guo
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Yuxiang Lin
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Liuwen Yu
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Jialin Hou
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Jing Li
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Peng Zhou
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Wenzhe Zhang
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Shengmei Li
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Xuan Jin
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Weifeng Cai
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Kun Zhang
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Yeyuan Huang
- grid.256112.30000 0004 1797 9307Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Chuan Wang
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
| | - Fangmeng Fu
- grid.411176.40000 0004 1758 0478Department of Breast Surgery, Fujian Medical University Union Hospital, No.29, Xin Quan Road, Gulou District, 350001 Fuzhou, Fujian Province China ,grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian Province China ,grid.256112.30000 0004 1797 9307Breast Cancer Institute, Fujian Medical University, 350001 Fuzhou, Fujian Province China
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10
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Yang SY, Li Y, Nie JY, Yang ST, Yang XJ, Wang MH, Zhang J. Metaplastic breast cancer with chondrosarcomatous differentiation combined with concurrent bilateral breast cancer: A case report. World J Clin Cases 2022; 10:5064-5071. [PMID: 35801025 PMCID: PMC9198873 DOI: 10.12998/wjcc.v10.i15.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metaplastic breast carcinoma (MBC) is a rare subtype of invasive breast cancer comprising malignant epithelial and mesenchymal cells. Compared with other invasive breast cancers, MBC is not only histologically distinctly heterogeneous but also has a rapid and aggressive growth pattern, which leads to a significant risk of recurrence and mortality.
CASE SUMMARY In this study, we report the case of a patient with a large left breast mass diagnosed with bilateral invasive ductal carcinoma in both breasts after a preoperative core needle aspiration biopsy of the bilateral breast mass. The patient received neoadjuvant chemotherapy and underwent bilateral breast modified radical mastectomy. Postoperative pathology suggested carcinosarcoma with predominantly chondrosarcoma in the left breast and invasive ductal carcinoma (luminal B) in the right breast. As the patient did not achieve complete pathological remission after six cycles of neoadjuvant chemotherapy, we administered six months of intensive capecitabine treatment. Then the patient was switched to continuous treatment with endocrine therapy using letrozole + goserelin, and the patient is currently in stable condition. However, as MBC of the breast is concurrently diagnosed with chondrosarcoma differentiation, our case is sporadic.
CONCLUSION Given the variety of immunohistochemical types of bilateral breast cancer, achieving effective chemotherapy should be a key research focus.
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Affiliation(s)
- Si-Yuan Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Yang Li
- Department of Digestive Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Jian-Yun Nie
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Shou-Tao Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Xiao-Juan Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Mao-Hua Wang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Ji Zhang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
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11
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Mallory MA, Whiting K, Park A, Gönen M, Gilbert E, King TA, Pilewskie ML. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat 2022. [PMID: 35488092 DOI: 10.1007/s10549-022-06532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Lobular carcinoma in situ (LCIS) confers increased cancer risk in either breast, but it remains unclear if this population is at increased risk for bilateral breast cancer (BC) development. Here we report bilateral BC incidence among women with a history of LCIS. METHODS Women with classic-type LCIS diagnosed from 1980 to 2017 who developed unilateral BC (UBC) or bilateral BC were identified. Bilateral BC was categorized as synchronous (bilateral BC diagnosed < 6 months apart; SBBC) or metachronous (bilateral BC diagnosed ≥ 6 months apart; MBBC). Five-year incidence rates of bilateral BC among this population were evaluated. Comparisons were made to identify factors associated with bilateral BC. RESULTS At 7 years' median follow-up, 249/1651 (15%) women with LCIS developed BC; 34 with bilateral BC (2%). There were no clinicopathologic feature differences between those with UBC and bilateral BC. SBBC occurred in 18 without significant differences versus UBC. Among 211 with UBC and a contralateral breast at risk, 16 developed MBBC at a median follow-up of 3 years. MBBC patients were less likely to receive endocrine therapy and more likely to receive chemotherapy versus UBC. Tumor histology was not associated with MBBC. Estimated 5-year MBBC risk was 6.4%. Index estrogen/progesterone receptor positivity and endocrine therapy were the only factors associated with MBBC risk. CONCLUSION Bilateral BC occurred in 2% of women with LCIS history at median follow-up of 7 years. Similar to the general BC population, a decrease in MBBC is seen among women with a history of LCIS who develop hormone receptor-positive disease and those who receive endocrine therapy, highlighting the protective effects of this treatment.
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12
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Balaji K, Ramasubramanian V. Hypofractionated Hybrid Radiotherapy Techniques for Synchronous Bilateral Breast Cancer. Asian Pac J Cancer Prev 2021; 22:3933-3939. [PMID: 34967574 PMCID: PMC9080371 DOI: 10.31557/apjcp.2021.22.12.3933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: This study intends at a dosimetric comparison of four different hybrid plans which is a combination of different radiation therapy techniques, for synchronous bilateral breast cancer (SBBC) irradiation using a hypofractionated dose regimen. Methods: Four different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT, IMRT+VMAT, and VMAT+IMRT were planned using computed tomography (CT) images of fifteen SBBC patients. All hybrid plans were generated using a hypofractionated dose prescription of 40.5 Gy in 15 fractions. 70% of the dose was planned with a base-dose component and the remaining 30% of the dose was planned with a hybrid component. The plans were evaluated based on the PTV and organs at risk (OARs) dosimetric parameter results and computed a plan quality score for each plan. Results: The results for PTV parameters have shown that the 3DCRT+VMAT and 3DCRT+IMRT plans were better than other plans. The 3DCRT±IMRT plan was provided better results for OARs, while IMRT±VMAT and VMAT+IMRT plans were increased the low dose volumes to the heart and lungs. The 3DCRT+VMAT plan was required less monitor units and treatment time compared to other plans. Conclusion: The overall plan quality score that integrated the dosimetric parameters of PTV and OARs indicated that the 3DCRT+VMAT hybrid plan is superior for SBBC treatment.
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Affiliation(s)
- Karunakaran Balaji
- School of Advanced Sciences, Vellore Institute of Technology, Vellore, India.,Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, India
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13
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Zhang LL, Rong XC, Yuan L, Cai LJ, Liu YP. Breast cancer with an initial gastrointestinal presentation: a case report and literature review. Am J Transl Res 2021; 13:13147-13155. [PMID: 34956535 PMCID: PMC8661181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 06/14/2023]
Abstract
The most common sites of breast cancer metastasis are the lymph nodes, lungs, bones, and liver. Gastrointestinal (GI) metastasis is relatively rare and often occurs within several years after a breast cancer diagnosis. Most patients experience abdominal pain, anorexia, bleeding, vomiting, and other digestive system symptoms, symptoms which are difficult to distinguish from primary gastric cancer. There is no characteristic change seen under a digestive tract endoscopy, and the difference in morphology under the pathological microscope from that of primary poorly differentiated gastric adenocarcinoma is so small that it can easily cause a misdiagnosis. This paper reports the case of 46-year-old female patient whose first symptom was GI discomfort. She was hospitalized for GI surgery with an unknown medical history, but, during the preoperative examination, multiple breast masses were found on both sides, which were proved by pathology to be invasive lobular cancer. According to the medical literature, bilateral breast cancer with gastric metastasis is very rare, and, so far, this is the first reported case. Despite it being a rare phenomenon, it is necessary to be aware of the possibility of metastatic lobular carcinoma in the diagnosis of poorly differentiated gastric adenocarcinoma by biopsy.
