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de Souza IC, Langer FW. Post-radiation angiosarcoma of the breast in a patient with a history of invasive ductal carcinoma. Lancet 2024; 403:1681-1682. [PMID: 38677859 DOI: 10.1016/s0140-6736(24)00688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Izabela Cristina de Souza
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Felipe Welter Langer
- Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
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2
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ElSherif A, Freyvogel Ramirez M, Moore EC, Dietz JR, Tu C, Valente SA. Mastectomy margins for ductal carcinoma-in-situ (DCIS): 18 Years of follow-up. Am J Surg 2023; 226:646-651. [PMID: 37481406 DOI: 10.1016/j.amjsurg.2023.07.012] [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: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In patients undergoing mastectomy for ductal carcinoma in situ (DCIS), the significance of a positive or close (<2 mm) margin and associated recurrence risk is unclear. The study sought to evaluate risk of recurrence in relation to the mastectomy surgical margin. METHODS A single institution retrospective review of patients with DCIS who underwent mastectomy between 2000 and 2010 was performed. Patient demographics, tumor biology, margin status and adjuvant therapy were recorded. The incidence of local recurrence (LR), distant metastasis were analyzed. RESULTS A total of 282 patients with DCIS were identified. Overall, 12.3% of patients had a pathological positive/close margin (n = 9 tumor on ink and n = 36 <2 mm). Adjuvant radiation was administered to 11 patients with a positive or close margin. At a median follow-up of 12 years, LR was 3.4% (n = 10). None of the patients with LR had a positive or close margin. Additionally, none of the patients who received radiation developed LR. CONCLUSION Risk of recurrence after mastectomy for DCIS is low and appears to be unrelated to margin status or the use of radiation therapy.
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MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy
- Follow-Up Studies
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Retrospective Studies
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/surgery
- Margins of Excision
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Affiliation(s)
- Ayat ElSherif
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Mary Freyvogel Ramirez
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Edwina C Moore
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, United States
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Stephanie A Valente
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
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3
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Shah C, Vicini F. Adjuvant Radiation Therapy for Ductal Carcinoma In Situ of the Breast: A Clinician's Dilemma. Ann Surg Oncol 2023; 30:6281-6283. [PMID: 37280311 DOI: 10.1245/s10434-023-13691-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Radiotherapy, Adjuvant
- Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/pathology
- Carcinoma in Situ/pathology
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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4
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Chua BH, Link EK, Kunkler IH, Olivotto IA. Breast radiotherapy for non-low-risk ductal carcinoma in situ: to boost or not to boost? - Authors' reply. Lancet 2023; 401:24. [PMID: 36610769 DOI: 10.1016/s0140-6736(22)02373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Breast/pathology
- Mastectomy, Segmental
- Breast Neoplasms/radiotherapy
- Neoplasm Recurrence, Local/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Radiotherapy, Adjuvant
- Carcinoma in Situ
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Affiliation(s)
- Boon H Chua
- Faculty of Medicine and Health, University of New South Wales and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW 2031, Australia.
| | - Emma K Link
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC, Australia
| | - Ian H Kunkler
- Edinburgh Cancer Research Centre, Institute of Genetic and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
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5
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Mulliez T, De Ridder M. Breast radiotherapy for non-low-risk ductal carcinoma in situ: to boost or not to boost? Lancet 2023; 401:23-24. [PMID: 36610767 DOI: 10.1016/s0140-6736(22)02399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Breast/pathology
- Radiotherapy, Adjuvant
- Breast Neoplasms/radiotherapy
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma in Situ
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels 1090, Belgium; Department of Radiotherapy, Institut Andrée Dutreix, Dunkerque, France
| | - Mark De Ridder
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels 1090, Belgium.
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6
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Coles CE, Chatterjee S, Jagsi R, Kirby AM. Breast radiotherapy for ductal carcinoma in situ: could less be more? Lancet 2022; 400:408-410. [PMID: 35933995 DOI: 10.1016/s0140-6736(22)01381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, UK.
| | | | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anna M Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
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7
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Chua BH. Breast Irradiation in Ductal Carcinoma In Situ. Chirurgia (Bucur) 2021; 116:S105-S112. [PMID: 34967318 DOI: 10.21614/chirurgia.116.5.suppl.s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Abstract
There is strong and consistent evidence that whole breast irradiation after breast conserving surgery significantly decreases the risk of ipsilateral breast events, in situ or invasive, underpinning its established role in patients with ductal carcinoma in situ (DCIS). Pending publication of the full results of BIG 3-07/TROG 07.01 randomised trial, addition of tumour bed boost to whole breast irradiation is recommended in the presence of adverse clinical-pathologic features, and the use of moderately hypofractionated whole breast dose-fractionation schedules is supported. As published data supporting the use of adjuvant partial breast irradiation in patients with low-risk DCIS are limited, its off-study application should be limited to low-risk patients defined by international and national guidelines. Finally, low-risk patients may not derive clinically meaningful benefits from radiation therapy and research on molecular profiling is ongoing to improve prognostic precision and guide safe omission of radiation therapy after breast conserving surgery.
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MESH Headings
- Breast
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/surgery
- Treatment Outcome
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8
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Chi MS, Ko HL, Chen CC, Hsu CH, Chen LK, Cheng FTF. Single institute experience of intraoperative radiation therapy in early-stage breast cancer. Medicine (Baltimore) 2021; 100:e27842. [PMID: 34797318 PMCID: PMC8601266 DOI: 10.1097/md.0000000000027842] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Intraoperative radiation therapy (IORT) is an alternative to whole breast irradiation in selected early-stage breast cancer patients. In this single institute analysis, we report the preliminary results of IORT given by Axxent Electronic Brachytherapy (eBT) system.Patients treated with lumpectomy and eBT within a minimum follow-up period of 12 months were analyzed. Eligible criteria include being over the age of 45, having unifocal invasive ductal carcinoma (IDC) or ductal carcinoma in situ <3 cm in diameter, not exhibiting lymph node involvement on preoperative images, and negative sentinel lymph node biopsy. The eBT was given by preloaded radiation plans to deliver a single fraction of 20 Gray (Gy) right after lumpectomy.From January 2016 to April 2019, a total of 103 patients were collected. There were 78 patients with IDC and 25 with ductal carcinoma in situ. At a mean follow-up time of 31.1 months (range, 14.5-54.0 months), the local control rate was 98.1%. Two IDC patients had tumor recurrences (1 local and 1 regional failure). Post-IORT radiotherapy was given to 4 patients. There were no cancer related deaths, no distant metastases, and treatment side effects greater than grade 3 documented.We report the largest single institute analysis using the eBT system in Taiwan. The low recurrence and complication rates at a 31.1 month follow-up time support the use of the eBT system in selected early-stage breast cancer patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Brachytherapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Follow-Up Studies
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local
- Treatment Outcome
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Affiliation(s)
- Mau-Shin Chi
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hui-Ling Ko
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chang-Cheng Chen
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Hsien Hsu
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Liang-Kuang Chen
- Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Fiona Tsui-Fen Cheng
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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9
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Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, Alvarado M, Douek M, Saunders C, Flyger H, Eiermann W, Brew-Graves C, Williams NR, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Corica T, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Blanc-Onfroy ML, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McReady D, Hoefer R, Kelemen P, Petralia G, Falzon M, Joseph D, Tobias JS. New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. Br J Cancer 2021; 125:380-389. [PMID: 34035435 PMCID: PMC8329051 DOI: 10.1038/s41416-021-01440-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/09/2020] [Revised: 04/26/2021] [Accepted: 05/13/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. TRIAL REGISTRATION ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).
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Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, UK.
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Steffi Pigorsch
- Department of Radiation Oncology, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Henrik Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Eiermann
- Department of Gynecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ingrid Potyka
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Nicholas Roberts
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Siobhan Laws
- Department of Surgery, Royal Hampshire County Hospital, Winchester, UK
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Berlin, Germany
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, & Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Dennis Holmes
- John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fernando Bozza
- Department of Surgery, Instituto Oncologico Veneto (IVO) IRCCS, Padoa, Italy
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, Ludwig Maximilians Universitat, Munich, Germany
| | | | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jens Blohmer
- Sankt Gertrauden-Krankenhaus, and The Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Pond Kelemen
- Ashikari Breast Center, New York Medical College, New York, NY, USA
| | - Gloria Petralia
- Department of Surgery, University College London Hospitals, London, UK
| | - Mary Falzon
- Department of Pathology University College London Hospitals, London, UK
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, UK
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10
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Pires A, Rodrigues J, Pereira HG. Does every woman require a post-lumpectomy mammogram and ultrasound before radiotherapy when negative margins? Cancer Radiother 2021; 26:467-473. [PMID: 34284966 DOI: 10.1016/j.canrad.2021.06.020] [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: 02/28/2021] [Revised: 05/09/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Most studies regarding the value of post lumpectomy imaging (PLI) studies rely on mammography alone and are often focused on patients that present with suspicious microcalcifications or in situ disease. This way, its true benefit remains controversial, which explained the heterogeneity between centers. This is the first study to evaluate the role of mammography with breast and axillary ultrasound undertaken before radiotherapy in patients with conservatively managed invasive and/or in situ carcinoma with negative margins. MATERIALS AND METHODS In this retrospective study, medical records for patients referred to our External Radiotherapy Unit between January 2018 and December 2019 were reviewed. RESULTS A total of 1251 patients (1262 breasts) were analyzed. A total of 3.4% had suspicious findings for local residual breast disease, with 1.0% having a re-excision positive for residual malignancy. Presentation with microcalcifications alone (OR=4.854), extension of microcalcifications>3cm (OR=13.500), histologic subtype pure ductal carcinoma in situ (OR=12.348), presence of invasive carcinoma≤1mm of the pathological margins (OR=4.630), stage pTis (5.630), and absence of invasive component (OR=4.629), were associated with an increased risk for residual malignancy. Only one patient (0.1%) had nodal residual involvement. CONCLUSION PLI detected residual local cancer in 1.0% of the patients. PLI plays an important role in the evaluation of patients undergoing breast-conserving therapy with negative margins. The major question that remains is whether it changes survival outcomes.
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MESH Headings
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Calcinosis/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Mammography
- Margins of Excision
- Mastectomy, Segmental
- Neoplasm, Residual
- Retrospective Studies
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Affiliation(s)
- A Pires
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - J Rodrigues
- Cancer Epidemiology Group, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - H G Pereira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
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11
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Ciérvide R, Montero Á, Potdevin G, García J, Aranda MG, Álvarez B, Rossi K, López M, Hernando O, Valero J, Sánchez E, Chen X, Alonso R, Letón PF, Rubio C. 5-year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis ®) for very early breast cancer patients: was it all worth it? Clin Transl Oncol 2021; 23:2358-2367. [PMID: 34043153 DOI: 10.1007/s12094-021-02636-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer. MATERIAL AND METHODS Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied. RESULTS Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8-99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months. CONCLUSION APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties.
