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Ying-Ying L, Tian-Jian Y, Guang-Yu L. Prognostic significance of further axillary dissection in breast cancer patients with micrometastases & the number of micrometastases: a SEER population-based analysis. Future Sci OA 2018; 4:FSO303. [PMID: 29796305 DOI: 10.4155/fsoa-2018-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/19/2022] Open
Abstract
Aim: To investigate the benefits of axillary dissection in patients with micrometastases. Methods: A review of data from the Surveillance, Epidemiology, and End Results database was performed from 2004 to 2013. Kaplan–Meier curves, Cox regression models, and propensity score matching were utilized to comprehensively evaluate the cohort. Results: Multivariate analysis after propensity score matching showed that patients with one to two micrometastases did not substantially benefit from axillary lymph node dissection in breast cancer-specific survival (p = 0.725). However, a subgroup analysis indicated that axillary dissection may benefit estrogen receptor-negative patients. Moreover, patients who carried three micrometastases had a significantly lower crude hazard ratio in breast cancer-specific survival. Conclusion: Axillary lymph node dissection may have advantages in high-risk micrometastatic patients. Patients with three micrometastases should be treated with caution. The current study demonstrated that among patients undergoing breast-conserving surgery following radiation with T1–T2 invasive breast cancer and one to two nodal micrometastases, there was no difference in the breast cancer-specific survival for patients with and without axillary lymph node dissection. Although negative results of the Z0011 and International Breast Cancer Study Group 23–01 trials have been reported, high-risk micrometastatic patients (e.g., estrogen receptor negative, young age) may be candidates for radical axillary treatment according to the unclear radiation field and higher recurrence rate. The preliminary assessment of three micrometastatic patients showed a lower breast cancer-specific survival than patients with one to two micrometastases. This study provides a novel perspective to the American Joint Committee on Cancer with respect to micrometastases.
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152
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Arsenali B, de Jong HWAM, Viergever MA, Gilhuijs KGA. System for image-guided resection of nonpalpable breast lesions: Proof of concept. Med Phys 2018; 45:2169-2178. [PMID: 29574889 DOI: 10.1002/mp.12884] [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: 10/27/2017] [Revised: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In breast-conserving surgery (BCS), the cancer is sometimes incompletely excised, leading to reduced patient survival. To pursue complete excisions, radioactive seed localization (RSL) may be used to insert an iodine-125 seed into the tumor. The seed is used as a marker for the location of the tumor during surgery. RSL does not, however, show the extent of the tumor. Based on RSL, we pursue to visualize the seed location together with the extent from diagnostic images. METHODS A system with two gamma-camera heads and two parallel-hole collimators was recently proposed to triangulate the location of an iodine-125 seed during BCS. In the present study, this system was extended with a range camera to visualize a sphere centered on the seed in relation to the breast. This sphere contains the entire tumor and thus defines the target volume for BCS. Physical experiments with acrylic block phantoms (thickness ranging from 3.5 to 6.5 cm) were performed to assess the absolute bias and the precision with which this sphere can be visualized. RESULTS When a 6.5 cm thick phantom was used, along the horizontal plane, the target volume was visualized with an absolute bias and a precision of 2.1 and 0.8 mm, respectively. Along the vertical axis (i.e., z-axis), these values were 4.2 and 2.8 mm, respectively. CONCLUSIONS The proposed system visualizes the target volume with an absolute bias that may be acceptable for BCS.
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Affiliation(s)
- Bruno Arsenali
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Kenneth G A Gilhuijs
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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153
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Huang XZ, Chen Y, Chen WJ, Zhang X, Wu CC, Zhang CY, Sun SS, Wu J. Effect of radiotherapy after breast-conserving surgery in older patients with early breast cancer and breast ductal carcinoma in situ: a meta-analysis. Oncotarget 2018; 8:28215-28225. [PMID: 28415667 PMCID: PMC5438644 DOI: 10.18632/oncotarget.15998] [Citation(s) in RCA: 5] [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: 10/22/2016] [Accepted: 02/28/2017] [Indexed: 01/06/2023] Open
Abstract
Background There are no consistent agreements on whether radiotherapy after breast-conserving surgery (BCS) could provide local control and survival benefit for older patients with early breast cancer or breast ductal carcinoma in situ (DCIS). The present study aimed to evaluate the efficacy of radiotherapy after BCS in older patients with early breast cancer or DCIS. Results Radiotherapy could reduce the risk of local relapse in older patients with early breast cancer. The 5-year AR of local relapse was 2.2% and 6.2% for radiotherapy and non-radiotherapy group, respectively, with low 5-year ARD of 4.0% and high NNT of 25. The 10-year AR of local relapse was 5.3% and 10.5% for radiotherapy and non-radiotherapy group, respectively, with the 10-year ARD of 5.2% and NNT of 20. However, radiotherapy could not improve survival benefits, including overall survival, cancer-specific survival, breast-cancer-specific survival, and distant relapse. Moreover, radiotherapy could reduce the risk of ipsilateral breast events in older patients with DCIS. Materials and Methods PubMed and Embase database were searched for relevant studies. Hazard ratios (HRs), risk ratios (RRs), absolute risk (AR), absolute risk difference (ARD), and number needed to treat (NNT) were used as effect measures to evaluate the efficacy of radiotherapy in older patients. Conclusions Our study indicates that radiotherapy could slightly reduce the risk of local relapse in older patients with favorable early breast cancer. However, radiotherapy cannot translate into significant survival benefits.
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Affiliation(s)
- Xuan-Zhang Huang
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - You Chen
- The Wenzhou Dental Hospital, Wenzhou City 325027, P.R. China
| | - Wen-Jun Chen
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - Xi Zhang
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - Cong-Cong Wu
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - Chao-Ying Zhang
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - Shuang-Shuang Sun
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
| | - Jian Wu
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City 325027, P.R. China
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154
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Chen QX, Wang XX, Lin PY, Zhang J, Li JJ, Song CG, Shao ZM. The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer: a population-based study from the SEER 18 database. Oncotarget 2018; 8:4773-4780. [PMID: 27999201 PMCID: PMC5354870 DOI: 10.18632/oncotarget.13976] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 08/12/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Breast-conserving surgery (BCS) including radiotherapy (RT) has been demonstrated to provide at least equivalent prognosis to mastectomy in early-stage breast cancer. However, studies on triple-negative breast cancer (TNBC) patients are relatively scarce. The current population-based study aimed to investigate the distinct outcomes between BCS+RT and mastectomy in patients with TNBC. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 11,514 female TNBC cases diagnosed during the years 2010-2013. Those patients were subdivided into BCS+RT (5,469) and mastectomy groups (6,045), and we conducted a survival comparison between the two groups. The endpoints were breast cancer-specific survival (BCSS) and overall survival (OS). In the overall cohort, patients with BCS+RT exhibited distinctly better breast cancer-specific survival (BCSS) (log-rank, p < 0.001) and overall survival (OS) (log-rank, p < 0.001) than did mastectomy patients. When stratifying the TNBC patients according to age, histology grade, TNM stage, tumor size, and lymph node (LN) status, most patients in the BCS+RT group presented with better survival than did the patients in the mastectomy group, except for the grade I (log-rank, p = 0.830, both BCSS and OS) and stage I (log-rank, BCSS, p = 0.127; OS, p = 0.093) patients. In addition, after adjusting for confounding variables by multivariable Cox proportional hazard analysis, BCS+RT still tended to present with higher BCSS and OS. In conclusion, from our study on SEER data, BCS+RT displayed elevated BCSS and OS in TNBC patients compared to mastectomy, at least equally. Our study provided further evidence for surgeons that BCS with RT is available for TNBC patients.
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Affiliation(s)
- Qing-Xia Chen
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Xiao Wang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Pei-Yang Lin
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Zhang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jun-Jing Li
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chuan-Gui Song
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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155
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Wang S, Ma X, Hong X, Cheng Y, Tian Y, Zhao S, Liu W, Tang Y, Zhao R, Song L, Teng Z, Lu G. Adjuvant Photothermal Therapy Inhibits Local Recurrences after Breast-Conserving Surgery with Little Skin Damage. ACS Nano 2018; 12:662-670. [PMID: 29271636 DOI: 10.1021/acsnano.7b07757] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Adjuvant treatments following breast-conserving surgery (BCS) are essential to reduce the risk of local recurrences in patients with breast cancer. However, current adjuvant treatments are based on ionizing radiation, which brings radiation-induced damage and amplifies the risk of death. Here we explore the feasibility of using non-ionizing light to induce photothermal therapy as an adjuvant treatment to BCS. In an orthotopic breast cancer mice model, we demonstrate that adjuvant photothermal therapy (aPTT) decreases the incidence of local recurrences after BCS with no expense of cosmetic outcome. In comparison with conventional photothermal therapy, the technique used in aPTT provides more uniformly distributed light energy and less risk of skin burns and local recurrences. Overall, this work represents a departure from the traditional concept of using PTT as an alternative to surgery and reveals the potential of using PTT as an alternative to adjuvant radiation therapy, which is valuable especially for patients susceptible to radiation damage.
