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Özdemir A, Güven M, Binici S, Uygur S, Toktaş O. Impact of 18F-FDG PET/CT in the management decisions of breast cancer board on early-stage breast cancer. Clin Transl Oncol 2024; 26:1139-1146. [PMID: 37848693 DOI: 10.1007/s12094-023-03331-1] [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: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Breast cancer is the most common malignancy accounting for 11.7% of all cancer cases, with a rising incidence rate. Various diagnostic methods, including 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), play a crucial role in breast cancer diagnosis and staging. However, the unnecessary use of advanced imaging techniques such as PET/CT in early-stage breast cancer can have negative effects on both economics and patients. We aimed to investigate the impact of PET/CT on the management decisions of early-stage breast cancer patients by the breast cancer tumor board. METHODS A retrospective analysis was performed on a cohort of 81 patients with early-stage breast cancer who were evaluated by breast cancer tumor board from January 2015 to December 2020. Demographic, clinical, and radiographic data, along with surgical procedures and treatment options, were documented and analyzed. RESULTS The results showed that 18F-FDG PET/CT had a moderate impact on treatment decisions of breast cancer tumor board, as only treatment decisions were changed in 14,86% of the patients. The surgical procedure decision of breast cancer tumor board changed in 12.35% of patients, while 87.65% of patients had consistent decisions before and after PET/CT. Pathological assessments revealed invasive ductal carcinoma as the most prevalent tumor type, and molecular subtypes were predominantly luminal B. PET/CT use had limited impact on surgical procedures and did not significantly alter treatment decisions of breast cancer tumor board in this early-stage breast cancer cohort. CONCLUSIONS In conclusion, this study highlights the importance of adherence to the guidelines and appropriate use of PET/CT in early-stage breast cancer management. PET/CT should be reserved for cases where it is clinically warranted, considering the potential economic burden and minimal impact on treatment decisions of breast cancer tumor board in this patient population.
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Affiliation(s)
- Abdulselam Özdemir
- Department of General Surgery, Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Osman Toktaş
- Department of General Surgery, Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
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Shimomura A, Sagara Y, Koto R, Fujiwara M, Kanemura Y, Kitagawa H, Saji S. Real-world data of HER2-negative early breast cancer patients treated with anthracycline and/or taxane regimens in Japan. Breast Cancer 2024:10.1007/s12282-024-01572-8. [PMID: 38679657 DOI: 10.1007/s12282-024-01572-8] [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: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Anthracycline- and taxane-based chemotherapy regimens are established treatments for human epidermal growth factor receptor (HER)2-negative early-stage breast cancer with high risk of recurrence. This study examined the prevalence of these chemotherapy regimens as perioperative therapy, the patterns of retreatment, and factors influencing prescription choices in Japan. METHODS This observational cohort study focused on high-risk early-stage breast cancer patients not undergoing anti-HER2 therapy, utilizing data from a hospital-based claims database in Japan spanning from April 2008 to September 2021. RESULTS Of 42,636 high-risk patients who underwent breast cancer surgery, 32,133 (75.4%) were categorized as having luminal-type (received endocrine therapy) and 10,503 (24.6%) as having triple-negative cancer (not receiving any endocrine therapies). Most patients (98.7%) with luminal-type breast cancer received perioperative therapy, and 40.3% of those received anthracycline/taxane. In the triple-negative group, 57.0% of all patients received perioperative therapy and of those, 93.4% received anthracycline/taxane. Being over 40 years old, having an early stage (clinical stage ≤ II), and receiving treatment in non-specialized facilities were associated with less use of anthracycline/taxane in the luminal-type group. For the triple-negative group, associated factors with less use of anthracycline/taxane included being over 60 years old, treatment in small hospital (capacity < 200 beds), and treatment in non-specialized facilities. CONCLUSIONS Approximately half the patients in both the luminal-type and triple-negative groups were prescribed anthracycline and/or taxane for perioperative chemotherapy. The choice was associated with patient age, cancer stage, and the scale and specialization of the treatment facilities. This study sheds light on the current state of breast cancer treatment practices in Japan.
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Affiliation(s)
- Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Social Medical Corporation Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Ryo Koto
- Medical Department, AstraZeneca K.K., Osaka, Japan
| | | | | | | | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan.
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Vongsaisuwon M, Vacharathit V, Lerttiendamrong B, Manasnayakorn S, Tantiphlachiva K, Vongwattanakit P, Treeratanapun N. Reconsidering the Role of Frozen Section in Sentinel Lymph Node Biopsy for Mastectomy Patients. J Surg Res 2024; 293:64-70. [PMID: 37716102 DOI: 10.1016/j.jss.2023.08.013] [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: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Axillary lymph node dissection was recommended for mastectomy patients with more than two nodal metastases from sentinel lymph node biopsy. Conventionally, intraoperative frozen section was sent routinely to reduce the need for second-stage axillary lymph node dissection; however, recent global trend has seen decreasing usage of the intraoperative analyses. This pilot study conducted in Thailand aimed to evaluate the role of intraoperative frozen section of sentinel lymph node biopsy in early-stage breast cancer patients who underwent mastectomy. METHODS A 5-y retrospective study of 1773 patients was conducted in Thailand. The inclusion criteria were early-stage breast cancer patients with either radiologically negative nodes, or radiographically borderline nodes found to be negative on fine needle aspiration who underwent mastectomy and sentinel lymph node biopsy. Reoperations were indicated when three or more nodal metastases were detected on the pathological analysis. The reoperation rate prevented by frozen section and the reoperation rate needed for those with permanent section alone were reported. RESULTS Among 265 patients, 202 patients underwent concomitant intraoperative frozen section while the remaining 63 patients underwent permanent section alone. Six patients (3.0%) from the frozen section group and one patient (1.6%) from the permanent section group were found with more than two nodal metastases. Despite using intraoperative frozen sections, only one patient from each group required reoperation. There was no significant difference in the number of patients requiring reoperation between the frozen section group and the permanent section group. CONCLUSIONS Our study provides strong evidence to all surgeons that in early breast cancer patients undergoing mastectomy, sentinel lymph node biopsy with permanent section analysis alone may not lower the standard of care compared to using additional intraoperative frozen section analysis. Adopting this practice may lead to decreased operation costs, operative time, and anesthetic side effects.
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Affiliation(s)
- Mawin Vongsaisuwon
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Sopark Manasnayakorn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kasaya Tantiphlachiva
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Nattanan Treeratanapun
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Sigurdson S, Thibodeau S, Montgomery L, Olding T, Hopman W, Korzeniowski M. Analysis of multicatheter interstitial brachytherapy: Accelerated partial breast irradiation in a retrospective cohort of early-stage breast cancer patients. Brachytherapy 2024; 23:52-57. [PMID: 37806789 DOI: 10.1016/j.brachy.2023.08.008] [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: 05/02/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To determine cardiac dose received by patients treated with high dose rate interstitial brachytherapy. Patients with early-stage, node negative breast cancer can be treated using multi-catheter interstitial brachytherapy accelerated partial breast irradiation (MIB-APBI), with the benefit of reduced treatment volumes and favorable toxicity. METHODS AND MATERIALS We conducted a retrospective review of left-sided breast cancer patients treated using MIB-APBI at our institution since 2014. The mean heart dose (MHD) was calculated using the Oncentra 3.2 planning system. The minimum distance between the planning target volume (PTVeval) and heart contour was measured manually. FINDINGS 81 patients were included. The upper outer quadrant was the most common site. The MHD was 97.8 cGy (EQD2a/b=2) (range 22-229 cGy). MHD significantly correlated with the closest distance between PTVeval and heart contour (correlation coefficient -0.823, p <0.001); size of PTVeval (cc) and quadrant location did not. CONCLUSIONS Appropriately selected women with early-stage, low-risk, left-sided breast cancer who received MIB-APBI had acceptable MHD. There was a strong correlation between the distance of PTVeval and MHD. Quadrant breast tumor is in cannot be used as a surrogate for MHD in brachytherapy. Our findings contribute to the growing evidence of the utility and safety of MIB-APBI.
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Affiliation(s)
- Samantha Sigurdson
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada.
| | - Stephane Thibodeau
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Logan Montgomery
- Department of Oncology, Division of Medical Physics, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Tim Olding
- Department of Oncology, Division of Medical Physics, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Kingston Health Sciences Research Centre & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Martin Korzeniowski
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
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Rogers C, Cobb AN, Lloren JIC, Chaudhary LN, Johnson MK, Huang CC, Teshome M, Kong AL, Singh P, Cortina CS. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 2024; 203:317-328. [PMID: 37864105 PMCID: PMC10872271 DOI: 10.1007/s10549-023-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.
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Affiliation(s)
- Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Jan I C Lloren
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chiang-Ching Huang
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Mediget Teshome
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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Zhan Q, Zhao X, Zheng G, Liu J, Wu S, Huang J, Yu L, Fu F. Effects of Breast-Conserving Surgery and Mastectomy on the Survival of Patients with Early-Stage (T1-2N0-1M0) HER2-Positive Breast Cancer: A Propensity Score-Matched Analysis. Oncol Res Treat 2023; 46:511-519. [PMID: 37931609 DOI: 10.1159/000534856] [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: 04/22/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Although breast-conserving therapy (BCT) promises at least a similar survival rate for patients with early breast cancer compared with mastectomy, its efficacy in patients with human epidermal growth factor receptor 2 (HER2)-positive tumors remains unclear. Therefore, we conducted this study to explore differential effects of BCT and mastectomy on survival outcomes of patients with early-stage HER2-positive breast cancer. METHODS Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and basic characteristics of patients who received either BCT or mastectomy were balanced using propensity score matching (PSM). Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression were performed. RESULTS In total, 20,277 patients were diagnosed with T1-2N0-1M0 HER2-positive breast cancer between 2010 and 2015. After PSM, 6,185 pairs of patients were enrolled for further analysis. Compared with those undergoing mastectomy, patients receiving BCT had superior overall survival (OS) (hazard ratio [HR], 0.63; 95% confidence interval [CI]: 0.55-0.73; p < 0.001) and breast cancer-specific survival (BCSS) (HR: 0.59; 95% CI: 0.48-0.71; p < 0.001). The subgroup analyses revealed that survival outcomes (OS and BCSS) of BCT were better than those of mastectomy among estrogen receptor (ER)+/progesterone receptor (PR)+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes (p < 0.05 for all); however, patients with ER-/PR+/HER2+ subtypes who underwent BCT had similar OS and BCSS (p > 0.05 for both) to those treated with mastectomy. DISCUSSION/CONCLUSION Despite the aggressiveness of the disease, we found that BCT may confer better long-term survival than mastectomy for patients with T1-2N0-1M0 HER2-positive breast cancer, particularly for those with ER+/PR+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes. In addition, our study provided insights into the clinical applications of BCT. However, this retrospective study has introduced several inevitable limitations, and further prospective research is warranted to verify these conclusions.
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Affiliation(s)
- Qiaohui Zhan
- Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xuye Zhao
- Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Guifeng Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Jiahui Liu
- Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Songling Wu
- Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Jiawen Huang
- Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Liuwen Yu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Grayson S, Sereika S, Conley Y, Bender C, Carr K, Wesmiller S. Psychoneurological symptom cluster trajectories in individuals treated for early-stage breast cancer. Support Care Cancer 2023; 31:563. [PMID: 37676346 DOI: 10.1007/s00520-023-08018-5] [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: 03/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND/PURPOSE The psychoneurological (PN) symptom cluster has been defined in the literature as anxiety, depression, fatigue, sleep disturbance, and pain. PN symptoms are influenced by cancer and its treatment as well as biological and psychosocial factors. The purpose of this analysis was to describe temporal patterns of the PN symptom cluster severity in breast cancer survivors over the year following initial surgical intervention and investigate the time-dependent effect of treatment modality on symptom severity. METHODS In a prospective longitudinal study, symptom data were collected from individuals with early-stage breast cancer 48 h after initial surgery and at monthly intervals for the subsequent 12 months using the PROMIS®-29 subscales for anxiety, depression, fatigue, sleep disturbance, and pain. Applying group-based trajectory modeling, we classified participants into subgroups with similar temporal patterns of PN symptom cluster severity and included treatment modality as a time-dependent covariate. RESULTS Across 353 participants (mean age 60.10 ± 11.9 years, 88.95% white, 66.57% undergoing segmental mastectomies), four distinct trajectory subgroups (mild [47.6%; n = 168], moderate [28.3%; n = 100], severe [15.9%; n = 56], and most severe increasing [8.2%; n = 29]) were revealed for PN symptom cluster severity. Chemotherapy was associated with greater severity in all symptom severity subgroups, while radiation was associated with greater symptom severity in the mild and most severe increasing subgroups. CONCLUSIONS AND IMPLICATIONS A subgroup of individuals with early-stage breast cancer experienced persistent severe PN symptoms. Future research should focus on psychosocial, biological, and disease-related characteristics of individuals in the most severe symptom group to inform preventative treatments and effective interventions.