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MESH Headings
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Disease-Free Survival
- Dose Fractionation, Radiation
- Feasibility Studies
- Female
- Fiducial Markers
- Heart/radiation effects
- Humans
- Lung/radiation effects
- Mastectomy, Segmental
- Middle Aged
- Organ Motion
- Organs at Risk/radiation effects
- Postoperative Care/methods
- Prospective Studies
- Radiosurgery/instrumentation
- Radiosurgery/methods
- Respiration
- Skin/radiation effects
- Time Factors
- Tomography, X-Ray Computed
- Tumor Burden
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Affiliation(s)
- R Ciérvide
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain.
| | - Á Montero
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - G Potdevin
- Department of Radiation Oncology, Fundación Valle del Lili, Cali, Colombia
| | - J García
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
| | - M G Aranda
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - B Álvarez
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - K Rossi
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - M López
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - O Hernando
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
| | - J Valero
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - E Sánchez
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
| | - X Chen
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
| | - R Alonso
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
| | - P F Letón
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
| | - C Rubio
- Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain
- Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain
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12
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de Paula U, D'Angelillo RM, Andrulli AD, Apicella G, Caruso C, Ghini C, Gomellini S, Ponti E, Pompei M, Caccavari A, Petrocchi A, Costarelli L, Giordano M, La Pinta M, Meli EZ, Mauri M, Minelli M, Rossi R, Scavina P, Broglia L, Ponzani T, Loreti A, Fortunato L. Long-Term Outcomes of Once-Daily Accelerated Partial-Breast Irradiation With Tomotherapy: Results of a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2021; 109:678-687. [PMID: 33098960 DOI: 10.1016/j.ijrobp.2020.10.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE We report long-term outcomes of phase 2 trial on patients with invasive breast cancer treated with accelerated partial-breast irradiation (APBI) using tomotherapy after breast conservative surgery. METHODS AND MATERIALS From December 2010 to December 2018, we treated 338 women with APBI-tomotherapy: 38.5 Gy in 10 once-daily fractions. Patients selected were age ≥50 years old, with ≤3 cm in size unifocal tumor and at least 2 mm of clear margins. Disease outcomes were analyzed by clinicopathologic characteristics, molecular phenotypes, and American Society for Radiation Oncology (ASTRO) 2017 updated consensus groupings. RESULTS The median age was 65 years (range, 50-86). The invasive ductal (87.5%) and the luminal A-like molecular phenotype (70%) were the most common tumors. Overall 242 patients (71.6%) were considered "suitable" for enrollment in APBI according to the eligibility criteria of the ASTRO-2017 consensus statement. With a median follow-up of 76 months (range, 17-113), 2 patients (0.6%) had an invasive ipsilateral breast tumor recurrence (IBTR), and 2 patients (0.6%) had an axillary ipsilateral failure. The rate of local control in terms of free of IBTR was 99.4% and locoregional control (no recurrence in ipsilateral breast as well as in regional nodes) was 98.8%. Progression-free survival was 98.4% and 92% at 5 and 10 years, respectively. Acute and late skin toxicity, graded according to the Common Terminology Criteria for Adverse Events, were 7.7% (G1) and 0.6% (G2) and 4.4% (G1) and 1.1% (G2), respectively. There were no grade 3/4 toxicities, however. Very few patients (2%) or physicians (2%) assessed cosmetic outcome as fair or poor at the 2-year follow-up. CONCLUSIONS This phase 2 trial on APBI-tomotherapy shows excellent long-term results. Once-daily fractionation schedule was well tolerated with a low rate of adverse events and worse cosmetic outcome. In this series, even among those deemed cautionary or unsuitable for APBI by ASTRO criteria, we demonstrated a low rate of IBTR.
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MESH Headings
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Consensus
- Dose Fractionation, Radiation
- Esthetics
- Female
- Humans
- Kaplan-Meier Estimate
- Margins of Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local
- Progression-Free Survival
- Radiotherapy/methods
- Radiotherapy, Intensity-Modulated
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Ugo de Paula
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy.
| | - Rolando Maria D'Angelillo
- Radioterapia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | | | | | - Cristina Caruso
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Christian Ghini
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Sara Gomellini
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Elisabetta Ponti
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Marco Pompei
- Radioterapia Oncologica, Ospedale San Giovanni Addolorata, Rome, Italy
| | | | | | | | - Marco Giordano
- Anatomia Patologica Ospedale San Giovanni Addolorata, Rome, Italy
| | - Massimo La Pinta
- Chirurgia Senologica Ospedale San Giovanni Addolorata, Rome, Italy
| | | | - Maria Mauri
- Oncologia Medica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Mauro Minelli
- Oncologia Medica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Rosalinda Rossi
- Oncologia Medica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Paola Scavina
- Oncologia Medica, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Laura Broglia
- Diagnostica per Immagini, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Tatiana Ponzani
- Diagnostica per Immagini, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Andrea Loreti
- Chirurgia Plastica e Ricostruttiva, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Lucio Fortunato
- Chirurgia Senologica Ospedale San Giovanni Addolorata, Rome, Italy
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13
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Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, Alvarado M, Douek M, Saunders C, Flyger HL, Eiermann W, Brew-Graves C, Williams NR, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Corica T, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Le Blanc-Onfroy M, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McCready D, Hoefer R, Kelemen P, Petralia G, Falzon M, Joseph DJ, Tobias JS. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ 2020; 370:m2836. [PMID: 32816842 PMCID: PMC7500441 DOI: 10.1136/bmj.m2836] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer. DESIGN Prospective, open label, randomised controlled clinical trial. SETTING 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada. PARTICIPANTS 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT). INTERVENTIONS Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients). MAIN OUTCOME MEASURES Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes. RESULTS Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005). CONCLUSION For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned. TRIAL REGISTRATION ISRCTN34086741, NCT00983684.
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Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Steffi Pigorsch
- Department of Gynaecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Henrik L Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Eiermann
- Department of Gynaecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Ingrid Potyka
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Nicholas Roberts
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | | | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Siobhan Laws
- Department of Surgery, Royal Hampshire County Hospital, Winchester, UK
| | - Marc Sütterlin
- Department of Gynaecology and Obstetrics, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dennis Holmes
- University of Southern California, John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, Los Angeles, CA, USA
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, The Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jens Blohmer
- Sankt Gertrauden Hospital, Charité, Medical University of Berlin, Berlin, Germany
| | - David McCready
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Pond Kelemen
- Ashikari Breast Center, New York Medical College, New York, NY, USA
| | - Gloria Petralia
- Department of Surgery, University College London Hospitals, London, UK
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London, UK
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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14
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Kustić D, Klarica Gembić T, Grebić D, Petretić Majnarić S, Nekić J. The role of different lymph node staging systems in predicting prognosis and determining indications for postmastectomy radiotherapy in patients with T1-T2pN1 breast carcinoma. Strahlenther Onkol 2020; 196:1044-1054. [PMID: 32710122 DOI: 10.1007/s00066-020-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the risk of locoregional recurrence (LRR), postmastectomy radiotherapy (PMRT) is recommended in T1-T2pN1 breast carcinoma (BC). We aimed to elucidate our institutional strategies underlying selection of these patients for PMRT. In the no-PMRT subset, we compared various lymph node (LN) staging systems' abilities to predict 5‑year overall and locoregional-free survival (OS/LRFS). METHODS We retrospectively enrolled 548 women with T1-T2pN1 BC undergoing mastectomy and axillary LN dissection. Depending on PMRT delivery, the participants were divided into the PMRT and no-PMRT groups. Predictors of OS/LRFS were calculated for the no-PMRT group only. Based on Cox regression modelling, the number of positive LNs (PLN), negative LNs (NLN), LN ratio (LNR), log odds of PLN (LODDS), and modified LNR (mLNR) were modelled, each respectively, with OS model covariates (age, grade III, lymphovascular invasion [LVI], tumor size, hormone receptor [HR] status) and LRFS model covariates (age, grade III, LVI). The C‑statistic, Akaike information criterion, and likelihood ratio χ2 of the models were compared. RESULTS Median follow-up was 60.5 (18-82), 61 (28-82), and 60 (18-80) months for the entire cohort, PMRT, and no-PMRT group, respectively. The PMRT and no-PMRT groups had comparable OS (p = 0.235). LRFS was better (p = 0.030) in the PMRT group comprising 105 subjects (19.16%) who were younger, more likely to have a higher-grade, HR-, HER2+ tumors, more PLNs, fewer NLNs, Ki-67 ≥ 20%, LVI, and extranodal extension (p ≤ 0.001). In the no-PMRT group, LNR-based OS/LRFS models exhibited superior prognostic performance. CONCLUSION In early-stage BC patients undergoing mastectomies, LN dissections and no PMRT, we propose LNR-based multivariable models to predict OS/LRFS with superior accuracy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymphatic Irradiation
- Lymphatic Metastasis/radiotherapy
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging/methods
- Neoplasms, Hormone-Dependent/therapy
- Prognosis
- Proportional Hazards Models
- Radiotherapy, Adjuvant/methods
- Retrospective Studies
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Affiliation(s)
- Domagoj Kustić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Damir Grebić
- Clinic for Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Jasna Nekić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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15
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Blohmer M, Zhu L, Atkinson JM, Beriwal S, Rodríguez-López JL, Rosenzweig M, Brufsky AM, Tseng G, Lucas PC, Lee AV, Oesterreich S, Jankowitz RC. Patient treatment and outcome after breast cancer orbital and periorbital metastases: a comprehensive case series including analysis of lobular versus ductal tumor histology. Breast Cancer Res 2020; 22:70. [PMID: 32586354 PMCID: PMC7318761 DOI: 10.1186/s13058-020-01309-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/10/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy to spread to the orbit and periorbit, and the invasive lobular carcinoma (ILC) histologic subtype of breast cancer has been reported to form these ophthalmic metastases (OM) more frequently than invasive ductal carcinomas (IDC). We herein report our single academic institution experience with breast cancer OM with respect to anatomical presentation, histology (lobular vs. ductal), treatment, and survival. METHODS We employed the natural language processing platform, TIES (Text Information Extraction System), to search 2.3 million de-identified patient pathology and radiology records at our institution in order to identify patients with OM secondary to breast cancer. We then compared the resultant cohort, the "OM cohort," to two other representative metastatic breast cancer patient (MBC) databases from our institution. Histological analysis of selected patients was performed. RESULTS Our TIES search and manual refinement ultimately identified 28 patients who were diagnosed with breast cancer between 1995 and 2016 that subsequently developed OM. Median age at diagnosis was 54 (range 28-77) years of age. ER, PR, and HER2 status from the 28 patients with OM did not differ from other patients with MBC from our institution. The relative proportion of patients with ILC was significantly higher in the OM cohort (32.1%) than in other MBC patients in our institution (11.3%, p = 0.007). Median time to first OM in the OM cohort was 46.7 months, and OM were the second most frequent first metastases after bony metastases. After diagnosis of the first distant metastasis of any kind, median survival of patients with ILC (21.4 months) was significantly shorter than that of patients with IDC (55.3 months, p = 0.03). Nine patients developed bilateral OM. We observed a significant co-occurrence of OM and central nervous system metastases (p = 0.0053). The histological analysis revealed an interesting case in which the primary tumor was of a mixed ILC/IDC subtype, while only ILC was present in the OM. CONCLUSIONS OM from breast cancer are illustrative of the difference in metastatic behavior of ILC versus IDC and should be considered when treating patients with ILC, especially in those with complaints of visual acuity changes.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Middle Aged
- Orbital Neoplasms/metabolism
- Orbital Neoplasms/radiotherapy
- Orbital Neoplasms/secondary
- Prognosis
- Radiotherapy, Intensity-Modulated
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Martin Blohmer
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Li Zhu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer M Atkinson
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Sushil Beriwal
- University of Pittsburgh School of Medicine, Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Joshua L Rodríguez-López
- University of Pittsburgh School of Medicine, Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Margaret Rosenzweig
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - George Tseng
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Peter C Lucas
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adrian V Lee
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Rachel C Jankowitz
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Rena Rowan Breast Center, Perelman Center for Advanced Medicine and the Abramson Cancer Center, 3rd Floor, West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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16
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Alouani E, Parent L, Massabeau C, Selmes G, Jouve E, Izar F. [Rib fracture following intra-operative radiotherapy for breast cancer. Case Report and local experience]. Cancer Radiother 2020; 24:64-66. [PMID: 32044159 DOI: 10.1016/j.canrad.2019.10.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Abstract
Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.