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Affiliation(s)
- Shouju Wang
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University , Nanjing 210093, P. R. China
| | - Xingqun Ma
- The Affiliated Bayi Hospital of Nanjing University of Chinese Medicine , Nanjing 210002, P. R. China
| | - Xuhao Hong
- Department of Physics, Nanjing University , Nanjing 210000, P. R. China
| | - Yingxia Cheng
- The Affiliated Bayi Hospital of Nanjing University of Chinese Medicine , Nanjing 210002, P. R. China
| | - Ying Tian
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
| | - Shuang Zhao
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
| | - Wenfei Liu
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
| | - Yuxia Tang
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
| | - Ruizhi Zhao
- Department of Physics, Nanjing University , Nanjing 210000, P. R. China
| | - Liang Song
- Research Laboratory for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055, P. R. China
| | - Zhaogang Teng
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University , Nanjing 210093, P. R. China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University , Nanjing 210002, P. R. China
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University , Nanjing 210093, P. R. China
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156
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Lagendijk M, Vos EL, Nieboer D, Verhoef C, Corten EML, Koppert LB. Evaluation of cosmetic outcome following breast-conserving therapy in trials: panel versus digitalized analysis and the role of PROMs. Breast J 2018; 24:519-525. [PMID: 29316049 DOI: 10.1111/tbj.12980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/12/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 11/28/2022]
Abstract
Cosmetic outcome is an important quality of life-related end point following breast-conserving therapy (BCT). To advise on a gold standard, we compare cosmetic outcome evaluated by panel and an objective evaluation (BCCT.core software). Second, patient-reported outcome measures (PROMs) are compared to cosmetic outcome evaluation by panel and BCCT.core. Sixty-eight breast cancer patients were included following BCT between 2007 and 2012. Two independent 6-member panels and two observers using the BCCT.core evaluated cosmetic outcome. First, reproducibility, repeatability, and relatedness of panel and BCCT.core were analyzed using the interclass correlation coefficient (ICC). Second, the association between panel/BCCT.core with PROMs (EORTC-QLQ-C30/BR23, EQ-5D-5L, and BREAST-Q) was analyzed with a linear regression and the goodness of fit by the R2 . Both panel and BCCT.core evaluations showed "excellent" intraobserver agreement (ICC 0.93 [95% CI: 0.83; 0.97] and 0.93 [95% CI: 0.84; 0.97]) for respectively panel 1 and BCCT.core 1 and "excellent" interobserver agreement (ICC 0.94 [95% CI: 0.90; 0.96] and 0.85 [95% CI: 0.77; 0.91]) respectively for panel and BCCT.core. Association between panel and BCCT.core varied, ICC 0.59-0.69. Only the PROM BREAST-Q showed a significant association with both panel evaluations and BCCT.core observers (panel 1 and BCCT.core 1; R2 of .157 [P = .002] and .178 [P = .001]). Both panel and BCCT.core showed comparable "excellent" intraobserver and interobserver agreement. For future trials evaluating cosmetic outcome following BCT, one of those can be chosen. Solely, the PROM BREAST-Q showed a significant association with panel and/or BCCT.core evaluation. To enable standardized cosmetic outcome evaluation and corresponding patient satisfaction in future trials, at least the BREAST-Q should be combined with a panel or BCCT.core evaluation.
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Affiliation(s)
- Mirelle Lagendijk
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Evelien M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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157
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Heiss N, Rousson V, Ifticene-Treboux A, Lehr HA, Delaloye JF. Risk factors for positive resection margins of breast cancer tumorectomy specimen following breast-conserving surgery. Horm Mol Biol Clin Investig 2017; 32:/j/hmbci.ahead-of-print/hmbci-2017-0023/hmbci-2017-0023.xml. [PMID: 29222935 DOI: 10.1515/hmbci-2017-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/27/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022]
Abstract
Background The aim of the study was to identify risk factors for positive surgical margins in breast-conserving surgery for breast cancer and to evaluate the influence of surgical experience in obtaining complete resection. Methods All lumpectomies for invasive breast carcinoma and ductal carcinoma in situ (DCIS) between April 2008 and March 2010 were selected from the database of a single institution. Re-excision rates for positive margins as well as patient and histopathologic tumor characteristics were analyzed. Surgical experience was staged by pairs made of Resident plus Specialist or Consultant. Two periods were defined. During period A, the majority of operations were performed by Residents under supervision of Specialist or Consultant. During period B, only palpable tumors were operated by Residents. Results The global re-excision rate was 27% (50 of 183 patients). The presence of DCIS increased the risk for positive margins: 60% (nine of 15 patients) in the case of sole DCIS compared to 26% (41 of 160 patients) for invasive cancer (p = 0.005) and 35% (42 of 120 patients) in the case of peritumoral DCIS compared to 11% (seven of 62 patients) in the case of sole invasive cancer (p = 0.001). Re-excision rate decreased from 36% (23 of 64 patients) during period A to 23% (27 of 119 patients) during period B (p = 0.055). There was no significant difference between the surgical pairs. Conclusion In our study, DCIS was the only risk factor for positive surgical margins. Breast-conserving surgery for non-palpable tumors should be performed by Specialists, however, palpable tumors can be safely operated by Residents under supervision.
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Affiliation(s)
- Niko Heiss
- Gynécologie-Obstétrique, 65, Avenue Jean Jaurès, F-30900 Nîmes, France, Phone: +0033/466047720, Fax: +0033/466047722
| | - Valentin Rousson
- Institut de médecine sociale et préventive, CHUV Lausanne, Lausanne, Switzerland
| | | | - Hans-Anton Lehr
- Institut für Pathologie im Medizin Campus Bodensee, Friedrichshafen, Germany
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158
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Zhang A, Li J, Qiu H, Wang W, Guo Y. Comparison of rigid and deformable registration through the respiratory phases of four-dimensional computed tomography image data sets for radiotherapy after breast-conserving surgery. Medicine (Baltimore) 2017; 96:e9143. [PMID: 29390317 PMCID: PMC5815729 DOI: 10.1097/md.0000000000009143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the geometric differences in gross tumor volume (GTV) and surgical clips propagated by rigid image registration (RIR) and deformable image registration (DIR) using a four-dimensional computed tomography (4DCT) image data set for patients treated with boost irradiation or accelerated partial breast irradiation after breast-conserving surgery (BCS). METHODS The 4DCT data sets of 44 patients who had undergone BCS were acquired. GTV and selected clips were manually delineated on end-inhalation phase (CT0) and end-exhalation phase (CT50) images of 4DCT data sets. Subsequently, the GTV and selected clips from CT0 images were transformed and propagated to CT50 images using RIR and DIR, respectively. The geometric differences in GTV and surgical clips from DIR were compared with those of RIR. RESULTS The mean Dice similarity coefficient (DSC) index was 0.860 ± 0.042 for RIR and 0.870 ± 0.040 for DIR for GTV (P = .000). The three-dimensional distance to the center of mass (COM) of the GTV from RIR was longer than that from DIR (1.22 mm and 1.10 mm, respectively, P = .000). Moreover, in the anterior-posterior direction, displacements from RIR were significantly greater than those from DIR for both GTV (0.70 mm and 0.50 mm, respectively) and selected clips (upper clip, 0.45 mm vs 0.20 mm; inner clip, 0.55 mm vs 0.30 mm; outer clip, 0.40 mm vs 0.20 mm; lower clip, 0.50 mm vs 0.25 mm) (P = .000). However, in the left-right and superior-inferior directions, there were no significant displacement differences between RIR and DIR for GTV and the selected clips (all P > .050). CONCLUSION DIR can improve the overlap for GTV registration from CT0 to CT50 images from 4DCT scanning. Furthermore, DIR is superior to RIR in reflecting the displacement of GTV and selected clips in the anterior-posterior direction induced by respiratory movement.