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Affiliation(s)
- Susan Grayson
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Susan Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katrina Carr
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Wesmiller
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Li Z, Shen G, Shi M, Zheng Y, Guan Y, Xin Y, Wang M, Zhao F, Ren D, Zhao J. Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis. Cancer Pathog Ther 2023; 1:205-215. [PMID: 38327841 PMCID: PMC10846319 DOI: 10.1016/j.cpt.2023.03.002] [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] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 02/09/2024]
Abstract
Background A high body mass index (BMI) can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors. However, the association between high BMI and prognosis in early-stage breast cancer (EBC) remains unclear. We aimed to assess the effects of high BMI on the prognosis of patients with EBC. Methods The PubMed, Embase, and Cochrane Library databases and proceedings of major oncological conferences related to the effects of BMI on the prognosis of breast cancer were searched up to November 2021. Fixed- and random-effects models were used for meta-analyses. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free survival (DFS) and overall survival (OS) were extracted from the included literature. Results Twenty retrospective cohort studies with 33,836 patients with EBC were included. Overweight patients had worse DFS (HR: 1.16, 95% CI: 1.05-1.27, P = 0.002) and OS (HR: 1.20; 95% CI: 1.09-1.33, P < 0.001). Obesity also had adverse effects on DFS (HR: 1.17, 95% CI: 1.07-1.29, P = 0.001) and OS (HR: 1.30, 95% CI: 1.17-1.45, P < 0.001). Likewise, patients with high BMI had worse DFS (HR: 1.16, 95% CI: 1.08-1.26, P < 0.001) and OS (HR: 1.25, 95% CI: 1.14-1.39, P < 0.001). In subgroup analyses, overweight had adverse effects on DFS (HR: 1.11, 95% CI: 1.04-1.18, P = 0.001) and OS (HR: 1.18, 95% CI: 1.11-1.26, P < 0.001) in multivariate analyses, whereas the relationship that overweight had negative effects on DFS (HR: 1.21, 95% CI: 0.99-1.48, P = 0.058) and OS (HR: 1.39, 95% CI: 0.92-2.10, P = 0.123) was not statistically significant in univariate analysis. By contrast, obesity had adverse effects on DFS (HR: 1.21, 95% CI: 1.06-1.38, P = 0.004 and HR: 1.14, 95% CI: 1.08-1.22, P < 0.001) and OS (HR: 1.33, 95% CI: 1.15-1.54, P < 0.001 and HR: 1.23, 95% CI: 1.15-1.31, P < 0.001) in univariate and multivariate analyses, respectively. Conclusions Compared with normal weight, increased body weight (overweight, obesity, and high BMI) led to worse DFS and OS in patients with EBC. Once validated, these results should be considered in the development of prevention programs.
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Affiliation(s)
| | | | | | - Yonghui Zheng
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yumei Guan
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yuanfang Xin
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Miaozhou Wang
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Fuxing Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Dengfeng Ren
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
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Lu H, Yan H, Liao S, Deng J, Zhang J, Yao F, Zheng H, Sun S, Zhang Y. Efficacy, cardiotoxicity and factors affecting pathologic complete response of neoadjuvant chemotherapy with anthracycline-containing verses anthracycline-free regimens plus dual HER2 blockade for HER2-positive early-stage breast cancer: a retrospective study. Transl Cancer Res 2023; 12:1490-1502. [PMID: 37434677 PMCID: PMC10331454 DOI: 10.21037/tcr-22-2547] [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: 11/04/2022] [Accepted: 05/06/2023] [Indexed: 07/13/2023]
Abstract
Background The aim of this study was to compare the efficacy, cardiotoxicity and factors affecting pathologic complete response (pCR) of neoadjuvant chemotherapy (NACT) regimen TCbHP (docetaxel/nab-paclitaxel, carboplatin, trastuzumab and pertuzumab) and AC-THP (doxorubicin, cyclophosphamide followed by docetaxel/nab-paclitaxel, trastuzumab and pertuzumab) for human epidermal growth factor receptor 2-positive (HER2+) early-stage breast cancer at a retrospective cohort. Methods This retrospective study included the patients with HER2+ early-stage breast cancer who received NACT with the regimen TCbHP or AC-THP and then underwent surgery from 2019 to 2022. pCR rate and breast-conserving rate were calculated to evaluate the efficacy of the regimens. Left ventricular ejection fraction (LVEF) from echocardiograms and abnormal electrocardiographs (ECGs) were collected to evaluate the cardiotoxicity of the two regimens. Association between the characteristics of the breast cancer lesions by magnetic resonance imaging (MRI) and the pCR rate were also explored. Results A total of 159 patients were enrolled, including 48 patients in the AC-THP group and 111 patients in the TCbHP group. The pCR rate of the TCbHP group 64.0% (71/111) was significantly higher than that of for the the AC-THP group 37.5% (18/48) (P=0.002). Estrogen receptor (ER) status (P=0.011, OR: 0.437, 95% CI: 0.231-0.829), progesterone receptor (PR) status (P=0.001, OR: 0.309, 95% CI: 0.157-0.608) and IHC HER2 status (P=0.003, OR: 7.167, 95% CI: 1.970-26.076) were significantly correlated with the pCR rate. LVEF decreased at 6 and 12 months after treatment in the AC-THP group (P=0.024 and 0.040), which only decreased after 6 months of treatment in the TCbHP group (P=0.048). Post-NACT MRI characteristics including mass features (P<0.001) and enhancement type (P<0.001) were significantly associated with pCR rate. Conclusions Early-stage HER2+ breast cancer treated with the TCbHP regimen has a higher pCR rate than the AC-THP group. The TCbHP regimen appears to have lower cardiotoxicity than the AC-THP regimen in terms of LVEF. Mass features and enhancement type at post-NACT MRI significantly associated with the pCR rate of breast cancer patients.
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Affiliation(s)
- Hang Lu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Han Yan
- Department of Cardiac Function, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shichong Liao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingwen Deng
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiucheng Zhang
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Yao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongmei Zheng
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology and Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yimin Zhang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Balic M, Thomssen C, Gnant M, Harbeck N. St. Gallen/Vienna 2023: Optimization of Treatment for Patients with Primary Breast Cancer - A Brief Summary of the Consensus Discussion. Breast Care (Basel) 2023; 18:213-222. [PMID: 37383954 PMCID: PMC10294024 DOI: 10.1159/000530584] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 06/30/2023] Open
Abstract
The St. Gallen Consensus Conference on early breast cancer treatment 2023 was again a live event and took place in Vienna, Austria. After 4 years and one virtual event due to the pandemic, more than 2,800 participants from over 100 countries came together in Vienna, and the 2023 St. Gallen/Vienna conference was a great success. Over 3 days, the global faculty reviewed the most important evidence published during the last 2 years and debated over controversial topics, and finally, the consensus votes aimed to define the impact of the new data on everyday routine practice. Focuses of this year's conference were radiotherapy and local management of the axilla, genetics, and their impact on treatment, as well as the role of the immune system and tumor-infiltrating lymphocytes in pathological reports and treatment decision-making. The traditional panel votes were moderated for the first time by Harold Burstein from Boston, and with questions previously voted on and live voting, the panel managed for the most part to clarify the critical questions. This report by editors of BREAST CARE summarizes the results of the 2023 international panel votes with respect to locoregional and systemic treatment as a brief news update but does not intend to replace the official St. Gallen Consensus publication that not just reports but also interprets the panel votes and will follow shortly in a major oncological journal. The next (19th) St. Gallen International Breast Cancer Conference will again take place in Vienna (save the date: March 12-15, 2025).
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Affiliation(s)
- Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology and CCCMunich, Breast Center, LMU University Hospital, (LMU), Munich, Germany
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11
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Mäurer MA, Drozdz S, Ehrenpfordt J, Schwedas M, Friedlein M, Hille N, Riede C, Schrott S, Graf M, Wurschi G, Kamp MA, Wittig A, Knippen S. Development, implementation, and results of a simulation-based hands-on brachytherapy workshop for medical students. Strahlenther Onkol 2023; 199:370-378. [PMID: 36881115 PMCID: PMC9990013 DOI: 10.1007/s00066-023-02058-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) require the development of competence-oriented teaching formats. In addition, there is a great need for high-quality teaching in the field of radiation oncology, which manifests itself already during medical school. For this reason, we developed a simulation-based, hands-on medical education format to teach competency in performing accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy for early breast cancer. In addition, we designed realistic breast models suitable for teaching both palpation of the female breast and implantation of brachytherapy catheters. METHODS From June 2021 to July 2022, 70 medical students took part in the hands-on brachytherapy workshop. After a propaedeutic introduction, the participants simulated the implantation of single-lead catheters under supervision using the silicone-based breast models. Correct catheter placement was subsequently assessed by CT scans. Participants rated their skills before and after the workshop on a six-point Likert scale in a standardized questionnaire. RESULTS Participants significantly improved their knowledge-based and practical skills on APBI in all items as assessed by a standardized questionnaire (mean sum score 42.4 before and 16.0 after the course, p < 0.001). The majority of respondents fully agreed that the workshop increased their interest in brachytherapy (mean 1.15, standard deviation [SD] 0.40 on the six-point Likert scale). The silicone-based breast model was found to be suitable for achieving the previously defined learning objectives (1.19, SD 0.47). The learning atmosphere and didactic quality were rated particularly well (mean 1.07, SD 0.26 and 1.13, SD 0.3 on the six-point Likert scale). CONCLUSION The simulation-based medical education course for multicatheter brachytherapy can improve self-assessed technical competence. Residency programs should provide resources for this essential component of radiation oncology. This course is exemplary for the development of innovative practical and competence-based teaching formats to meet the current reforms in medical education.
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Affiliation(s)
- Matthias A Mäurer
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.
- Clinician Scientist Program "OrganAge", Jena University Hospital, 07747, Jena, Germany.
| | - Sonia Drozdz
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Juliet Ehrenpfordt
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Michael Schwedas
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Melissa Friedlein
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Nadine Hille
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Cora Riede
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Steffen Schrott
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Maximilian Graf
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Georg Wurschi
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
- Clinician Scientist Program "CSP-11", Jena University Hospital, 07747, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Andrea Wittig
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Stefan Knippen
- Department for Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
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Akbulak F, Can G. Effectiveness of mandala coloring in reducing anxiety in women with early-stage breast cancer receiving chemotherapy for the first time. Explore (NY) 2023; 19:42-47. [PMID: 35508427 DOI: 10.1016/j.explore.2022.04.007] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Many people with cancer experience fear or anxiety when starting chemotherapy for the first time. Mandala coloring is an art therapy approach commonly used for anti-stress therapy. OBJECTIVE To assess whether mandala coloring reduces the anxiety experienced by women with early-stage breast cancer during their first chemotherapy session. DESIGN A quasi-experimental controlled study with pretest/posttest design. SETTING The study was conducted in the outpatient chemotherapy unit of the Istanbul University Institute of Oncology between March 2017 and May 2018. PARTICIPANTS Eight-four women with early-stage breast cancer who presented for their first session of chemotherapy were included, 41 in the intervention group and 43 in the control group. INTERVENTION Patients in the intervention group were asked to color a mandala for 30 min while receiving premedication prior to chemotherapy. No intervention was applied to the control group. MAIN OUTCOME MEASURES Levels of distress and anxiety were assessed before and after premedication using the distress thermometer and State-Trait Anxiety Inventory. RESULTS The sample group consisted primarily of women who had primary school education, were married, and were homemakers. Average distress levels were low in both the intervention and control group before premedication, and state anxiety scores did not differ statistically between the groups before or after premedication. However, patients in the intervention group who had high distress levels before premedication showed a significant decrease in state anxiety score after premedication, while patients in the control group showed no decrease.
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Affiliation(s)
- Fatma Akbulak
- Istanbul Health and Technology University, Güngören, İstanbul, Turkey.
| | - Gülbeyaz Can
- Istanbul University-Cerrahpaşa Florence Nightingale School of Nursing, Çağlayan, İstanbul/Turkey.
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Wang Y, Gavan SP, Steinke D, Cheung KL, Chen LC. The impact of age on health utility values for older women with early-stage breast cancer: a systematic review and meta-regression. Health Qual Life Outcomes 2022; 20:169. [PMID: 36564800 PMCID: PMC9789668 DOI: 10.1186/s12955-022-02067-w] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION An increasing number of postmenopausal women are diagnosed with breast cancer at an older age (≥ 70 years). There is a lack of synthesised health utility data to support decision-making for managing breast cancer in this older population. This study aimed to identify the availability of, and the subsequent impact of age on, health state utility values (HSUVs) measured by the EQ-5D for older women with early-stage breast cancer. METHOD This systematic review identified EQ-5D (3L or 5L version) HSUVs for postmenopausal women with early-stage breast cancer. Studies were identified from a previous systematic review (inception to 2009) and an electronic database search (Medline and Embase; 2009 to September 2021). Mean HSUVs were summarised by health state. Quality appraisal was performed on studies reporting HSUVs for older ages (≥ 70 years). Multivariable meta-regression assessed the association between HSUVs and age, health state, treatments received, and time of measuring the utility values (greater or less than one year post-treatment). RESULTS Fifty EQ-5D HSUVs were identified from 13 studies. Mean HSUVs decreased as health state worsened: from the stable (mean=0.83) to progression (mean=0.79) and advanced (mean=0.68) states. Two studies reported six HSUVs estimated from the sample of women with a mean age ≥ 70. Meta-regression model fit improved by including age as an independent variable and attenuated the estimated utility decrements associated with worse health states. Utility decrements for the progression and advanced states were -0.052 (95%CI: -0.097, -0.007) and -0.143 (95%CI: -0.264, -0.022) respectively. The breast cancer-specific utility decrement associated with a one-year increase in age was -0.001 (95%CI: -0.004, 0.002). CONCLUSION Relevant and accurate HSUVs are essential to help support decision-making about the most effective and cost-effective ways to manage early-stage breast cancer in older women. Age has a vital role in determining health utility values in this population. This study provides analysts and decision-makers with HSUVs and utility decrements that reflect the disease process in this older population.