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Affiliation(s)
- Ling-Ling Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Xiao-Cui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Li Yuan
- Department of Endoscopy Room, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Li-Jing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
| | - Yue-Ping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, P. R. China
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14
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Jia H, Zheng Y, Wang P, Wei Z, Li X, Fu G, Wang C. A Retrospective Study on the Clinicopathologic Characteristics and Outcomes of 179 Cases of Synchronous and Metachronous Bilateral Breast Cancer in China. Clin Breast Cancer 2021; 22:e341-e349. [PMID: 34728164 DOI: 10.1016/j.clbc.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the clinicopathologic characteristics and outcome of bilateral breast cancer (BBC) in the Chinese population. METHODS A retrospective study was conducted on 7797 cases with primary breast cancer, including 7618 cases of unilateral breast cancer (UBC) and 179 cases of BBC. Among the latter, there were 108 cases of synchronous BBC (SBBC) and 71 cases of metachronous BBC (MBBC). RESULTS In the present study, the incidence of SBBC and MBBC are 1.39% and 0.91% among the general population, respectively. In comparison of UBC and BBC, SBBC and MBBC, there are significant differences in the common clinicopathological characteristics, such as pathologic stage, hormone receptor (HR) status and molecular type. In respect of the surgical treatment of BBC, 49.72% of the patients chose mastectomy. The 3-year disease free survival (DFS) for SBBC and MBBC are 94.4% and 96.9%, respectively. There is no difference in the overall survival (OS) and DFS between SBBC and MBBC. The histological grade and type of surgery on tumors of both sides are important influencing factors of DFS in the BBC patients. CONCLUSION There are statistical differences in the clinicopathological characteristics and outcomes between SBBC and MBBC among the Chinese population. Therefore, the treatment of BBC patients should be individualized.
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Affiliation(s)
- Huiqing Jia
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China,Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Yan Zheng
- Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Ping Wang
- Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Zhimin Wei
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xia Li
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangming Fu
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqin Wang
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China,Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
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15
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McKenzie E, Razvi Y, Bosnic S, Wronski M, Zhang L, Karam I, Donovan E, Milton L, Behroozian T, Drost L, Yee C, Wong G, Lam E, Chow E. Dosimetry and outcomes in patients receiving radiotherapy for synchronous bilateral breast cancers. J Med Imaging Radiat Sci 2021; 52:527-543. [PMID: 34580051 DOI: 10.1016/j.jmir.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Synchronous bilateral breast cancer (SBBC) is rare and there is little evidence describing organs at risk (OAR) and limits to the heart and lungs caused by radiotherapy (RT). Quantifying mean heart dose (MHD) and mean lung dose (MLD) from RT in this patient cohort may lead to better understanding of doses to OAR and resultant effects on clinical outcomes. The primary objective was to assess median MHD and MLD in SBBC, while secondary aims included analyses of 1) factors associated with MHD and MLD, 2) V5 and V20 values and 3) factors associated with clinical outcomes. METHODS Patients planned for adjuvant bilateral whole breast/chest wall (WB) RT from a single institution treated in 2011-2018 were included. Median MHD and MLD (Gy) were stratified by hypofractionated (42.56 Gy/16 fractions, HFRT) and conventional fractionation (50 Gy/ 25 fractions, CFRT) and summarized separately based on the following treatments: 1) locoregional RT, WB tangential RT either 2) no boost 3) sequential boost or 4) simultaneous integrated boost. MHD, MLD, lung V5 and V20 values, and demographics were collected. Linear regression analyses identified factors associated with MHD and MLD and factors associated with clinical outcomes. RESULTS A total of 88 patients were included. The median MHD for HFRT and CFRT was 1.99 Gy and 2.94 Gy, respectively. The median MLD for HFRT and CFRT was 6.00 Gy and 10.08 Gy, respectively. MHD and MLD were significantly associated with the occurrence of a cardiac or pulmonary event post-radiation. Patients who had a mastectomy or tumoral muscle involvement were more likely to develop a local recurrence, metastasis or new primary while patients who had a lumpectomy or tumor with a positive estrogen receptor status were less likely to experience these events. CONCLUSIONS Further investigation should be conducted to identify SBBC RT techniques that mitigate dose to OARs to improve clinical outcomes in bilateral breast patients.
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Affiliation(s)
- Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Yasmeen Razvi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sandi Bosnic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Matt Wronski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Elysia Donovan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Lauren Milton
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tara Behroozian
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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16
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Yoneyama K, Nakagawa M, Hara A. Bilateral nipple-sparing mastectomy and breast reconstruction in BRCA1 mutation-positive simultaneous bilateral breast cancer: A case study. Int J Surg Case Rep 2021; 81:105788. [PMID: 33756165 PMCID: PMC8020432 DOI: 10.1016/j.ijscr.2021.105788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mutation-positive patients who develop unilateral breast cancer require different treatments, such as prophylactic mastectomy of the contralateral breast, from those used for other breast cancer patients. If a mutation is found before surgery, it is necessary to consider a surgical procedure that includes reconstruction. For BRCA mutation-positive patients, a suitable treatment must be selected. In Japan, a test for BRCA mutation has been covered by health insurance since 2020, making it possible to preoperatively test patients who are suspected of being positive. We report a case of simultaneous bilateral breast cancer that was found to be BRCA mutation-positive preoperatively and underwent bilateral subcutaneous mastectomy and breast reconstruction. CASE PRESENTATION A 57-year-old woman was admitted to our hospital after a breast cancer screening revealed a mass in the left breast. She had a family history of breast cancer, including her sister, aunt, and cousin. She was suspected of being malignant with a mass on both sides of her breast on imaging. She underwent needle biopsy and was diagnosed as having bilateral invasive ductal carcinoma, for which she was placed on preoperative chemotherapy. Due to the strong family history of bilateral breast cancer, the patient was recommended to undergo a BRCA gene-mutation test and she consented. The result was positive for BRCA1 mutation. Although it was judged that bilateral breast-conserving surgery was sufficiently possible, bilateral subcutaneous mastectomy and breast reconstruction were performed based on BRCA mutation-positive status. DISCUSSION Performing a preoperative BRCA test may change the surgical procedure. BRCA tests are beneficial to patients, but the timing of the tests is important. Care must be taken not to force the patient. CONCLUSIONS Knowing whether the patient is BRCA mutation-positive is extremely important for selecting surgical procedures and treatment methods. BRCA testing should be recommended for patients who are strongly suspected of being positive, but the decision should be the patient's. It is therefore necessary to provide accurate information and engage in a dialogue with the patient, but the medical staff should not pressure the patient to have the test.