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Affiliation(s)
- Aiping Zhang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- Department of Radiation Oncology
- The Third Hospital of Jinan, China
| | | | - Heng Qiu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province
| | - Wei Wang
- Department of Radiation Oncology
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159
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Lopez-de-Andres A, Jimenez-Trujillo I, Hernandez-Barrera V, de Miguel-Diez J, Mendez-Bailon M, de Miguel-Yanes JM, Perez-Farinos N, Salinero-fort MA, del Barrio JL, Romero-Maroto M, Jimenez-Garcia R. Association of type 2 diabetes with in-hospital complications among women undergoing breast cancer surgical procedures. A retrospective study using the Spanish National Hospital Discharge Database, 2013-2014. BMJ Open 2017; 7:e017676. [PMID: 29122795 PMCID: PMC5695447 DOI: 10.1136/bmjopen-2017-017676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To compare the type of surgical procedures used, comorbidities, in-hospital complications (IHC) and in-hospital outcomes between women with type 2 diabetes mellitus (T2DM) and age-matched women without diabetes who were hospitalised with breast cancer. In addition, we sought to identify factors associated with IHC in women with T2DM who had undergone surgical procedures for breast cancer. DESIGN Retrospective study using the National Hospital Discharge Database, 2013-2014. SETTING Spain. PARTICIPANTS Women who were aged ≥40 years with a primary diagnosis of breast cancer and who had undergone a surgical procedure. We grouped admissions by T2DM status. We selected one matched control for each T2DM case. MAIN OUTCOME MEASURES The type of procedure (breast-conserving surgery (BCS) or mastectomy), clinical characteristics, complications, length of hospital stay and in-hospital mortality. RESULTS We identified 41 458 admissions (9.23% with T2DM). Overall, and in addition to the surgical procedure, we found that comorbidity, hypertension and obesity were more common among patients with T2DM. We also detected a higher incidence of mastectomy in women with T2DM (44.69% vs 42.42%) and a greater rate of BCS in patients without T2DM (57.58% vs 55.31%). Overall, non-infectious complications were more common among women with T2DM (6.40% vs 4.56%). Among women who had undergone BCS or a mastectomy, IHC were more frequent among diabetics (5.57% vs 3.04% and 10.60% vs 8.24%, respectively). Comorbidity was significantly associated with a higher risk of IHC in women with diabetes, independent of the specific procedure used.province CONCLUSIONS: Women with T2DM who undergo surgical breast cancer procedures have more comorbidity, risk factors and advanced cancer presentations than matched patients without T2DM. Mastectomies are more common in women with T2DM. Moreover, the procedures among women with T2DM were associated with greater IHC. Comorbidity was a strong predictor of IHC in women with T2DM.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Isabel Jimenez-Trujillo
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Valentin Hernandez-Barrera
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Mendez-Bailon
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Jose L del Barrio
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Martin Romero-Maroto
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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160
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Sun Y, Liao M, He L, Zhu C. Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8367. [PMID: 29069026 PMCID: PMC5671859 DOI: 10.1097/md.0000000000008367] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The application of breast-conserving surgery (BCS) on patients with locally advanced breast cancer (LABC) with good response to neoadjuvant chemotherapy (NACT) still remains controversial. The objective in this study is to analyze the safety of BCS in the management of LABC in patients with good response to NACT. METHODS We searched the electronic databases of Medline (Pubmed) and Cochrane Library for reports on local recurrence (LR), regional recurrence (RR), distant recurrence (DR), 5-year disease-free survival (DFS) or 5-year overall survival (OS) in patients with LABC receiving BCS or mastectomy (MT) and with good response to NACT. Based on the research results, we conducted a meta-analysis using Review Manager 5.3. RESULTS Our study showed that 16 studies with a combined total of 3531 patients, of whom 1465 patients underwent BCS, whereas 2066 patients underwent MT. There was no significant heterogeneity among these studies (Q statistic: P = .88; I = 0%). Patients with good response to NACT showed no significant difference in LR and RR [odd ratio (OR) = 0.83; 95% confidence interval (CI): 0.60-1.15; P = .26; OR = 0.56; 95% CI: 0.33-0.93; P = .03], while we figured out a lower DR (OR = 0.51; 95% CI: 0.42-0.63; P < .01), a higher DFS (OR = 2.35; 95% CI: 1.84 to 3.01, P < .01) and a higher OS (OR = 2.12; 95% CI: 1.51 to 2.98, P < .01) in BCS compared with MT. CONCLUSION This meta-analysis concluded that BCS was a safe surgery for patients with LABC and had good response to NACT.
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Affiliation(s)
| | - Mingjuan Liao
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Chenfang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, 200011, China
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161
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Noguchi M, Ohno Y, Morioka E, Noguchi M, Nakano Y, Kosaka T, Shimada KI. A novel oncoplastic technique for breast cancer localized in the lower pole of the breast. J Surg Oncol 2017; 117:137-141. [PMID: 28940202 DOI: 10.1002/jso.24824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Masakuni Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yukako Ohno
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Emi Morioka
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Miki Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yasuharu Nakano
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
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162
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Di Salvo F, Caranci N, Spadea T, Zengarini N, Minicozzi P, Amash H, Fusco M, Stracci F, Falcini F, Cirilli C, Candela G, Cusimano R, Tumino R, Sant M. Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget 2017; 8:68402-68414. [PMID: 28978126 PMCID: PMC5620266 DOI: 10.18632/oncotarget.19447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/26/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status. METHODS 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles. RESULTS In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.
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Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Caranci
- Agenzia Sanitaria e Sociale Regione Emilia Romagna, Bologna, Italy
| | - Teresa Spadea
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Nicolas Zengarini
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hade Amash
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Fusco
- Naples Cancer Registry, ASL Napoli 3 Sud, Brusciano, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Department, University of Perugia, Perugia, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department AUSL Modena, Modena, Italy
| | - Giuseppina Candela
- Trapani Cancer Registry, Health Prevention Department ASL 9 Trapani, Trapani, Italy
| | - Rosanna Cusimano
- Palermo Cancer Registry, Health Science Department University of Palermo, Palermo, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry, Health Prevention Department ASP Ragusa, Ragusa, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Li N, Zheng Z, Li J, Fan J, Wang T, Zhang J, Wang H, Chen J, Lv Y, Yi J, Huang M, Ling R. Immediate breast reconstruction with omental flap for luminal breast cancer patients: Ten clinical case reports. Medicine (Baltimore) 2017; 96:e7797. [PMID: 28816969 PMCID: PMC5571706 DOI: 10.1097/md.0000000000007797] [Citation(s) in RCA: 7] [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: 01/02/2023] Open
Abstract
RATIONALE Luminal subtype breast cancer, accounting for 70 to 80% of all breast cancers, has been reported to be associated with good prognosis. However, for the patients with large mass or worse mass position, omental flap transplantation may provide a new option for breast reconstruction. PATIENT CONCERNS Ten patients (6 luminal B1, 2 luminal B2, 2 luminal A), were enrolled into the study, between January 23, 2015 and August 22, 2016. The mean age was 34.6 ± 6.96 (24-44) years old. Immunohistochemistry demonstrated that the tumor cells were positive for estrogen receptor and progestrone receptor. DIAGNOSES According to the clinicopathological features, diagnosis of breast cancer patients were made. INTERVENTIONS Breast-conserving surgery, laparoscopic greater omentum harvest and vascular anas-tomosis were carried out orderly. Postoperative operative results, cosmetic outcomes, complications, as well as blood supply were investigated for surgery evaluation. Reasonable chemotherapy and irradia-tion were adopted to patients according to the pathological condition. OUTCOMES We successfully accomplished breast reconstruction by omental flap transplantation, ex-cept one failed case because of the necrosis of omentum and changed to fat transplantation. The volumes and symmetry of breasts were all satisfied. The blood supply was detected to be fluent. Only one case of slight hematoma and another case of one distant metastasis were observed during fol-low-up period. No arm mordities or arm movement restriction occurred after surgery. Moreover, radia-tion therapy and chemotherapy had no clear effects on the reconstructed breast. LESSONS Immediate breast reconstruction surgery by transplanting omental flap for luminal breast cancer patients can be considered successful based on the excellent clinic outcome.
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Affiliation(s)
- Nanlin Li
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Zhao Zheng
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jipeng Li
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jing Fan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Ting Wang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Juliang Zhang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Hui Wang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jianghao Chen
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Yonggang Lv
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Jun Yi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University
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164
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Freitas-Junior R, Ribeiro LFJ, Moreira MAR, Queiroz GS, Esperidião MD, Silva MAC, Pereira RJ, Zampronha RAC, Rahal RMS, Soares LR, dos Santos DL, Thomazini MV, de Faria CFS, Paulinelli RR. Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial. Clinics (Sao Paulo) 2017; 72:426-431. [PMID: 28793003 PMCID: PMC5525160 DOI: 10.6061/clinics/2017(07)07] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.
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Affiliation(s)
- Ruffo Freitas-Junior
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
- *Corresponding author. E-mail:
| | | | | | - Geraldo Silva Queiroz
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | | | - Rubens José Pereira
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | - Rosemar Macedo Sousa Rahal
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
| | - Leonardo Ribeiro Soares
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | - Maria Virginia Thomazini
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
| | | | - Régis Resende Paulinelli
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
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165
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Grootendorst MR, Cariati M, Pinder SE, Kothari A, Douek M, Kovacs T, Hamed H, Pawa A, Nimmo F, Owen J, Ramalingam V, Sethi S, Mistry S, Vyas K, Tuch DS, Britten A, Van Hemelrijck M, Cook GJ, Sibley-Allen C, Allen S, Purushotham A. Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using 18F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study. J Nucl Med 2017; 58:891-898. [PMID: 27932562 DOI: 10.2967/jnumed.116.181032] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
In early-stage breast cancer, the primary treatment option for most women is breast-conserving surgery (BCS). There is a clear need for more accurate techniques to assess resection margins intraoperatively, because on average 20% of patients require further surgery to achieve clear margins. Cerenkov luminescence imaging (CLI) combines optical and molecular imaging by detecting light emitted by 18F-FDG. Its high-resolution and small size imaging equipment make CLI a promising technology for intraoperative margin assessment. A first-in-human study was conducted to evaluate the feasibility of 18F-FDG CLI for intraoperative assessment of tumor margins in BCS. Methods: Twenty-two patients with invasive breast cancer received 18F-FDG (5 MBq/kg) 45-60 min before surgery. Sentinel lymph node biopsy was performed using an increased 99mTc-nanocolloid activity of 150 MBq to facilitate nodal detection against the γ-probe background signal (cross-talk) from 18F-FDG. The cross-talk and 99mTc dose required was evaluated in 2 lead-in studies. Immediately after excision, specimens were imaged intraoperatively in an investigational CLI system. The first 10 patients were used to optimize the imaging protocol; the remaining 12 patients were included in the analysis dataset. Cerenkov luminescence images from incised BCS specimens were analyzed postoperatively by 2 surgeons blinded to the histopathology results, and mean radiance and margin distance were measured. The agreement between margin distance on CLI and histopathology was assessed. Radiation doses to staff were measured. Results: Ten of the 12 patients had an elevated tumor radiance on CLI. Mean radiance and tumor-to-background ratio were 560 ± 160 photons/s/cm2/sr and 2.41 ± 0.54, respectively. All 15 assessable margins were clear on CLI and histopathology. The agreement in margin distance and interrater agreement was good (κ = 0.81 and 0.912, respectively). Sentinel lymph nodes were successfully detected in all patients. The radiation dose to staff was low; surgeons received a mean dose of 34 ± 15 μSv per procedure. Conclusion: Intraoperative 18F-FDG CLI is a promising, low-risk technique for intraoperative assessment of tumor margins in BCS. A randomized controlled trial will evaluate the impact of this technique on reexcision rates.
