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Sars C, Sackey H, Frisell J, Dickman PW, Karlsson F, Kindts I, Marta GN, Freitas-Junior R, Tvedskov TF, Kassem L, Ali AS, Ihalainen H, Neron M, Kontos M, Kaidar-Person O, Meattini I, Francken AB, van Duijnhoven F, Moberg IO, Marinko T, Kollar A, Ahmed M, Remoundos D, Banks J, Jagsi R, Dossett LA, Lindqvist EK. Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists. Breast Cancer Res Treat 2023; 199:293-304. [PMID: 36879102 PMCID: PMC9988205 DOI: 10.1007/s10549-023-06896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. METHODS We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. RESULTS A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. CONCLUSIONS This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.
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Affiliation(s)
- Carl Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Helena Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Karlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | | | | | - Ruffo Freitas-Junior
- CORA Advanced Center for Diagnosis of Breast Diseases, Hospital das Clínicas, Federal University of Goias, Goiânia, Brazil
| | | | - Loay Kassem
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed S Ali
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Hanna Ihalainen
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mathias Neron
- Institut du Cancer de Montpellier, Surgical Oncology Department, Université Montpellier, Montpellier, France
| | - Michalis Kontos
- 1st Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Orit Kaidar-Person
- Breast Radiation Unit, Sheba Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | - Ingvild Ona Moberg
- Department of Breast and Endocrine Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tanja Marinko
- Institute of Oncology, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Attila Kollar
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Mahbubl Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Ebba K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
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Goričar K, Dugar F, Dolžan V, Marinko T. NBN, RAD51 and XRCC3 Polymorphisms as Potential Predictive Biomarkers of Adjuvant Radiotherapy Toxicity in Early HER2-Positive Breast Cancer. Cancers (Basel) 2022; 14:cancers14184365. [PMID: 36139526 PMCID: PMC9496855 DOI: 10.3390/cancers14184365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Adjuvant radiotherapy for breast cancer patients significantly improves survival and causes side effects. It is known that the response to radiotherapy is individual, but we are not yet able to predict patients with high risk for acute or late radiotherapy adverse events. This study aimed to investigate the association between homologous recombination repair (HRR) polymorphisms and radiotherapy toxicity and thus contribute to the knowledge on potential predictive biomarkers of radiotherapy toxicity in early HER2-positive breast cancer. This study was among the first to evaluate the role of HRR genetic variability with cardiac toxicity. RAD51 polymorphisms were associated with cardiac adverse events, while XRCC3 polymorphisms were associated with skin adverse events. Our results suggest that polymorphisms in key HRR genes might be used as potential biomarkers of late treatment-related adverse events in early HER2-positive breast cancer treated with radiotherapy. Abstract Radiotherapy (RT) for breast cancer significantly impacts patient survival and causes adverse events. Double-strand breaks are the most harmful type of DNA damage associated with RT, which is repaired through homologous recombination (HRR). As genetic variability of DNA repair genes could affect response to RT, we aimed to evaluate the association of polymorphisms in HRR genes with tumor characteristics and the occurrence of RT adverse events in early HER2-positive breast cancer. Our study included 101 breast cancer patients treated with adjuvant RT and trastuzumab. All patients were genotyped for eight single nucleotide polymorphisms in NBN, RAD51 and XRCC3 using competitive allele-specific PCR. Carriers of XRCC3 rs1799794 GG genotype were less likely to have higher tumor differentiation grade (OR = 0.05, 95% CI = 0.01–0.44, p = 0.007). Carriers of RAD51 rs1801321 TT genotype were more likely to have higher NYHA class in univariable (OR = 10.0; 95% CI = 1.63–61.33; p = 0.013) and multivariable (OR = 9.27; 95% CI = 1.28–67.02; p = 0.027) analysis. Carriers of RAD51 rs12593359 GG genotype were less likely to have higher NYHA class in univariable (OR = 0.09; 95% CI = 0.01–0.79; p = 0.030) and multivariable (OR = 0.07; 95% CI = 0.01–0.81; p = 0.034) analysis. Carriers of XRCC3 rs1799794 GG genotypes experienced more skin adverse events based on LENT-SOMA scale in univariable (OR = 5.83; 95% CI = 1.22–28.00; p = 0.028) and multivariable (OR = 10.90; 95% CI = 1.61–73.72; p = 0.014) analysis. In conclusion, XRCC3 and RAD51 polymorphisms might contribute to RT adverse events in early HER2-positive breast cancer patients.