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Affiliation(s)
- E Alouani
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - L Parent
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - C Massabeau
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - G Selmes
- Département de chirurgie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - E Jouve
- Département de chirurgie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - F Izar
- Département d'oncoradiothérapie, institut Claudius-Regaud, institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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17
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Kim JS, Kim K, Jung W, Shin KH, Im SA, Kim HJ, Kim YB, Chang JS, Choi DH, Park YH, Kim DY, Kim TH, Choi BO, Lee SW, Kim S, Kwon J, Kang KM, Chung WK, Kim KS, Nam JH, Yoon WS, Kim JH, Cha J, Oh YK, Kim IA. Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16-12). Breast 2020; 49:41-47. [PMID: 31677532 PMCID: PMC7375558 DOI: 10.1016/j.breast.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study evaluated the influence of prognostic factors and whole brain radiotherapy (WBRT) on overall survival (OS) of breast cancer (BC) patients with brain metastases (BM). METHODS AND MATERIALS Medical records of 730 BC patients diagnosed with BM from 2000 to 2014 at 17 institutions were retrospectively reviewed. OS was calculated from BM diagnosis. Median follow-up duration was 11.9 months (range, 0.1-126.2). RESULTS Median OS was 15.0 months (95% CI: 14.0-16.9). Patients with different BC-specific graded prognostic assessment (GPA) scores showed significant differences (p < 0.001) in OS. In multivariate analysis, histologic grade 3 (p = 0.014), presence of extracranial metastasis (p < 0.001), the number of BM (>4; p = 0.002), hormone receptor negativity (p = 0.005), HER2-negativity (p = 0.003), and shorter time interval (<30 months) between BC and BM diagnosis (p = 0.007) were associated with inferior OS. By summing the β-coefficients of variables that were prognostic in multivariate analyses, we developed a prognostic model that stratified patients into low-risk (≤0.673) and high-risk (>0.673) subgroups; the high-risk subgroup had poorer median OS (10.1 months, 95% CI: 7.9-11.9 vs. 21.9 months, 95% CI: 19.5-27.1, p < 0.001). Univariate and multivariate analyses of propensity score-matched patients diagnosed with BM ≥ 30 months after BC diagnosis (n = 389, "late BM") revealed that WBRT-treated patients showed superior OS compared to non-WBRT-treated patients (p = 0.070 and 0.030, respectively). CONCLUSION Our prognostic model identified high-risk BC patients with BM who might benefit from increased surveillance; if validated, our model could guide treatment selection for such patients. Patients with late BM might benefit from WBRT as initial local treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Brain Neoplasms/mortality
- Brain Neoplasms/radiotherapy
- Brain Neoplasms/secondary
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Prognosis
- Republic of Korea/epidemiology
- Retrospective Studies
- Survival Analysis
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea.
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Hee-Jun Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Republic of Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Yeon Hee Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Dae Yong Kim
- Proton Therapy Center, National Cancer Center, Republic of Korea
| | - Tae Hyun Kim
- Proton Therapy Center, National Cancer Center, Republic of Korea
| | - Byung Ock Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University College of Medicine, Republic of Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Republic of Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea; Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Republic of Korea
| | - Ji Ho Nam
- Department of Radiation Oncology, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Republic of Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Republic of Korea
| | - Yoon Kyeong Oh
- Department of Radiation Oncology, Chosun University Medical School, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
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18
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Whelan TJ, Julian JA, Berrang TS, Kim DH, Germain I, Nichol AM, Akra M, Lavertu S, Germain F, Fyles A, Trotter T, Perera FE, Balkwill S, Chafe S, McGowan T, Muanza T, Beckham WA, Chua BH, Gu CS, Levine MN, Olivotto IA. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial. Lancet 2019; 394:2165-2172. [PMID: 31813635 DOI: 10.1016/s0140-6736(19)32515-2] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whole breast irradiation delivered once per day over 3-5 weeks after breast conserving surgery reduces local recurrence with good cosmetic results. Accelerated partial breast irradiation (APBI) delivered over 1 week to the tumour bed was developed to provide a more convenient treatment. In this trial, we investigated if external beam APBI was non-inferior to whole breast irradiation. METHODS We did this multicentre, randomised, non-inferiority trial in 33 cancer centres in Canada, Australia and New Zealand. Women aged 40 years or older with ductal carcinoma in situ or node-negative breast cancer treated by breast conserving surgery were randomly assigned (1:1) to receive either external beam APBI (38·5 Gy in ten fractions delivered twice per day over 5-8 days) or whole breast irradiation (42·5 Gy in 16 fractions once per day over 21 days, or 50 Gy in 25 fractions once per day over 35 days). Patients and clinicans were not masked to treatment assignment. The primary outcome was ipsilateral breast tumour recurrence (IBTR), analysed by intention to treat. The trial was designed on the basis of an expected 5 year IBTR rate of 1·5% in the whole breast irradiation group with 85% power to exclude a 1·5% increase in the APBI group; non-inferiority was shown if the upper limit of the two-sided 90% CI for the IBTR hazard ratio (HR) was less than 2·02. This trial is registered with ClinicalTrials.gov, NCT00282035. FINDINGS Between Feb 7, 2006, and July 15, 2011, we enrolled 2135 women. 1070 were randomly assigned to receive APBI and 1065 were assigned to receive whole breast irradiation. Six patients in the APBI group withdrew before treatment, four more did not receive radiotherapy, and 16 patients received whole breast irradiation. In the whole breast irradiation group, 16 patients withdrew, and two more did not receive radiotherapy. In the APBI group, a further 14 patients were lost to follow-up and nine patients withdrew during the follow-up period. In the whole breast irradiation group, 20 patients were lost to follow-up and 35 withdrew during follow-up. Median follow-up was 8·6 years (IQR 7·3-9·9). The 8-year cumulative rates of IBTR were 3·0% (95% CI 1·9-4·0) in the APBI group and 2·8% (1·8-3·9) in the whole breast irradiation group. The HR for APBI versus whole breast radiation was 1·27 (90% CI 0·84-1·91). Acute radiation toxicity (grade ≥2, within 3 months of radiotherapy start) occurred less frequently in patients treated with APBI (300 [28%] of 1070 patients) than whole breast irradiation (484 [45%] of 1065 patients, p<0·0001). Late radiation toxicity (grade ≥2, later than 3 months) was more common in patients treated with APBI (346 [32%] of 1070 patients) than whole breast irradiation (142 [13%] of 1065 patients; p<0·0001). Adverse cosmesis (defined as fair or poor) was more common in patients treated with APBI than in those treated by whole breast irradiation at 3 years (absolute difference, 11·3%, 95% CI 7·5-15·0), 5 years (16·5%, 12·5-20·4), and 7 years (17·7%, 12·9-22·3). INTERPRETATION External beam APBI was non-inferior to whole breast irradiation in preventing IBTR. Although less acute toxicity was observed, the regimen used was associated with an increase in moderate late toxicity and adverse cosmesis, which might be related to the twice per day treatment. Other approaches, such as treatment once per day, might not adversely affect cosmesis and should be studied. FUNDING Canadian Institutes for Health Research and Canadian Breast Cancer Research Alliance.