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Affiliation(s)
- Kimiyasu Yoneyama
- Department of Breast Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa 254-0065, Japan.
| | - Motohito Nakagawa
- Department of Breast Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa 254-0065, Japan.
| | - Asuka Hara
- Department of Breast Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa 254-0065, Japan.
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17
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Ding S, Sun X, Lu S, Wang Z, Chen X, Shen K. Association of molecular subtype concordance and survival outcome in synchronous and metachronous bilateral breast cancer. Breast 2021; 57:71-79. [PMID: 33774461 PMCID: PMC8027898 DOI: 10.1016/j.breast.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to analyze the association of molecular subtype concordance and disease outcome in patients with synchronous bilateral breast cancer (SBBC) and metachronous breast cancer (MBBC). Patients and methods Patients diagnosed with SBBC or MBBC in the Surveillance, Epidemiology, and End Results (SEER) database or Comprehensive Breast Health Center (CBHC) Ruijin Hospital, Shanghai were retrospectively reviewed and included. Clinicopathologic features, molecular subtype status concordance, and prognosis were compared in patients with SBBC and MBBC. Other prognostic factors for breast cancer-specific survival (BCSS) and overall survival (OS) were also identified for bilateral breast cancer patients. Results Totally, 3395 and 115 patients were included from the SEER and Ruijin CBHC cohorts. Molecular subtype concordance rate was higher in the SBBC group compared to MBBC in both SEER cohort (75.8% vs 57.7%, p < 0.001) and Ruijin CBHC cohort (76.2% vs 45.2%, p = 0.002). Survival analyses indicated that SBBC was related to worse BCSS than MBBC (p = 0.015). Molecular subtype discordance was related to worse BCSS (hazard ratio (HR), 1.64, 95% confidential interval (CI), 1.18–2.27, p = 0.003) and OS (HR, 1.59, 95% CI, 1.24–2.04, p < 0.001) in the SBBC group, but not for the MBBC group (p = 0.650 for BCSS, p = 0.669 for OS). Conclusions Molecular subtype concordance rate was higher in the SBBC group than MBBC group. Patients with discordant molecular subtype was associated with worse disease outcome in the SBBC patients, but not in MBBC, which deserves further clinical evaluation. SBBC was associated with higher concordance rates of ER, PR, HER2, and molecular subtype status compared to MBBC. SBBC had worse BCSS than MBBC. Molecular subtype discordance was independently related to worse prognosis in SBBC but has no impact on prognosis of MBBC.
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Affiliation(s)
- Shuning Ding
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Xi Sun
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Shuangshuang Lu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Zheng Wang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China.
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Rd, Shanghai, 200025, China.
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Sun T, Lin X, Zhang G, Qiu Q, Li C, Yin Y. Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer. Radiat Oncol 2021; 16:35. [PMID: 33602267 PMCID: PMC7890882 DOI: 10.1186/s13014-021-01763-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.
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Affiliation(s)
- Tao Sun
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Xiutong Lin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Guifang Zhang
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingtao Qiu
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Chengqiang Li
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Yong Yin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Muthuselvi CA, Bijina TK, Pichandi A. Evaluation of Optimal Combination of Planning Parameters (Field Width, Pitch, and Modulation Factor) in Helical Tomotherapy for Bilateral Breast Cancer. J Med Phys 2021; 45:234-239. [PMID: 33953499 PMCID: PMC8074714 DOI: 10.4103/jmp.jmp_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim of the study was to find the most balanced plan with an optimal combination of planning parameters in helical tomotherapy (HT) for bilateral breast irradiation by evaluating dosimetric indices and time factors. In particular, we investigated the best combination of field width (FW), pitch, and modulation factor (MF). Materials and Methods: A total of 90 plans (18 plans for each patient) was created in this study, with different combination of planning parameters (FW: 2.5 cm [F1] and 5 cm [F2]; pitch: 0.215 [P1], 0.287 [P2], and 0.43 [P3]; and MF: 2.0 [M1], 2.5 [M2], and 3.0 [M3]). Plans were analyzed using several dosimetric indices: homogeneity index, conformity index, dose near minimum D98%, dose near maximum D2%, and the coverage by D95% of the target. Organ at risk (OAR) doses were evaluated by mean dose, V5Gy and V25Gy for the heart and mean dose V5Gy and V20Gy for both the lungs. Treatment time was also reported for all plans. Results: Reducing FW from 5 cm to 2.5 cm increased the treatment time by 40%–50% and improved homogeneity of the target. Tightening the pitch value from 0.43 to 0.215 improved target as well as OAR doses without increasing the treatment time. Increasing MF from 2 to 3 improved all the dosimetric indices and also increased treatment time. Conclusions: On the basis of our analysis, a plan with FW 5 cm, pitch 0.215, and MF 2.5 can be considered as an optimal combination of planning parameters for bilateral breast irradiation in HT technique.
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Affiliation(s)
- C A Muthuselvi
- Department of Radiotherapy, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - T K Bijina
- Department of Radiotherapy, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - A Pichandi
- Department of Radiotherapy, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
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Shinden Y, Saho H, Nomoto Y, Nagata A, Minami K, Nakajo A, Akahane T, Hiraki T, Tanimoto A, Owaki T, Kijima Y, Natsugoe S. Breast cancer with an intraductal component that was proven genetically to be metastasis of contralateral breast cancer: a case report. Surg Case Rep 2020; 6:215. [PMID: 32833091 PMCID: PMC7445210 DOI: 10.1186/s40792-020-00966-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background When diagnosing patients with bilateral breast cancer, it is challenging to determine the relationship between multiple breast cancer lesions at the individual patient level with certainty. Case presentation A 35-year-old Japanese woman was diagnosed with a left breast cancer. She was previously diagnosed with right pT3N3M0 stage IIIC breast cancer and underwent chemotherapy with targeted therapy, radiotherapy, and endocrine therapy as adjuvant treatment after mastectomy and axillary lymph node dissection. Approximately 2 years after the first surgery, her left breast cancer was preoperatively diagnosed as a contralateral primary breast cancer, and left mastectomy and axillary lymph node dissection were performed. Histopathologically, the tumor was determined to be invasive ductal carcinoma accompanied with several intraductal components. After a second surgery, mutation analysis of her bilateral breast cancer was performed in a clinical study, which revealed that her metachronous bilateral breast tumors had the same GATA3 and CSMD1 mutations. Thus, mutation analysis strongly supported her latter left breast cancer being a metastatic lesion from the former right breast cancer. Some difficulties in diagnosing bilateral breast cancer exist when determining whether they are double primary cancers or represent contralateral breast metastasis. The existence of intraductal components is a critical piece of information for suspecting primary lesions. However, this case demonstrated that metastatic contralateral breast lesions can have intraductal components. Conclusion Herein we report a genetically proven contralateral breast metastasis with some intraductal components.