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Affiliation(s)
- Maarten R Grootendorst
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Massimiliano Cariati
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Ashutosh Kothari
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Douek
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tibor Kovacs
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hisham Hamed
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amit Pawa
- Anesthetic Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fiona Nimmo
- Day Surgery Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julie Owen
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Vernie Ramalingam
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sweta Sethi
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sanjay Mistry
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kunal Vyas
- Sagentia Ltd., Cambridge, United Kingdom
| | - David S Tuch
- Lightpoint Medical Ltd., Chesham, United Kingdom
| | - Alan Britten
- Medical Physics Department, St George's Hospital, London, United Kingdom
| | | | - Gary J Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; and
| | - Chris Sibley-Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Arnie Purushotham
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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166
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Ishitobi M, Okuno J, Kittaka N, Nakayama T, Koyama H, Tamaki Y. Distant recurrence risk following early ipsilateral breast tumor recurrence. Oncol Lett 2017; 13:2886-2890. [PMID: 28521393 PMCID: PMC5431387 DOI: 10.3892/ol.2017.5797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2017] [Indexed: 11/30/2022] Open
Abstract
At present, the risk factors for distant recurrence among patients with early ipsilateral breast tumor recurrence (IBTR) require further investigation. Early IBTR is defined as occurring within 3 years following the initial surgery. In the current study, 40 patients with early IBTR were examined to determine the risk factors for distant recurrence. A node-positive status at the time of primary surgery and the administration of adjuvant chemotherapy following the primary surgery were significantly correlated with poorer distant disease-free survival (P=0.001 and P=0.002, respectively). Multivariate analyses revealed that the nodal status at the time of primary surgery was an independent predictive factor for distant recurrence (P=0.050). Therefore, the results of the current study revealed that the nodal status at the time of primary surgery was an independent predictive factor for distant recurrence among patients with early IBTR.
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Affiliation(s)
- Makoto Ishitobi
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Jun Okuno
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Nobuyoshi Kittaka
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Hiroki Koyama
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
| | - Yasuhiro Tamaki
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka 537-8511, Japan
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167
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Qi X, Chen A, Zhang P, Zhang W, Cao X, Xiao C. Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery. Oncol Lett 2017; 14:79-88. [PMID: 28693138 PMCID: PMC5494880 DOI: 10.3892/ol.2017.6112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/23/2017] [Indexed: 11/06/2022] Open
Abstract
The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11-5.44; distant metastasis, 2.24 and 1.19-4.24; mortality, 2.50 and 1.06-5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26-16.98), DFS (RR=6.81; 95% CI, 2.86-16.20) and OS (RR=9.14; 95% CI, 2.53-33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.
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Affiliation(s)
- Xiaomin Qi
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Aoxiang Chen
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Pei Zhang
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Wei Zhang
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Xuchen Cao
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Chunhua Xiao
- First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300060, P.R. China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
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168
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Mallory MA, Sagara Y, Aydogan F, DeSantis S, Jayender J, Caragacianu D, Gombos E, Vosburgh KG, Jolesz FA, Golshan M. Feasibility of Intraoperative Breast MRI and the Role of Prone Versus Supine Positioning in Surgical Planning for Breast-Conserving Surgery. Breast J 2017; 23:713-717. [PMID: 28295903 DOI: 10.1111/tbj.12796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed the feasibility of supine intraoperative MRI (iMRI) during breast-conserving surgery (BCS), enrolling 15 patients in our phase I trial between 2012 and 2014. Patients received diagnostic prone MRI, BCS, pre-excisional supine iMRI, and postexcisional supine iMRI. Feasibility was assessed based on safety, sterility, duration, and image-quality. Twelve patients completed the study; mean duration = 114 minutes; all images were adequate; no complications, safety, or sterility issues were encountered. Substantial tumor-associated changes occurred (mean displacement = 67.7 mm, prone-supine metric, n = 7). We have demonstrated iMRI feasibility for BCS and have identified potential limitations of prone breast MRI that may impact surgical planning.
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Affiliation(s)
- Melissa A Mallory
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yasuaki Sagara
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Fatih Aydogan
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen DeSantis
- Breast Oncology Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jagadeesan Jayender
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Diana Caragacianu
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eva Gombos
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kirby G Vosburgh
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ferenc A Jolesz
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
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Carrara GFA, Scapulatempo-Neto C, Abrahão-Machado LF, Brentani MM, Nunes JS, Folgueira MAAK, da Costa Vieira RA. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up. Clinics (Sao Paulo) 2017; 72:134-142. [PMID: 28355358 PMCID: PMC5348585 DOI: 10.6061/clinics/2017(03)02] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01). CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.
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Affiliation(s)
| | | | | | - Maria Mitzi Brentani
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Oncologia, Departamento de Radiologia, São Paulo/SP, Brazil
| | - João Soares Nunes
- Hospital de Câncer de Barretos, Departamento de Oncologica Clínica, Barretos/SP, Brazil
| | | | - René Aloisio da Costa Vieira
- Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Barretos/SP, Brazil
- Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Departamento de Mastologia e Reconstrução Mamária, Barretos/SP, Brazil
- *Corresponding author. E-mail:
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Emoto N, Fujikawa T, Yoshimoto Y, Kawamoto H, Tanaka A. Is breast cancer surgery safely performed in patients receiving antithrombotic therapy? Innov Surg Sci 2017; 2:15-21. [PMID: 31579729 PMCID: PMC6754011 DOI: 10.1515/iss-2017-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022] Open
Abstract
Aim The aim of the study was to assess the safety of surgery for breast cancer in patients with antithrombotic therapy (ATT), including antiplatelet therapy (APT) and anticoagulation therapy (ACT) for thromboembolic risks. Methods One hundred ninety-three consecutive patients receiving breast surgery for breast cancer at our institution between 2010 and 2015 were retrospectively reviewed. Among them, ATT was regularly used in 50 patients (25.9%). Our perioperative management included maintenance of preoperative aspirin monotherapy for APT and bridging heparin for ACT in patients at high thromboembolic risks and early postoperative reinstitution in all ATT cases. The outcome variables of patients with ATT (ATT group) were compared to those of patients without ATT (non-ATT group), and the significant risk factors for postoperative complications were determined by multivariate analysis. Results This series included 127 mastectomy and 66 breast-conserving surgery. ATT group showed significantly high frequency of history of cerebral infarction and percutaneous coronary intervention (PCI). In the ATT group, 32 patients (16.6%) were categorized as high risk for thromboembolism, but there was neither thromboembolic event nor perioperative death in the whole cohort. Surgical blood loss and rates of intraoperative transfusion were identical between the groups. Whereas overall postoperative bleeding complication was more frequently observed in the ATT group compared to the non-ATT group (12.0% vs. 3.5%, p=0.360) in univariate analyses, multivariate analysis showed that neither ATT nor preoperative aspirin continuation affected postoperative bleeding complications. Conclusion Even in patients undergoing ATT, surgery for breast cancer is safely performed without any increase in blood loss or postoperative bleeding, and no thromboembolism was experienced in the series. Our perioperative management of ATT patients is valid during breast surgery, although this patient population is still challenging and should be rigorously managed.
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Affiliation(s)
- Norio Emoto
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Yasunori Yoshimoto
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroshi Kawamoto
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Akira Tanaka
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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Zhang A, Li J, Wang W, Wang Y, Mu D, Chen Z, Shao Q, Li F. A comparison study between gross tumor volumes defined by preoperative magnetic resonance imaging, postoperative specimens, and tumor bed for radiotherapy after breast-conserving surgery. Medicine (Baltimore) 2017; 96:e5839. [PMID: 28079816 PMCID: PMC5266178 DOI: 10.1097/md.0000000000005839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
BACKGROUND The identification and contouring of target volume is important for breast-conserving therapy. The aim of the study was to compare preoperative magnetic resonance imaging (MRI), postoperative pathology, excised specimens' (ES) size, and tumor bed (TB) delineation as methods for determining the gross tumor volume (GTV) for radiotherapy after breast-conserving surgery (BCS). METHODS Thirty-three patients with breast cancer who underwent preoperative MRI and radiotherapy after BCS were enrolled. The GTVs determined by MRI, pathology, and the ES were defined as GTVMRI, GTVPAT, and GTVES, respectively. GTVMRI+1 was defined as a 1.0-cm margin around the GTVMRI. The radiation oncologist delineated GTV of the TB (GTVTB) using planning computed tomography according to ≥5 surgical clips placed in the lumpectomy cavity (LC). RESULTS The median GTVMRI, GTVMRI+1, GTVPAT, GTVES, and GTVTB were 0.97 cm (range, 0.01-6.88), 12.58 cm (range, 3.90-34.13), 0.97 cm (range, 0.01-6.36), 15.46 cm (range, 1.15-70.69), and 19.24 cm (range, 4.72-54.33), respectively. There were no significant differences between GTVMRI and GTVPAT, GTVMRI+1 and GTVES, GTVES and GTVTB (P = 0.188, 0.070, and 0.264, respectively). GTVMRI is positively related with GTVPAT. However, neither GTVES nor GTVTB correlated with GTVMRI (P = 0.071 and 0.378, respectively). Furthermore, neither GTVES nor GTVTB correlated with GTVMRI+1 (P = 0.068 and 0.375, respectively). CONCLUSION When ≥5 surgical clips were placed in the LC for BCS, the volume of TB was consistent with the volume of ES. Neither the volume of TB nor the volume of ES correlated significantly with the volume of tumor defined by preoperative MRI.