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Affiliation(s)
- Timothy J Whelan
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada.
| | - Jim A Julian
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Tanya S Berrang
- Radiation Therapy Program, BC Cancer - Victoria, University of British Columbia, Vancouver, BC, Canada
| | - Do-Hoon Kim
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Isabelle Germain
- Department of Radiation Oncology, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Alan M Nichol
- Division of Radiation Oncology, University of British Columbia and BC Cancer - Vancouver, BC, Canada
| | - Mohamed Akra
- Department of Radiation Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Sophie Lavertu
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Francois Germain
- Department of Radiation Oncology, CHU de Québec - Université Laval, Québec, QC, Canada; Division of Radiation Oncology, University of British Columbia and BC Cancer - Kelowna, BC, Canada
| | - Anthony Fyles
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Francisco E Perera
- Department of Oncology, Western University and London Regional Cancer Program, London, ON, Canada
| | | | - Susan Chafe
- Department of Oncology, Division of Radiation Oncology, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Thomas McGowan
- Trillium Health Partners Credit Valley Hospital, Mississauga, ON, Canada
| | - Thierry Muanza
- Department of Oncology, McGill University and Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Wayne A Beckham
- Department of Physics and Astronomy, University of Victoria and BC Cancer - Victoria, BC, Canada
| | - Boon H Chua
- University of New South Wales and Prince of Wales Hospital, Sydney, NSW, Australia
| | - Chu Shu Gu
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Mark N Levine
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
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19
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Komaei I, Guccione F, Sarra F, Palmeri E, Ieni A, Cardia R, Currò G, Navarra G, Palmeri R. Radiation-induced undifferentiated pleomorphic sarcoma of the breast: a rare but serious complication following breast-conserving therapy. A case report and literature review. G Chir 2019; 40:544-550. [PMID: 32007118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) of the breast is an extremely rare, but aggressive subtype of sarcoma that can develop in radiotherapy (RT)-treated breast cancer patients. Due to the low incidence, there are many uncertainties regarding the adequate management of these tumors. We present a rare case of radiation-induced UPS in a 63-year-old woman who had undergone breast conserving therapy for invasive ductal carcinoma of the left breast, six years prior to presentation. CASE PRESENTATION A 63-year-old woman presented with a rapidly growing left breast mass. She had been diagnosed with invasive ductal carcinoma of the left breast for which she underwent a left upper outer quadrantectomy and ipsilateral axillary dissection followed by RT, six years previously. During her routine oncologic follow-up, the mammography revealed a dense, nodular opacity with microcalcifications. The breast ultrasound (US) confirmed the presence of the nodule. US-guided fine needle aspiration biopsy was performed and the diagnosis of UPS was made, the reason for which the patient underwent wide local excision of the left breast. CONCLUSION The diagnosis of RT-induced UPS is challenging and often missed due to the low incidence, long latency period, unspecific imaging findings, and difficulties in clinical and histological detection of these lesions. These tumors should be considered in differential diagnoses of rapidly-growing breast masses in previously RT-treated breast cancer patients, as they can mimic the local recurrence of the primary tumor. Since the prevalence of breast-conserving surgery followed by RT has been increasing, the careful monitoring of at risk patients is of utmost importance, as UPSs are highly aggressive tumors associated with very poor outcomes.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor
- Breast Neoplasms/etiology
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Diagnosis, Differential
- Epirubicin/administration & dosage
- Female
- Humans
- Letrozole/administration & dosage
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasms, Radiation-Induced/diagnosis
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Radiation-Induced/pathology
- Neoplasms, Radiation-Induced/therapy
- Photons
- Radiotherapy, High-Energy/adverse effects
- Sarcoma/diagnosis
- Sarcoma/etiology
- Sarcoma/pathology
- Sarcoma/therapy
- Ultrasonography, Mammary
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20
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Xie L, Bao X, Cai T, Silva SG, Ma J, Zhang Z, Guo X, Marks LB. Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer. Int J Radiat Oncol Biol Phys 2019; 105:275-284. [PMID: 31201893 DOI: 10.1016/j.ijrobp.2019.06.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/13/2019] [Accepted: 06/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To estimate the effect of radiation therapy (RT) on nonbreast second malignant neoplasms (SMNs) in young women survivors of stage I-IIIA breast cancer. METHODS AND MATERIALS Women aged 20 to 44 years who received a diagnosis of stage I-IIIA breast cancer (1988-2008) were identified in the Surveillance, Epidemiology, and End Results 9 registries. Bootstrapping approach and competing-risk proportional hazards models were used to evaluate the effect of RT on nonbreast SMN risk. The analysis was repeated in racial subgroups. Radiotolerance score analysis of normal airway epithelium was performed using Gene Expression Omnibus (GEO) data sets. RESULTS Within records of 30,003 women with primary breast cancer, 20,516 eligible patients were identified, including 2,183 African Americans (AAs) and 16,009 Caucasians. The 25-year cumulative incidences of SMN were 5.2% and 3.6% (RT vs no-RT) for AAs, with 12.8-year and 17.4-year (RT vs no-RT) median follow-up (hazard ratio [HR] = 1.81; 95% bootstrapping confidence interval [BCI], 1.02-2.50; P < .05), respectively, and 6.4% and 5.9% (RT vs no-RT) for Caucasians with 14.3-year and 18.1-year (RT vs no-RT) median follow-up (HR = 1.10; 95% BCI, 0.61-1.40; P > .05), respectively. The largest portion of excess RT-related SMN risk was lung cancer (AA: HR = 2.08, 95% BCI, 1.02-5.39, P < .05; Caucasian: HR = 1.50, 95% BCI, 0.84-5.38, P > .05). Subpopulation Treatment Effect Pattern Plot (STEPP) analysis revealed higher post-RT nonbreast SMN risk in those 20 to 44 years of age, with larger HRs for RT in AAs. Radiotolerance score (RTS) of normal airway epithelium from young AA women was significantly lower than that from young Caucasian women (P = .038). CONCLUSIONS With a projected 25-year follow-up, RT is associated with elevated risk of nonbreast SMNs, particularly second lung cancer, in young women survivors of stage I-IIIA breast cancer. Nonbreast SMNs associated with RT are higher in AA women than Caucasian women.
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Affiliation(s)
- Liyi Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuhui Bao
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
| | - Tianji Cai
- Department of Sociology, University of Macau, Taipa, Macau, China
| | - Susan G Silva
- Department of Clinical Trials Statistics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Lawrence B Marks
- Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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21
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Inoue H, Hirano A, Ogura K, Kamimura M, Hattori A, Yukawa H, Sakaguchi S, Tanaka N, Matsuoka A, Kodera A, Shimizu T. Breast-conserving surgery without radiation in elderly women with early breast cancer. Surg Oncol 2019; 31:22-25. [PMID: 31479976 DOI: 10.1016/j.suronc.2019.08.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/07/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Irradiation after breast-conserving surgery (BCS) decreases the incidence of ipsilateral breast tumor recurrence (IBTR) and breast cancer-related death. However, daily radiation treatments are burdensome to elderly patients, whose risk of IBTR is relatively low. Since 2001, we have offered BCS without radiation to patients meeting our selection criteria. This study assessed the prognosis of the patients who chose this option. METHODS Between 2001 and 2014, 203 patients met the selection criteria: aged ≥60 years; pathologically node-negative, hormone-positive breast cancer; a negative surgical margin; and no lymphovascular invasion. Among these patients, 84 and 119 underwent BCS with or without radiation, respectively. IBTR, overall survival (OS), and breast cancer-specific survival (BCSS) were evaluated. RESULTS The median follow-up duration was 6.2 years. There were no significant differences in tumor size or the number of patients with adjuvant therapy between the groups. The 5-year IBTR rates were 0.9% and 1.6% in the non-irradiated and irradiated groups, respectively (p = 0.308). The 5-year OS rates were 94.1% and 98.7% (p = 0.391). Similarly, the 5-year BCSS rates were 97.2% and 98.7% (p = 0.812). CONCLUSION It is suggested that the omission of irradiation could be an option for elderly breast cancer patients who satisfy our criteria.
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Affiliation(s)
- Hiroaki Inoue
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Akira Hirano
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
| | - Kaoru Ogura
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Mari Kamimura
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Akinori Hattori
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroko Yukawa
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Shiho Sakaguchi
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Natsuko Tanaka
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Aya Matsuoka
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Asaka Kodera
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tadao Shimizu
- Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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22
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Wilhite TJ, Youland RS, Tian S, Finley RR, Sarkaria JN, Corbin KS. Pathogenic Germ Line Variants in a Patient With Severe Toxicity From Breast Radiotherapy. Clin Breast Cancer 2019; 19:e400-e405. [PMID: 31031124 DOI: 10.1016/j.clbc.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Tyler J Wilhite
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Ryan S Youland
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Shulan Tian
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Randi R Finley
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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23
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Bondiau PY, Gal J, Chapellier C, Haudebourg J, Courdi A, Levy J, Gerard A, Sumodhee S, Maurin M, Château Y, Barranger E, Ferrero JM, Thariat J. Robotic Stereotactic Boost in Early Breast Cancer, a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2019; 103:374-380. [PMID: 30612961 DOI: 10.1016/j.ijrobp.2018.09.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and toxicity of a single-fraction 8-Gy stereotactic boost after whole-breast irradiation in early breast cancer. The primary aim of this phase 2 study was to evaluate cutaneous breast toxicity using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4) 3 months after the boost. Secondary objectives were local control, survival, and patient-reported quality of life using the European Organisation for Research and Treatment of Cancer QLQ-C30 and breast-specific European Organisation for Research and Treatment of Cancer QLQ-BR 23 questionnaires. METHODS AND MATERIALS Patients with invasive ductal or lobular pT1-2 breast cancer treated with lumpectomy with clear margins and pN0 were included. Patients requiring chemotherapy were excluded. RESULTS Twenty-eight eligible patients received the planned boost, and 26 had hormonal therapy. The procedure was technically successful without procedural complications. A median of 3 fiducials were tracked, and 115 beams were used. There were 22 acute grade 1 breast skin toxicities, including fibrosis, pain, erythema, or pigmentation. There were 2 acute grade 2 erythemas. Median skin boost dose was inversely correlated with acute skin toxicity (P = .028). QLQ-C30 scores revealed acute dyspnea and arm symptoms without correlation to the boost dose. Breast symptom QLQ-BR23 scores did not deteriorate, although upset with hair loss and systemic side effects of hormonal therapy were observed. After a median follow-up of 38 months, 1 patient had in-boost-field relapse, and there were 5 late grade 1 and 1 grade 2 skin toxicities. CONCLUSIONS Single-fraction stereotactic boost after conventional whole-breast irradiation in early breast cancer is feasible with minor toxicities. Quality of life and specific breast items showed excellent patient acceptance.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/psychology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/psychology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Lobular/psychology
- Carcinoma, Lobular/radiotherapy
- Feasibility Studies
- Female
- Fibrosis
- Humans
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm Recurrence, Local
- Prospective Studies
- Quality of Life
- Radiosurgery/methods
- Robotic Surgical Procedures/methods
- Severity of Illness Index
- Skin/radiation effects
- Surveys and Questionnaires
- Tomography, X-Ray Computed
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Affiliation(s)
| | - Jocelyn Gal
- Department of Biostatistics, Centre Antoine Lacassagne, Nice, France
| | | | | | - Adel Courdi
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Johan Levy
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Anais Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Shakeel Sumodhee
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Maeva Maurin
- Department of Clinical Research, Centre Antoine Lacassagne, Nice, France
| | - Yann Château
- Department of Clinical Research, Centre Antoine Lacassagne, Nice, France
| | | | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Juliette Thariat
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France; Department of Radiation Oncology, Centre François Baclesse, Caen, France - Unicaen - Normandie Universite
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24
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Abstract
A 43-year-old woman with a positive family history of breast cancer presented with a painless lump in her left axilla for 2 years. Clinical diagnosis was a left axillary sebaceous cyst as the lump was inseparable from the skin. The lesion was excised under local anaesthesia and reported as breast tissue widely infiltrated by an invasive ductal carcinoma (grade 2). The malignancy was not involving the epidermis but <1 mm away from deeper margins. Re-excision of the deeper tissue with an axillary sentinel lymph nodes biopsy was performed and deep margins were reported to be tumour-free with no nodal involvement.