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Affiliation(s)
- Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Hazuki Saho
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuki Nomoto
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ayako Nagata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Minami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Toshiaki Akahane
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tsubasa Hiraki
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tetsuhiro Owaki
- Education Center for Doctors in Remote Islands and Rural Areas, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
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Megaro G, Rossi L, Ceddia S, Sinjari M, Mannino A, Gozzi E, Cosimati A, Brandi M, Bitca V, Toscani I, Cimino G, Tomao S. Synchronous and Metachronous Metastatic Breast Cancer, with Different Histology and Opposite Immunophenotype, Treated with Combination of Chemotherapy, Anti-Her2, and Endocrine Therapy: A Case Report. Case Rep Oncol 2020; 13:544-549. [PMID: 32547382 PMCID: PMC7275194 DOI: 10.1159/000507433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
Abstract
In the case of our patient, the synergic action of endocrine therapy and chemotherapy plus dual anti-HER2 combination allowed a complete disease control. Therapy should be scheduled by considering the two cancers as individual entities. The approach to breast cancer is changing from being considered a singular disease to a multiform one, according to current research focused on biological markers such as HER2, ERs, and PRs, with important implications in clinical, prognostic, and therapeutic features.
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Affiliation(s)
- Giacomina Megaro
- Department of Paediatric Haematology and Oncology, Ospedale Bambin Gesù, Rome, Italy
| | - Luigi Rossi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Serena Ceddia
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Marsela Sinjari
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Adele Mannino
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Elisa Gozzi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Antonella Cosimati
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Martina Brandi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Victoria Bitca
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Ilaria Toscani
- Medical Oncology Ospedale G. da Saliceto, Piacenza, Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Haematology, University of Rome "Sapienza", Rome, Italy
| | - Silverio Tomao
- Medical Oncology Unit A Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy
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Huber A, Seidler SJ, Huber DE. Clinicopathological Characteristics, Treatment and Outcome of 123 Patients with Synchronous or Metachronous Bilateral Breast Cancer in a Swiss Institutional Retrospective Series. Eur J Breast Health 2020; 16:129-136. [PMID: 32285035 DOI: 10.5152/ejbh.2020.5297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/09/2020] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the prognosis, the patient and tumor characteristics, and the treatment of bilateral breast cancer (BBC) and to compare synchronous (sBBC) and metachronous BBC (mBBC). Materials and Methods For this retrospective study, data from 123 consecutive BBC patients (56 sBBC and 67 mBBC) that were presented at the Sion Hospital tumor board between 2007 and 2018 were collected retrospectively. Results Mean follow-up was 85 months. 2nd tumors in both groups were more often diagnosed radiologically. Mean time interval between mBBC was 115 months. A shorter interval was positively correlated with a negative hormonal receptor (HR) status and higher grade for the 2nd tumor. There was no difference in overall survival (OS) and relapse-free survival (RFS) between sBBC and mBBC. OS was longer if both tumors were hormonal receptor (HR) positive. mBBC exhibited a higher local recurrence rate than sBBC (p=0.03). Conclusion sBBC and mBBC patients did not show any difference in OS or RFS, although mBBC patients were more prone to local relapses.
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Affiliation(s)
- Alexandre Huber
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Daniela E Huber
- Gynecology Department, Hôpital du Valais, Sierre, Switzerland
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Abstract
Introduction: Many breast cancer (BC) patients develop the disease bilaterally. The emergence of two tumors in the same host is unlikely to be a random co-incidence: bilateral BC (biBC) patients are enriched by women who are susceptible to this disease due to genetic or non-genetic factors.Areas covered: Data on molecular pathogenesis and translational aspects of biBC research are summarized.Expert opinion: Studies on concordant and discordant molecular events occurring in paired tumors resemble twin studies, as they help to reveal core components of BC pathogenesis and to analyze interactions between host factors and tumor phenotype. Mutation profiling of biBC pairs suggested that most biBCs are clonally independent malignancies, although some instances of presumably contralateral metastatic spread were shown as well. Many biBCs, especially synchronous ones, demonstrate the similarity of essential tumor characteristics, which can be explained by sharing of genetic background, hormonal milieu, metabolic environment, and external exposures. biBC is strongly associated with BC-predisposing germline mutations; therefore, clinical management of biBC patients must include comprehensive genetic testing. Some contralateral metachronous BCs demonstrate high-level microsatellite instability (MSI-H). MSI-H is sometimes observed in radiation- and chemotherapy-induced tumors; therefore, it is possible that some second BCs are causally related to the therapy applied for the first cancer. MSI-H tumors are responsive to immune checkpoint blockade; hence, MSI-H analysis is advisable for biBC molecular testing. Systematic cataloging of biBC molecular portraits is likely to provide valuable information on fundamental aspects of cancer pathogenesis.
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Affiliation(s)
- Evgeny N Imyanitov
- Department of Tumour Growth Biology, N.N. Petrov Institute of Oncology, St.-Petersburg, Russia.,Department of Clinical Genetics, St.-Petersburg Pediatric Medical University, St.-Petersburg, Russia.,Department of Oncology, I.I. Mechnikov North-Western Medical University, St.-Petersburg, Russia
| | - Ekatherina Sh Kuligina
- Department of Tumour Growth Biology, N.N. Petrov Institute of Oncology, St.-Petersburg, Russia
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Sakai T, Ozkurt E, DeSantis S, Wong SM, Rosenbaum L, Zheng H, Golshan M. National trends of synchronous bilateral breast cancer incidence in the United States. Breast Cancer Res Treat 2019; 178:161-167. [PMID: 31325072 DOI: 10.1007/s10549-019-05363-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Increase in breast cancer survivorship, advancements in diagnostic imaging and standardization of contralateral breast screening before breast cancer surgery have resulted in increased detection of contralateral breast cancer (CBC). The aim of this study was to assess national trends of synchronous bilateral breast cancer (sBBC) and metachronous bilateral breast cancer (mBBC) incidence in newly diagnosed breast cancer patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (1973-2014) was used to identify 11,177 women diagnosed with CBC. CBC was classified as sBBC when primary breast cancer in both breasts is diagnosed in the same year, or as mBBC, when diagnosed more than one year from primary breast cancer. Temporal trends in sBBC incidence were then evaluated using the Cochran-Armitage test for trend. RESULTS Of the 11,177 women diagnosed with CBC, 4228 (38%) had sBBC and 6949 (62%) had mBBC. The incidence of sBBC increased significantly from 1.4% in 1975 to 2.9% in 2014 (p < 0.001). sBBC was more likely to be diagnosed as early stage in recent years (78% in 1975 vs. 90% in 2014 [p < 0.001]), and 69% of patients were treated with mastectomy in 2014. CONCLUSION The number of sBBC has increased, and contralateral tumors are more likely to be detected at an early stage with the first primary breast cancer. Despite the early stage findings, most were treated with mastectomy. Further studies are needed to define the best therapy for patients with contralateral disease and optimal surveillance and detection methods.