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Affiliation(s)
- Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Franja Dugar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tanja Marinko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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3
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Podlesnikar T, Berlot B, Dolenc J, Goričar K, Marinko T. Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging. Front Cardiovasc Med 2022; 9:887705. [PMID: 35966531 PMCID: PMC9366112 DOI: 10.3389/fcvm.2022.887705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Radiotherapy (RT) is one of the pillars of cancer therapy. High-dose radiation exposure on the thorax is mainly used in the context of adjuvant RT after breast surgery, in lung and esophageal cancer, and as a complement to systemic treatment in lymphoma. Due to the anatomical proximity, the heart inevitably receives some radiation that can result in acute and chronic cardiotoxicity, leading to heart failure, coronary artery disease, pericardial and valvular heart disease. Current evidence suggests there is no safe radiation dose to the heart, which poses a need for early recognition of RT-induced cardiac injury to initiate cardioprotective treatment and prevent further damage. Multimodality cardiac imaging provides a powerful tool to screen for structural and functional abnormalities secondary to RT. Left ventricular ejection fraction, preferably with three-dimensional echocardiography or cardiovascular magnetic resonance (CMR), and global longitudinal strain with speckle-tracking echocardiography are currently the key parameters to detect cardiotoxicity. However, several novel imaging parameters are tested in the ongoing clinical trials. CMR parametric imaging holds much promise as T1, T2 mapping and extracellular volume quantification allow us to monitor edema, inflammation and fibrosis, which are fundamental processes in RT-induced cardiotoxicity. Moreover, the association between serum biomarkers, genetic polymorphisms and the risk of developing cardiovascular disease after chest RT has been demonstrated, providing a platform for an integrative screening approach for cardiotoxicity. The present review summarizes contemporary evidence of RT-induced cardiac injury obtained from multimodality imaging—echocardiography, cardiovascular computed tomography, CMR and nuclear cardiology. Moreover, it identifies gaps in our current knowledge and highlights future perspectives to screen for RT-induced cardiotoxicity.
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Affiliation(s)
- Tomaž Podlesnikar
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
- *Correspondence: Tomaž Podlesnikar,
| | - Boštjan Berlot
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jure Dolenc
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Marinko
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Kurir Borovcic M, Mavric Z, Zagar T, Homar V, Kopcavar Gucek N, Skufca Smrdel AC, Knific J, Borstnar S, Marinko T, Zadravec Zaletel L, Kos N, Strazisar B, Slapar T, Mastnak Mlakar D, Kovacevic N, Hadzic V, Pelhan B, Sremec M, Rozman T, Besic N. The patient's needs before and six months after the initiation of breast cancer treatment: A prospective study in 600 breast cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24062 Background: Our aim was to determine the frequency of health-related problems faced by breast cancer patients before and six months after the initiation of breast cancer treatment. Methods: This prospective study involved 600 female breast cancer patients (26-65 years, mean 52), who participated in the pilot study in the novel individualized integrated rehabilitation programme in 2019-2022 and were followed for at least six months. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN) before the initiation of cancer treatment and six months after. The patients received neoadjuvant chemotherapy in 22% of the cases, tumorectomy in 53%, mastectomy in 39%, breast reconstruction in 27%, sentinel node biopsy in 67%, lymphadenectomy in 23%, external beam radiotherapy in 73%, chemotherapy in 45%, anti-HER-2 therapy in 11% and hormonal therapy in 74% of the cases. Data on the patients’ demographics, disease extent, cancer treatment and problems reported in the questionnaires were collected and analysed using descriptive analysis. Results: The problems reported by patients before the initiation of cancer treatment and after six months are presented in Table. In 14 out of 22 parameters, the frequency of problems increased in the six months after the initiation of treatment: fatigue, insomnia, lymphedema, shoulder movement impairment, disturbing scars, heart problems, hot flashes/sweating, gynaecological problems, sexual problems, body image worries, inappropriate nutrition, pain in the shoulder or arm, alopecia and concerns about returning to work. On the other hand, the frequency of problems decreased six months after the initiation of cancer treatment in 6 out of 22 parameters. Our patients less often had depression or anxiety, were too little physically active, smoked, consumed alcohol or used food supplements than before. Conclusions: Six months after the initiation of breast cancer treatment patients have more problems than at the time before treatment.[Table: see text]
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Affiliation(s)
| | - Zlatka Mavric
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tina Zagar
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Vesna Homar
- Community Health Centre Vrhnika, Vrhnika, Slovenia
| | | | | | - Jana Knific
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tanja Marinko
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Natasa Kos