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MESH Headings
- Adult
- Antineoplastic Agents, Hormonal/adverse effects
- Axilla
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Diagnosis, Differential
- Epidermal Cyst/diagnosis
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/diagnostic imaging
- Lymphatic Metastasis/diagnostic imaging
- Lymphatic Metastasis/pathology
- Magnetic Resonance Imaging
- Sentinel Lymph Node Biopsy
- Tamoxifen/adverse effects
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Uzma Jalali
- Department of General Surgery, Royal Albert Edward Infirmary, Wigan, Lancashire, UK
| | - Alhad Dhebri
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Eszter Karip
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Roger Hunt
- Department of Histopathology, Wythenshawe Hospital, Manchester, UK
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25
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Struik GM, Godart J, Verduijn GM, Kolkman-Deurloo IK, de Vries KC, de Boer R, Koppert LB, Birnie E, Ghandi A, Klem TM, Pignol JP. A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol. Trials 2018; 19:689. [PMID: 30558672 PMCID: PMC6298013 DOI: 10.1186/s13063-018-3035-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) is a treatment option for selected early stage breast cancer patients. Some APBI techniques lead to skin toxicity with the skin dose as main risk factor. We hypothesize that a spacer injected between the skin and target volume reduces the skin dose and subsequent toxicity in permanent breast seed implant (PBSI) patients. METHODS In this parallel-group, single-center, randomized controlled trial, the effect of a subcutaneous spacer injection on skin toxicity among patients treated with PBSI is tested. Eligibility for participation is derived from international guidelines for suitable patients for partial breast radiotherapy, e.g. women aged ≥ 50 years with a histologically proven non-lobular breast carcinoma and/or ductal carcinoma in situ (DCIS), tumor size ≤ 3 cm, node-negative, and PBSI technically feasible. Among exclusion criteria are neoadjuvant chemotherapy, lymphovascular invasion, and allergy for hyaluronic acid. For the patients allocated to receive spacer, after the PBSI procedure, 4-10 cc of biodegradable hyaluronic acid (Barrigel™, Palette Life Sciences, Santa Barbara, CA, USA or Restylane SubQ®, Galderma Benelux, Breda, the Netherlands) is injected directly under the skin using ultrasound guidance to create an extra 0.5-1 cm space between the treatment volume and the skin. The primary outcome is the rate of telangiectasia at two years, blindly assessed using Bentzen's 4-point scale. Secondary outcomes include: local recurrence; disease-free and overall survival rates; adverse events (pain, redness, skin/subcutaneous induration, radiation dermatitis, pigmentation, surgical site infection); skin dose; cosmetic and functional results; and health-related quality of life. A Fisher's exact test will be used to test differences between groups on the primary outcome. Previous studies found 22.4% telangiectasia at two years. We expect the use of a spacer could reduce the occurrence of telangiectasia to 7.7%. A sample size of 230 patients will allow for a 10% lost to follow-up rate. DISCUSSION In this study, the effect of a subcutaneous spacer injection on the skin dose, late skin toxicity, and cosmetic outcome is tested in patients treated with PBSI in the setting of breast-conserving therapy. Our results will be relevant for most forms of breast brachytherapy as well as robotic radiosurgery, as skin spacers could protect the skin with these other techniques. TRIAL REGISTRATION Netherlands Trial Register, NTR6549 . Registered on 27 June 2017.
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MESH Headings
- Brachytherapy/adverse effects
- Brachytherapy/methods
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Dermal Fillers/administration & dosage
- Dermal Fillers/adverse effects
- Female
- Humans
- Hyaluronic Acid/administration & dosage
- Hyaluronic Acid/adverse effects
- Hyaluronic Acid/analogs & derivatives
- Injections, Subcutaneous
- Mastectomy, Segmental
- Middle Aged
- Netherlands
- Radiation Dosage
- Radiodermatitis/diagnosis
- Radiodermatitis/etiology
- Radiodermatitis/prevention & control
- Radiotherapy, Adjuvant
- Randomized Controlled Trials as Topic
- Telangiectasis/diagnosis
- Telangiectasis/etiology
- Telangiectasis/prevention & control
- Time Factors
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Gerson M. Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Jeremy Godart
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Gerda M. Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | | | - Kim C. de Vries
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Raymond de Boer
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Linetta B. Koppert
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, the Netherlands
- Department of Genetics, UMC Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
| | - Ali Ghandi
- Department of Radiology, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, the Netherlands
| | - Taco M. Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
- Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS B3H1V7 Canada
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26
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Petit JY, Veronesi U, Orecchia R, Rey P, Didier F, Giraldo A, Luini A, De Lorenzi F, Rietjens M, Garusi C, Intra M, Yamaguchi S, Martella S. The Nipple-Sparing Mastectomy: Early Results of a Feasibility Study of a New Application of Perioperative Radiotherapy (Eliot) in the Treatment of Breast Cancer When Mastectomy is Indicated. Tumori 2018; 89:288-91. [PMID: 12908785 DOI: 10.1177/030089160308900311] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Breast cancer surgery has become less and less mutilating, however a mastectomy is required in the case of multicentric, large tumors or recurrences after conservative treatment. The removal of the nipple areola complex during the mastectomy dramatically increases the feeling of mutilation. To reduce this negative psychological impact, in cancers located outside of the central area of the breast, we propose a new type of nipple-sparing mastectomy associated with intraoperative electron beam radiotherapy (ELIOT) delivered on the region of the areola. The nipple-sparing mastectomy is performed leaving 5 mm of glandular tissue behind the nipple areola complex to preserve its blood supply. The reconstruction is immediately performed with a prosthesis or an autologous flap. Patients and Methods Twenty-five patients were included in the study; two of them had a bilateral nipple-sparing mastectomy. Results Pathological examinations demonstrated the presence of 19 infiltrating carcinomas and 8 ductal carcinoma in situ. Two patients had a superficial skin areolar slough followed by spontaneous healing. One necrosis of the areola occurred due to extensive retroareolar dissection. In the early follow-up, the color of the areola was preserved. All patients except one expressed their satisfaction of having kept their areola. Conclusions These preliminary results are encouraging but they require further studies to evaluate the long-term results, the local recurrence rate and the psychological impact.
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Affiliation(s)
- Jean Yves Petit
- Plastic Surgery Division, European Institute of Oncology, Milan, Italy.
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27
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Rovirosa-Casino A, Biete A, Velasco M, Moreno F. Unusual Breast Edema and Erythema during Radiotherapy in the Conservative Approach of Breast Cancer. A Case Report. Tumori 2018; 79:275-7. [PMID: 8249183 DOI: 10.1177/030089169307900410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The appearance of breast edema in the conservative approach of breast cancer is correlated with axillary dissection, and it is worsened by radiotherapy. In rare cases there are serious edema and erythema of the breast at the beginning of radiotherapy. We present a patient with edema and erythema of the breast with an unusual evolution after conservative surgical treatment of the breast cancer. Possible etiologies and published data are reviewed.
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Affiliation(s)
- A Rovirosa-Casino
- Radiotherapy Department, Clinic I Provincial Hospital of Barcelona, Spain
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28
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Intra M, Leonardi MC, Gatti G, Vento AR, Ciocca M, Veronesi P, Bassani G, Dos Santos GR, Rodriguez J, Luini A, Orecchia R, Veronesi U. Intraoperative Radiotherapy during Breast Conserving Surgery in Patients Previously Treated with Radiotherapy for Hodgkin's Disease. Tumori 2018; 90:13-6. [PMID: 15143964 DOI: 10.1177/030089160409000104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Women who have received radiotherapy for Hodgkin's disease have an increased risk of developing breast cancer. Breast-conserving surgery followed by breast irradiation is generally considered to be contraindicated in such patients owing to the high cumulative radiation dose to the breast. Mastectomy is therefore recommended as the preferred treatment option in these women. Methods We report 3 patients affected by breast cancer who had previously been treated with mantle radiation for Hodgkin's disease and on whom breast-conserving surgery and full-dose intraoperative radiotherapy with electrons (ELIOT) were performed. Results A total dose of 17 Gy (prescribed at 100% isodose) in one case and 21 Gy (at the 90% isodose) in two cases was delivered directly to the mammary gland without acute complications and with good cosmetic results. Conclusions In women previously irradiated for Hodgkin's disease, ELIOT could avoid repeat irradiation of the whole breast, thereby permitting conservative surgical treatment.
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Affiliation(s)
- Mattia Intra
- Department of Breast Surgery, University of Milan, Italy.
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29
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Silvestris N, Di Cosimo S, Ferretti G, Angelini F, De Benedetti G, D'Alberto A, Caselli M, D'Aprile M. Breast Cancer Metastatic to the Choroid in a Male Patient Case Report. Tumori 2018; 89:333-5. [PMID: 12908795 DOI: 10.1177/030089160308900321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Choroidal metastases have been observed in about 8% of patients with metastatic breast cancer, even if their true incidence is likely to be higher, as they are not routinely investigated in the absence of symptoms. Radiotherapy is the treatment of choice for symptom palliation. The prognosis is traditionally poor, with a reported average survival of one year. Here we describe the third case reported in the literature of a metastatic tumor to the choroid from a male breast carcinoma.
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Affiliation(s)
- Nicola Silvestris
- Operative Unit of Medical Oncology, Oncology Center Giorgio Porfiri, Hospital Santa Maria Goretti, Latina, Italy.
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30
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Abstract
The role of internal mammary chain lymph node removal in breast cancer is still not clarified. Although it has been proven that elective dissection of the internal mammary chain nodes does not improve survival, their selective treatment based on sentinel lymph node biopsy is under evaluation. There is another possibility to establish the status of internal mammary chain nodes - sampling of the nodes during the preparation of the site for microvascular anastomosis to the internal mammary artery and vein for free flap transfer. From August 2002 to December 2003, 54 free flaps were performed for breast reconstruction. In 11 cases, an internal mammary chain lymph node was harvested. A positive internal mammary chain node was found in only one case. In this case, the treatment policy was changed by adding irradiation to the internal mammary chain. The sampling of internal mammary chain nodes during preparation of the site for microvascular anastomosis to the internal mammary artery and vein should be a part of the reconstructive procedure after total mastectomy for invasive breast cancer because it could change the treatment plan.