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Affiliation(s)
- Yubo Wang
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
| | - Sean P. Gavan
- grid.5379.80000000121662407Manchester Centre for Health Economics, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Douglas Steinke
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
| | - Kwok-Leung Cheung
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT UK
| | - Li-Chia Chen
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
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Yang Y, Zhang J, Li JY, Xu L, Wang SN, Zhang JQ, Xun Z, Xia Y, Cao JB, Liu Y, Shi LY, Li W, Shi YL, He YG, Gu DJ, Yu ZY, Chen K, Lan J. The ctDNA-based postoperative molecular residual disease status in different subtypes of early-stage breast cancer. Gland Surg 2022; 11:1924-1935. [PMID: 36654951 PMCID: PMC9840987 DOI: 10.21037/gs-22-634] [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: 10/11/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
Background Breast cancer is a highly heterogeneous disease. Early-stage, non-metastatic breast cancer is considered curable after definitive treatment. Early detection of tumor recurrence and metastasis through sensitive biomarkers is helpful for guiding clinical decision-making and early intervention in second-line treatment, which could improve patient prognosis and survival. Methods In this real-world study, we retrospectively analyzed 82 patients with stages I to III breast cancer who had been analyzed by molecular residual disease (MRD) assay. A total of 82 tumor tissues and 224 peripheral blood samples were collected and detected by next-generation sequencing (NGS) based on a 1,021-gene panel in this study. Results MRD positivity was detected in 18 of 82 patients (22.0%). The hormone receptor-/human epidermal growth factor receptor 2+ (HR-/HER2+) subgroup had the highest postoperative MRD detection rate at 30.8% (4/13). The BRCA2 and SLX4 genes were significantly enriched in all patients in the MRD positive group and FGFR1 amplification was significantly enriched in the MRD negative group with HR+/HER2-. The number of single nucleotide variants (SNVs) in tissue samples of MRD-positive patients was higher than that of MRD-negative patients (11.94 vs. 8.50 SNVs/sample). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that there was a similar biological function of the tumor-mutated genes in the 2 MRD status groups. Conclusions This real-world study confirmed that patient samples of primary tumor tissue with different MRD status and molecular subtypes had differential genetic features, which may be used to predict patients at high risk for recurrence.
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Affiliation(s)
- Yang Yang
- Medical College of Soochow University, Suzhou, China
| | - Jie Zhang
- Department of Gynecology & Obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiao-Yang Li
- Department of Ultrasound, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lu Xu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Si-Ning Wang
- Medical College of Soochow University, Suzhou, China
| | - Jun-Qi Zhang
- Medical College of Soochow University, Suzhou, China
| | - Zhou Xun
- Medical College of Soochow University, Suzhou, China
| | - Yu Xia
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian-Bo Cao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Liu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li-Yan Shi
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Li
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Yuan-Ge He
- Geneplus-Beijing Institute, Beijing, China
| | - De-Jian Gu
- Geneplus-Beijing Institute, Beijing, China
| | - Zheng-Yuan Yu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Chen
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Lan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Mollavelioglu B, Cetin Aktas E, Cabioglu N, Abbasov A, Onder S, Emiroglu S, Tükenmez M, Muslumanoglu M, Igci A, Deniz G, Ozmen V. High co-expression of immune checkpoint receptors PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT on tumor-infiltrating lymphocytes in early-stage breast cancer. World J Surg Oncol 2022; 20:349. [PMID: 36271406 DOI: 10.1186/s12957-022-02810-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/08/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
High expression of immune checkpoint receptors (ICRs) in the tumor microenvironment regulates the anti-tumor response. In this study, the differential expressions of ICRs on tumor-infiltrating lymphocytes (TILs) in patients with early-stage breast cancer were investigated.The study included 32 patients who underwent surgery with a diagnosis of early-stage breast cancer between September 2018 and March 2020. TIL isolation was performed using a MACS tumor separation device and tumor separation kit. PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT expression of cytotoxic T and natural killer (NK) cells on TILs and peripheral blood lymphocytes (PBLs) were determined by flow cytometry.Patients with a high Ki-67 index, high TIL density, and HER-2 positivity were more likely to have increased CD16+CD56dim NK cells on TILs. Patients with T2 tumors were more likely to have increased expression of PD-1, LAG-3, and TIGIT on tumor-infiltrating CD8+ cytotoxic T cells than those with T1 tumors. PD-1, CTLA-4, TIGIT, LAG-3, and TIM-3 expression of CD8+ T and CD16-CD56bright NK cells in TILs showed significant positive correlations with each other. PD1+CD8+, TIGIT+CD16+, and CTLA-4+CD56+ cells in PBLs and TILs were found to be negatively correlated, whereas only TIM-3+ expression of CD8+ T and CD16+CD56dim cells in PBLs and TILs showed positive correlations.Our results suggest that CD16+CD56dim NK cells on TILs may play a major role in the immune response against HER2-positive or highly proliferating breast tumors in patients with early-stage breast cancer. Furthermore, various ICRs were found to be highly co-expressed with each other on TILs, including PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT. These receptors may synergistically suppress the response to the tumor, which may trigger immune escape mechanisms in the early stage of carcinogenesis. However, ICR expressions other than TIM3 on PBLs were not found to accompany their counterparts on TILs.
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Affiliation(s)
- Baran Mollavelioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Esin Cetin Aktas
- Department of Immunology, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Aykhan Abbasov
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selman Emiroglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Mustafa Tükenmez
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Vahit Ozmen
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey.
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Treeratanapun N, Lerttiendamrong B, Vacharathit V, Tantiphlachiva K, Vongwattanakit P, Manasnayakorn S, Vongsaisuwon M. Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital. BMC Surg 2022; 22:261. [PMID: 35794594 PMCID: PMC9260991 DOI: 10.1186/s12893-022-01709-6] [Citation(s) in RCA: 1] [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: 05/08/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2021, there is an increased global trend for sending sentinel lymph node biopsy (SLNB) specimens for permanent section (PS) without intraoperative frozen sections (FS). This pilot study conducted in Thailand determines the re-operation rate for SLNB without FS. METHOD We retrospectively reviewed 239 SLNB cases without FS at King Chulalongkorn Memorial Hospital from April 2016 to April 2021. The patients were diagnosed with primary invasive breast cancer with clinically negative nodes. The clinical nodal status was assessed from physical examination. The re-operation rate was determined by the number of positive SLNs; where 3 more nodal metastases were subjected to a second surgical procedure. RESULT Between April 2016 and April 2021, 239 patients who had undergone SLNB in accordance with ACOSOG Z0011 criteria with PS alone was enrolled. A total of 975 SLNs were removed from these 239 patients, with an average of 4.15 nodes per patient. Out of 239 patients, 21 (8.8%) and 6 (2.5%) had metastatic disease in 1 and 2 nodes, respectively. The remaining 212 (88.7%) patients had no nodal metastasis. None of the patients were subjected to a second surgical procedure. CONCLUSION We conclude that the implementation of SLNB with PS analysis alone in patients who satisfy the ACOSOG Z0011 criteria, with a re-operation rate of 0%, does not have outcomes that would be altered by the standard of care additional FS analysis. With ommision of FS analysis, operation cost, operative time and anesthetic side effects are projected to decrease.
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Affiliation(s)
- Nattanan Treeratanapun
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Bhoowit Lerttiendamrong
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Voranaddha Vacharathit
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Kasaya Tantiphlachiva
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Phuphat Vongwattanakit
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Sopark Manasnayakorn
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand
| | - Mawin Vongsaisuwon
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Sirindhorn Building 1873, Rama 4 Rd., Lumphini, Bangkok, 10330, Thailand.
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Vasigh M, Meshkati Yazd SM, Karoobi M, Hajebi R, Yazdankhah Kenari A. Does ultrasound evaluation of the axilla increase the rate of axillary lymph node dissection in early stage clinically node negative breast cancer patients? BMC Surg 2022; 22:80. [PMID: 35241059 PMCID: PMC8895764 DOI: 10.1186/s12893-022-01530-1] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Management and axillary staging of breast cancer has become less invasive and more conservative, over the decades. Considering Z011, axillary lymph node dissection (ALND) can be avoided in T1-2 N0-1 breast cancers with one or two positive sentinel lymph nodes (SLNs), if they are candidates for breast conserving surgery and radiotherapy. The aim of this study was to recognize if pre-operative axillary US evaluation in early-stage breast cancer could lead to more ALND in post Z011 era. Method 463 breast cancer patients were evaluated. 368 early-stage breast cancer patients (T1-2 N0) were included. We did not perform axillary US in early stage clinically node negative patients; however, 97 patients had axillary US prior to our visit. If axillary US could detect more than two suspicious LNs, US guided biopsy was performed. The remaining clinically node negative patients underwent upfront SLNB. ALND was performed if more than two SLNs were metastatic, or US-guided ALN biopsy proved metastatic involvement. Results 97 patients had axillary US evaluation before the surgery. 67 patients (69.2%) did not have any suspicious US detected axillary LNs, 17 patients (17.5%) had one, 7 patients (7.2%) had two, and 6 patients (6.2%) had more than two suspicious LNs according to their axillary US evaluation. Those with more than two suspicious LNs underwent ALN US-guided biopsy. Metastatic involvement of the LNs was proved in all of them and they underwent upfront ALND. ALND revealed more than 2 metastatic LNs in 2/6 patients (33.3%). 91 patients who were evaluated by axillary US, had less than two US detected suspicious LNs and underwent SLNB. Amongst 24 patients with one or two US detected suspicious LNs, 1/24 patient had more than two positive SLNs and underwent ALND. In this group 15.6% underwent ALND and 5.2% of them were unnecessary according to the recent guidelines. Axillary US had a false positive rate of 36.6%. The sensitivity of axillary US in distinguishing patients with more than two suspicious LNs in clinically node negative patients was 25%. In the second group (without pre-operative axillary US evaluation), SLNB was performed. 204/272 patients (75%) did not have LN metastasis. 54/272 patients (19.9%) had one or two metastatic SLNs and according to Z011, ALND was omitted. 5.1% had more than two metastatic SLNs and underwent ALND. Conclusion US evaluation of the axilla in early stage, clinically node negative breast cancer patients, is not sensitive enough to recognize more than two metastatic ALNs. It leads to more unnecessary ALND. Despite the small number of patients in this study, these results question the rationale of axillary US guided biopsy in low burden (less than two) suspicious LNs. looking for an imaging modality with a higher sensitivity in detecting the Burdon of axillary metastatic involvement is mandatory.
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Affiliation(s)
- Mahtab Vasigh
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, 14176-13151, Tehran, Iran
| | - Seyed Mostafa Meshkati Yazd
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, 14176-13151, Tehran, Iran
| | - Mohammadreza Karoobi
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, 14176-13151, Tehran, Iran
| | - Reza Hajebi
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, 14176-13151, Tehran, Iran
| | - Adel Yazdankhah Kenari
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, 14176-13151, Tehran, Iran.
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18
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Ganz PA, Bandos H, Geyer CE, Robidoux A, Paterson AH, Polikoff J, Baez-Diaz L, Brufsky AM, Fehrenbacher L, Parsons AW, Ward PJ, Provencher L, Hamm JT, Stella PJ, Carolla RL, Margolese RG, Shibata HR, Perez EA, Wolmark N. Behavioral and health outcomes from the NRG Oncology/NSABP B-36 trial comparing two different adjuvant therapy regimens for early-stage node-negative breast cancer. Breast Cancer Res Treat 2022; 192:153-161. [PMID: 35112166 PMCID: PMC8979645 DOI: 10.1007/s10549-021-06475-2] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The NSABP B-36 compared four cycles of doxorubicin and cyclophosphamide (AC) with six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC-100) in node-negative early-stage breast cancer. A sub-study within B-36, focusing on symptoms, quality of life (QOL), menstrual history (MH), and cardiac function (CF) was conducted. PATIENTS AND METHODS Patients completed the QOL questionnaire at baseline, during treatment, and every 6 months through 36 months. FACT-B Trial Outcome Index (TOI), symptom severity, and SF-36 Vitality and Physical Functioning (PF) scales scores were compared between the two groups using a mixed model for repeated measures analysis. MH was collected at baseline and subsequently assessed if menstrual bleeding occurred within 12 months prior to randomization. Post-chemotherapy amenorrhea outcome was examined at 18 months and was defined as lack of menses in the preceding year. Logistic regression was used to test for association of amenorrhea and treatment. CF assessment was done at baseline and 12 months. Correlation analysis was used to address associations between changes in baseline and 12-month PF and concurrent CF changes measured by LVEF. RESULTS FEC-100 patients had statistically significantly lower TOI scores during chemotherapy (P = 0.02) and at 6 months (P < 0.001); lower Vitality score at 6 months (P < 0.01), and lower PF score during the first year than AC patients. There were no statistically significant QOL score differences between the two groups beyond 12 months. No significant differences in symptom severity between the two groups were observed. Rates of amenorrhea were significantly different between FEC-100 and AC (67.4% vs. 59.1%, P < 0.001). There was no association between changes in LVEF and PF (P = 0.38). CONCLUSIONS Statistically significant QOL differences between the two groups favored AC; however, the magnitude was small and unlikely to be clinically meaningful. There was a clinical and statistically significant difference in risk for amenorrhea, favoring AC. TRIAL REGISTRY NCT00087178; Date of registration: 07/08/2004.