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Affiliation(s)
- Aiping Zhang
- Medicine and Life Sciences College of Shandong Academy of Medical Sciences, Jinan University
- Department of Radiation Oncology
| | | | - Wei Wang
- Department of Radiation Oncology
| | | | | | - Zhaoqiu Chen
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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Kim MJ, Kim CS, Park YS, Choi EH, Han KD. The Efficacy of Intraoperative Frozen Section Analysis During Breast-Conserving Surgery for Patients with Ductal Carcinoma In Situ. Breast Cancer (Auckl) 2016; 10:205-210. [PMID: 27980416 PMCID: PMC5147452 DOI: 10.4137/bcbcr.s40868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Recently, the incidence of ductal carcinoma in situ (DCIS), a noninvasive breast malignancy, has increased. This has resulted in an increase in the incidence of breast-conserving surgery (BCS). Numerous studies have suggested that intraoperative frozen section analysis (IFSA) could reduce the rate of additional excisions required to obtain adequate resection margins. However, DCIS is a known risk factor for positive margin status during BCS. Furthermore, some authors have concluded that IFSA may not be reliable for the detection of DCIS. AIM The aim of this study was to evaluate the safety and efficacy of IFSA in patients with DCIS. METHODS The operative and pathological reports of patients with DCIS, who underwent BCS at our institute between 2006 and 2015, were retrospectively reviewed. The results of IFSA and the pathological findings of final reanalyzed frozen tissue specimens were analyzed. RESULTS In total, 25 patients were included in our analysis. None of the patients required additional operations. The correct diagnosis rate for IFSA was 89.6%, with a sensitivity and specificity of 60.0% and 95.8%, respectively. CONCLUSION IFSA could be beneficial for determining safety resection margins in patients with DCIS.
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Affiliation(s)
- Mi Jin Kim
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Cheol Seung Kim
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Young Sam Park
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Eun Hye Choi
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Kyu Dam Han
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
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173
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Abstract
BACKGROUND Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after bcs, and the effect that a reduction in the reoperation rate could have on the B.C. health care system. METHODS A decision tree was constructed to estimate the average cost per patient undergoing initial bcs with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy. RESULTS Costs ranged from a low of $8,225 per patient with definitive bcs [95% confidence interval (ci): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% ci: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted bcs (95% ci: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually. SUMMARY The implementation of initiatives to reduce reoperation after bcs could result in significant savings to the health care system, while potentially improving the quality of patient care.
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Affiliation(s)
- R E Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver
| | - C R Baliski
- Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, University of British Columbia, Vancouver, BC; Department of Surgery, University of British Columbia, Vancouver, BC
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174
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Wang X, Liu J, Wang W, Feng Q, Wang X. Clinical analysis of intraoperative radiotherapy during breast-conserving surgery of early breast cancer in the Chinese Han population. Oncotarget 2016; 6:43120-6. [PMID: 26517686 PMCID: PMC4767495 DOI: 10.18632/oncotarget.5716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/16/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While results of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) have been reported when used either as a boost at the time of surgery or as the sole radiation treatment, the clinical safety and cosmetic outcome of IORT in the Chinese Han population has not. This report reviews oncologic and cosmetic outcomes for Chinese Han breast cancer patients who received IORT either as a boost or as their sole radiation treatment at our hospital. METHODS From July 2008 to December 2012, 50 early-stage Chinese Han breast cancer patients received BCS and IORT, either as boost or as their sole radiation treatment. Patients received adjuvant chemotherapy or hormonal therapy, according to our institution's guidelines. Patients were followed to determine oncologic events, short-term toxicity and overall cosmesis. RESULTS With a median follow-up of 51.8 months (range 22.6 months to 75.7 months), 2 patients (4.0%) developed local relapses and were salvaged by mastectomy. There were no metastases and no deaths. The average wound healing time was 17 days. Three patients (6.0%) developed postoperative infection, 5 patients (10.0%) had delayed wound healing, and 2 patients (4.0%) experienced wound edema. There were no lyponecrosis or hematomas observed. The evaluation of cosmetic outcome showed 44 patients (88.0%) graded as excellent or good while 6 patients (12.0%) were graded as fair or poor. No patients experienced radiotherapy related acute hematological toxicity, but 3 patients (6.0%), all IORT boost patients, developed skin pigmentation. CONCLUSIONS For early-stage breast cancer patients, intraoperative radiotherapy after breast-conserving surgery in the Chinese Han population is both safe and reliable and has resulted in very acceptable cosmetic outcomes.
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Affiliation(s)
- Xin Wang
- Department of Breast Surgical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaqi Liu
- Department of Breast Surgical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Wenyan Wang
- Department of Breast Surgical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Qinfu Feng
- Department of Radiotherapy, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
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Gillespie EF, Matsuno RK, Xu B, Triplett DP, Hwang L, Boero IJ, Einck JP, Yashar C, Murphy JD. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 96:251-258. [PMID: 27473817 PMCID: PMC5014714 DOI: 10.1016/j.ijrobp.2016.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/03/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. METHODS AND MATERIALS We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. RESULTS Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. CONCLUSIONS This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.
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Affiliation(s)
| | | | - Beibei Xu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel P Triplett
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Lindsay Hwang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Isabel J Boero
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
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Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK. Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: A NCDB analysis. Oncotarget. 2015;6:40127-40140. [PMID: 26517676 PMCID: PMC4741884 DOI: 10.18632/oncotarget.5394] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/29/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose Recent studies have revealed that breast-conserving surgery (BCS) with radiotherapy (RT) led to better survival than mastectomy in some populations. We compared the efficacy of BCS+RT and mastectomy using the National Cancer Database (NCDB, USA). Methods Non-metastatic breast cancers in the NCDB from 2004–2011 were identified. The Kaplan-Meier method, Coxregression and propensity score analysis were used to compare the overall survival (OS) among patients with BCS+RT, mastectomy alone and mastectomy+RT. Results A total of 160,880 patients with a median follow-up of 43.4 months were included. The respective 8-year OS values were 86.5%, 72.3% and 70.4% in the BCS+RT, mastectomy alone and mastectomy+RT group, respectively (P < 0.001). After exclusion of patients with comorbidities, mastectomy (alone or with RT) remained associated with a lower OS in N0 and N1 patients. However, the OS of mastectomy+RT was equivalent to BCS+RT in N2–3 patients. Among patients aged 50 or younger, the OS benefit of BCS+RT over mastectomy alone was statistically significant (HR1.42, 95% CI 1.16–1.74), but not clinically significant (<5%) in N0 patients, whereas in N2–3 patients, the OS of BCS+RT was equivalent to mastectomy+RT (85.2% vs. 84.8%). The results of the propensity analysis were similar. Conclusions BCS+RT resulted in improved OS compared with mastectomy ± RT in N0 and N1 patients. In N2–3 patients, BCS+RT has an OS similar to mastectomy+RT when patients with comorbidities were excluded. Among patients aged 50 or younger, the OS of BCS+RT is equivalent to mastectomy ± RT.
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Shearer R, Rashid M, Hubbard G, Abbott N, Daltrey I, Mullen R. Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation. Gland Surg 2016; 5:385-90. [PMID: 27563559 DOI: 10.21037/gs.2016.03.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations. METHODS A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. RESULTS A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%). CONCLUSIONS Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.
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Affiliation(s)
- Rosalyn Shearer
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Majid Rashid
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Gill Hubbard
- The University of Stirling, The Centre for Health Sciences, Inverness, UK
| | - Nick Abbott
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Ian Daltrey
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Russell Mullen
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
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Hisada T, Sawaki M, Ishiguro J, Adachi Y, Kotani H, Yoshimura A, Hattori M, Yatabe Y, Iwata H. Impact of intraoperative specimen mammography on margins in breast-conserving surgery. Mol Clin Oncol 2016; 5:269-272. [PMID: 27588192 DOI: 10.3892/mco.2016.948] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/29/2016] [Accepted: 05/09/2016] [Indexed: 11/06/2022] Open
Abstract
A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required.
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Affiliation(s)
- Tomoka Hisada
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Junko Ishiguro
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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Abstract
BACKGROUND Breast-conserving surgery is an established alternative for the majority of women with early stage breast cancer. Consensus on negative margins (no ink on tumour) for invasive cancer makes mutilating extensive lumpectomies unnecessary. Several breast-conserving surgical methods are described in the literature. The aim of this study was to describe and evaluate a technique using the inframammary fold incision. METHODS Twenty-seven patients with suspected breast cancer (stage I-II) underwent breast-conserving surgery using the inframammary fold incision. Data regarding tumour characteristics, margin status, complications, oncologic and aesthetic outcome was analysed retrospectively. RESULTS After a median follow-up of 35 months, 23 of the 24 patients with breast cancer (95.8%) had no evidence of disease. Post-operative complications (as defined by infection requiring antibiotic treatment and/or seroma requiring drainage) were seen in three of the 27 patients (11.1%). The final pathological examination revealed a positive excision margin in four patients (16.7%). Post-operative evaluation with the BREAST-Q™ BCT module showed a mean RASCH score of 72.5 regarding 'Satisfaction with breast'. The aesthetic result with a hidden scar is exemplified. CONCLUSION Breast-conserving surgery using the inframammary fold incision seems to be a safe method with better cosmesis; however, further research is needed.