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Affiliation(s)
- Zoran M Arnez
- Department of Plastic Surgery and Burns, University Clinical Center, Ljubljana, Slovenia
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31
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Xie L, Lin C, Zhang H, Bao X. Second malignancy in young early-stage breast cancer patients with modern radiotherapy: A long-term population-based study (A STROBE-compliant study). Medicine (Baltimore) 2018; 97:e0593. [PMID: 29703057 PMCID: PMC5944535 DOI: 10.1097/md.0000000000010593] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Second cancer is a leading cause of death in long-term survivors of younger early-stage breast cancer patients. To date, relationship of age, receipt of radiotherapy (RT), and estimated doses received by target organs have not yet been well elucidated. Using Surveillance, Epidemiology, and End Results database, patients aged 20 to 44, diagnosed with a first primary staging I-IIIA ipsilateral breast invasive ductal carcinoma, underwent surgery during 1988 to 2009 were identified, and those with a second malignancy at ≥1-year follow-up were analyzed to calculate cumulative incidences (CIs) of second malignancy in whole group and each subgroup. Subgroups were dichotomized by surgery type, axillary dissection, and axillary lymph node status. With a median follow-up of 11.8 years, 22,628 women including 1495 patients (6.6%) developing second malignancies (3.7% contralateral breast cancer, 2.9% non-breast second malignancies, and 0.7% high-dose site second malignancies) were identified. Three-dimensional coordinate systems with age at primary diagnosis, time after primary breast cancer diagnosis, and CI of second malignancy as 3 axes, for endpoints including all second malignancy, second primary contralateral breast cancer, and non-breast second malignancy were presented, along with the risk in RT and non-RT groups in overall group and subgroups. Five-, 10-, 15-, and 20-year all second malignancy-free survivals in RT and non-RT groups were 89.5% versus 85.4%, 80.1% versus 75.0%, 72.9% versus 67.9%, and 65.6% versus 61.8% (P < .0001). From the large national dataset, a broad visualized overview of second malignancy risk, including second contralateral breast cancer and non-breast second cancer, suggests generally beneficial therapeutic ratio for radiotherapy in young women with early-stage breast cancer.
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Affiliation(s)
- Liyi Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Chen Lin
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang
| | - Huan Zhang
- Department of Internal Medicine, Shanghai Changhai Hospital, Shanghai, China
| | - Xuhui Bao
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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32
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Ghasemi A, Danesh B, Yazdani-Charati J, Hosseinimehr SJ. Randomized Double-blind Placebo-controlled Trial of Celecoxib for the Prevention of Skin Toxicity in Patients Receiving Radiation Therapy for Breast Cancer. Antiinflamm Antiallergy Agents Med Chem 2018; 17:57-67. [PMID: 29651970 DOI: 10.2174/1871523017666180411162114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/27/2018] [Accepted: 03/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The skin toxicity-induced by ionizing radiation may limit the duration of treatment and may lead to discomfort in quality of life of patients during radiotherapy. OBJECTIVE The purpose of this randomized, placebo-controlled, double-blind study was to investigate the preventive effect of oral administration of celecoxib (CLX) on the acute radiation- induced skin toxicity in patients with breast cancer. METHODS Sixty breast cancer patients were randomly assigned to use CLX (400 mg per day) or placebo capsules during radiotherapy. Radiation-induced dermatitis was classified according to the radiation therapy oncology group (RTOG) criteria, as well as pain and itching were scored according to the VAS (Visual Analogue Scale) for six weeks of treatment. Breast swelling was evaluated through increase in the size of the breast during radiotherapy. RESULTS Oral administration of CLX capsule during and after radiotherapy reduced significantly radiation-induced itching and pain in patients with breast cancer. CLX reduced the frequency of increased breast size caused by radiotherapy in patients as compared with placebo; however, this difference was statistically not significant. Patients who received CLX had insignificantly skin dermatitis when compared with placebo group. CONCLUSION However, CLX was unable to reduce the dermatitis caused by ionizing radiation; it significantly reduced itching and pain in patients during radiotherapy. CLX may have beneficial effects in the quality life of breast cancer patients for treatment.
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Affiliation(s)
- Arash Ghasemi
- Department of Radiology and Radiation Oncology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behzad Danesh
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani-Charati
- Department of Biostatics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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33
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Di Bella G, Colori B, Toscano R. Complete objective response, stable for 5 years, with the Di Bella Method, of multiple-metastatic carcinoma of the breast. Neuro Endocrinol Lett 2017; 38:401-407. [PMID: 29298280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
Breast cancer is the most common cancer and the leading cause of cancer death among women. Despite all efforts, about 11,939 deaths and 50,000 new diagnoses for breast cancer were estimated among Italian women in 2016. Therefore new approaches are needed to improve the survival and higher remission rates. We present a case of a woman with carcinoma of the breast and multiple metastases after right mastectomy, axillary dissection, repeated cycles of chemo and radiotherapy, and estrogen block. Biological method formulated by Prof. L. Di Bella (DBM) produced a complete and stable objective response without toxicity. The DBM includes antiproliferative molecules, such as somatostatin, prolactin and estrogen inhibitors together with differentiating and apoptotic molecules such as melatonin (MLT), Retinoids, Vitamin E, D3, Vit. C, Calcium, Amino sugars, associated with metronomic microdoses of chemotherapy drugs. The blood tests did not show any damage but a progressive reduction of Prolactin, Estradiol, and IGF1, and continuing low levels of GH. The objective result of this case, in the absence of toxicity, demonstrates the efficacy of the treatment and is in agreement with the positive results already published on the use of the DBM. Not requiring hospital or day hospital admission, and with no significant toxicity, the DBM avoided the significant side effects of chemo- and radiotherapy. We believe that this case can encourage more interest and more in-depth studies on the possibilities that have been opened up in oncology by the DBM treatment of the metastatic breast cancer.
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Affiliation(s)
| | - Biagio Colori
- Rizzoli Scientific Research and Care Institute, Via Giulio Cesare Pupilli, 40136 Bologna, Italy
| | - Rosilde Toscano
- Di Bella Foundation, Via Guglielmo Marconi 51 Bologna, 40122, Italy
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34
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Bernichon E, Vallard A, Wang Q, Attignon V, Pissaloux D, Bachelot T, Heudel PE, Ray-Coquard I, Bonnet E, de la Fouchardière A, Faure C, Chopin N, Beurrier F, Racadot S, Sunyach MP, Rancoule C, Perol D, Corset V, Agrapart V, Tinquaut F, Blay JY, Magné N, Trédan O. Genomic alterations and radioresistance in breast cancer: an analysis of the ProfiLER protocol. Ann Oncol 2017; 28:2773-2779. [PMID: 28945826 DOI: 10.1093/annonc/mdx488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer (BC) patients with comparable prognostic features have heterogeneous outcomes, party related to a possible radiotherapy resistance leading to local-regional recurrences (LRR). The objective of the present study was to identify predictive molecular biomarkers of LRR of BC. PATIENTS AND METHODS Genetic profile of 146 BC patients' tumours included in the ProfiLER clinical trial (NC01774409) between 2013 and 2016 were analysed using next-generation-sequencing and comparative-genomic-hybridization tests. Patients and tumour characteristics were retrospectively collected and analysed for association with genomic rearrangements (mutations, amplification, deletions). Only gene alterations observed in >3% of the tumours were selected. RESULTS A total of 193 genomic rearrangements were identified, and 16 were observed in >3% of tumours. One was statistically correlated to the risk of local relapse. A median loco-regional progression-free survival (LRPFS) of 23.6 years was reported for PIK3CA mutation carriers (n = 31, 21.2%) versus 9.9 years for PIK3CA wild-type patients (HR 0.27, 95% CI 0.12-0.65, P = 0.002 in univariate analysis). PIK3CA mutation was identified as an independent protective factor on LRR using multivariate analysis (HR 0.29, 95% CI 0.09-0.99, P = 0.047). All other mutations, amplifications or deletions were not found associated with LRPFS. CONCLUSION PIK3CA mutation was associated with a lower risk of local relapse in this population of BCs. This is consistent with recent studies suggesting PIK3CA to be part of biological pathways impacting the radiosensitivity.
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MESH Headings
- Adult
- Biomarkers, Tumor/genetics
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Class I Phosphatidylinositol 3-Kinases/genetics
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Gene Rearrangement
- Genomics
- High-Throughput Nucleotide Sequencing
- Humans
- Lymphatic Metastasis
- Middle Aged
- Mutation
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Prognosis
- Prospective Studies
- Radiation Tolerance/genetics
- Retrospective Studies
- Survival Rate
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Affiliation(s)
| | - A Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - Q Wang
- Department of Translational Research
| | | | | | | | | | | | | | | | | | | | | | | | | | - C Rancoule
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - D Perol
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - V Corset
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - V Agrapart
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - F Tinquaut
- Department of Hygée Center, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - J-Y Blay
- Department of Translational Research; Department of Medical Oncology
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez; Department of Laboratoire de Radiobiologie Cellulaire et Moléculaire, CNRS UMR 5822, Institut de Physique Nucléaire de Lyon, IPNL, Lyon Medicine University, Lyon, France.
| | - O Trédan
- Department of Translational Research; Department of Medical Oncology
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35
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Yadav P, Yan Y, Ignatowski T, Olson A. Dosimetric aspects of breast radiotherapy with three-dimensional and intensity-modulated radiotherapy helical tomotherapy planning modules. Med Dosim 2017; 42:42-46. [PMID: 28129971 DOI: 10.1016/j.meddos.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 09/08/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022]
Abstract
In this work, we investigated the dosimetric differences between the intensity-modulated radiotherapy (IMRT) plans and the three-dimensional (3D) helical plans based on the TomoTherapy system. A total of 15 patients with supine setup were randomly selected from the data base. For patients with lumpectomy planning target volume (PTV), regional lymph nodes were also included as part of the target. For dose sparing, the significant differences between the helical IMRT and helical 3D were only found in the heart and contralateral breast. For the dose to the heart, helical IMRT reduced the maximum point dose by 6.98Gy compared to the helical 3D plan (p = 0.01). For contralateral breast, the helical IMRT plans significantly reduced the maximum point dose by 5.6Gy compared to the helical 3D plan. However, compared to the helical 3D plan, the helical IMRT plan increased the volume for lower dose (13.08% increase in V5Gy, p = 0.01). In general, there are no significant differences in dose sparing between helical IMRT and helical 3D plans.