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Affiliation(s)
- Takehiko Sakai
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Enver Ozkurt
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Stephen DeSantis
- Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Stephanie M Wong
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,McGill University Health Centre, Montreal, QC, Canada
| | - Laurel Rosenbaum
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mehra Golshan
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA.
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Lakovschek IC, Petru E, Pollheimer MJ, Ratschek M, Augustin H, Bjelic-Radisic V. A rare case of cancer-to-cancer metastasis: breast cancer to renal cell cancer : Case report and review of literature. Wien Med Wochenschr 2019; 169:350-3. [PMID: 31041627 DOI: 10.1007/s10354-019-0694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Background Cancer-to-cancer metastasis is very rare with less than 50 cases described in literature. This article reports a case of breast cancer with synchronous metastasis to clear cell renal cell cancer. Case description A 79-year-old woman was diagnosed with a bilateral breast carcinoma. Sonographic staging investigation of the abdomen revealed a 6 cm wide expansion of the right kidney. Bilateral mastectomy and nephrectomy of the right kidney was performed. The histology revealed a clear cell renal cell carcinoma and in the center of the tumor a 0.5 cm metastasis of the breast cancer. The patient’s comorbidities and performance status precluded chemotherapy und she received palliative radiotherapy, targeted monoclonal antibody therapy and antihormonal treatment. Conclusions Even if cancer-to-cancer metastasis is a very rare phenomenon, the simultaneous or consecutive finding of a renal tumor in women with breast cancer should be carefully evaluated.
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Wang Y, Du C, Tu L, Luo F, Yan X. Favorable progression-free survival in women with two different histopathological subtypes of bilateral breast cancer. J Cancer Res Ther 2018; 14:1627-1631. [PMID: 30589050 DOI: 10.4103/jcrt.jcrt_997_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose The aim of this study was to classify bilateral breast cancers (BBCs) into two groups according to histopathological or molecular subtypes of the two breast diseases in each patient and to study their characteristics in relation to survival outcomes. Methods Fifty-six BBC patients were enrolled in the study. They were classified according to whether the two breast diseases were of the same or different histopathological subtypes (defined as S-his or D-his groups) and molecular subtypes (defined as S-mole and D-mole groups). Progression-free survival (PFS), overall survival (OS), and important characteristics were then compared between the groups. Results We observed that the PFS and OS of the S-mole and D-mole groups failed to reach a significant difference. However, D-his BBC patients enjoyed longer PFS than their S-his counterparts, although the OS was similar. To explore the reason for the extended PFS in D-his BBC patients, we first focused on the possible prognostic contribution by various histopathological subtypes in the groups. We compared the proportion of infiltrating ductal carcinoma, infiltrating lobular carcinoma, and other breast cancer subtypes in the D-his and S-his groups, and demonstrated that they were not associated with longer PFS. We then examined age, menopausal status, tumor, node, and metastasis (TNM) stage, expressions of estrogen receptor (ER), progesterone receptor (PR) and Ki67, and metastasis to lymph nodes, viscera, and bone. The results indicated no significant between-group differences in age, TNM stage, ER/PR expression, and metastasis to viscera and bone. However, significantly lower levels of Ki67and decreased lymph node metastasis rate were associated with D-his BBC patients, which might explain the observed longer PFS. Conclusions In comparison to S-his, D-his BBC patients had longer PFS, which was associated with lower levels of Ki67 and a decreased lymph node metastasis rate.
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Affiliation(s)
- Yuyi Wang
- Department of Medical Oncology, Cancer Center, Lung Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chi Du
- Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, Sichuan, China
| | - Li Tu
- Department of Medical Oncology, Cancer Center, Lung Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Feng Luo
- Department of Medical Oncology, Cancer Center, Lung Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xi Yan
- Department of Medical Oncology, Cancer Center, Lung Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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van Bommel R, Lameijer JRC, Voogd AC, Nederend J, Louwman MWJ, Setz-Pels W, Strobbe LJ, Tjan-Heijnen VCG, Duijm LE. Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography. Eur J Radiol 2018; 108:215-21. [PMID: 30396659 DOI: 10.1016/j.ejrad.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.
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Dhadlie S, Whitfield J, Hendahewa R. Synchronous bilateral breast cancer: A case report of heterogeneous estrogen receptor status. Int J Surg Case Rep 2018; 53:102-106. [PMID: 30391732 PMCID: PMC6216046 DOI: 10.1016/j.ijscr.2018.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/29/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022] Open
Abstract
Hormone receptors are established biomarkers for treatment and prognosis of patients with breast cancer. Receptor status change is dynamic and unstable throughout tumour progression and during advance stage disease. Four mechanisms of breast cancer heterogeneity have been described which includes differentiation of state of cell origin, cell plasticity, genetic evolution of cancer and tumour microenvironment.
Introduction Tumour heterogeneity is important in the management of breast cancer. Hormone receptors are established biomarkers for treatment and prognosis of patients with breast cancer. There are three immunohistochemical biomarkers: estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2). We explore whether heterogeneity in hormone receptor status in synchronous bilateral breast alters therapeutic management. Case presentation This case details a 54 year old woman who was referred to our clinic by her general practitioner for investigation of bilateral breast pain that she had for 6 months. On clinical examination pathological nodes were palpated in bilateral axilla. There was left sided nipple inversion with a palpable mass in the upper outer quadrant of approximately 3 cm diameter. On examination of the right breast there was skin tethering of the nipple and 3 masses were palpated, the largest being in the upper inner quadrant at 5 cm diameter. Ultrasound and mammography of bilateral breasts demonstrated advanced bilateral breast cancer with axillary node metastases. Core biopsies demonstrated invasive carcinoma. The right breast lesion was ER negative whilst the left breast lesion was ER positive. Discussion In patients with synchronous bilateral breast cancer ER discordance in patients have been associated with higher mortality than ER concordant positive patients and lower mortality than ER concordant negative patients within the first 5 years of surveillance [1]. Conclusion Heterogeneity in hormone receptor status alters the therapeutic management of patients with synchronous bilateral breast cancer. Both hormone therapy and chemotherapy should be considered in these patients. It is of utmost importance to evaluate the tumor receptor status in cases of synchronous bilateral breast tumour and to assess for change in relation to tumour progression or treatment. Further study in the status change of receptors could open up new treatment modalities.