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Affiliation(s)
- Jenny Heiman Ullmark
- a Department of Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.,b Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Christina Sahlin
- a Department of Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Håkan Hallberg
- a Department of Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Roger Olofsson Bagge
- b Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
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Lerebours F, Rivera S, Mouret-Reynier MA, Alran S, Venat-Bouvet L, Kerbrat P, Salmon R, Becette V, Bourgier C, Cherel P, Boussion V, Balleyguier C, Thibault F, Lavau-Denes S, Nabholz JM, Sigal B, Trassard M, Mathieu MC, Martin AL, Lemonnier J, Mouret-Fourme E. Randomized phase 2 neoadjuvant trial evaluating anastrozole and fulvestrant efficacy for postmenopausal, estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer patients: Results of the UNICANCER CARMINA 02 French trial (UCBG 0609). Cancer 2016; 122:3032-40. [PMID: 27315583 DOI: 10.1002/cncr.30143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 01/28/2016] [Revised: 03/31/2016] [Accepted: 04/21/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment strategies for locally advanced breast cancer in elderly patients too frail to receive neoadjuvant chemotherapy and the introduction of new classes of drugs in the early 2000s have led to the consideration of endocrine therapy as a neoadjuvant treatment for younger hormone receptor (HR)-positive, postmenopausal patients not eligible for primary breast-conserving surgery (BCS). METHODS This was a multicenter, phase 2, randomized trial designed to evaluate as its primary objective the clinical response rate after up to 6 months of neoadjuvant endocrine therapy (NET) alone in HR-positive/human epidermal growth factor receptor 2 (HER2)-negative patients with 1 mg of anastrozole (arm A) or 500 mg of fulvestrant (arm B). Secondary objectives included the BCS rate, tumor response assessment (breast ultrasound and magnetic resonance imaging), pathological response (Sataloff classification), safety profile, relapse-free survival (RFS), and predictive markers of responses and outcomes. RESULTS From October 2007 to April 2011, 116 women (mean age, 71.6 years) with operable infiltrating breast adenocarcinoma (T2-T4, N0-N3, M0) were randomized to receive anastrozole or fulvestrant. The clinical response rates at 6 months were 52.6% (95% confidence interval [CI], 41%-64%) in arm A and 36.8% (95% CI, 25%-49%) in arm B. BCS was performed for 57.6% of arm A patients and 50% of arm B patients. The RFS rates at 3 years were 94.9% in arm A and 91.2% in arm B. The Preoperative Endocrine Prognostic Index status was significantly predictive of RFS. Both treatments were well tolerated. CONCLUSIONS Both drugs are effective and well tolerated as NET in postmenopausal women with HR-positive/HER2-negative breast cancer. NET could be considered a treatment option in this subpopulation. Cancer 2016;122:3032-3040. © 2016 American Cancer Society.
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181
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Zhang H, Tan H, Gao J, Wei Y, Yu Z, Zhou Y. The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery. Exp Ther Med 2016; 12:1275-1278. [PMID: 27588049 PMCID: PMC4998097 DOI: 10.3892/etm.2016.3449] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.
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Affiliation(s)
- Huiyu Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Hongna Tan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Wei
- Department of Urology, Henan Province Zhigong Hospital, Zhengzhou, Henan 450002, P.R. China
| | - Zhan Yu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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182
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Taran-Munteanu L, Hartkopf A, Eigentler TK, Vogel U, Brucker S, Taran FA. A Case of Choroidal Melanoma Metastatic to the Breast. Geburtshilfe Frauenheilkd 2016; 76:579-581. [PMID: 27239068 DOI: 10.1055/s-0042-105956] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A 61-year-old woman developed blurred vision in her left eye in December 2006. A clinical diagnosis of choroidal melanoma was made. The patient underwent excision of the left lens, followed by vitrectomy and stereotactic radiotherapy. She remained systemically healthy until 50 months later when, during a CT scan done for staging purposes, a newly visible lump was noted in the lower quadrant of her left breast. Core needle biopsy of the lesion in the left breast was performed, and histologic examination revealed metastasis from the choroidal melanoma. The patient underwent breast-conserving surgery of the left breast. Definitive histological examination showed clear tumor margins in the resected specimen and one sentinel lymph node without evidence of metastatic cells. Twenty-nine months after surgery, a similar nodule was detected in the upper quadrant of the left breast. Core biopsy again showed metastatic melanoma, and similar breast-conserving surgery was performed. Systemic examination, including magnetic resonance imaging of the head and computed tomography of the pelvis, abdomen, and chest, was done regularly and revealed no significant findings. Solitary breast metastases from choroidal melanoma are extremely rare. Nevertheless, clinicians should be aware of this rare form of metastasis when treating patients with suspicious breast lesions and a history of choroidal melanoma. If solitary metastasis is confirmed, then breast-conserving surgery may be recommended.
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Affiliation(s)
| | - A Hartkopf
- Department of Gynecology, University Women's Clinic Tübingen
| | - T K Eigentler
- Department of Dermatology, University Clinic Tübingen
| | - U Vogel
- Department of Pathology, University Clinic Tübingen
| | - S Brucker
- Department of Gynecology, University Women's Clinic Tübingen
| | - F A Taran
- Department of Gynecology, University Women's Clinic Tübingen
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183
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Ditsatham C, Somwangprasert A, Watcharachan K, Wongmaneerung P, Khorana J. Factors affecting local recurrence and distant metastases of invasive breast cancer after breast-conserving surgery in Chiang Mai University Hospital. Breast Cancer (Dove Med Press) 2016; 8:47-52. [PMID: 27051315 PMCID: PMC4807892 DOI: 10.2147/bctt.s99184] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose of this study was to collect data regarding breast cancer profiles and factors that affect local recurrence and distant metastasis after breast-conserving surgery (BCS) in Chiang Mai University Hospital. MATERIALS AND METHODS This study was a retrospective review in a single institution of newly diagnosed invasive breast cancer patients who were treated with BCS between April 9, 2001 and December 25, 2011. RESULTS A total of 185 patients treated with BCS were included in this study, with an average age of 46.83 years. The average recurrence age was 41.1 years and the average nonrecurrence age was 47.48 years, with a recurrence rate of 10.27%. Premenopause was significant in recurrence (P=0.047), as well as non-estrogen-expression patients (P=0.001) and patients who did not receive antihormonal treatment (P=0.011). CONCLUSION The recurrence rate in our institute was 10.27%. Factors affecting recurrence after BCS included young age, premenopausal status, nonexpression of the estrogen receptor, and patients who had not received antihormonal treatment. The recurrence rate was higher in the first 90 postoperative months.
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Affiliation(s)
- Chagkrit Ditsatham
- Division of Head, Neck, and Breast Surgery, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kirati Watcharachan
- Division of Head, Neck, and Breast Surgery, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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184
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Ubukata M, Kamio T, Ohchi T, Noguchi E, Tsukada H, Kameoka S. Radiation recall dermatitis occurring 6 years and 4 months after breast-conserving surgery: A case report. Oncol Lett 2016; 11:3071-3074. [PMID: 27123065 DOI: 10.3892/ol.2016.4346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 11/23/2015] [Indexed: 11/06/2022] Open
Abstract
Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of invasive breast cancer. It has been demonstrated that radiation therapy not only prevents recurrence in the preserved breast, but that it also contributes to improved patient survival. The present study describes the case of a 37-year-old woman with radiation recall dermatitis that occurred 6 years and 4 months after breast-conserving surgery. Erythema with a relatively distinct border was observed at the irradiated site on the left breast; eczema was diagnosed by a dermatologist. Inflammatory breast cancer was ruled out, since chest X-ray, abdominal ultrasound and bone scintigraphy were negative. Following ~1 month of topical corticosteroid application and oral second generation antihistamine treatment, the erythema was alleviated and the subjective symptoms also disappeared. Only a few cases of radiation recall dermatitis have been described in the fields of radiology and dermatology, but not yet in the surgical field. In the future, the incidence of radiation recall dermatitis is predicted to increase due to the increasing number of patients undergoing breast-conserving therapy. Whether in the surgical, radiological or dermatological field, if erythema is detected at the irradiated site during post-operative follow-up, routine care should be provided, keeping in mind the possibility of radiation recall dermatitis and inflammatory breast cancer.
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Affiliation(s)
- Mamiko Ubukata
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Takako Kamio
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Tetsuya Ohchi
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Eiichiro Noguchi
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Hiroko Tsukada
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Shingo Kameoka
- Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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185
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Benson JR, Jatoi I. Highlights of the San Antonio Breast Cancer Symposium 2015: part 2. Future Oncol 2016; 12:897-900. [PMID: 26880386 DOI: 10.2217/fon-2016-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
38th San Antonio Breast Cancer Symposium (SABCS), San Antonio, TX, USA, 8-12 December 2015 The 38th annual San Antonio Breast Cancer Symposium was convened in San Antonio (TX, USA) on 8-12 December 2015. More than 7000 clinicians and scientists from around the world participated in the symposium, which featured a range of presentations and keynote talks pertaining to breast cancer screening, prevention, loco-regional and systemic therapies. This two-part report highlights a selection of important studies presented at this premier breast cancer event with part 1 focusing on radiotherapy treatment, translational approaches to immunotherapy and longer term cardiotoxicity from anti-HER2 therapies. The second part of this report will discuss a range of topics including de-escalation of chemotherapy regimens in luminal A tumors, the prognostic relevance of circulating tumor cells, the optimum treatment of triple-negative breast cancer and shifting attitudes to primary surgical treatment.