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Affiliation(s)
- Poonam Yadav
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Yue Yan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Tasha Ignatowski
- Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Anna Olson
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
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36
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Morlino A, La Torre G, Lapadula L, Cammarota A. IORT in breast cancer. Our experience of the first patients treated. Ann Ital Chir 2017; 88:253-257. [PMID: 28874627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM The aim of this study was to assess the therapeutic effect of intraoperative radiotherapy, describe the method and examine the results of our experience. BACKGROUND Breast conserving therapy has recently become a standard treatment modality in patients with early invasive cancer. Radiotherapy, along with surgery, is an integral part of such treatment. The important thing of radiotherapy is to deliver a high dose to the tumour bed. One of the methods is the intraoperative radiotherapy. MATERIALS AND METHODS The analysis comprised 41 breast cancer patients treated with breast conserving surgery. Patient's range age was 35-80 years. Cancer type distribution inlcuded: 95% ductal carcinoma, 5% other carcinoma. Applicator size: 4 cm. (12%), 5 cm. (64%), 6 cm. (17%), 7 cm. (7%). Electron energies: 6 MeV (22%), 8 MeV (56%), 10 MeV (22%). Intraoperative radiation therapy was delivered in the operating theatre during surgery. After that, all patients were treated with whole breast irradiation. RESULTS 41 patients treated with IORT procedures completed. In general there were no severe postoperative complications and we did not detect tumor recurrence in any patient even if the time elapsed from the treatment is still short. CONCLUSIONS Due to its exceptional physical and radiobiological properties, intraoperative radiation therapy can be a good alternative to other methods of boosting dose to the postoperative site in management. KEY WORDS Breast cancer, IORT, intraoperative radiotherapy, Surgery.
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Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Monica Morrow
- Department of Surgery, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jennifer Bellon
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Tari A King
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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Fourquet A, Krhili SL, Campana F, Chilles A, Kirova YM. [Normofractionated breast irradiation in breast cancer. Indications and benefits]. Cancer Radiother 2016; 20:564-6. [PMID: 27592268 DOI: 10.1016/j.canrad.2016.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022]
Abstract
Whole-breast normofractionated irradiation following breast-conserving surgery is the reference treatment. It delivers a dose of 50Gy in 25 fractions of 2Gy to the reference point, and, in some patients, an additional dose of 16Gy in 8 fractions of 2Gy in the tumor bed. Long-term results and toxicity of this irradiation scheme was prospectively evaluated in several randomised trials and meta-analyses, in invasive cancers as well as in ductal carcinoma in situ. The average 10-year rate of in breast recurrences was 6 % in these trials, with limited cardiac and pulmonary toxicity and limited rate of severe fibrosis. Identification of risk factors of recurrences may help to design new irradiation schemes adapted to tumor biology. The new irradiation schemes must be rigorously evaluated in the long-term in the frame of prospective clinical trials, in order to validate them as new standards of treatment.
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Affiliation(s)
- A Fourquet
- Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - S-L Krhili
- Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Campana
- Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Chilles
- Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y-M Kirova
- Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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Abstract
REFLEXIONS ABOUT NEW STRATEGIES OF RADIOTHERAPY FOR EARLY BREAST CANCER: Radiotherapy (RT) remains a major treatment element in early breast cancer, with a major impact on local control and survival. For ductal carcinoma in situ (DCIS), RT reduces local recurrence (LR) rates by 50 to 60 % after conservative surgery (both in situ and invasive). This was confirmed by four randomized trials and one meta-analysis. For infiltrating breast cancers (IBC), RT also reduces LR rates by 65 to 75 % after conservative surgery. Boost allows an additional reduction of LR. RT is efficient in all age categories, but hypofractionated schemes are particularly adapted to elderly women. Partial breast irrradiation techniques are very much heterogeneous and lack follow-up. They should be used in LR low-risk patients only and in the frame of controlled studies. Locoregional RT for high-risk patients (especially in pN+) remains essential to reduce the locoregional recurrence rate and to increase survival, as confirmed in several meta-analyses. Four studies showed a survival benefit (2-3 %), thanks to internal mammary chain irradiation in LR high-risk patients. Moreover, axillary RT seems to be a likely valuable alternative to axillary dissection in case of sentinel node invasion. Finally, with the modern techniques and dosimetric optimization, RT toxicity was reduced, or even cancelled, arousing hope for a better increased benefit for the patients in the future.
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MESH Headings
- Age Factors
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Female
- Humans
- Lymphatic Metastasis
- Meta-Analysis as Topic
- Neoplasm Recurrence, Local/prevention & control
- Radiation Dose Hypofractionation
- Randomized Controlled Trials as Topic
- Retreatment
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Affiliation(s)
- Bruno Cutuli
- Institut du Cancer Courlancy, 38, rue de Courlancy, 51100 Reims.
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García Novoa A, Acea Nebril B, Díaz I, Builes Ramírez S, Varela C, Cereijo C, Mosquera Oses J, López Calviño B, Seoane Pillado MT. Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II). Cir Esp 2016; 94:331-8. [PMID: 27256280 DOI: 10.1016/j.ciresp.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/05/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6±0.7 vs. 1.4±0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR=7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors.
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Affiliation(s)
- Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España.
| | - Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Inma Díaz
- Servicio de Radioterapia, Centro Oncológico de Galicia, La Coruña, España
| | - Sergio Builes Ramírez
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Cristina Varela
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Carmen Cereijo
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Joaquín Mosquera Oses
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Beatriz López Calviño
- Unidad de Estadística y Epidemiología, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
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Abstract
BACKGROUND Radiotherapy as an adjuvant to mastectomy is integral to the treatment of breast cancer, but can result in skin ulceration. Skin ulceration following radiotherapy is traditionally managed by removing the implant and allowing the skin to heal by secondary intention. CASE REPORT A 42-year-old woman underwent radiotherapy following a breast reconstruction. She developed a 2 x 3cm radiation ulcer. The ulcer was managed by removing the implant and performing capsulectomy. A Beckers 50 expander was placed and reinforced with acellular dermal matrix inferolaterally. At follow-up the patient had a good cosmetic outcome. CONCLUSION Post-radiation skin ulcers present a challenge to treat with no current standardised management. The use of acellular dermal matrix may present a new technique to promote healing in these testing cases.
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Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, Charles Bell House, London, London W1W 7EJ, UK.
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jeffrey S Tobias
- Department of Clinical Oncology, Univeristy College London Hospitals, London, UK
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, Charles Bell House, London, London W1W 7EJ, UK
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Strnad V, Uter W, Polgár C. Partial breast irradiation and the GEC-ESTRO trial - Authors' reply. Lancet 2016; 387:1718-9. [PMID: 27116274 DOI: 10.1016/s0140-6736(16)00697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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Affiliation(s)
- Frank Vicini
- Michigan Healthcare Professionals, Farmington Hills, MI, USA
| | - Chirag Shah
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH 44195, USA.
| | - Douglas Arthur
- Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Atif Khan
- Department of Radiation Oncology, Robert Wood Johnson University Hospital/Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - David Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA, USA; Department of Radiation Oncology, Brown University, Providence, RI, USA
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Khazai L, Chau A, Hoover S, Rosa M. Papillary endothelial hyperplasia arising in the irradiated breast: A diagnostic dilemma. Pathol Res Pract 2016; 212:604-7. [PMID: 27157404 DOI: 10.1016/j.prp.2015.11.022] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Papillary endothelial hyperplasia (PEH) is a benign proliferative lesion that may occur in any site of the body, but most commonly affects the skin and subcutaneous tissues. In the breast, PEH has been documented but is rare. PEH is notorious for being misdiagnosed as angiosarcoma due to its complex growth pattern, papillary processes and interlacing vascular channels. The occurrence of PEH years after breast irradiation constitutes a pathological and clinical diagnostic challenge because angiosarcoma is far more common in this setting. The most important features that differentiate papillary endothelial hyperplasia from angiosarcoma are its presentation as a round nodule without infiltrative borders, its localization inside a vessel or in association with thrombus, and the lack of significant cytologic atypia or areas of solid growth, even in the presence of a complex architecture. Clinical history and site of involvement (cutaneous versus parenchymal) are usually of help to establish a correct diagnosis. Herein, we describe two cases of PEH presenting in patients with history of breast carcinoma and breast radiation therapy. The clinical and morphological features as well as the differential diagnoses are discussed. To our knowledge, no other cases of PEH of the breast occurring in the post-radiation setting have been described in the literature.
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Affiliation(s)
- Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, United States
| | - Alec Chau
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, United States
| | - Susan Hoover
- Breast Surgical Oncology, Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, United States
| | - Marilin Rosa
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, United States.
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47
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Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387:849-56. [PMID: 26686957 PMCID: PMC4792688 DOI: 10.1016/s0140-6736(15)01168-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ductal carcinoma in situ is currently managed with excision, radiotherapy, and adjuvant hormone therapy, usually tamoxifen. We postulated that an aromatase inhibitor would be safer and more effective. We therefore undertook this trial to compare anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy. METHODS The double-blind, randomised, phase 3 National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial was done in 333 participating NSABP centres in the USA and Canada. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole-breast irradiation were enrolled and randomly assigned (1:1) to receive either oral tamoxifen 20 mg per day (with matching placebo in place of anastrozole) or oral anastrozole 1 mg per day (with matching placebo in place of tamoxifen) for 5 years. Randomisation was stratified by age (<60 vs ≥60 years) and patients and investigators were masked to treatment allocation. The primary outcome was breast cancer-free interval, defined as time from randomisation to any breast cancer event (local, regional, or distant recurrence, or contralateral breast cancer, invasive disease, or ductal carcinoma in situ), analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00053898, and is complete. FINDINGS Between Jan 1, 2003, and June 15, 2006, 3104 eligible patients were enrolled and randomly assigned to the two treatment groups (1552 to tamoxifen and 1552 to anastrozole). As of Feb 28, 2015, follow-up information was available for 3083 patients for overall survival and 3077 for all other disease-free endpoints, with median follow-up of 9·0 years (IQR 8·2-10·0). In total, 212 breast cancer-free interval events occurred: 122 in the tamoxifen group and 90 in the anastrozole group (HR 0·73 [95% CI 0·56-0·96], p=0·0234). A significant time-by-treatment interaction (p=0·0410) became evident later in the study. There was also a significant interaction between treatment and age group (p=0·0379), showing that anastrozole is superior only in women younger than 60 years of age. Adverse events did not differ between the groups, except for thrombosis or embolism--a known side-effect of tamoxifen-for which there were 17 grade 4 or worse events in the tamoxifen group versus four in the anastrozole group. INTERPRETATION Compared with tamoxifen, anastrozole treatment provided a significant improvement in breast cancer-free interval, mainly in women younger than 60 years of age. This finding means that women will benefit from having a choice of effective agents for ductal carcinoma in situ. FUNDING US National Cancer Institute and AstraZeneca Pharmaceuticals LP.