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Affiliation(s)
- Patricia A. Ganz
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California at Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hanna Bandos
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Charles E. Geyer
- NSABP/NRG Oncology, Pittsburgh, PA,Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, TX
| | - André Robidoux
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Surgery, Breast Cancer Research Group (GRCS), Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, PQ, Canada
| | - Alexander H.G. Paterson
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Jonathan Polikoff
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Research and Evaluation – Clinical Trials – Oncology, Kaiser Permanente - San Diego Mission, CA
| | - Luis Baez-Diaz
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Cancer Medicine, Puerto Rico NCORP/UPR Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Adam M. Brufsky
- NSABP/NRG Oncology, Pittsburgh, PA,UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Louis Fehrenbacher
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Kaiser Permanente, Northern CA Region, Vallejo, CA
| | - Ann W Parsons
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Presbyterian Oncology, MBCCOP, University of New Mexico, Albuquerque, NM
| | - Patrick J. Ward
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, Oncology/Hematology Care Clinical Trials, Cincinnati, OH
| | - Louise Provencher
- NSABP/NRG Oncology, Pittsburgh, PA,Centre des Maladies du Sein Deschenes-Fabia, CHU de Québec/Université Laval, Québec City, PQ, Canada
| | - John T. Hamm
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, Norton Cancer Institute, a part of Norton Healthcare, Louisville, KY
| | - Philip J. Stella
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, St Joseph Mercy Hospital, Ann Arbor, MI
| | - Robert L. Carolla
- NSABP/NRG Oncology, Pittsburgh, PA,CCOP, Ozark Health Ventures LLC-Cancer Research for the Ozarks, Springfield, MO
| | - Richard G. Margolese
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Jewish General Hospital, Montreal, PQ, Canada
| | - Henry R. Shibata
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Surgery, McGill University Health Centre, Montreal, PQ, Canada
| | - Edith A. Perez
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Hematology/Oncology and Cancer Biology, Mayo Clinic Jacksonville, Jacksonville, FL,NCCTG/ALLIANCE, Rochester, MN
| | - Norman Wolmark
- NSABP/NRG Oncology, Pittsburgh, PA,UPMC Hillman Cancer Center, Pittsburgh, PA
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Kruse ML, Kang IM, Bagegni NA, Howell WT, Moore HCF, Bedell CH, Stokoe CT. Management of Diarrhea in Patients with HER2-Positive Breast Cancer Treated with Neratinib: A Case Series and Summary of the Literature. Oncol Ther 2021. [PMID: 34800263 DOI: 10.1007/s40487-021-00178-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/13/2021] [Accepted: 10/29/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Neratinib and neratinib-based combinations have demonstrated efficacy for treatment of human epidermal growth factor receptor 2-positive (HER2+) early-stage and metastatic breast cancers. However, diarrhea has been reported as a common adverse event leading to neratinib discontinuation. Results from the CONTROL trial suggest that proactive diarrhea management with antidiarrheal prophylaxis or dose escalation of neratinib from a lower starting dose to the full FDA-approved dose of 240 mg/day can reduce the incidence, duration, and severity of neratinib-associated diarrhea in patients with early-stage breast cancer. Dose escalation has been included in the FDA-approved label for both early-stage and metastatic HER2+ breast cancer since June 2021. CASE SERIES This series of five cases details real-world clinical implementation of strategies for management of neratinib-induced diarrhea in patients with early-stage and metastatic HER2+ breast cancer, including a patient with a pre-existing gastrointestinal disorder. MANAGEMENT AND OUTCOME In four of five cases, diarrhea was managed with neratinib dose escalation, and antidiarrheal prophylaxis with loperamide plus colestipol was used in the remaining case. Management of diarrhea allowed all patients to remain on therapy. DISCUSSION This case series shows that neratinib-associated diarrhea can be managed effectively with neratinib dose escalation from a lower initial starting dose and/or prophylactic antidiarrheal medications in a real-world clinical setting. The findings highlight the importance of patient-provider communication in proactive management of adverse events. Widespread implementation of the strategies described here may improve adherence and thereby clinical outcomes for patients with HER2+ breast cancer treated with neratinib.
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20
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Stahl KA, Dodge D, Olecki EJ, Holguin RP, McLaughlin C, Wong W, Shen C. Insurance Status and Travel Distance to Single Treatment Facility Predictive of Mastectomy. J Surg Res 2021; 270:22-30. [PMID: 34628160 DOI: 10.1016/j.jss.2021.08.035] [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: 03/26/2021] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We evaluated the impact of insurance status and travel distance on the receipt of total mastectomy without reconstruction (TM) compared to breast conserving surgery with radiation (BCT) for early-stage breast cancer (BC) patients who received care at a single facility. We hypothesized that, lack of insurance and increased travel distance would be predictive of TM over BCT and disparities would vary by different races and/or ethnicities. METHODS Using the National Cancer Database from 2010-2017, we examined surgical patients with stage I or II BC, who received care at one facility. Chi-square tests examined subgroup differences by BCT or TM. Multivariable logistic regressions evaluated patient, facility, and pathologic factors associated with the receipt of TM over BCT for the entire cohort and by races and/or ethnicities. RESULTS Of the 284,202 patients, 70.1% received BCT while 29.9% received TM. After adjustment travel distance > 60 miles to a treatment facility, and non-insured patients were more likely to receive TM over BCT, when compared to travel distance < 20 miles and private insurance (all P < 0.05). Compared to other races and/or ethnicities, African Americans traveling > 60 miles were 65.4% more likely to receive TM over BCT compared to those traveling < 20 miles (P < .0001). Across all races and/or ethnicities after adjustment, lack of insurance was predictive for receipt of TM over BCT (P < 0.05). CONCLUSIONS Despite treatment at one facility, increased travel distance and insurance status are independently predictive of the receipt of TM over BCT in patients with early-stage BC. While travel distance is particularly impactful for African Americans, the impact of not having insurance on surgical treatments is universal across all races and/or ethnicities.
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Affiliation(s)
- Kelly A Stahl
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Daleela Dodge
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Elizabeth J Olecki
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Rolfy Perez Holguin
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Christopher McLaughlin
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - William Wong
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Chan Shen
- College of Medicine, Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, Hershey, Pennsylvania.
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21
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Franceschini D, Fogliata A, Spoto R, Dominici L, Lo Faro L, Franzese C, Comito T, Lobefalo F, Reggiori G, Cozzi L, Sagona A, Gentile D, Scorsetti M. Long term results of a phase II trial of hypofractionated adjuvant radiotherapy for early-stage breast cancer with volumetric modulated arc therapy and simultaneous integrated boost. Radiother Oncol 2021; 164:50-56. [PMID: 34537289 DOI: 10.1016/j.radonc.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE to report toxicity and cosmetic outcome with a median follow-up of 6 years of a phase II trial of hypofractionated radiotherapy with volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) for early-stage breast cancer after conservative surgery. MATERIALS AND METHODS From August 2010 to September 2014, patients requiring adjuvant radiotherapy for early-stage breast cancer were treated according to a phase I-II protocol with SIB to 40.5 and 48 Gy to the breast and the boost region, respectively, with VMAT technique. The primary endpoint evaluated the treatment feasibility regarding adherence to required dose constraints for target, heart and lungs. Acute and late toxicity, local and distant control were secondary endpoints. RESULTS 450 patients were included in the trial and analysed after a median follow-up of 6 years. Acute toxicity was already presented in a previous paper. Regarding late toxicity, 93% of patients had no skin alteration at five years, while 5.3% and 1.3% did record G1 and G2 residual toxicity, respectively. Cosmetic outcome was scored good or excellent in almost all cases (97.2%), fair only in 2.3% of patients. Residual tenderness in the irradiated breast was reported by 10% of patients. Cosmesis and breast pain improved during follow-up. Two cases of G2 pneumonitis and two cases of ischemic cardiopathy were registered during follow-up. Five cases presented local recurrence in the homolateral breast, four patients had a new primary cancer in the contralateral breast, while distant metastasis developed in 7 patients. CONCLUSION After more than six years, hypofractionated VMAT with SIB for adjuvant radiotherapy in early-stage breast cancer patients remains a safe and effective approach. Mature data on skin toxicity and cosmetic outcome are encouraging. However, longer follow-up is required to evaluate local control, cardiac toxicity and secondary carcinogenesis.
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Affiliation(s)
- D Franceschini
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - A Fogliata
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy.
| | - R Spoto
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Dominici
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Lo Faro
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - C Franzese
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - T Comito
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - F Lobefalo
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - G Reggiori
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy
| | - L Cozzi
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - A Sagona
- IRCCS Humanitas Research Hospital, Breast Unit, Milan-Rozzano, Italy
| | - D Gentile
- Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Breast Unit, Milan-Rozzano, Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
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22
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Palumbo I, Borghesi S, Gregucci F, Falivene S, Fontana A, Aristei C, Ciabattoni A. Omission of adjuvant radiotherapy for older adults with early-stage breast cancer particularly in the COVID era: A literature review (on the behalf of Italian Association of Radiotherapy and Clinical Oncology). J Geriatr Oncol 2021; 12:1130-1135. [PMID: 34020908 PMCID: PMC8131185 DOI: 10.1016/j.jgo.2021.05.008] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
This review is aimed at evaluating whether radiation therapy (RT) can be omitted in older adult early-stage low-risk breast cancer (BC) patients. The published data are particularly relevant at present, during the COVID-19 pandemic emergency, to define a treatment strategy and to prioritize essential therapy. Cochrane Database of Systematic Reviews and PubMED were systematically researched from outset through April 2020 using Mesh terms. Only randomized controlled trials (RCT), with one arm without adjuvant whole-breast irradiation (WBI), were included in the analysis. Recent literature regarding the COVID pandemic and BC RT was assessed. The reported RCTs identified a group of BC patients (pT1-2N0M0 R0, grade 1-2, estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative tumours) in which the absolute risk of local recurrence (LR) was considered low enough to omit RT. The most common risk factors were tumor diameter, nodal and receptor status. Adjuvant RT had a significant impact on LR but not on distant metastasis (DM) or death. During the COVID 19 pandemic, results from RTCs were re-considered to define treatment recommendations for BC patients. International scientific societies and radiation oncology experts suggested RT omission, whenever possible, in older adult early-stage BC patients. Adjuvant RT might be omitted in a highly selected group of older adult early-stage BC patients with favourable prognostic factors. Hypofractionated regimens should be the standard. RT omission, partial breast irradiation (PBI), and ultra- hypofractionated regimens could be considered in selected cases due to the pandemic.
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Affiliation(s)
- Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Borghesi
- Radiation Oncology Department, Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Fabiana Gregucci
- Radiation Oncology Division, Miulli-Felli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Sara Falivene
- Radiation Oncology Division, Ospedale del Mare, Asl Napoli 1 centro, Napoli, Italy
| | - Antonella Fontana
- Radiation Oncology Division, Santa Maria Goretti Hospital, Latina, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy,Corresponding author at: Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia General Hospital, Sant'Andrea delle Fratte, 06156 Perugia, Italy
| | - Antonella Ciabattoni
- Radiation Oncology Division, San Filippo Neri, Hospital, ASL Roma 1, Roma, Italy
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23
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Jacobs DHM, Charaghvandi RK, Horeweg N, Maduro JH, Speijer G, Roeloffzen EMA, Mast M, Bantema-Joppe E, Petoukhova AL, van den Bongard DHJG, Koper P, Crijns APG, Marijnen CAM, Verkooijen HM. Health-related quality of life of early-stage breast cancer patients after different radiotherapy regimens. Breast Cancer Res Treat 2021; 189:387-98. [PMID: 34216316 DOI: 10.1007/s10549-021-06314-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/26/2021] [Accepted: 06/22/2021] [Indexed: 02/08/2023]
Abstract
Purpose To evaluate and compare health-related quality of life (HRQL) of women with early-stage breast cancer (BC) treated with different radiotherapy (RT) regimens. Methods Data were collected from five prospective cohorts of BC patients treated with breast-conserving surgery and different RT regimens: intraoperative RT (IORT, 1 × 23.3 Gy; n = 267), external beam accelerated partial breast irradiation (EB-APBI, 10 × 3.85 Gy; n = 206), hypofractionated whole breast irradiation(hypo-WBI, 16 × 2.67 Gy; n = 375), hypo-WBI + boost(hypo-WBI-B, 21–26 × 2.67 Gy; n = 189), and simultaneous WBI + boost(WBI-B, 28 × 2.3 Gy; n = 475). Women ≥ 60 years with invasive/in situ carcinoma ≤ 30 mm, cN0 and pN0-1a were included. Validated EORTC QLQ-C30/BR23 questionnaires were used to asses HRQL. Multivariable linear regression models adjusted for confounding (age, comorbidity, pT, locoregional treatment, systemic therapy) were used to compare the impact of the RT regimens on HRQL at 12 and 24 months. Differences in HRQL over time (3–24 months) were evaluated using linear mixed models. Results There were no significant differences in HRQL at 12 months between groups except for breast symptoms which were better after IORT and EB-APBI compared to hypo-WBI at 12 months (p < 0.001). Over time, breast symptoms, fatigue, global health status and role functioning were significantly better after IORT and EB-APBI than hypo-WBI. At 24 months, HRQL was comparable in all groups. Conclusion In women with early-stage breast cancer, the radiotherapy regimen did not substantially influence long-term HRQL with the exception of breast symptoms. Breast symptoms are more common after WBI than after IORT or EB-APBI and improve slowly until no significant difference remains at 2 years posttreatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06314-4.