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Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrookes Hospital & University of Cambridge, Cambridge, UK
| | - Ismail Jatoi
- Division of Surgical Oncology, Dale H Dorn Chair in Surgery, University of Texas Health Science Centre, San Antonio, TX, USA
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186
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Abstract
38th San Antonio Breast Cancer Symposium, San Antonio, TX, USA, 8-12 December 2015 The 38th annual San Antonio Breast Cancer Symposium (SABCS) was convened in San Antonio (TX, USA) on 8-12 December 2015. More than 7000 clinicians and scientists from around the world participated in the symposium, which featured a range of presentations and keynote talks pertaining to breast cancer screening, prevention, loco-regional and systemic therapies. This two-part report highlights a selection of important studies presented at this premier breast cancer event with part 1 focusing on radiotherapy treatment, translational approaches to immunotherapy and longer term cardiotoxicity from anti-HER2 therapies. The second part of this report will discuss a range of topics including de-escalation of chemotherapy regimens in luminal A tumors, the prognostic relevance of circulating tumor cells, the optimum treatment of triple-negative breast cancer and shifting attitudes to primary surgical treatment.
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Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrookes Hospital & University of Cambridge, Cambridge, UK
| | - Ismail Jatoi
- Division of Surgical Oncology, Dale H Dorn Chair in Surgery, University of Texas Health Science Centre, San Antonio, TX, USA
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187
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Bleicher RJ, Ruth K, Sigurdson ER, Daly JM, Boraas M, Anderson PR, Egleston BL. Breast conservation versus mastectomy for patients with T3 primary tumors (>5 cm): A review of 5685 medicare patients. Cancer 2015; 122:42-9. [PMID: 26479066 DOI: 10.1002/cncr.29726] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/27/2015] [Accepted: 09/16/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although breast conservation therapy (BCT) is standard for breast cancer treatment, patients with tumors measuring >5 cm have been excluded from clinical trials. Nevertheless, only a few small retrospective series to date have compared BCT with mastectomy for tumors measuring >5 cm. The current study was performed to determine whether survival is equivalent for BCT versus mastectomy using a large national data set. METHODS Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked cases were identified for patients aged ≥ 66 years undergoing breast conservation for invasive, noninflammatory, nonmetastatic breast cancer between 1992 and 2009. Propensity score-based adjustment was used to account for demographics and tumor and treatment factors. RESULTS A total of 5685 patients with tumors measuring >5.0 cm underwent breast surgery, with 15.6% receiving BCT. Mean ages of the patients and tumor sizes were similar. Predictors of BCT included neoadjuvant chemotherapy and postoperative radiotherapy use, higher income, breast cancer as a first malignancy, and a higher Charlson Comorbidity Index. Predictors of mastectomy included younger age, nonductal histology, higher grade, numbers of lymph nodes examined and found to be positive, American Joint Committee on Cancer stage III disease, postoperative chemotherapy use, and residential region of the country. Adjusted overall and breast cancer-specific survival were not different between patients treated with BCT and mastectomy (hazard ratio, 0.934; 95% confidence interval, 0.791-1.103 [P = .419] for overall survival; and subdistribution hazard ratio, 1.042; 95% confidence interval, 0.793-1.369 [P = .769] for breast cancer-specific survival), with each improving over time. The median follow-up was 7.0 years. CONCLUSIONS For Medicare patients with tumors measuring >5 cm, survival is similar between those treated with BCT and mastectomy as for patients with smaller primary tumors. Despite exclusion from randomized trials, BCT may remain an option for patients with larger tumors when deemed clinically and cosmetically amenable to surgical resection.
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Affiliation(s)
- Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Karen Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elin R Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John M Daly
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marcia Boraas
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Penny R Anderson
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian L Egleston
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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188
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Shah C, Vicini FA, Berry S, Julian TB, Ben Wilkinson J, Shaitelman SF, Khan A, Finkelstein SE, Goldstein N. Ductal Carcinoma In Situ of the Breast: Evaluating the Role of Radiation Therapy in the Management and Attempts to Identify Low-risk Patients. Am J Clin Oncol 2015; 38:526-33. [PMID: 25036472 PMCID: PMC4644064 DOI: 10.1097/coc.0000000000000102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ductal carcinoma in situ of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with ductal carcinoma in situ include mastectomy or breast-conserving therapy. Although several randomized trials have confirmed a >50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared with breast-conserving surgery alone, controversy persists regarding whether or not RT is needed in selected "low-risk" patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery is associated with higher rates of local recurrence even after selecting patients with optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead focusing on approaches such as multigene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multigene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of RT.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Summa Health System, Akron, Ohio
| | - Frank A. Vicini
- Michigan Healthcare Professionals/21 Century Oncology, Farmington Hills, Michigan
| | - Sameer Berry
- Department of Radiation Oncology, Summa Health System, Akron, Ohio
| | - Thomas B. Julian
- Department of Surgery, Division of Breast Surgical Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - J. Ben Wilkinson
- Department of Radiation Oncology, Willis Knighton Health System, Shreveport, LA
| | | | - Atif Khan
- Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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189
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Tanaka H, Hayashi S, Kajiura Y, Kitahara M, Matsuyama K, Kanematsu M, Hoshi H. Evaluation of the field-in-field technique with lung blocks for breast tangential radiotherapy. Nagoya J Med Sci 2015; 77:339-45. [PMID: 26412879 PMCID: PMC4574320] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 03/18/2015] [Indexed: 12/04/2022]
Abstract
Several studies have reported the advantages of the field-in-field (FIF) technique in breast radiotherapy, including dose reduction in the lungs by using lung field blocks. We evaluated the FIF technique with lung blocks for breast tangential radiotherapy. Sixteen patients underwent free breathing (FB) computed tomography (CT), followed by two CT procedures performed during breath hold after light inhalation (IN) and light exhalation (EX). Three radiotherapy plans were created using the FIF technique based on the FB-CT images: one without lung blocks (LB0) and two with lung blocks whose monitor units (MUs) were 5 (LB5) and 10 (LB10), respectively. These plans were copied to the IN-CT and EX-CT images. V20Gy, V30Gy, and V40Gy of the ipsilateral lung and V100%, V95%, and the mean dose (Dmean) to the planning target volume (PTV) were analyzed. The extent of changes in these parameters on the IN-plan and EX-plan compared with the FB-plan was evaluated. V20Gy, V30Gy, and V40Gy were significantly smaller for FB-LB5 and FB-LB10 than for FB-LB0; similar results were obtained for the IN-plan and EX-plan. V100%, V95%, and Dmean were also significant smaller for FB-LB5 and FB-LB10 than for FB-LB0. The extent of changes in V20Gy, V30Gy, and V40Gy on the IN-plan and EX-plan compared with the FB-plan was not statistically significant. Lung blocks were useful for dose reduction in the lung and a simultaneous PTV decrease. This technique should not be applied in the general population.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
,Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Shinya Hayashi
- Depertment of Radiation Oncology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yuichi Kajiura
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
,Department of Radiology, Gifu University Hospital, Gifu, Japan
| | | | | | - Masayuki Kanematsu
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
,Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Hiroaki Hoshi
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
,Department of Radiology, Gifu University Hospital, Gifu, Japan
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190
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Qian GW, Ni XJ, Wang Z, Jiang YZ, Yu KD, Shao ZM. Effect of radiotherapy on survival of women with locally excised ductal carcinoma in situ of the breast: a Surveillance, Epidemiology, and End Results population-based analysis. Onco Targets Ther 2015; 8:1407-18. [PMID: 26089689 PMCID: PMC4467663 DOI: 10.2147/ott.s82087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although it has been previously reported that radiotherapy (RT) effectively reduced the incidence of local recurrence of ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), little is known about the effect of RT on survival of patients with locally excised DCIS. Patients and methods Using Surveillance, Epidemiology, and End Results registry data, we selected 56,968 female DCIS patients treated with BCS between 1998 and 2007. Overall survival (OS) and breast cancer-specific survival (BCSS) were compared among patients who received RT or no RT using the Kaplan–Meier methods and Cox proportional hazards regression models. Results Median follow-up was 91 months. In the multivariable model, patients receiving postoperative RT had better OS than those undergoing BCS alone (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.53–0.67, P<0.001). This pattern remained after stratification by estrogen receptor (ER) status and age. In contrast, RT delivery was not significantly associated with improved BCSS (HR 0.71, 95% CI 0.48–1.03, P=0.073). However, after stratifying by the above two variables, RT contributed to better BCSS in ER-negative/borderline patients (HR 0.41, 95% CI 0.19–0.88, P=0.023) and younger patients (≤50 years old; HR 0.37, 95% CI 0.15–0.91, P=0.030). Conclusion Our analysis confirms the beneficial effect of RT on OS in women with locally excised DCIS and reveals the specific protective effect of RT on BCSS in ER-negative/borderline and younger patients.