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | - Bojan Pelhan
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Marko Sremec
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Tina Rozman
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Nikola Besic
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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5
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Besic N, Kurir Borovcic M, Mavric Z, Mozetic A, Zagar T, Homar V, Kopcavar Gucek N, Skufca Smrdel AC, Knific J, Marinko T, Zadravec Zaletel L, Kos N, Strazisar B, Mastnak Mlakar D, Kovacevic N, Hadzic V, Pelhan B, Sremec M, Rozman T, Borstnar S. The association of early integrated rehabilitation and moderate or severe fatigue in 600 patients with breast cancer: A comparison between the intervention group and control group in a prospective study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12074 Background: Fatigue after breast cancer treatment is a major health problem that is very difficult to treat. Our aim was to determine whether the early introduction of focused rehabilitation from the start of the cancer treatment is associated with the frequency of fatigue in breast cancer patients. Methods: The subjects of our prospective study were 600 female breast cancer patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022 and were followed for at least six months. The control group included 300 patients and the intervention group 300 patients. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN): before and six months after the beginning of cancer treatment. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before six months after the beginning of treatment and recommended appropriate interventions according to the patient's problems. The integrated rehabilitation coordinator referred patients for additional treatments in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics, disease extent, cancer treatment and complaints reported in questionnaires were collected. This data and the frequency of fatigue six months after the beginning of treatment in both groups of patients were analysed using the chi-square and ANOVA test. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, or radiotherapy. There were no differences between the groups in the prevalence of fatigue before the start of treatment. Before the cancer treatment, 50% of the patients in both groups reported fatigue, while moderate or severe fatigue was reported in the intervention and control groups in 9% and 10% (p = 0.69), respectively. Six months after the beginning of cancer treatment, fatigue was reported in the intervention and control groups in 66% and 70% (p = 0.38), respectively. However, moderate or severe fatigue were reported in the intervention and control groups in 17% and 26% (p = 0.02), respectively. Conclusions: Early integrated rehabilitation is associated with a lower prevalence of moderate or severe fatigue in breast cancer patients in comparison to the control group six months after the beginning of cancer treatment.
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Affiliation(s)
- Nikola Besic
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Zlatka Mavric
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Tina Zagar
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Vesna Homar
- Community Health Centre Vrhnika, Vrhnika, Slovenia
| | | | | | - Jana Knific
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tanja Marinko
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Natasa Kos
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | - Bojan Pelhan
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Marko Sremec
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Tina Rozman
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Offersen B, Alsner J, Nielsen H, Bechmann T, Nielsen M, Mjaaland I, Kamby C, Krkove C, Lorincz T, Al-Rawi S, Stoere E, Schreiber A, Krause M, Kasti U, Matthiessen L, Kedzierawski P, Marinko T, Luukkaa M, Skyttä T, Jensen M, Overgaard J. OC-0102 DBCG phase III randomized trial of hypo- vs standard fractionated RT in 2879 pN+ breast cancer pts. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ratosa I, Privsek N, Dobnikar N, Matos E, Gojkovic Horvat A, Golo D, Gugic J, Ivanetic Pantar M, Paulin Kosir M, Marinko T, Grasic Kuhar C. PO-1238 Long-term outcome in patients with ductal carcinoma in situ of the breast. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Milo M, Lörincz T, Nielsen M, Kamby C, Bechmann T, Al-Rawi S, Matthiessen L, Krause M, Schreiber A, Mjaaland I, Kasti U, Brix E, kedzierawski P, Marinko T, kirkove C, Overgaard J, Offersen B. OC-0829 Acute toxicity after loco regional breast radiation therapy in the randomized DBCG SKAGEN trial 1. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta GN, Montero A, Offersen BV, Aznar MC, Belka C, Brunt AM, Dicuonzo S, Franco P, Krause M, MacKenzie M, Marinko T, Marrazzo L, Ratosa I, Scholten A, Senkus E, Stobart H, Poortmans P, Coles CE. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol 2022; 23:e21-e31. [PMID: 34973228 DOI: 10.1016/s1470-2045(21)00539-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
High-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-based radiotherapy.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Carlotta Becherini
- Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Liesbeth Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Orit Kaidar-Person
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Netherlands; Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gustavo Nader Marta
- Department of Radiation Oncology-Hospital Sírio-Libanês, São Paulo, Brazil; Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Department of Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Claus Belka