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Waqas K, Lima Ferreira J, Tsourdi E, Body JJ, Hadji P, Zillikens M. Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer. J Bone Oncol 2021; 28:100355. [PMID: 33948427 PMCID: PMC8080519 DOI: 10.1016/j.jbo.2021.100355] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/03/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Adjuvant endocrine therapy induces bone loss and increases fracture risk in women with hormone-receptor positive, early-stage breast cancer (EBC). We aimed to update a previous position statement on the management of aromatase inhibitors (AIs) induced bone loss and now included premenopausal women. METHODS We conducted a systematic literature search of the medical databases from January 2017 to May 2020 and assessed 144 new studies. RESULTS Extended use of AIs beyond 5 years leads to persistent bone loss in breast cancer extended adjuvant trials and meta-analyses. In addition to bone mineral density (BMD), vertebral fracture assessment (VFA) and trabecular bone score (TBS) were shown to independently predict fracture risk in real life prospective studies. FRAX® tool does not seem to be reliable for assessing fracture risk in CTIBL. In premenopausal women, there is strong evidence that intravenous zoledronate prevents bone loss but weak conflicting evidence on reducing disease recurrence from independent randomised controlled trials (RCTs). In postmenopausal women, the strongest evidence for fracture prevention is for denosumab based on a well-powered RCT while there is strong evidence for bisphosphonates (BPs) to prevent and reduce CTIBL but no convincing data on fractures. Adjuvant denosumab has failed to show anticancer benefits in a large, well-designed RCT. DISCUSSION AND CONCLUSIONS Extended use of AIs and persistent bone loss from recent data reinforce the need to evaluate fracture risk in EBC women initiated on AIs. Fracture risk should be assessed with clinical risk factors and BMD along with VFA, but FRAX is not adapted to CTIBL. Anti-resorptive therapy should be considered in those with a BMD T-score < -2.0 SD or with ≥ 2 clinical risk factors including a BMD T-score < -1.0 SD. In premenopausal women, intravenous zoledronate is the only drug reported to prevent bone loss and may have additional anticancer benefits. In postmenopausal women, either denosumab or BPs can be prescribed for fracture prevention with pertinent attention to the rebound phenomenon after stopping denosumab. Adjuvant BPs, in contrast to denosumab, have shown high level evidence for reducing breast cancer recurrence in high-risk post-MP women which should be taken into account when choosing between these two.
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Affiliation(s)
- Komal Waqas
- Bone Centre, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joana Lima Ferreira
- Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Elena Tsourdi
- Department of Medicine III and 4. Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Peyman Hadji
- Frankfurt Center of Bone Health, Goethestrasse 23, Frankfurt, Germany and Philipps-University of Marburg, Germany
| | - M.C. Zillikens
- Bone Centre, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
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25
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Gao S, Wang P, Feng Y, Xie X, Duan M, Fan Y, Liu S, Huang L, Zhou F. RIFS2D: A two-dimensional version of a randomly restarted incremental feature selection algorithm with an application for detecting low-ranked biomarkers. Comput Biol Med 2021; 133:104405. [PMID: 33930763 DOI: 10.1016/j.compbiomed.2021.104405] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022]
Abstract
The era of big data introduces both opportunities and challenges for biomedical researchers. One of the inherent difficulties in the biomedical research field is to recruit large cohorts of samples, while high-throughput biotechnologies may produce thousands or even millions of features for each sample. Researchers tend to evaluate the individual correlation of each feature with the class label and use the incremental feature selection (IFS) strategy to select the top-ranked features with the best prediction performance. Recent experimental data showed that a subset of continuously ranked features randomly restarted from a low-ranked feature (an RIFS block) may outperform the subset of top-ranked features. This study proposed a feature selection Algorithm RIFS2D by integrating multiple RIFS blocks. A comprehensive comparative experiment was conducted with the IFS, RIFS and existing feature selection algorithms and demonstrated that a subset of low-ranked features may also achieve promising prediction performance. This study suggested that a prediction model with promising performance may be trained by low-ranked features, even when top-ranked features did not achieve satisfying prediction performance. Further comparative experiments were conducted between RIFS2D and t-tests for the detection of early-stage breast cancer. The data showed that the RIFS2D-recommended features achieved better prediction accuracy and were targeted by more drugs than the t-test top-ranked features.
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Sankaran S, Dikshit JB, Prakash SV C, Mallikarjuna SE, Somashekhar SP, Patil S, Kumar R, Prasad K, Shet D, Bakre MM. CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario. Indian J Surg Oncol 2021; 12:21-29. [PMID: 33994724 PMCID: PMC8119549 DOI: 10.1007/s13193-019-01014-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/30/2019] [Accepted: 11/12/2019] [Indexed: 01/04/2023] Open
Abstract
CanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis-free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.
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Affiliation(s)
- Satish Sankaran
- OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India
| | - Jyoti Bajpai Dikshit
- OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India
| | - Chandra Prakash SV
- OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India
| | - SE Mallikarjuna
- OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India
| | | | - Shekhar Patil
- Sri Shankara Cancer Hospital and Research Center, Bangalore, India
- HCG, Bangalore, India
| | - Rajeev Kumar
- Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | | | - Dinesh Shet
- Father Muller Medical College, Mangalore, India
| | - Manjiri M. Bakre
- OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India
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Wang W, Guo B, Cui C, Sun T, Liu S. Management of early-stage breast cancer patients during the coronavirus disease 2019 (COVID-19) pandemic: The experience in China from a surgical standpoint. J Cancer 2021; 12:2190-2198. [PMID: 33758597 PMCID: PMC7974893 DOI: 10.7150/jca.50501] [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: 07/09/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women globally. Currently, due to limited data, there are no international guidelines for addressing the management of a large group of patients during infectious disease pandemics. Coronavirus disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO), has rapidly spread globally. The COVID-19 pandemic changed our daily routines and forced us to rethink the management of breast cancer patients. Clinicians need to take into account multiple factors such as the timing and delivery of cancer care, epidemic prevention and control, and the allocation of medical resources. Determining ways to reasonably adjust the treatment strategy is a real challenge. In this review, we aim to discuss particular challenges associated with managing breast cancer patients during the COVID-19 pandemic, share experience from Chinese oncologists and surgeons and propose some practical approaches to the management of early-stage breast cancer patients from a surgical standpoint.
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Affiliation(s)
- Wan Wang
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Street, Harbin 150001, China
| | - Chunguo Cui
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Tong Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Shengnan Liu
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
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Ahn HS, Kim SM, Jang M, Yun BL, Kang E, Kim EK, Park SY, Kim B. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy can predict a heavy nodal metastatic burden in early-stage breast cancer. Ultrasonography 2021; 40:520-529. [PMID: 34399049 PMCID: PMC8446498 DOI: 10.14366/usg.20143] [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: 09/14/2020] [Accepted: 01/21/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study aimed to predict a heavy nodal burden (≥3 metastatic axillary lymph nodes [LNs]) using axillary ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in patients with early-stage breast cancer. METHODS We retrospectively reviewed the medical records of 403 women (404 cancers) who underwent US-guided FNAB for axillary LN staging from January 2006 to December 2015. US findings and US-guided FNAB results were reviewed and compared using pathology results as the reference. Diagnostic performance was analyzed, and clinicopathological and radiological findings were compared between patients with <3 metastatic LNs and ≥3 metastatic LNs. RESULTS The final pathology results revealed that 20.5% of cancers had heavy nodal metastases. US-guided FNAB showed significantly higher sensitivity (79.0% vs. 63.0%, P=0.009) and specificity (84.8% vs. 79.3%, P=0.036) in predicting heavy nodal metastases than did US. The presence of a larger number of suspicious LNs (two or more) on axillary US and positive FNAB results were significantly correlated with a heavy nodal burden in the multivariate analysis. The odds ratios were 4.20 (95% confidence interval [CI], 1.90 to 9.39) for two suspicious LNs, 9.40 (95% CI, 2.99 to 29.54) for three or more suspicious LNs, and 14.22 (95% CI, 6.78 to 29.82) for positive FNAB results. CONCLUSION The number of suspicious LNs detected on axillary US and FNAB results can help predict a heavy axillary nodal burden in patients with early-stage breast cancer.
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Affiliation(s)
- Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
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29
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Sanchez K, Kim I, Chun B, Pucilowska J, Redmond WL, Urba WJ, Martel M, Wu Y, Campbell M, Sun Z, Grunkemeier G, Chang SC, Bernard B, Page DB. Multiplex immunofluorescence to measure dynamic changes in tumor-infiltrating lymphocytes and PD-L1 in early-stage breast cancer. Breast Cancer Res 2021; 23:2. [PMID: 33413574 PMCID: PMC7788790 DOI: 10.1186/s13058-020-01378-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The H&E stromal tumor-infiltrating lymphocyte (sTIL) score and programmed death ligand 1 (PD-L1) SP142 immunohistochemistry assay are prognostic and predictive in early-stage breast cancer, but are operator-dependent and may have insufficient precision to characterize dynamic changes in sTILs/PD-L1 in the context of clinical research. We illustrate how multiplex immunofluorescence (mIF) combined with statistical modeling can be used to precisely estimate dynamic changes in sTIL score, PD-L1 expression, and other immune variables from a single paraffin-embedded slide, thus enabling comprehensive characterization of activity of novel immunotherapy agents. METHODS Serial tissue was obtained from a recent clinical trial evaluating loco-regional cytokine delivery as a strategy to promote immune cell infiltration and activation in breast tumors. Pre-treatment biopsies and post-treatment tumor resections were analyzed by mIF (PerkinElmer Vectra) using an antibody panel that characterized tumor cells (cytokeratin-positive), immune cells (CD3, CD8, CD163, FoxP3), and PD-L1 expression. mIF estimates of sTIL score and PD-L1 expression were compared to the H&E/SP142 clinical assays. Hierarchical linear modeling was utilized to compare pre- and post-treatment immune cell expression, account for correlation of time-dependent measurement, variation across high-powered magnification views within each subject, and variation between subjects. Simulation methods (Monte Carlo, bootstrapping) were used to evaluate the impact of model and tissue sample size on statistical power. RESULTS mIF estimates of sTIL and PD-L1 expression were strongly correlated with their respective clinical assays (p < .001). Hierarchical linear modeling resulted in more precise estimates of treatment-related increases in sTIL, PD-L1, and other metrics such as CD8+ tumor nest infiltration. Statistical precision was dependent on adequate tissue sampling, with at least 15 high-powered fields recommended per specimen. Compared to conventional t-testing of means, hierarchical linear modeling was associated with substantial reductions in enrollment size required (n = 25➔n = 13) to detect the observed increases in sTIL/PD-L1. CONCLUSION mIF is useful for quantifying treatment-related dynamic changes in sTILs/PD-L1 and is concordant with clinical assays, but with greater precision. Hierarchical linear modeling can mitigate the effects of intratumoral heterogeneity on immune cell count estimations, allowing for more efficient detection of treatment-related pharmocodynamic effects in the context of clinical trials. TRIAL REGISTRATION NCT02950259 .
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Affiliation(s)
- Katherine Sanchez
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Isaac Kim
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Brie Chun
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Joanna Pucilowska
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - William L Redmond
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Walter J Urba
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Maritza Martel
- Department of Pathology, Providence Portland Medical Center, Portland, OR, USA
| | - Yaping Wu
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - Mary Campbell
- Department of Pathology, Providence Portland Medical Center, Portland, OR, USA
| | - Zhaoyu Sun
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
| | - Gary Grunkemeier
- Medical Data Research Center, Providence Health & Services, Portland, OR, USA
| | - Shu Ching Chang
- Medical Data Research Center, Providence Health & Services, Portland, OR, USA
| | - Brady Bernard
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA
- Providence Cancer Institute, Portland, OR, USA
| | - David B Page
- Earle A. Chiles Research Institute, 4805 N.E. Glisan St., North Tower, Suite 2N87, Portland, OR, 97213, USA.
- Providence Cancer Institute, Portland, OR, USA.
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Zeidman M, Schmidt H, Alberty-Oller JJ, Pisapati KV, Ahn S, Mazumdar M, Ru M, Moshier E, Port E. Trends in neoadjuvant chemotherapy versus surgery-first in stage I HER2-positive breast cancer patients in the National Cancer DataBase (NCDB). Breast Cancer Res Treat 2021; 187:177-185. [PMID: 33392839 DOI: 10.1007/s10549-020-06041-2] [Citation(s) in RCA: 4] [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: 12/19/2019] [Accepted: 11/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is the standard of care for locally advanced HER2 + breast cancer (BC). Optimal sequencing of treatment (NAC vs. surgery first) is less clear cut in stage I (T1N0) HER2 + BC, where information from surgical pathology could impact adjuvant treatment decisions. Utilizing the NCDB, we evaluated the trend of NAC use compared to upfront surgery in patients with small HER2 + BC. METHODS We identified NCDB female patients diagnosed with T1 N0 HER2 + BC from 2010 through 2015. Prevalence ratios (PR) using multivariable robust Poisson regression models were calculated to measure the association between baseline characteristics and the receipt of NAC. Analysis of trends over time was denoted by annual percent change (APC) of NAC versus surgery upfront. RESULTS Of the 14,949 that received chemotherapy and anti-HER2 therapy during the study period, overall 1281 (8.6%) received NAC and 13,668 (91.4%) received adjuvant treatment. Patients receiving NAC increased annually from 4.2% in 2010 to 17.3% in 2015, with the most rapid increase occurring between years 2013 (8.5%) and 2014 (14.2%). The greatest increase was seen in patients with cT1c tumors with an APC of 37.8% over the study period (95% CI 29.0, 47.3%, p < 0.01), although a significant trend was likewise seen in patients with cT1a (APC = 26.1%,95% CI 1.59, 56.6%), and cT1b (APC = 27.4%, 95% CI 18.0, 37.7%) tumors. Predictors of neoadjuvant therapy receipt were age younger than 50 (PR = 1.69, 95% CI 1.52, 1.89), Mountain/Pacific area (PR = 1.24, 95% CI 1.05, 1.46), and estrogen receptor negativity (ER- PR + : PR = 2.01, 95% CI 1.51, 2.68; ER- PR- : PR = 1.49, 95% CI 1.32, 1.69). CONCLUSIONS Neoadjuvant therapy for T1 N0 HER2 + BC increased over the study period and was mostly due increased use in clinical T1c tumors. This may be consistent with secular change in Pertuzumab treatment following FDA approval in 2013.