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Affiliation(s)
- Sunny Dhadlie
- Caboolture Hospital, 120 McKean Street, 4510, Queenland, Australia.
| | - Joseph Whitfield
- QML Pathology, 11 Riverview Place, Murrarie, 4172, Queensland, Australia.
| | - Rasika Hendahewa
- Caboolture Hospital, 120 McKean Street, 4510, Queenland, Australia.
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Biermann J, Parris TZ, Nemes S, Danielsson A, Engqvist H, Werner Rönnerman E, Forssell-Aronsson E, Kovács A, Karlsson P, Helou K. Clonal relatedness in tumour pairs of breast cancer patients. Breast Cancer Res 2018; 20:96. [PMID: 30092821 PMCID: PMC6085699 DOI: 10.1186/s13058-018-1022-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/18/2018] [Indexed: 01/18/2023] Open
Abstract
Background Molecular classification of tumour clonality is currently not evaluated in multiple invasive breast carcinomas, despite evidence suggesting common clonal origins. There is no consensus about which type of data (e.g. copy number, mutation, histology) and especially which statistical method is most suitable to distinguish clonal recurrences from independent primary tumours. Methods Thirty-seven invasive breast tumour pairs were stratified according to laterality and time interval between the diagnoses of the two tumours. In a multi-omics approach, tumour clonality was analysed by integrating clinical characteristics (n = 37), DNA copy number (n = 37), DNA methylation (n = 8), gene expression microarray (n = 7), RNA sequencing (n = 3), and SNP genotyping data (n = 3). Different statistical methods, e.g. the diagnostic similarity index (SI), were used to classify the tumours as clonally related recurrences or independent primary tumours. Results The SI and hierarchical clustering showed similar tendencies and the highest concordance with the other methods. Concordant evidence for tumour clonality was found in 46% (17/37) of patients. Notably, no association was found between the current clinical guidelines and molecular tumour features. Conclusions A more accurate classification of clonal relatedness between multiple breast tumours may help to mitigate treatment failure and relapse by integrating tumour-associated molecular features, clinical parameters, and statistical methods. Guidelines need to be defined with exact thresholds to standardise clonality testing in a routine diagnostic setting. Electronic supplementary material The online version of this article (10.1186/s13058-018-1022-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jana Biermann
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden.
| | - Toshima Z Parris
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden
| | - Szilárd Nemes
- Swedish Hip Arthroplasty Register, 405 30, Gothenburg, Sweden
| | - Anna Danielsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden
| | - Hanna Engqvist
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden
| | - Elisabeth Werner Rönnerman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden.,Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Eva Forssell-Aronsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden
| | - Khalil Helou
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Box 425, SE-405 30, Gothenburg, Sweden
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Abstract
The occurrence of bilateral breast cancer is rare. A second primary in the contralateral breast can either be synchronous or metachronous. Lobular carcinoma of the breast is known for its multicentricity and bilateral spread. The synchronous mixed pattern of carcinoma of the breast has also been reported in the same breast. The family history of breast carcinoma, estrogen receptor negativity, and human epidermal growth factor receptor-2 positivity are risk factors for the development of contralateral breast malignancy. In metachronous, bilateral breast cancer (MBBC) usually a single histological variant is seen at different time periods. However, we report a rare case of MBBC in a 66-year-old female patient with positive family history who had infiltrating lobular carcinoma (ILC) in the left breast followed by infiltrating ductal carcinoma in the right breast after a span of 2½ years, even after undergoing modified radical mastectomy with adjuvant chemotherapy followed by hormonal therapy for ILC of left breast.
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Affiliation(s)
- Anand Singla
- Department of Surgery, GMC, Patiala, Punjab, India
| | - Navneet Kaur
- Department of Pathology, GMC, Patiala, Punjab, India
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Yao J, Liu J, Li Y, Li Y, Wu Q, Yang Y. HER2 positive bilateral metachronous primary breast carcinoma: A case report. Cancer Biol Ther 2018; 19:349-354. [PMID: 29333901 PMCID: PMC5915025 DOI: 10.1080/15384047.2018.1423916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) positive is a unique molecular subtype of breast cancer (BC) characterized by high malignancy and poor prognosis. Bilateral primary breast cancer (BPBC) harboring HER2 gene amplification is available to be detected among the BC survivors due to the increasing use of anti-HER2 adjuvant therapy. However, owing to the paucity of cases reported, knowledge of treating HER2-positive BPBC patients including the clinical behavior, histopathologic characteristics, anti-HER2 therapeutic response and disease outcome are not fully understood. Here we report a case of its kind receiving nonstandardized treatment during adjuvant stage. Upon tumor recurrence with liver metastasis, she received trastuzumab combined with chemotherapy and reached a PFS of 14.5 months in first-line treatment. While maintained trastuzumab plus carboplatin as second-line treatment progressed promptly, re-treatment of trastuzumab after lapatinib administration in third line can still benefit the patient. The present case report delineates an anti-HER2 path for a particular characterized patient, and also provides new evidence of trastuzumab re-usage after disease progression of prior anti-HER2 therapy.
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Affiliation(s)
- Jinghao Yao
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Jing Liu
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Yawei Li
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Yumei Li
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Qiong Wu
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Yan Yang
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
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Callari M, Dugo M, Miodini P, Veneroni S, Bianchini G, Daidone MG, Cappelletti V. Dissecting Time- from Tumor-Related Gene Expression Variability in Bilateral Breast Cancer. Int J Mol Sci 2018; 19:E196. [PMID: 29315233 DOI: 10.3390/ijms19010196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/29/2017] [Accepted: 01/05/2018] [Indexed: 12/04/2022] Open
Abstract
Metachronous (MBC) and synchronous bilateral breast tumors (SBC) are mostly distinct primaries, whereas paired primaries and their local recurrences (LRC) share a common origin. Intra-pair gene expression variability in MBC, SBC, and LRC derives from time/tumor microenvironment-related and tumor genetic background-related factors and pairs represents an ideal model for trying to dissect tumor-related from microenvironment-related variability. Pairs of tumors derived from women with SBC (n = 18), MBC (n = 11), and LRC (n = 10) undergoing local-regional treatment were profiled for gene expression; similarity between pairs was measured using an intraclass correlation coefficient (ICC) computed for each gene and compared using analysis of variance (ANOVA). When considering biologically unselected genes, the highest correlations were found for primaries and paired LRC, and the lowest for MBC pairs. By instead limiting the analysis to the breast cancer intrinsic genes, correlations between primaries and paired LRC were enhanced, while lower similarities were observed for SBC and MBC. Focusing on stromal-related genes, the ICC values decreased for MBC and were significantly different from SBC. These findings indicate that it is possible to dissect intra-pair gene expression variability into components that are associated with genetic origin or with time and microenvironment by using specific gene subsets.