- Department of Radiation Oncology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany
| | - Adrian Murray Brunt
- School of Medicine, University of Keele, Keele, UK; Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, Maggiore della Carità University Hospital, Novara, Italy
| | - Mechthild Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; National Center for Tumor Diseases, Partner Site Dresden, German Cancer Research Center, Heidelberg, Germany; German Cancer Research Center, Heidelberg and German Cancer Consortium, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology, Dresden, Germany
| | | | - Tanja Marinko
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Livia Marrazzo
- Medical Physics Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Astrid Scholten
- Department of Radiotherapy, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
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Meattini I, Visani L, Ratosa I, Saieva C, Ribnikar D, Scoccimarro E, Becherini C, Orazem M, Stocchi G, Bellini C, Lorenzetti V, Orsatti C, Angelini L, Desideri I, Scotti V, Morandi A, Marinko T, Livi L. 242P Impact of metastases directed radiation therapy on CDK4/6 inhibitors treatment for metastatic breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Ratosa I, Anzic M, Gojkovic Horvat A, Ivanetic Pantar M, Golo D, Gugic J, Paulin Kosir M, Marinko T. PO-1084 Radiotherapy with simultaneous integrated boost for breast cancer: acute toxicity outcomes. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Marinko T, Dugar F, Dolžan V, Goričar K. PO-1121 Polymorphisms in DNA repair genes and radiotherapy late adverse events in breast cancer patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Orazem M, Zumer B, Segedin B, Marinko T. PO-1463 Is irradiation of SARS-CoV-2-positive cancer patients safe and feasible in clinical practice? Radiother Oncol 2021. [PMCID: PMC8629147 DOI: 10.1016/s0167-8140(21)07914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Anzic M, Marinko T. Effect of Adjuvant Hormonal Therapy on the Development of Pulmonary Fibrosis after Postoperative Radiotherapy for Breast Cancer. J Breast Cancer 2020; 23:449-459. [PMID: 33154822 PMCID: PMC7604379 DOI: 10.4048/jbc.2020.23.e48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Breast cancer is the most common malignancy among women. Therefore, it is of paramount importance to study the adverse effects of oncological treatment of breast cancer, with one of adverse effects being pulmonary fibrosis (PF). PF is an irreversible condition and can significantly reduce the quality of life. Following lumpectomy, radiotherapy is the standard adjuvant treatment for breast cancer. Additionally, hormone receptor-positive breast cancers are treated with adjuvant hormonal therapy. While radiotherapy is one of the known causes of PF, the effect of hormone therapy on its development is not well-defined. Some studies have shown that the concomitant administration of endocrine therapy, primarily tamoxifen, and irradiation may potentiate the development of PF. However, guidelines regarding the timing of hormone therapy administration with respect to adjuvant radiotherapy are not clearly defined. This review aims to provide a comprehensive overview of the available information regarding the effect of hormone therapy and its timing of administration with respect to adjuvant radiotherapy on the incidence of PF.
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Affiliation(s)
- Mitja Anzic
- Division of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia
| | - Tanja Marinko
- Division of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Marinko T, Konda JS, Dolžan V, Goričar K. Genetic variability of PON1 and NT-proBNP levels after breast cancer radiotherapy. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Ratosa I, Orazem M, Scoccimarro E, Steinacher M, Dominici L, Aquilano M, Cerbai C, Desideri I, Ribnikar D, Marinko T, Livi L, Meattini I. Cyclin-Dependent Kinase 4/6 Inhibitors Combined With Radiotherapy for Patients With Metastatic Breast Cancer. Clin Breast Cancer 2020; 20:495-502. [PMID: 32622736 DOI: 10.1016/j.clbc.2020.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) represent the standard treatment for hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer. Data about the balance between efficacy and toxicity of combined palliative radiotherapy (RT) and CDK4/6 inhibition are lacking. PATIENTS AND METHODS We undertook a review of 46 patients with metastatic breast cancer on systemic treatment with CDK4/6i who underwent 62 metastases-directed RT. Clinical, laboratory, and RT treatment planning data were collected. Statistical analyses included Student t test, paired sample t test, and logistic regression modeling. RESULTS Thirty patients (65.2%) received palbociclib, 15 (32.6%) received ribociclib, and one patient received abemaciclib (2.2%). Median total prescribed RT dose was 20 Gy (range, 8-63 Gy). Sites of RT were bone (n = 50; 80.7%), visceral (n = 7; 11.3%), or brain metastases (n = 3; 4.8%), as well as primary tumor of the breast (n = 2; 3.2%). Overall, the rates of grade 3 or higher adverse events (AEs) were 6.5%, 4.3%, 15.2%, and 23.9% before the start of RT, during RT, 2 and 6 weeks after RT completion, respectively. We found no correlation between dose distribution to organs at risk and the development of AEs. The local control rates for the entire cohort were 98% at 6 months and 90% at 12 months. Overall, pain relief (complete or partial) was experienced by 80% (24/30) of patients who initially reported pain at the treated metastatic site. CONCLUSION We observed a modest increase in the rates of grade 3 or higher AEs after combined RT and CDK4/6i, with maintained efficacy of concomitant RT.