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Affiliation(s)
- Michael Zeidman
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA. .,Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hank Schmidt
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Jaime Alberty-Oller
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti V Pisapati
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Soojin Ahn
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Healthcare Delivery Science at the Mount Sinai Health System, New York, NY, USA
| | - Meng Ru
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Healthcare Delivery Science at the Mount Sinai Health System, New York, NY, USA
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Healthcare Delivery Science at the Mount Sinai Health System, New York, NY, USA
| | - Elisa Port
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Bosma SCJ, Hoogstraat M, van Werkhoven E, de Maaker M, van der Leij F, Elkhuizen PHM, Fourquet A, Poortmans P, Boersma LJ, Bartelink H, van de Vijver MJ. A case-control study to identify molecular risk factors for local recurrence in young breast cancer patients. Radiother Oncol 2020; 156:127-135. [PMID: 33245949 DOI: 10.1016/j.radonc.2020.11.025] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate risk factors for local recurrence (LR) after breast conserving therapy in young breast cancer patients randomized in the "Young Boost Trial". MATERIAL & METHODS In the "Young Boost Trial" 2421 patients ≤50 years old were randomized between a 16 Gy and 26 Gy boost after breast conserving surgery and whole breast radiation (50 Gy). We performed a case-control study comparing patients who developed a LR (cases) and for each of them three control patients free of recurrence (controls). Clinicopathological factors, copy number- and gene expression profiles of primary tumors were compared between cases and controls, and between primary tumors and local recurrences. RESULTS The cumulative 5-year LR rate was 1.07% (95% CI 0.72-1.59%) and 10-year LR rate 2.56% (1.81-3.62%). Analysis of a subset of primary tumors and local recurrences showed similar histopathological characteristics (n = 15), copy number (n = 13) and gene expression profiles (n = 14). Basal subtype was strongly associated with LR in univariable and multivariable analysis. Gains of CCND1 were identified more frequently among controls, while more frequent gains of FGFR1 and IGF1R were observed among cases. Upregulation of genes involved in the p53-pathway was observed in recurring tumors compared to non-recurring tumors. We could not identify a genomic classifier for LR. CONCLUSIONS All investigated local recurrences were true genomic recurrences. Although differences in copy number variation and gene expression pathways were observed in recurring tumors compared to non-recurring tumors, no genomic classifier for LR could be identified.
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Affiliation(s)
- Sophie C J Bosma
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Marlous Hoogstraat
- Department of Bioinformatics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel de Maaker
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paula H M Elkhuizen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alain Fourquet
- Department of Radiation Oncology, Institute Curie, Paris, France
| | - Philip Poortmans
- Department of Radiation Oncology, Institute Curie, Paris, France; Department of Radiation Oncology, Iridium Netwerk, Wilrijk Antwerp, Belgium; University of Antwerp, Edegem Antwerp, Belgium
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Harry Bartelink
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Msika R, Fourquet A, Laki F, Porte B, Servois V, Kirova Y. Institut Curie guidelines on breast target volume delineation for patients treated in lateral position. Cancer Radiother 2020; 24:795-798. [PMID: 32981844 DOI: 10.1016/j.canrad.2020.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/25/2020] [Revised: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To develop guidelines for and describe the delineation of breast for patients treated in lateral position and to transform this three-dimensional technique based on the virtual simulation to volume-based modern intensity-modulated irradiation technique. MATERIAL AND METHODS In our department, during the daily delineation, radiation oncologists specialized in breast cancer treatment sought consensus on the delineation of clinical treatment volume of the breast through dialogue based on cases. A radiation oncologist delineated clinical treatment volumes on CT scans of five to 20 patients, followed by a discussion and adaptation of the delineation between all radiation oncologists of the team. The consensus established between clinicians was discussed, corrected and improved. All patients were delineated in treatment position; skin markers were used to visualize the breast tissue after careful palpation. RESULTS Breast clinical treatment volume was situated and delineated between pectoral muscle and 5mm below the skin (dosimetric considerations), within the space outlined by skin markers, that showed the limits of the palpable breast tissue. In lateral position some vessels were very useful to define the limits as rami mammarii (from thoracica interna) for the internal one and thoracica lateralis for the external. This is the first atlas proposed for the delineation of the breast clinical treatment volumes for breast cancer using alternative technique of breast irradiation (lateral). CONCLUSION This atlas will be helpful for the volume definition in our daily practice of breast irradiation in lateral position and can open perspectives to develop also atlases for other alternative techniques as treatment in prone position.
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Affiliation(s)
- R Msika
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Laki
- Department of surgical oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - B Porte
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - V Servois
- Department of radiology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Wang L, Zhu M, Cui Y, Zhang X, Li G. Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer. Cancer Cell Int 2020; 20:446. [PMID: 32943994 PMCID: PMC7488558 DOI: 10.1186/s12935-020-01533-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/22/2019] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the clinical efficacy of intraoperative radiotherapy (IORT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC), and to investigate the relationship between its influencing factors and clinical efficacy and prognosis. Methods A total of 73 patients with early-stage BC who underwent IORT after BCS in our hospital were selected in this research. Results Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of disease-free survival (DFS) and overall survival (OS). It was found that only age (χ2 = 14.035, P = 0.003) was statistically positively correlated with the patient’s DFS, and local recurrence and metastasis rate and mortality were higher in patients over 70 years old. Log rank test was used to analyze multiple factors. Only the diameter of the applicator (χ2 = 70.378, P < 0.05) was statistically significant with wound complications, and the larger the diameter, the higher incidence of wound complications. The remaining risk factors did not increase the incidence of wound complications. COX multivariate analysis showed that age was an independent risk factor for DFS rate and the risk factor had no significant effect on the OS rate of patients undergoing IORT after BCS. Conclusions IORT may be a safe form of treatment for the selected patients with early-stage BC, and can achieve satisfactory esthetic effect. Larger applicator diameters may increase the incidence of wound complications. Age is an independent risk factor for DFS in early-stage BC patients undergoing IORT after BCS.
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Affiliation(s)
- Lin Wang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
| | - Minmin Zhu
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China.,Nanshi Hospital of Nanyang, Nanyang, Henan China
| | - Yuelong Cui
- Anyang District Hospital of Puyang, Anyang, Henan China
| | - Xudong Zhang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
| | - Guowen Li
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450000 Henan China
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Feng K, Meng X, Liu J, Xing Z, Zhang M, Wang X, Feng Q, Wang X. Update on intraoperative radiotherapy for early-stage breast cancer. Am J Cancer Res 2020; 10:2032-2042. [PMID: 32774999 PMCID: PMC7407349] [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: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023] Open
Abstract
Intraoperative radiotherapy (IORT) is a practical and feasible alternative or an adjunct to whole-breast external beam radiation therapy (EBRT) for adjuvant treatment of breast cancer. A large number of experiments have proved IORT is non-inferior for treating early breast cancer due to its advantages, including precise radiotherapy, protection of healthy tissues and organs and sound cosmetic effects. IORT can use both electron beams and X-rays. Some aspects of the clinical use of IORT are still controversial, and extensive trails are ongoing. In this article, we review the published evidence and some ongoing clinical practice to introduce IORT in breast cancer treatment.
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Affiliation(s)
- Kexin Feng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Xiangzhi Meng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Jiaqi Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Zeyu Xing
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Menglu Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Xin Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021, China
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Shen C, Thornton JD, Gu D, Dodge D, Zhou S, He W, Zhao H, Giordano SH. Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer. Oncologist 2020; 25:e1574-e1582. [PMID: 32390251 DOI: 10.1634/theoncologist.2019-0868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/12/2019] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve working-age patients with early-stage breast cancer. METHODS Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extra-prolonged use of opioids. FINDINGS Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1-6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use. INTERPRETATION This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type. IMPLICATIONS FOR PRACTICE This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.
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Affiliation(s)
- Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Dian Gu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daleela Dodge
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Weiguo He
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Xiang H, Xin L, Liu Q, Zhang H, Zhang S, Ye J, Cheng Y, Li T, Liu Y, Xu L. Clinicopathological analysis of early-stage breast cancer patients that meet indications for BRCA1/2 genetic testing. Chin J Cancer Res 2020; 32:163-174. [PMID: 32410794 PMCID: PMC7219101 DOI: 10.21147/j.issn.1000-9604.2020.02.04] [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] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the clinicopathological characteristics and prognostic factors of early-stage breast cancer patients with indications for breast cancer susceptibility genes 1/2 (BRCA1/2) genetic testing in China.
Methods Based on the indication criteria for BRCA genetic testing specified in the National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, genetic/familial high-risk assessment: Breast and ovarian (Version 2. 2019), a retrospective analysis was performed on patients with early-stage invasive breast cancer treated at Breast Disease Center, Peking University First Hospital between January 2008 and December 2016. Clinicopathological characteristics of all patients were analyzed, and prognoses were calculated using the Kaplan-Meier method and a Cox proportionate hazards model.
Results A total of 906 early-stage breast cancer patients who had indications for BRCA genetic testing and had complete clinicopathological data and follow-up information were included in the study group, accounting for 34.7% of all breast cancer patients treated in Breast Disease Center, Peking University First Hospital during the study period. Compared with breast cancer patients without indications for BRCA genetic testing, the overall survival (OS) and disease-free survival (DFS) of patients with indications were not significantly different. In the study group, patients with premenopausal status, high T stage, lymph node positive, estrogen receptor (ER) negative, Ki-67>20% and presence of a vascular tumor thrombus had worse prognosis. There were more family histories of gastrointestinal cancer in patients with related indications than in patients without such indications.
Conclusions Single-center data showed that more than 30% of patients with early-stage breast cancer had indications for BRCA genetic testing. There was no prognostic difference in patients with or without indications for BRCA genetic testing. Premenopausal status, high T stage, lymph node positive, ER negative, Ki-67>20%, and presence of a vascular tumor thrombus were associated with poor prognosis.
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Affiliation(s)
- Hongyu Xiang
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Ling Xin
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Qian Liu
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Hong Zhang
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Shuang Zhang
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Jingming Ye
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Yuanjia Cheng
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Yinhua Liu
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - Ling Xu
- Breast Disease Center, Peking University First Hospital, Beijing 100034, China
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LeVasseur N, Li H, Cheung W, Myers P, Mckevitt E, Warburton R, Willemsma KA, Tan AD, Chia S, Simmons C. Effects of High Anxiety Scores on Surgical and Overall Treatment Plan in Patients with Breast Cancer Treated with Neoadjuvant Therapy. Oncologist 2019; 25:212-217. [PMID: 32162800 DOI: 10.1634/theoncologist.2019-0512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/08/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with newly diagnosed breast cancer and high levels of anxiety often pursue more aggressive surgical interventions. The neoadjuvant treatment (NAT) setting could provide a window of opportunity to address patients' anxiety. However, the impact of anxiety on surgical decisions in the setting of NAT for breast cancer has not been previously studied. MATERIALS AND METHODS A prospective database of patients with breast cancer treated with NAT at BC Cancer was used to identify patients treated with NAT and subsequent surgical resection. Patients with bilateral breast cancer or BRCA mutations or those referred to the hereditary cancer program were excluded. An anxiety score of 0-3 was assigned based on responses to the Edmonton Symptom Assessment System and Psychosocial Screen for Cancer. Clinicopathological information and treatment data were retrieved and cross-referenced between the low-anxiety (scores 0-1) and high-anxiety (scores 2-3) cohorts. RESULTS From 2012 to 2016, 203 patients met eligibility criteria. Of these, 93 patients (45.8%) had low anxiety and 110 patients (54.2%) had high anxiety. Overall, 161 patients (79.3%) had locally advanced cancers; no differences in stage, grade, or biomarkers were found between the low- and high-anxiety cohorts. Patients with high self-reported anxiety at initial consultation were younger (mean 56 years vs. 60 years; p = .011) and more likely to undergo mastectomy for breast-conserving surgery-eligible disease and bilateral mastectomy for unilateral disease compared with those with low anxiety (37.3% vs. 18.3%; likelihood ratio 9.15; p = .002). No significant differences in treatment timelines were identified between the two cohorts. CONCLUSION Patients with high anxiety at initial consultation were nine times more likely to undergo aggressive surgery compared with patients with low anxiety. These findings underscore the need for early identification of patients who may benefit from tailored supportive and educational services to address sources of anxiety and knowledge gaps. IMPLICATIONS FOR PRACTICE The prevalence of anxiety among women with newly diagnosed breast cancer is being increasingly acknowledged. However, health care providers have not fully appreciated the impact of anxiety on the surgical management of patients with early-stage breast cancer. This study highlights the importance of self-reported anxiety on surgical management. The preoperative period provides a unique window of opportunity to address sources of anxiety and provide targeted educational materials over a period of 4-6 months, which may ultimately lead to less aggressive surgery when it is not needed.