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van Bommel RMG, Voogd AC, Nederend J, Setz-Pels W, Louwman MWJ, Strobbe LJ, Venderink D, Tjan-Heijnen VCG, Duijm LEM. Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography. Breast 2018; 38:101-106. [PMID: 29306176 DOI: 10.1016/j.breast.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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Krześniak M, Butkiewicz D, Rachtan J, Matuszczyk I, Grzybowska E, Rusin M. A novel germline TP53 mutation p.Pro190Arg detected in a patient with lung and bilateral breast cancers. Adv Med Sci 2017; 62:207-210. [PMID: 28499267 DOI: 10.1016/j.advms.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/08/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Li-Fraumeni syndrome (LFS) is a rare genetic disease with strong predispositions to multiple early-onset neoplasms, mostly sarcomas, breast cancers, brain tumors and adrenocortical carcinomas (LFS core cancers). In most LFS families the germline mutations of TP53 tumor suppressor gene were found. Lung cancer does not belong to the core cancers of LFS, however its higher incidence is observed in families with TP53 mutations. Our aim was to search for TP53 mutations in female lung cancer patients whose clinico-demographic characteristics suggested a probable genetic predisposition to the disease. MATERIALS AND METHODS The coding region of TP53 from blood DNA was sequenced using Sanger method. The functioning of detected mutation was tested by luciferase reporter assay. RESULTS We found a nucleotide substitution c.569C>G, p.Pro190Arg, which was not described in the TP53 germline mutation database (http://p53.iarc.fr/TP53GermlineMutations.aspx). The mutation destroys the ability of p53 to transactivate BAX promoter and significantly reduces transactivation potential of p53 toward the promoter of MDM2 gen. CONCLUSION We identified novel germline mutation of TP53.
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Affiliation(s)
- Małgorzata Krześniak
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Dorota Butkiewicz
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Jadwiga Rachtan
- Epidemiology Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Kraków Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - Iwona Matuszczyk
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Ewa Grzybowska
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Marek Rusin
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland.
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Fiorentino A, Mazzola R, Naccarato S, Giaj-Levra N, Fersino S, Sicignano G, Tebano U, Ricchetti F, Ruggieri R, Alongi F. Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetric modulated arc therapy and simultaneous integrated boost. Radiol Med 2017; 122:464-471. [PMID: 28224401 DOI: 10.1007/s11547-017-0741-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the present retrospective analysis was to evaluate dosimetric parameters, feasibility and outcome for Synchronous Bilateral Breast Cancer (SBBC) patients treated with adjuvant radiotherapy (RT) by Volumetric Modulated Arc Therapy (VMAT). METHODS From September 2011 to April 2016, 1100 Breast Cancer (BC) patients were referred to our institution to receive adjuvant breast RT, and those with SBBC were selected for the present analysis. A total of 16 patients were identified. A total dose of 50 Gy in 25 fractions was prescribed to the Planning Target Volume of the whole bilateral breast (PTVBN) with or without the supraclavicular and infraclavicular nodes, while a total dose of 60 Gy in 25 fractions was prescribed to the surgical bed (PTVboost). Several V xGy and Dx% parameters were analyzed for the PTVs, together with Conformity and Homogeneity indexes (CI, HI), and for the critical Organs at risk (OARs), lungs and heart first. RESULTS With a median follow-up of 24 months, no acute or late side effects more than grade 2 were observed. All patients are alive without any sign of disease. For target dose coverage, our observed inter-patients averages (±1 sd) were V 95% Dp = 96.7 ± 1.6% (96.3 ± 1.8%) to the left (right) PTVBN, V 95% Dp = 98.6 ± 2.7% (99.4 ± 0.9%) to the left (right) PTVboost, and D 2% = 64.4 ± 1.8 Gy (65.0 ± 2.0 Gy) to the left (right) PTVboost, respectively. With regard to the heart, the inter-patient average of D mean was 8.3 ± 3.3 Gy. For the lungs, the inter-patient average of D mean, V 5 Gy and V 20 Gy were 11.8 ± 2.3 Gy, 78.9 ± 15.3% and 15.7 ± 5%, respectively. CONCLUSIONS The present retrospective analysis showed the feasibility, tolerability and safety of VMAT in the treatment of SBBC patients. Further studies are necessary to confirm these preliminary data.
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Affiliation(s)
- Alba Fiorentino
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - Stefania Naccarato
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Sergio Fersino
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Gianluisa Sicignano
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Umberto Tebano
- Radiation Oncology School, University of Padua, Padua, Italy
| | - Francesco Ricchetti
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Ruggero Ruggieri
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
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Khalil AI, Bendahhou K, Mestaghanmi H, Saile R, Benider A. [Synchronous bilateral breast cancer: experiences in the Mohammed VI Cancer Treatment Center, CHU Ibn Rochd, Casablanca]. Pan Afr Med J 2016; 25:121. [PMID: 28292084 PMCID: PMC5325485 DOI: 10.11604/pamj.2016.25.121.9967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022] Open
Abstract
Synchronous bilateral breast cancers (SBBC) are characterized by extensive clinical and morphological heterogeneity, with an frequency between 1.5 and 3.2%. Women treated for unilateral breast cancer are at higher risk of developing contralateral breast cancer. Screening and advances in breast imaging have improved detection rates of SBBC. Our study aims to analyze the epidemiological, clinical, histological and therapeutic features of bilateral breast cancer. We conducted a cross-sectional study of patients with breast cancer treated at the Mohammed VI Center over a two year period. Statistical analysis of the results was performed using R. software. 31 patients had SBBC, representing 2.4% of breast cancer cases in our Center. The average age was 47.8 ± 8.4 years, 22.6% of patients used oral contraceptives. A family history of breast cancer was observed in 22.6% of cases. The most common histological type was invasive ductal carcinoma (58.1%), SBR grade II and III were common (38.7%). Hormone receptors were positive for progesterone (38.7%) and for estrogen (41.9%). HER2 was overexpressed in 20.0% of cases. 29.0% of patients received hormonal therapy and 3.2% targeted therapies. Our study showed that bilateral breast cancer represents a small percentage of all breast cancers but have specific clinical features that help to differentiate it from unilateral breast cancer.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Contraceptives, Oral/administration & dosage
- Cross-Sectional Studies
- Female
- Humans
- Middle Aged
- Morocco
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | | | - Houriya Mestaghanmi
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Rachid Saile
- Laboratoire de Biologie et Santé, Unité de Recherche Associée au CNRST-URAC 34, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Abdellatif Benider
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd Casablanca, Maroc
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Seppälä J, Heikkilä J, Myllyoja K, Koskela K. Volumetric modulated arc therapy for synchronous bilateral whole breast irradiation - A case study. Rep Pract Oncol Radiother 2015; 20:398-402. [PMID: 26549999 DOI: 10.1016/j.rpor.2015.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/13/2015] [Accepted: 05/24/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The treatment planning of bilateral breast irradiation (BBI) is a challenging task. The overlapping of tangential fields is usually unavoidable without compromising the target coverage. The purpose of this study was to investigate the technical feasibility and benefits of a single isocentre volumetric modulated arc therapy (VMAT) in BBI. METHODS AND MATERIALS Two women with bilateral breast cancer were included in this case study. The first patient (Pat#1) underwent a bilateral breast-conserving surgery and sentinel lymph node biopsy. The second patient (Pat#2) underwent a bilateral ablation and axillary lymph node dissection. Planning target volumes (PTV) and organs at risk were delineated on CT images. VMAT plans were created with four (two for both sides, Pat#1) or two (one for each breast, Pat#2) separate VMAT fields. Subsequently, traditional tangential field plans were generated for each patient and the dosimetric parameters were compared. RESULTS The treatment times of the patients with VMAT were less than 15 min with daily CBCT imaging. When compared to the standard tangential field technique, the VMAT plans improved the PTV dose coverage and dose homogeneity with improved sparing of lungs and heart. With traditional field arrangement, the overlapping of the tangential fields was inevitable without significantly compromising the target coverage, whereas with VMAT the hotspots were avoided. The patients were treated with the VMAT technique and no acute skin toxicity was observed with either of the patients. CONCLUSIONS A single isocentre VMAT technique has been implemented clinically for BBI. With the VMAT techniques, the dose delivery was quick and the hotspots in the field overlapping areas were avoided. The PTV dose coverage was superior in VMAT plans when compared with conventional tangential technique plans.