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Affiliation(s)
- Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
| | - Miha Orazem
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Erika Scoccimarro
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mateja Steinacher
- Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Luca Dominici
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Michele Aquilano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domen Ribnikar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tanja Marinko
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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17
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Kaidar-Person O, Vrou Offersen B, Hol S, Arenas M, Aristei C, Bourgier C, Cardoso MJ, Chua B, Coles CE, Engberg Damsgaard T, Gabrys D, Jagsi R, Jimenez R, Kirby AM, Kirkove C, Kirova Y, Kouloulias V, Marinko T, Meattini I, Mjaaland I, Nader Marta G, Witt Nystrom P, Senkus E, Skyttä T, Tvedskov TF, Verhoeven K, Poortmans P. ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol 2019; 137:159-166. [PMID: 31108277 DOI: 10.1016/j.radonc.2019.04.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Immediate breast reconstruction (IBR) rates after mastectomy are increasing. Postmastectomy radiation therapy (PMRT) contouring guidelines for target volumes in the setting of IBR are lacking. Therefore, many patients who have had IBR receive PMRT to target volumes similar to conventional simulator-based whole breast irradiation. The aim of this paper is to describe delineation guidelines for PMRT after implant-based IBR based on a thorough understanding of the surgical procedures, disease stage, patterns of recurrence and radiation techniques. They are based on a consensus endorsed by a global multidisciplinary group of breast cancer experts.
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Affiliation(s)
- Orit Kaidar-Person
- Oncology Institute, Radiation Oncology Unit, Rambam Medical Center, Haifa, Israel.
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Danish Center for Particle Therapy, Department of Oncology, Aarhus University Hospital, Denmark
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, University Rovira i Virgili, Spain
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Italy
| | - Celine Bourgier
- Department of Radiation Oncology, ICM - Val d'Aurelle, INSERM U1194, IRCM; Montpellier University, Montpellier, France
| | - Maria Joao Cardoso
- Breast Unit, Champalimaud Foundation, and Nova Medical School, Lisbon, Portugal
| | - Boon Chua
- Faculty of Medicine, The University of New South Wales, UNSW Sydney, NSW, Australia
| | | | | | - Dorota Gabrys
- Department of Radiation Oncology, Maria Sklodowska Curie Memorial Cancer Centre, Gliwice, Poland
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Carine Kirkove
- Department of Radiation Oncology, University Hospital St-Luc, Brussels, Belgium
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Vassilis Kouloulias
- National and Kapodistrian University of Athens, Medical School, 2nd Dpt of Radiology, Radiotherapy Unit, Athens, Greece
| | - Tanja Marinko
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia
| | - Icro Meattini
- Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Italy, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ingvil Mjaaland
- Department of Oncology & Radiotherapy, Stavanger University Hospital, Norway
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Petra Witt Nystrom
- The Skandion Clinic, Uppsala, Sweden and Danish Center for Particle Therapy, Aarhus, Denmark
| | - Elzbieta Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Poland
| | - Tanja Skyttä
- Department of Oncology, Tampere University Hospital, Finland
| | - Tove F Tvedskov
- Dept. of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Karolien Verhoeven
- GROW School for Oncology and Developmental Biology, Department of Radiation Oncology, Maastricht University Medical Centre, Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Institut Curie, and Paris Sciences & Lettres University, Paris, France
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Znidaric T, Gugic J, Marinko T, Gojkovic Horvat A, Paulin Kosir MS, Golo D, Ivanetic Pantar M, Ratosa I. Breast cancer patients with brain metastases or leptomeningeal disease: 10-year results of a national cohort with validation of prognostic indexes. Breast J 2019; 25:1117-1125. [PMID: 31286623 DOI: 10.1111/tbj.13433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Abstract