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Affiliation(s)
| | - Huaqi Li
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Winson Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Paula Myers
- Department of Patient and Family Counselling, BC Cancer, Vancouver, Canada
| | | | | | | | - Adam Deruchie Tan
- Department of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stephen Chia
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
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Xu HP, Bronsart E, Costa É, Krhili S, Logerot C, Bazire L, Fournier-Bidoz N, Belshi A, Fourquet A, Kirova YM. Patterns of locoregional failure in women with early-stage breast cancer treated by whole breast irradiation in the lateral isocentric decubitus position: Large-scale single-centre experience. Cancer Radiother 2019; 23:116-124. [PMID: 30935887 DOI: 10.1016/j.canrad.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/26/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate locoregional control and describe the patterns of failure in patients with breast cancer receiving whole breast radiotherapy in the isocentric lateral decubitus position technique. PATIENTS AND METHODS In a series of 832 consecutive female patients with early-stage breast cancer including invasive and in situ tumours treated by breast-conserving surgery followed by three-dimensional conformal whole breast irradiation in the isocentric lateral decubitus position between 2005 and 2010, all patients who experienced locoregional recurrence were studied. Five-year recurrence-free and overall survival rates were calculated. Regional recurrence mapping patterns were also determined. RESULTS The median age of this series of 832 women was 61.5 years (range: 29-90 years). Various types of fractionation were used: 50Gy in 25 fractions (17.9%), 66Gy in 33 fractions (50Gy in 25 fractions to breast followed by sequential boost to tumour bed to a total dose 66Gy in 33 fractions.) (46.5%), 40Gy in 15 fractions or 41.6Gy in 13 fractions (26.1%) and 30Gy in 5 fractions (9.5%). With a median follow-up of 6.4 years, only 36 patients experienced locoregional recurrence and no association with the fractionation regimen was identified (P=0.2). In this population of 36 patients, 28 (3.3%) had "in-breast" local recurrences (77.8%), two had local recurrences and regional lymph node recurrence (5.6%), and six had regional lymph node recurrence only (in non-irradiated areas; 16.6%). The median time to recurrence was 50 months. Complete mapping of patterns of recurrences was performed and, in most cases, local recurrences were situated adjacent to the primary tumour bed. Cases of local recurrences presented a significantly lower distant metastasis rate (P<0.001) and had a significantly longer overall survival compared to patients with regional lymph node recurrence (P<0.001). However, multivariate Cox regression analysis showed that the site of recurrence had no significant impact on overall survival (P=0.14). CONCLUSION The results of this study indicate a low local recurrence rate. Further careful follow-up and recording of recurrences is needed to improve the understanding of patterns of recurrence.
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Affiliation(s)
- H-P Xu
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - E Bronsart
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - É Costa
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - S Krhili
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - C Logerot
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Bazire
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - N Fournier-Bidoz
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Belshi
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y-M Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Mortimer J, Di Palma J, Schmid K, Ye Y, Jahanzeb M. Patterns of occurrence and implications of neratinib-associated diarrhea in patients with HER2-positive breast cancer: analyses from the randomized phase III ExteNET trial. Breast Cancer Res 2019; 21:32. [PMID: 30813966 PMCID: PMC6391844 DOI: 10.1186/s13058-019-1112-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/30/2018] [Accepted: 01/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background We characterized patterns of occurrence and the impact of neratinib-associated diarrhea in the absence of protocol-directed antidiarrheal prophylaxis or a formal diarrhea management plan using data from Extended Adjuvant Treatment of Breast Cancer with Neratinib (ExteNET). Methods ExteNET is a multicenter, double-blind, placebo-controlled, randomized phase III trial involving community-based and academic institutions in 40 countries. Women with HER2-positive early-stage breast cancer with prior standard primary therapy and trastuzumab-based (neo)adjuvant therapy were randomized to neratinib 240 mg/day or placebo for 12 months. Safety, a secondary outcome, was assessed using the National Cancer Institute Common Terminology Criteria version 3.0. Health-related quality of life by diarrhea grade was assessed using Functional Assessment of Cancer Therapy-Breast (FACT-B). Results Two thousand eight hundred sixteen women (1408 per group) were safety-evaluable. Grade 3 and 4 diarrhea occurred in 561 (39.8%) and 1 (0.1%) patients with neratinib versus 23 (1.6%) and 0 patients with placebo, respectively. In the neratinib group, 28.6% of patients had grade 3 events during month 1 decreasing to ≤ 6% after month 3. The median cumulative duration of grade 3/4 diarrhea with neratinib was 5 days (interquartile range, 2–9). Serious diarrheal events (n = 22, 1.6%) and diarrheal events requiring hospitalization (n = 20, 1.4%) were rare with neratinib. Changes in FACT-B total score by diarrhea grade in the neratinib group did not meet the threshold for clinically important differences. Conclusions In the absence of antidiarrheal prophylaxis, neratinib-related diarrhea is short-lived and not associated with complications or long-term sequelae. This suggests that targeted preventive management with antidiarrheal prophylaxis early during neratinib treatment is appropriate. Trial registration ClinicalTrials.gov NCT00878709. Registered 9 April 2009. Electronic supplementary material The online version of this article (10.1186/s13058-019-1112-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
| | - Jack Di Palma
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Kendra Schmid
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yining Ye
- Puma Biotechnology Inc., South San Francisco, CA, USA.,Present address: QED Therapeutics, San Francisco, CA, USA
| | - Mohammad Jahanzeb
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Deerfield Beach, FL, USA
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LeVasseur N, Stober C, Ibrahim M, Gertler S, Hilton J, Robinson A, McDiarmid S, Fergusson D, Mazzarello S, Hutton B, Joy AA, McInnes M, Clemons M. Perceptions of vascular access for intravenous systemic therapy and risk factors for lymphedema in early-stage breast cancer-a patient survey. ACTA ACUST UNITED AC 2018; 25:e305-e310. [PMID: 30111976 DOI: 10.3747/co.25.3911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The choice of vascular access for systemic therapy administration in breast cancer remains an area of clinical equipoise, and patient preference is not consistently acknowledged. Using a patient survey, we evaluated the patient experience with vascular access during treatment for early-stage breast cancer and explored perceived risk factors for lymphedema. Methods Patients who had received systemic therapy for early-stage breast cancer were surveyed at 2 Canadian cancer centres. Results Responses were received from 187 patients (94%). The route of vascular access was peripheral intravenous line (IV) in 24%, a peripherally inserted central catheter (picc) in 42%, and a surgically inserted central catheter (port) in 34%. Anthracycline-based regimens were associated with a greater use of central vascular access devices (cvads- that is, a picc or port; 86/97, 89%). Trastuzumab use was associated with greater use of ports (49/64, 77%). Although few patients (7%) reported being involved in the decisions about vascular access, most were satisfied or very satisfied (88%) with their access type. Patient preference centred mainly on avoiding delays in the initiation of chemotherapy. Self-reported rates of complications (183 evaluable responses) were infiltration with peripheral IVs (9/44, 20%), local skin infections with piccs (7/77, 9%), and thrombosis with ports (4/62, 6%). Perceived risk factors for lymphedema included use of the surgical arm for blood draws (117/156, 75%) and blood pressure measurement (115/156, 74%). Conclusions Most patients reported being satisfied with the vascular access used for their treatment. Improved education and understanding about the evidence-based requirements for vascular access are needed. Perceived risk factors for lymphedema remain variable and are not evidence-based.
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Affiliation(s)
- N LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - M Ibrahim
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - S Gertler
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - J Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa.,The Ottawa Hospital Research Institute, Ottawa
| | - A Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston
| | - S McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa; and
| | - D Fergusson
- The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | | | - B Hutton
- The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A A Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - M McInnes
- The Ottawa Hospital Research Institute, Ottawa.,Department of Radiology, University of Ottawa, Ottawa, ON
| | - M Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa.,The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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Bautista Hernandez MY, Lujan Castilla PJ, Quézada Bautista AA. Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico. Rep Pract Oncol Radiother 2018; 23:276-283. [PMID: 30090027 DOI: 10.1016/j.rpor.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/18/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022] Open
Abstract
Aim To evaluate whether hypofractionation with integrated boost to the tumour bed using intensity-modulated radiation therapy is an acceptable option and to determine whether this treatment compromises local control, toxicity and cosmesis. Background Retrospective studies have demonstrated that patients who are treated with HF and integrated boost experience adequate local control, a dosimetric benefit, decreased toxicity and acceptable cosmesis compared with conventional fractionation. Materials and methods A retrospective, observational and longitudinal study was conducted from January 2008 to June 2015 and included 34 patients with breast cancer (stage 0-II) who were undergoing conservative surgery.The prescribed doses were 45 Gy in 20 fractions (2.25 Gy/fraction) to the breast and 56 Gy in 20 fractions (2.8 Gy/fraction) to the tumour bed. Results Thirty-four patients were included. The mean follow-up was 49.29 months, and the mean age was 52 years. The mean percentage of PTV from the mammary region that received 100% of the prescribed dose was 97.89% (range 95-100), and the mean PTV percentage of the tumour bed that received 100% of the dose was 98% (95-100).The local control and the overall survival were 100%, and the cosmesis was good in 82% of the patients. Grade 1 acute toxicity was present in 16 patients (47%), and grade 1 chronic toxicity occurred in 6 cases (18%). Conclusion The results of the present study demonstrate that hypofractionation with integrated boost using intensity-modulated radiation therapy is an acceptable option that provides excellent local control and low toxicity.
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LeVasseur N, Stober C, Daigle K, Robinson A, McDiarmid S, Mazzarello S, Hutton B, Joy A, Fergusson D, Hilton J, McInnes M, Clemons M. Optimizing vascular access for patients receiving intravenous systemic therapy for early-stage breast cancer-a survey of oncology nurses and physicians. Curr Oncol 2018; 25:e298-e304. [PMID: 30111975 PMCID: PMC6092058 DOI: 10.3747/co.25.3903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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] [Indexed: 12/22/2022] Open
Abstract
Background Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema. Results Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk. Conclusions Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.
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Affiliation(s)
- N. LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C. Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - K. Daigle
- Department of Nursing, The Ottawa Hospital, Ottawa
| | - A. Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston; and
| | - S. McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa
| | | | - B. Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - D. Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J. Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
| | - M. McInnes
- Department of Radiology, The Ottawa Hospital, Ottawa, ON
| | - M. Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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Zhong J, Sun DS, Wei W, Liu X, Liu J, Wu X, Zhang Y, Luo H, Li Y. Contrast-Enhanced Ultrasound-Guided Fine-Needle Aspiration for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. Ultrasound Med Biol 2018; 44:1371-1378. [PMID: 29631800 DOI: 10.1016/j.ultrasmedbio.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to assess whether translymphatic contrast-enhanced ultrasound (CEUS) combined with fine-needle aspiration (FNA) can be used pre-operatively to assess the status of axillary lymph nodes in early-stage breast cancer patients. Furthermore, we wanted to determine whether this less invasive method could potentially be a pre-operative surgical strategy. One hundred sixty-four sentinel lymph nodes (SLNs) were detected by CEUS after intradermal injection of microbubbles in 126 cases. One hundred twenty of 126 cases (95.24%) were accurately diagnosed with the SLN-FNA method. All 6 false-negative cases were due to micrometastasis or macrometastasis. There were no false-positive results after CEUS-guided FNA biopsy based on post-operative histopathological results. In conclusion, translymphatic CEUS combined with SLN-FNA is a less traumatic approach that has high accuracy in the pre-operative evaluation of axillary lymph node status. It might have the potential to be as reliable an indicator for axillary lymph node dissection as SLN biopsy.
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Affiliation(s)
- Jieyu Zhong
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - De-Sheng Sun
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoling Liu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jun Liu
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoqin Wu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yusen Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Haiyu Luo
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yongbin Li
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Chowdhry VK, Bushey JA, Kwait RM, Goldberg S, Ritchie J, Ji YL, McKee R, Palladino D, Proulx GM. Intraoperative radiation therapy as part of planned monotherapy for early-stage breast cancer. ACTA ACUST UNITED AC 2018; 7:167-73. [PMID: 29937985 DOI: 10.1007/s13566-017-0338-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/06/2017] [Accepted: 12/11/2017] [Indexed: 01/07/2023]
Abstract
Introduction Adjuvant whole breast radiation therapy has developed into the standard of care for patients following a lumpectomy for early-stage breast cancer. However, there is recent interest in intraoperative radiation therapy (IORT) to minimize toxicity while still improving local control beyond surgical resection and anti-estrogen therapy alone. Materials and methods All patients were evaluated pre-operatively in a multidisciplinary clinic setting at a community hospital for suitability for breast conservation therapy. A total of 109 patients were reviewed receiving 110 IORT treatments. Patients were followed with clinical breast examinations and mammography as clinically indicated. Results At a median follow-up of 29.9 months, 2/110 (1.8%) patients experienced a local failure. One patient (0.9%) experienced a regional failure. Local control, disease-free survival and overall survival at 3 years were 98.9% (95%CI 92.2–99.8), 97.2% (95%CI 88.9–99.3), and 96.0% (95%CI 84.9–99.0), respectively. Five-year local control, disease-free survival, and overall survival rates were 96.3% (95%CI 84.7–99.2), 94.6% (95%CI 83.2–98.3), and 92.5% (95%CI 80.4–97.3), respectively. Patient self-reported cosmetic outcome was available for 51 patients, with all patients reporting being either very pleased, pleased, or satisfied with their cosmetic outcome, and no patients reported being dissatisfied or worse. Conclusions The results of our series suggest the feasibility of utilizing IORT in a community-based cancer center with a high degree of local control, and patient satisfaction with regard to cosmesis. While the results of this series suggest that IORT may be a promising modality, longer follow-up is warranted to better understand exactly which clinicopathological features can predict long-term locoregional disease control.