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MESH Headings
- Administration, Oral
- Age Factors
- Anastrozole
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/therapeutic use
- Aromatase Inhibitors/administration & dosage
- Aromatase Inhibitors/adverse effects
- Aromatase Inhibitors/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Double-Blind Method
- Embolism/chemically induced
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Nitriles/administration & dosage
- Nitriles/adverse effects
- Nitriles/therapeutic use
- Postmenopause
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Tamoxifen/therapeutic use
- Thrombosis/chemically induced
- Triazoles/administration & dosage
- Triazoles/adverse effects
- Triazoles/therapeutic use
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Affiliation(s)
- Richard G Margolese
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | - Reena S Cecchini
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas B Julian
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
| | - Patricia A Ganz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; University of California, Los Angeles, CA, USA
| | - Joseph P Costantino
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura A Vallow
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kathy S Albain
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SWOG, San Antonio, TX, USA; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Patrick W Whitworth
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; ALLIANCE/ACOSOG, Chicago, IL, USA; Nashville Breast Center, Nashville, TN, USA
| | - Mary E Cianfrocca
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SWOG, San Antonio, TX, USA; ECOG/ACRIN, Philadelphia, PA, USA; Department of Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Adam M Brufsky
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Hematology/Oncology, Magee Womens Hospital/University of Pittsburgh Department of Hematology/Oncology, Pittsburgh, PA, USA
| | - Howard M Gross
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Dayton Physicians LLC, Dayton, OH, USA
| | - Gamini S Soori
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Missouri Valley Cancer Consortium, Omaha, NE, USA
| | - Judith O Hopkins
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SCOR NCORP, Winston Salem, NC, USA; Department of Hematology/Oncology, Forsyth Regional Cancer Center, Winston Salem, NC, USA
| | - Louis Fehrenbacher
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Medical Oncology, Kaiser Permanente Northern California Vallejo, CA, USA
| | - Keren Sturtz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Medical Oncology Colorado Cancer Research Program, Denver, CO, USA
| | - Timothy F Wozniak
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; CCOP, Christiana Care Health Systems, Newark, DE, USA
| | - Thomas E Seay
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Atlanta Regional Community Clinical Oncology Program, Atlanta, GA, USA
| | - Eleftherios P Mamounas
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; UF Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Norman Wolmark
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
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48
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Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387:857-65. [PMID: 26686960 PMCID: PMC4792658 DOI: 10.1016/s0140-6736(15)01169-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The NSABP B-35 trial compared 5 years of treatment with anastrozole versus tamoxifen for reducing subsequent occurrence of breast cancer in postmenopausal patients with ductal carcinoma in situ. This report assesses the effect of these drugs on quality of life and symptoms. METHODS The study was done at 333 hospitals in North America. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole breast irradiation were randomly assigned to receive either tamoxifen (20 mg/day) or anastrazole (1 mg/day) for 5 years, stratified by age (<60 years vs ≥60 years). Patients and investigators were masked to treatment allocation. Patients completed questionnaires at baseline and every 6 months thereafter for 6 years. The primary outcomes were SF-12 physical and mental health component scale scores, and vasomotor symptoms (as per the BCPT symptom scale). Secondary outcomes were vaginal symptoms and sexual functioning. Exploratory outcomes were musculoskeletal pain, bladder symptoms, gynaecological symptoms, cognitive symptoms, weight problems, vitality, and depression. We did the analyses by intention to treat, including patients who completed questionnaires at baseline and at least once during follow-up. This study is registered with ClinicalTrials.gov, NCT00053898. FINDINGS Between Jan 6, 2003, and June 15, 2006, 3104 patients were enrolled in the study, of whom 1193 were included in the quality-of-life substudy: 601 assigned to tamoxifen and 592 assigned to anastrozole. We detected no significant difference between treatment groups for: physical health scores (mean severity score 46·72 for tamoxifen vs 45·85 for anastrozole; p=0·20), mental health scores (52·38 vs 51·48; p=0·38), energy and fatigue (58·34 vs 57·54; p=0·86), or symptoms of depression (6·19 vs 6·39; p=0·46) over 5 years. Vasomotor symptoms (1·33 vs 1·17; p=0·011), difficulty with bladder control (0·96 vs 0·80; p=0·0002), and gynaecological symptoms (0·29 vs 0·18; p<0·0001) were significantly more severe in the tamoxifen group than in the anastrozole group. Musculoskeletal pain (1·50 vs 1·72; p=0·0006) and vaginal symptoms (0·76 vs 0·86; p=0·035) were significantly worse in the anastrozole group than in the tamoxifen group. Sexual functioning did not differ significantly between the two treatments (43·65 vs 45·29; p=0·56). Younger age was significantly associated with more severe vasomotor symptoms (mean severity score 1·45 for age <60 years vs 0·65 for age ≥60 years; p=0·0006), vaginal symptoms (0·98 vs 0·65; p<0·0001), weight problems (1·32 vs 1·02; p<0·0001), and gynaecological symptoms (0·26 vs 0·22; p=0·014). INTERPRETATION Given the similar efficacy of tamoxifen and anastrozole for women older than age 60 years, decisions about treatment should be informed by the risk for serious adverse health effects and the symptoms associated with each drug. For women younger than 60 years old, treatment decisions might be driven by efficacy (favouring anastrozole); however, if the side-effects of anastrozole are intolerable, then switching to tamoxifen is a good alternative. FUNDING US National Cancer Institute, AstraZeneca Pharmaceuticals.
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Affiliation(s)
- Patricia A Ganz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; University of California, Los Angeles, CA, USA.
| | - Reena S Cecchini
- NRG Oncology, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas B Julian
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
| | - Richard G Margolese
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; The Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Joseph P Costantino
- NRG Oncology, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura A Vallow
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kathy S Albain
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southwest Oncology Group, San Antonio, TX, USA; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Patrick W Whitworth
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Alliance for Clinical Trials in Oncology/American College of Surgeons Oncology Group, Chicago, IL, USA; Nashville Breast Center, Nashville, TN, USA
| | - Mary E Cianfrocca
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southwest Oncology Group, San Antonio, TX, USA; Eastern Cooperative Oncology Group/American College of Radiology Imaging Network, Philadelphia, PA, USA; Department of Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Adam M Brufsky
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Hematology/Oncology, Magee Womens Hospital/University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Gross
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Dayton Physicians, Dayton, OH, USA
| | - Gamini S Soori
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Missouri Valley Cancer Consortium, Omaha, NE, USA
| | - Judith O Hopkins
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston Salem, NC, USA; Department of Hematology/Oncology, Forsyth Regional Cancer Center, Winston Salem, NC, USA
| | - Louis Fehrenbacher
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Medical Oncology, Kaiser Permanente, Northern California Vallejo, CA, USA
| | - Keren Sturtz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Medical Oncology Colorado Cancer Research Program, Denver, CO, USA
| | - Timothy F Wozniak
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Community Clinical Oncology Program, Christiana Care Health Systems, Wilmington, DE, USA
| | - Thomas E Seay
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Atlanta Regional Community Clinical Oncology Program, Atlanta, GA, USA
| | - Eleftherios P Mamounas
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; UF Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Norman Wolmark
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
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Strnad V, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, Lyczek J, Guinot JL, Dunst J, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Polat B, Kovács G, Fischedick AR, Wendt TG, Fietkau R, Hindemith M, Resch A, Kulik A, Arribas L, Niehoff P, Guedea F, Schlamann A, Pötter R, Gall C, Malzer M, Uter W, Polgár C. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 2016; 387:229-38. [PMID: 26494415 DOI: 10.1016/s0140-6736(15)00471-7] [Citation(s) in RCA: 467] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In a phase 3, randomised, non-inferiority trial, accelerated partial breast irradiation (APBI) for patients with stage 0, I, and IIA breast cancer who underwent breast-conserving treatment was compared with whole-breast irradiation. Here, we present 5-year follow-up results. METHODS We did a phase 3, randomised, non-inferiority trial at 16 hospitals and medical centres in seven European countries. 1184 patients with low-risk invasive and ductal carcinoma in situ treated with breast-conserving surgery were centrally randomised to either whole-breast irradiation or APBI using multicatheter brachytherapy. The primary endpoint was local recurrence. Analysis was done according to treatment received. This trial is registered with ClinicalTrials.gov, number NCT00402519. FINDINGS Between April 20, 2004, and July 30, 2009, 551 patients had whole-breast irradiation with tumour-bed boost and 633 patients received APBI using interstitial multicatheter brachytherapy. At 5-year follow-up, nine patients treated with APBI and five patients receiving whole-breast irradiation had a local recurrence; the cumulative incidence of local recurrence was 1.44% (95% CI 0.51-2.38) with APBI and 0.92% (0.12-1.73) with whole-breast irradiation (difference 0.52%, 95% CI -0.72 to 1.75; p=0.42). No grade 4 late side-effects were reported. The 5-year risk of grade 2-3 late side-effects to the skin was 3.2% with APBI versus 5.7% with whole-breast irradiation (p=0.08), and 5-year risk of grade 2-3 subcutaneous tissue late side-effects was 7.6% versus 6.3% (p=0.53). The risk of severe (grade 3) fibrosis at 5 years was 0.2% with whole-breast irradiation and 0% with APBI (p=0.46). INTERPRETATION The difference between treatments was below the relevance margin of 3 percentage points. Therefore, adjuvant APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is not inferior to adjuvant whole-breast irradiation with respect to 5-year local control, disease-free survival, and overall survival. FUNDING German Cancer Aid.
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Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
| | - Oliver J Ott
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | | | - Hellen Knauerhase
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Jaroslaw Lyczek
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skłodowskej, Warsaw, Poland; Podkarpacki Hospital Cancer Center Brzozów, Brzozów, Poland
| | - Jose Luis Guinot
- Department of Radiation Oncology, Valencian Institute of Oncology, Valencia, Spain
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Kiel, Germany
| | | | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Michael Allgäuer
- Department of Radiation Oncology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Kristina Lössl
- Department of Radiation Oncology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH Campus Lübeck, Lübeck, Germany
| | | | - Thomas G Wendt
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Marion Hindemith
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Alexandra Resch
- Department of Radiation Oncology, University Hospital AKH Wien, Vienna, Austria
| | - Anna Kulik
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skłodowskej, Warsaw, Poland
| | - Leo Arribas
- Department of Radiation Oncology, Valencian Institute of Oncology, Valencia, Spain
| | - Peter Niehoff
- Department of Radiation Oncology, University Hospital Kiel, Germany; Department of Radiotherapy, Municipal Hospital Cologne, University Witten-Herdecke, Witten, Germany
| | - Fernando Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Annika Schlamann
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Richard Pötter
- Department of Radiation Oncology, University Hospital AKH Wien, Vienna, Austria
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Martina Malzer
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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Affiliation(s)
- C E Coles
- Oncology Centre, Cambridge University NHS Foundation Trust, Cambridge CB2 0QQ, UK.
| | - J R Yarnold
- Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, London, UK
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