Development of brain metastasis (BM) and leptomeningeal (LM) disease in breast cancer (BC) patients indicates poor prognosis and impairs patients' quality of life. Prognostic survival scores for BM can help predict expected survival in order to choose the most appropriate treatment. The aim of our study was to analyze national data for BC patients treated with radiation therapy for BM/LM disease and validate the applicability of different survival prognostic scores. We retrospectively evaluated medical records of 423 BC patients with BM/LM disease receiving radiation therapy between April 2005 and December 2015. Patients were classified by BC Recursive Partitioning Analysis (B-RPA), Breast Graded Prognostic Assessment (Breast-GPA), Modified Breast Graded Prognostic Assessment (MB-GPA), and Simple Survival score for patients with BM from BC (SS-BM). Overall survival (OS) was calculated from the development of BM/LM disease to death or last follow-up date. After a median follow-up of 7.5 years, the median OS was 6.9 months (95% CI 5.5-7.8, range 0-146.4) and 1- and 2-year survival rates were 35% and 17%, respectively. Survival analysis showed significant differences in median OS regarding biologic subtypes (P < 0.0001), as follows: 3.2 (95% Confidence Interval (CI) 2.5-3.9), 3.9 (95% CI 2.3-5.6), 7.1 (95% CI 4.3-9.8), 12.1 (95% CI 8.3-15.9), and 15.4 (95% CI 8.8-22.1) months for primary triple-negative BC (TNBC), Luminal B HER2-negative, Luminal A, HER2-enriched, and Luminal B HER2-positive tumors, respectively. Good Karnofsky Performance Status (KPS), single metastasis, and absence of LM or extracranial disease all demonstrated better OS in univariate and multivariate analysis. All four employed prognostic indexes provided good prognostic value in predicting survival. SS-BM and MB-GPA showed the best discriminating ability (Concordance indexes C were 0.768 and 0.738, respectively). This study presents one of the largest single-institution series validating prognostic scores for BC patients with BM/LM. SS-BM and MB-GPA proved to be useful tools in the clinical decision-making process.
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Affiliation(s)
- Tanja Znidaric
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.,Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Jasenka Gugic
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Tanja Marinko
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | | | - Danijela Golo
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
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Marinko T, Goricar K, Dolzan V. HIF1A genetic variability and late adverse events of radiotherapy in breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12069 Background: Hypoxia-inducible factors (HIFs) are transcription factors that play an important part in the regulation of various cell processes involved in carcinogenesis such as cell proliferation, apoptosis, angiogenesis, and metastasis. Additionally, hypoxia could influence response to radiotherapy and radiation was shown to stabilize HIF-1α and affect release of cytokines. Previous studies have already shown that HIF1A genetic variability may modify cancer susceptibility, but data on its influence on treatment response are scarce. As nicotine induces HIF-1α expression, smoking could also modify treatment response. Our aim was to evaluate the association of common functional HIF1A rs11549465 polymorphism and smoking with late adverse events of radiotherapy in breast cancer patients. Methods: Our pilot retrospective study included 92 HER2-positive early breast cancer patients treated with adjuvant radiotherapy between 2005 and 2011. We isolated DNA from buccal swabs and genotyped all patients for HIF1A rs11549465 using competitive allele-specific PCR. Association of polymorphisms with adverse events and interaction with smoking was evaluated using logistic regression. Results: Median follow-up after radiotherapy was 4.2 (2.6-5.5) years. Overall, 30 (32.6%) patients reported late adverse events according to LENT-SOMA criteria, and 11 (12.0%) experienced skin toxicity according to CTCAE v.4.0 (Common Terminology Criteria for Adverse Events). Only 15 (16.3%) of patients were smokers. Minor allele frequency of HIF1A rs11549465 was 0.07. The studied polymorphism was not associated with late adverse events (OR = 0.75, 95% CI = 0.18-3.06, P = 0.688) or late skin toxicity (OR = 0.71, 95% CI = 0.08-6.15, P = 0.756) in our cohort of patients. We also observed no interaction between smoking, HIF1A genetic variability and late adverse events of radiotherapy. Conclusions: HIF1A rs11549465 was not associated with late adverse events of radiotherapy even if smoking was taken into account in our cohort of breast cancer patients.