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Affiliation(s)
- Jan Seppälä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Janne Heikkilä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Kimmo Myllyoja
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
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Taşdemir A, Karaman H, Ünal D, Mutlu H. Stewart-Treves Syndrome after Bilateral Mastectomy and Radiotherapy for Breast Carcinoma: Case Report. J Breast Health 2015; 11:92-94. [PMID: 28331699 DOI: 10.5152/tjbh.2015.1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 11/22/2022]
Abstract
Stewart-Treves syndrome is an angiosarcoma that occurs because of chronic lymphedema, which in most cases is a complication after mastectomy with axillary node dissection and postoperative radiation. Prognosis for this rare tumor is poor. The best therapy is early and radical excision. Chronic lymphedema seems to be an important pathogenic factor. We report a 59-year-old patient with chronic lymphedema and lymphangiosarcoma of the left upper limb who had a left modified radical mastectomy with axillary node dissection and postoperative radiation nine years ago. Additionally, the patient underwent a right modified radical mastectomy with axillary node dissection and postoperative radiation one year ago. In this report, we present a case of Stewart-Treves syndrome after the patient was operated for bilateral breast carcinoma, a review of literature, and principles of treatment.
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Affiliation(s)
- Arzu Taşdemir
- Department of Pathology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karaman
- Department of Pathology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Dilek Ünal
- Department of Oncology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hasan Mutlu
- Department of Radiation Oncology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Senkus E, Szade J, Pieczyńska B, Żaczek A, Pikiel J, Sosińska-Mielcarek K, Karpińska A, Jassem J. Are synchronous and metachronous bilateral breast cancers different? An immunohistochemical analysis aimed at intrinsic tumor phenotype. Int J Clin Exp Pathol 2013; 7:353-363. [PMID: 24427357 PMCID: PMC3885491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED The biology and pathomechanism of bilateral breast cancers is not fully understood. We compared the morphological and immunohistochemical characteristics of primary tumors in patients with synchronous bilateral breast cancers and metachronous bilateral breast cancers, with special focus on intrinsic tumor phenotype. METHODS Tumor morphology and expression of 8 immunohistochemical markers were assessed in tissue microarrays containing primary breast tumor cores from 113 metachronous bilateral breast cancers and 61 synchronous bilateral breast cancers. Analyzed markers included hormone receptors (estrogen receptor, progesterone receptor), HER2, Ki67, cytokeratin 5/6, E-cadherin, vimentin and epidermal growth factor receptor. Cutoff levels are provided in the table. RESULTS Metachronous bilateral breast cancers tumors had lower estrogen receptor expression (p=0.047) and higher expression of cytokeratin 5/6 (p=0.017) and of vimentin (p=0.008); in multivariate analysis only vimentin retained the significance (p=0.01). Ten (13%) and 11 (26%) of metachronous bilateral breast cancers and synchronous bilateral breast cancers had luminal A phenotype, 39 (50%) and 15 (36%) were luminal B HER2-negative, 13 (17%) and 12 (28%) - luminal B HER2-positive, 3 (4%) and 2 (5%) - HER2-positive (not luminal), and 12 (16%) and 2 (5%) had triple negative phenotype (p=0.07). CONCLUSION Metachronous bilateral breast cancers, compared to synchronous bilateral breast cancers, are characterized by more aggressive phenotype, expressed by lower expression of estrogen receptor and stronger expression of cytokeratin 5/6 and vimentin; this does not, however, translate into differences in the distribution of intrinsic tumor phenotypes.
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Affiliation(s)
- Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of GdańskGdańsk, Poland
| | - Jolanta Szade
- Department of Pathomorphology, Medical University of GdańskGdańsk, Poland
| | - Beata Pieczyńska
- Department of Pathomorphology, Medical University of GdańskGdańsk, Poland
| | - Anna Żaczek
- Laboratory of Cell Biology, Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of GdańskGdańsk, Poland
| | | | | | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of GdańskGdańsk, Poland
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Hayashi M, Yamamoto Y, Takata N, Iwase H. A case of synchronous bilateral breast cancer with different pathological responses to neoadjuvant chemotherapy with different biological character. Springerplus 2013; 2:272. [PMID: 23875131 PMCID: PMC3696175 DOI: 10.1186/2193-1801-2-272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/13/2013] [Indexed: 12/02/2022]
Abstract
We report a case of synchronous locally advanced bilateral breast cancer with different pathological responses to neoadjuvant chemotherapy with different biological character. The patient had presented bilateral breast cancer: the left breast cancer was hormone receptor negative, human epidermal growth factor receptor-2 (HER2) positive, and classified as T4bN1M0, stage IIIb, while the right was hormone receptor positive, HER2-negative, and classified as T4bN0M0, stage IIIb. We administered four cycles of anthracycline-based therapy followed by 12 weekly cycles of taxane with trastuzumab for neoadjuvant chemotherapy. We had achieved a significant left tumor reduction after each chemotherapy, but not right tumor. Bilateral modified radical mastectomies with axillary lymph-node dissection were performed. The therapeutic effect in the left was determined as a pathological complete response, in contrast to the right side. She has no recurrence for more than five years, though she had advanced cancer with oncologic emergency. This case could be an informative experience to understand the relation of tumor biology and response to systemic therapy.
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Affiliation(s)
- Mitsuhiro Hayashi
- Department of Breast and Endocrine Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto-city, Kumamoto, 860-8556 Japan
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Abstract
Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well.
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Affiliation(s)
- Sangeeta Taneja
- Department of MRI, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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