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Bacrie J, Laurans M, Iorio P, Fourme E, Volters AB, Bozec L, Lerebours F, Dubot C, Bensaoula O, Benzidane B, Pierga JY, Lefeuvre D. Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution. Support Care Cancer 2018; 26:4097-4103. [PMID: 29855772 DOI: 10.1007/s00520-018-4280-4] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Febrile neutropenia (FN) is one of the most common and most critical adverse effects of chemotherapy. Despite many existing guidelines based on the use of granulocyte-colony stimulating factor (G-CSF), FN continues to impair the quality of life and interfere with the treatment of many patients. The purpose of this study was to assess the incidence and management of FN associated with chemotherapy for early breast cancer in routine clinical practice. METHODS All patients with early-stage breast cancer (ESBC) treated by chemotherapy at Institut Curie, Hôpital René Huguenin, in 2014 were retrospectively included. The incidence and management of FN were reported. Risk factors associated with FN were studied by robust-error-variance Poisson regression. RESULTS A total of 524 patients received either neoadjuvant (N = 130) or adjuvant chemotherapy (N = 394). Most patients (80%) were treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC100; 3 cycles) followed by docetaxel 100 mg/m2 (D; 3 cycles). The overall incidence of FN was 17%. Eighteen percent of patients received primary prophylaxis (PP) for FN with G-CSF, using pegfilgrastim in 64% of cases and 74% of patients over the age of 70 received PP. Less than 5% of patients who received PP experienced FN. Recurrent FN after secondary prophylaxis was observed in 9% of patients. Forty-seven percent of cases of FN occurred after the first cycle and 30% occurred after the fourth cycle, corresponding to D ± trastuzumab (T). The FEC100 regimen was associated with a relative risk of FN of 1.98 (p = 0.09). Autoimmune (AI) and inflammatory diseases were associated with a higher risk of FN (RR 3.08; p < 0.01). No significant difference in the incidence of FN was observed between adjuvant and neoadjuvant chemotherapy. FN was managed on an outpatient basis in 72% of cases. Outpatients with FN were mainly treated by a combination of amoxicillin-clavulanic acid and ciprofloxacin. Dose reduction or chemotherapy regimen modification were necessary in 25% of patients after FN. No toxic death was reported. CONCLUSION The incidence of FN induced by adjuvant/neoadjuvant chemotherapy in ESBC is higher in routine clinical practice than in clinical trials. AI or inflammatory diseases were significant independent risk factors for FN. Primary prophylaxis in patients at risk (elderly, comorbid patients), especially treated with the FEC regimen, is the keystone of management of this adverse effect. Prevention and management of FN to ensure the patient's safety and quality of life are a major issue for both medical oncologists and supportive care physicians.
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Affiliation(s)
- Joy Bacrie
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France.
| | - Marc Laurans
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | - Pauline Iorio
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | | | | | - Laurence Bozec
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | | | - Coraline Dubot
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | - Okba Bensaoula
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
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Thöne K, Rudolph A, Obi N, Chang-Claude J, Flesch-Janys D. Prognostic impact of surgery for early-stage invasive breast cancer on breast cancer-specific survival, overall survival, and recurrence risk: a population-based analysis. Breast Cancer Res Treat 2018; 170:381-390. [PMID: 29556781 DOI: 10.1007/s10549-018-4754-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/13/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Recent cohort studies demonstrated better overall survival (OS) or breast cancer-specific survival (BCS) for breast-conserving therapy (BCT) followed by radiation (RT) compared to mastectomy alone (MT). This is the first observational study in which adjustments for a comprehensive set of prognostic factors, adjuvant therapies, mode of detection, and comorbidities were possible to investigate OS, BCS, as well as recurrence risk of patients undergoing BCT + RT, MT + RT, or MT. METHODS Women aged 50-74 years at diagnosis of early-stage invasive breast cancer (I-IIIa) between 2001 and 2005 at the German population-based case-control study (MARIE study) were recruited and followed prospectively as a case cohort until 2015. Kaplan-Meier estimates and stepwise adjusted multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI). RESULTS The 2762 patients included were followed up for a median of 11.9 years (95% CI 11.8-12.0). 74.2% of patients underwent BCT + RT; 10.3% MT + RT and 15.6% MT alone. Compared to patients treated with MT alone, patients treated with BCT + RT showed non-statistically significant improved OS (HR 0.79, 95% CI 0.61-1.02), BCS (HR 0.79, 95% CI 0.55-1.12), and no difference in recurrence risks (HR 1.01, 95% CI 0.74-1.37). For patients treated with MT + RT, there were no differences in OS (HR 1.06, 95% CI 0.75-1.50), BCS (HR 1.17, 95% CI 0.75-1.82), or recurrence risk (HR 1.33, 95% CI 0.89-1.97). CONCLUSIONS Among patients with early-stage breast cancer, clinical outcomes more than 10 years after diagnosis did not differ between the primary treatment options BCT + RT, MT + RT versus MT alone after full adjustment.
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Affiliation(s)
- Kathrin Thöne
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Martinistr. 52, 20246, Heidelberg, Germany
| | - Nadia Obi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Martinistr. 52, 20246, Heidelberg, Germany.,Genetic Tumor Epidemiology Group, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jacobs DHM, Speijer G, Petoukhova AL, Roeloffzen EMA, Straver M, Marinelli A, Fisscher U, Zwanenburg AG, Merkus J, Marijnen CAM, Mast ME, Koper PCM. Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients. Breast Cancer Res Treat 2018; 169:549-59. [PMID: 29460031 DOI: 10.1007/s10549-018-4712-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/10/2017] [Accepted: 02/03/2018] [Indexed: 12/27/2022]
Abstract
Background and purpose We investigated the acute toxicity of accelerated partial breast irradiation using external beam (EB-APBI) or intraoperative radiotherapy (IORT) techniques in elderly breast cancer patients. Materials and methods Women ≥ 60 years with unifocal breast tumors of ≤ 30 mm were eligible for this prospective multi-center cohort study. IORT was applied with electrons following lumpectomy (23.3 Gy). EB-APBI was delivered using 3D-CRT or IMRT in 10 daily fractions of 3.85 Gy within 6 weeks after surgery. Acute toxicity was scored using the CTCAE v3.0 at 3 months after treatment. Patient-reported symptoms were analyzed using visual analogue scales (VAS) for pain and fatigue (scale 0–10), and single items from the EORTC QLQ-C30 and Breast Cancer questionnaires. Results In total, 267 (IORT) and 206 (EB-APBI) patients were available for toxicity analysis. More patients experienced ≥ grade 2 CTCAE acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p = 0.03); grade 3 toxicity was low (3.3% IORT and 1.5% EB-APBI; ns); and no grade 4 toxicity occurred. EB-APBI patients experienced less fatigue direct postoperatively (EORTC p < 0.00, VAS p < 0.00). After 3 months only pain, according to the VAS scale, was significantly worse in the EB-APBI group (p < 0.00). Conclusion Acute toxicity after IORT and EB-APBI treatment is acceptable.
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Liu X, Yu H, Qiao Y, Yang J, Shu J, Zhang J, Zhang Z, He J, Li Z. Salivary Glycopatterns as Potential Biomarkers for Screening of Early-Stage Breast Cancer. EBioMedicine 2018; 28:70-79. [PMID: 29402727 PMCID: PMC5898026 DOI: 10.1016/j.ebiom.2018.01.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 11/29/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE We systematically investigated and assessed the alterations of salivary glycopatterns and possibility as biomarkers for diagnosis of early-stage breast cancer. DESIGN Alterations of salivary glycopatterns were probed using lectin microarrays and blotting analysis from 337 patients with breast benign cyst or tumor (BB) or breast cancer (I/II stage) and 110 healthy humans. Their diagnostic models were constructed by a logistic stepwise regression in the retrospective cohort. Then, the performance of the diagnostic models were assessed by ROC analysis in the validation cohort. Finally, a double-blind cohort was tested to confirm the application potential of the diagnostic models. RESULTS The diagnostic models were constructed based on 9 candidate lectins (e.g., PHA-E+L, BS-I, and NPA) that exhibited significant alterations of salivary glycopatterns, which achieved better diagnostic powers with an AUC value >0.750 (p<0.001) for the diagnosis of BB (AUC: 0.752, sensitivity: 0.600, and specificity: 0.835) and I stage breast cancer (AUC: 0.755, sensitivity: 0.733, and specificity: 0.742) in the validation cohort. The diagnostic model of I stage breast cancer exhibited a high accuracy of 0.902 in double-blind cohort. CONCLUSIONS This study could contribute to the screening for patients with early-stage breast cancer based on precise alterations of salivary glycopatterns.
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Affiliation(s)
- Xiawei Liu
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Hanjie Yu
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Yan Qiao
- Department of Surgical Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jiajun Yang
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Jian Shu
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Jiaxu Zhang
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Zhiwei Zhang
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Jianjun He
- Department of Surgical Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Zheng Li
- Laboratory for Functional Glycomics, College of Life Sciences, Northwest University, Xi'an 710069, China.
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Raghavendra A, Sinha AK, Valle-Goffin J, Shen Y, Tripathy D, Barcenas CH. Determinants of Weight Gain During Adjuvant Endocrine Therapy and Association of Such Weight Gain With Recurrence in Long-term Breast Cancer Survivors. Clin Breast Cancer 2018; 18:e7-e13. [PMID: 29239836 PMCID: PMC5937690 DOI: 10.1016/j.clbc.2017.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/19/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight gain is a negative prognostic factor in breast cancer (BC) patients. The risk factors for weight gain during adjuvant endocrine therapy (ET) and the extent to which such weight gain is associated with disease recurrence remain unclear. PATIENTS AND METHODS We retrospectively identified a cohort of women with a diagnosis of stage I-III, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC from January 1997 to August 2008, who had received initial treatment at the MD Anderson Cancer Center, had completed 5 years of ET, and had remained free of locoregional or distant relapse or contralateral BC for ≥ 5 years after diagnosis. The weight change at the end of 5 years of ET was measured as the percentage of the change in weight from the start of ET, with a weight gain of > 5% considered clinically significant. Multivariable logistic regression and Cox proportional hazards models were used to assess the determinants of such weight gain and the risk of recurrence after 5 years. RESULTS Of 1282 long-term BC survivors, 432 (33.7%) had a weight gain of > 5% after 5 years of ET. Women who were premenopausal at diagnosis were 1.40 times more likely than women who were postmenopausal at diagnosis to have a weight gain of > 5%. Asian women had the lowest risk of gaining weight. The recurrence risks of patients who had gained weight and those who had not were not significantly different. CONCLUSION Premenopausal BC patients had an increased risk of weight gain after 5 years of ET; however, BC patients with a weight gain of > 5% did not have an increased risk of disease recurrence.
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Affiliation(s)
- Akshara Raghavendra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arup K Sinha
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Biostatistics, The University of Texas School of Public Health, Houston, TX
| | | | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Poleszczuk J, Luddy K, Chen L, Lee JK, Harrison LB, Czerniecki BJ, Soliman H, Enderling H. Neoadjuvant radiotherapy of early-stage breast cancer and long-term disease-free survival. Breast Cancer Res 2017; 19:75. [PMID: 28666457 PMCID: PMC5493088 DOI: 10.1186/s13058-017-0870-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 07/25/2016] [Accepted: 06/20/2017] [Indexed: 02/08/2023] Open
Abstract
Background Compared with surgery alone, postoperative adjuvant radiotherapy (RT) improves relapse-free survival of patients with early-stage breast cancer. We evaluated the long-term overall and disease-free survival rates of neoadjuvant (presurgical) versus adjuvant RT in early-stage breast cancer patients. Methods We used the Surveillance, Epidemiology, and End Results (SEER) database provided by the National Institutes of Health to derive an analytic dataset of 250,195 female patients with early-stage breast cancer who received RT before (n = 2554; 1.02%) or after (n = 247,641; 98.98%) surgery. Disease-free survival, defined as time to diagnosis of a second primary tumor at any location, was calculated from automated patient identification matching of all SEER records. Results Partial and complete mastectomies were performed in 94.4% and 5.6% of patients, respectively. In the largest cohort of estrogen receptor-positive women who underwent partial mastectomy, the HR of developing a second primary tumor after neoadjuvant compared with adjuvant RT was 0.64 (95% CI 0.55–0.75; P < 0.0001). Overall survival was independent of radiation sequence (HR 1; P = 0.95). Neoadjuvant RT also resulted in a lower HR for second primary cancer among estrogen receptor-positive patients who underwent mastectomy compared with those who received adjuvant RT (HR 0.48, 95% CI 0.26–0.87; P = 0.0162). Conclusions Neoadjuvant RT may significantly improve disease-free survival without reducing overall survival, especially for estrogen receptor-positive patients with early-stage breast cancer. This finding warrants further exploration of potential long-term benefits of neoadjuvant radiotherapy for early-stage breast cancer in a controlled, prospective clinical trial setting, with correlative studies done to identify potential mechanisms of superiority. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0870-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Poleszczuk
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, SRB 4, Tampa, FL, 33612, USA. .,Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
| | - Kimberly Luddy
- Department of Cancer Imaging & Metabolism, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Lu Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Jae K Lee
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Hatem Soliman
- Department of Women's Oncology and Experimental Therapeutics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, SRB 4, Tampa, FL, 33612, USA. .,Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
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