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Affiliation(s)
- Tanja Marinko
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Katja Goricar
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vita Dolzan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Abstract
Background Breast cancer is the second most common cancer worldwide. Thanks to the modern oncological treatments, disease specific survival has improved throughout the last decades. The number of breast cancer survivors has been increasing, and more and more attention has been paid to the breast cancer treatment side effects. Whereas there are many data regarding ischemic heart disease after radiotherapy for breast cancer, there is not much data in the literature about the incidence and clinical meaning of pericardial disease after breast cancer radiotherapy. Conclusions Although radiation-induced pericarditis is the earliest form of radiation-induced cardiovascular disease after irradiation of the heart, it seems that in clinical practice, especially by using modern radiotherapy treatment techniques, it is underdiagnosed because patients are mostly asymptomatic. In some cases, especially in its late form and after multimodal systemic oncological treatment in combination with radiotherapy, it could be presented in severe form and life threatening. Treatment modalities for radiation-induced pericardial diseases are the same as in the non-irradiated population, but in the irradiated patients, surgery may be difficult.
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Affiliation(s)
- Tanja Marinko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
- Tanja Marinko, M.D., Ph.D., Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia. Phone: +386 1 5879 515; Fax: +386 1 5879 400
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Ratosa I, Znidaric T, Marinko T, Gojkovič Horvat A. Breast cancer and brain metastases in women under 45 years of age: Treatment results of radiation therapy at a single institution. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Ratosa I, Jenko A, Hudej R, Kos F, Gojkovic Horvat A, Golo D, Marinko T, Paulin Kosir M, Gugic J. EP-1182: Locoregional treatment of breast cancer with IMRT: a single center experience. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1. Radiother Oncol 2016; 118:205-8. [DOI: 10.1016/j.radonc.2015.12.027] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
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Ratosa I, Marinko T, Gojkovic Horvat A, Gugic J, Sesek M, Bozic M, Kosir MSP, Majdic E. PO99 TREATMENT OUTCOMES OF BREAST CANCER BRAIN METASTASES. Breast 2015. [DOI: 10.1016/s0960-9776(15)30111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gugic J, Horvat AG, Kuhar CG, Ratosa I, Marinko T, Majdic E, Kosir SP, Korosec P, Jugovec V, Matos E. P291 Influence of radiation boost on local control in patients with ductal carcinoma in situ. Breast 2015. [DOI: 10.1016/s0960-9776(15)70323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 2015; 114:3-10. [PMID: 25630428 DOI: 10.1016/j.radonc.2014.11.030] [Citation(s) in RCA: 386] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 11/15/2014] [Accepted: 11/15/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
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Affiliation(s)
| | - Liesbeth J Boersma
- Department of Radiation Oncology, Maastricht University Medical Centre - GROW (MAASTRO), The Netherlands
| | - Carine Kirkove
- Department of Radiation Oncology, Catholic University of Louvain, Belgium
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | | | - Albert Biete Sola
- Department of Radiation Oncology, Hospital Clinic i Provincial, Barcelona, Spain
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent Remouchamps
- Department of Radiation Oncology, Clinique Sainte Elisabeth (AMPR), Namur, Belgium
| | - Karolien Verhoeven
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Dorota Gabrys
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| | - Neil Kopek
- Department of Oncology, Division of Radiation Oncology, McGill University, Montréal, Canada
| | - Mechthild Krause
- German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dept. of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Dan Lundstedt
- Department of Oncology, Sahlgrenska Universitetssjukhuset, Gothenborg, Sweden
| | - Tanja Marinko
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Angel Montero
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain
| | - John Yarnold
- Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud university medical centre, The Netherlands
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Besic N, Satej N, Ratosa I, Horvat AG, Marinko T, Gazic B, Petric R. Long-term use of metformin and the molecular subtype in invasive breast carcinoma patients - a retrospective study of clinical and tumor characteristics. BMC Cancer 2014; 14:298. [PMID: 24774412 PMCID: PMC4005811 DOI: 10.1186/1471-2407-14-298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 04/23/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metformin may exhibit inhibitory effects on cancer cells by inhibiting mTOR signaling pathway. The aim of our retrospective study was to examine if patients with breast carcinoma (BC) and diabetes mellitus (DM) receiving metformin have a lower stage of carcinoma in comparison to patients not receiving metformin, and if the use of metformin correlates with the molecular subtype of BC. METHODS A chart review of 253 patients with invasive BC and DM (128 on metformin and 125 not on metformin) was performed. Control group consisted of 320 consecutive patients with invasive BC without DM. BC subtypes were classified by immunohistochemical surrogates as luminal A (estrogen receptor [ER] + and/or progesterone receptor [PR]+, HER-2-), luminal B (ER + and/or PR+, HER-2+), HER-2 (ER-, PR-, HER-2+), triple-negative/basal (ER-, PR-, HER-2-). RESULTS Patients on metformin had a lower proportion of T3 or T4 tumors than patients who were not receiving metformin (16% vs. 26%; p = 0.035). No statistical difference was found between the two study groups in N stage. Patients with DM on metformin, with DM not on metformin and the control group had different molecular subtypes of BC (p = 0.01): the luminal A subtype was found in 78%, 83% and 71%, the luminal B in 12.6%, 9% and 11%, HER-2 in 0.8%, 1.6% and 8%, and the triple-negative/basal-like subtype in 8.6%, 6.4% and 10%, respectively. CONCLUSION Our data indicate that long-term use of metformin use correlates with molecular subtype of BC in diabetics on metformin in comparison to diabetics not on metformin and patients without DM. However, most likely, different distribution of the molecular subtypes of BC in these three groups of patients was caused by other risk factors for breast carcinoma, such as age of patients or obesity.
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Affiliation(s)
- Nikola Besic
- Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia.
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Seruga B, Zadnik V, Kuhar CG, Marinko T, Cufer T, Zakotnik B, Zorman D, Ocana A, Amir E. Association of Aromatase Inhibitors With Coronary Heart Disease in Women With Early Breast Cancer. Cancer Invest 2014; 32:99-104. [DOI: 10.3109/07357907.2014.880452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seruga B, Zadnik V, Grasic Kuhar C, Marinko T, Zorman D, Cufer T, Zakotnik B, Ocana A, Amir E. Aromatase inhibitors and cardiac outcomes in women undergoing cardiac angiography after early breast cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
558 Background: Data show that in post-menopausal women with early breast cancer, longer use of aromatase inhibitor (AI) is associated with increased odds of ischemic heart disease. Here we explore the association between adjuvant AI use and cardiac disease in women undergoing cardiac angiography after a diagnosis of early breast cancer. Methods: We linked a database of 7,681 women who underwent cardiac angiography at the University Clinical Center of Ljubljana between December 2004 and November 2010 with the Cancer Registry for Slovenia. Women with early breast cancer that subsequently underwent cardiac angiography were identified. Information on cardiovascular risk factors was retrieved from the patients’ charts and from discharge letters after cardiac angiography. The endpoint of interest was a diagnosis of ischemic heart disease or left ventricular dysfunction (IHD-LVD) without evidence of valvular heart disease at the time of angiography. Conditional, logistic regression was used to test for associations between variables. Results: Among 117 eligible women 75% (n=88) were postmenopausal and 62% (n=73) had hormonal receptor positive (HR+) disease. Of these 42% (n=31) were treated with AI. Overall, 48% (n=56) of women were found to have IHD-LVD. In patients with HR+ breast cancer, use of AIs was significantly associated with IHD-LVD as compared to tamoxifen alone (HR 2.50, 95% CI 1.01-6.29, p=0.046). For each year of AI therapy, there was a trend for higher odds of IHD-LVD (OR: 1.25, 95% CI 0.95-1.67, p=0.116). This effect appeared independent of age, body mass index, baseline hypertension, hypercholesterolemia, diabetes and heart disease or prior anthracyclines exposure. Among all patients, use of anthracyclines and left-sided irradiation was associated with non-significant increases in IHD-LVD (HR 2.37, 95% CI 0.89-6.09, p=0.45 and HR 1.28, 95% CI 0.69-2.40, p=0.44 respectively). Conclusions: Compared to tamoxifen, AIs are associated with a time dependent increase in IHD-LVD. This risk appears independent of other risk factors for heart disease. Anthracycline exposure and left breast or chest wall radiation showed non-significant associations with IHD-LVD in this small cohort.
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Affiliation(s)
| | - Vesna Zadnik
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Tanja Marinko
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Darko Zorman
- University Clinical Center Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Eitan Amir
- Princess Margaret Hospital, Toronto, ON, Canada
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Petric R, Satej N, Ratosa I, Horvat AG, Marinko T, Lukancic MM, Gazic B, Besic N. 5117 POSTER Clinical and Histopathology Characteristics of Invasive Breast Carcinoma in Patients With Diabetes Mellitus. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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