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Affiliation(s)
- Guo-Wei Qian
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Jian Ni
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Zheng Wang
- Department of Radiation Oncology, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Ke-Da Yu
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Fudan University, Shanghai, People's Republic of China
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191
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Abstract
BACKGROUND The aim of this study was to compare the time to re-operation, following inadequate loco-regional surgery for breast cancer, between the public and private sectors of the Sunshine Coast region. METHODS A retrospective review was performed of the medical records of all female patients undergoing guide wire-localized, breast-conserving surgery at Nambour General Hospital and in the local private sector from January 2009 until April 2010. The dates of initial consultation, operation, post-operative consultation and any subsequent reoperation were recorded. RESULTS One hundred and seventeen public sector patients and 113 private sector patients were identified during the study period. Thirty-seven public patients (32%) and 46 private patients (41%) required re-operation. This difference was not significant (χ(2) = 2.06, degrees of freedom (df) = 1, P = 0.15). The mean time and standard error from the initial consultation to the first operation and re-operation in the public sector was 26 (2.3) and 62 (3.8) days, and in the private sector was 12 (1.2) and 30 (4.4) days, respectively P < 0.001. On average, 70% of public patients and 96% of private patients completed the surgical component of their breast cancer management within the Queensland Health-recommended time frame of 30 days (χ(2) = 26, df = 1, P < 0.001). CONCLUSION While experiencing similar rates of re-operative surgery in breast cancer management in the public and private sectors, the private sector deals with this issue in a more time efficient manner. An opportunity for intervention by quarantining theatre time is explored to improve the public sector time management.
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Affiliation(s)
- Matthew Solomon
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Colin T Cochrane
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David A Grieve
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Nambour General Hospital, Nambour, Queensland, Australia
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192
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Sakai T, Nishimura S, Ogiya A, Tanabe M, Kimura K, Morizono H, Iijima K, Miyagi Y, Makita M, Ito Y, Oguchi M, Horii R, Akiyama F, Iwase T. Four types of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery: classification of IBTR based on precise pathological examination. Pathol Int 2015; 65:113-8. [PMID: 25600703 DOI: 10.1111/pin.12253] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
We classified ipsilateral breast tumor recurrences (IBTRs) based on strict pathological rules. Ninety-six women who were surgically treated for IBTR were included. IBTRs were classified according to their origins and were distinguished based on strict pathological rules: relationship between the IBTR and the primary lumpectomy scar, surgical margin status of the primary cancer, and the presence of in situ lesions of IBTR. The prognosis of these subgroups were compared to that of new primary tumors (NP) in the narrow sense (NPn) that occurred far from the scar. Distant-disease free survival of IBTR that occurred close to the scar with in situ lesions and a negative surgical margin of the primary cancer (NP occurred close to the scar, NPcs) was similar to that of NPn. In contrast, IBTR that occurred close to the scar without in situ lesions (true recurrence (TR) that arose from residual invasive carcinoma foci, TRinv) had significantly poorer prognosis than NPn. IBTR that occurred close to the scar with in situ lesions and a positive surgical margin of the primary cancer (TR arising from a residual in situ lesion, TRis) had more late recurrences than NPcs. Precise pathological examinations indicated four distinct IBTR subtypes with different characteristics.
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Affiliation(s)
- Takehiko Sakai
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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193
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Menekşe E, Özyazıcı S, Karateke F, Turan Ü, Kuvvetli A, Gökler C, Özdoğan M, Önel S. Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects. J Breast Health 2015; 11:186-191. [PMID: 28331719 DOI: 10.5152/tjbh.2015.2572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to present our experience with rhomboid flap reconstruction, which is a simple technique, in breast cancer patients who underwent breast-conserving surgery. METHODS We reviewed the medical records of 13 patients with breast cancer who underwent rhomboid flap reconstruction. The patients were evaluated for tumor size, safe surgical margin, and other clinical and pathological features. RESULTS The mean age of the patients was 43.1 years (range: 28-69 years). The mean tumor diameter was 30.8 mm (range: 15-60 mm). The mean of the safe margin of resection was evaluated to be 17.8 mm (range: 5-30 mm). Re-excision was required for one patient in the same session. CONCLUSION Rhomboid flap reconstruction can facilitate the applicability of breast-conserving surgery in early breast cancer patients with large tumor-to-breast-size ratio or tumors close to the skin.
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Affiliation(s)
- Ebru Menekşe
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sefa Özyazıcı
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Turan
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cihan Gökler
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Özdoğan
- Department of Surgery, Adana Medline Hospital, Adana, Turkey
| | - Safa Önel
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
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194
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Abstract
Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients' risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients.
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Affiliation(s)
- Kathryn A Martinez
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA
| | - Allison W Kurian
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Sarah T Hawley
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA.,Division of General Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor MI, 48105, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
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195
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Lin Y, Wang B. Dosimetric absorption of intensity-modulated radiotherapy compared with conventional radiotherapy in breast-conserving surgery. Oncol Lett 2014; 9:9-14. [PMID: 25435927 PMCID: PMC4246647 DOI: 10.3892/ol.2014.2704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 01/27/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate the dosimetric benefits between intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CR) among patients receiving breast-conserving surgery. A dosimetric comparison of IMRT and CR was evaluated in 20 patients with early-stage breast cancer using a three-dimensional treatment planning system. The prescribed mammary gland dose was completed in 25 fractions with a total dose of 5,000 cGy. Homogeneity of the planning target volume (PTV), irradiation dose and volume of organs at risk (OARs) were evaluated through a dose-volume histogram. For the homogeneity of PTV, the average volume receiving 95% of the prescribed dose in the IMRT plan was similar to that in the CR plan (97 vs. 96%, respectively). With regard to normal tissue sparing in OARs, the ipsilateral lung V20 in the IMRT and CR plans was 27.8 and 20.8%, respectively. The mean dose and V30 of the heart for five patients were 598.4 versus 348.3 cGy and 10.06 versus 5.3%, respectively. The mean dose sparing the heart or lung was markedly reduced in the IMRT plan compared with the CR plan. The results of the current study demonstrated that whole breast IMRT improves PTV dose distribution and improves normal tissue sparing in OARs.
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Affiliation(s)
- Yang Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Benzhong Wang
- Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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196
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TANAKA HIDEKAZU, HAYASHI SHINYA, HOSHI HIROAKI. Cardiac counterclockwise rotation is a risk factor for high-dose irradiation to the left anterior descending coronary artery in patients with left-sided breast cancer who receiving adjuvant radiotherapy after breast-conserving surgery. Nagoya J Med Sci 2014; 76:265-72. [PMID: 25741035 PMCID: PMC4345684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/28/2014] [Indexed: 11/18/2022]
Abstract
Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotate around longitudinal axis, showing either clockwise or counterclockwise rotation (CCWR). On electrocardiography, the transition zone (TZ) was judged in precordial leads. CCWR was considered to be present if TZ was at or to the right of V3. The prescribed dose was 50 Gy in 25 fractions. The maximum (Dmax) and mean (Dmean) doses to the LAD artery and the volumes of the LAD artery receiving at least 20 Gy, 30 Gy and 40 Gy (V20Gy, V30Gy and V40Gy, respectively) were significantly higher in CCWR than in the non-CCWR patients. On multivariate analysis, TZ was significantly associated with Dmax, Dmean, V20Gy, V30Gy, and V40Gy. CCWR is a risk factor for high-dose irradiation to the LAD artery. Electrocardiography is useful for evaluating the cardiovascular risk of high-dose irradiation to the LAD artery.
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197
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Tanaka H, Hayashi S, Hoshi H. Determination of the optimal method for the field-in-field technique in breast tangential radiotherapy. J Radiat Res 2014; 55:769-773. [PMID: 24536020 PMCID: PMC4099991 DOI: 10.1093/jrr/rrt233] [Citation(s) in RCA: 13] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
Several studies have reported the usefulness of the field-in-field (FIF) technique in breast radiotherapy. However, the methods for the FIF technique used in these studies vary. These methods were classified into three categories. We simulated a radiotherapy plan with each method and analyzed the outcomes. In the first method, a pair of subfields was added to each main field: the single pair of subfields method (SSM). In the second method, three pairs of subfields were added to each main field: the multiple pairs of subfields method (MSM). In the third method, subfields were alternately added: the alternate subfields method (ASM). A total of 51 patients were enrolled in this study. The maximum dose to the planning target volume (PTV) (Dmax) and the volumes of the PTV receiving 100% of the prescription dose (V100%) were calculated. The thickness of the breast between the chest wall and skin surface was measured, and patients were divided into two groups according to the median. In the overall series, the average V100% with ASM (60.3%) was significantly higher than with SSM (52.6%) and MSM (48.7%). In the thin breast group as well, the average V100% with ASM (57.3%) and SSM (54.2%) was significantly higher than that with MSM (43.3%). In the thick breast group, the average V100% with ASM (63.4%) was significantly higher than that with SSM (51.0%) and MSM (54.4%). ASM resulted in better dose distribution, regardless of the breast size. Moreover, planning for ASM required a relatively short time. ASM was considered the most preferred method.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan
| | - Shinya Hayashi
- Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan
| | - Hiroaki Hoshi
- Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan
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198
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Houssami N, Morrow M. Margins in breast conservation: a clinician's perspective and what the literature tells us. J Surg Oncol 2014; 110:2-7. [PMID: 24756965 DOI: 10.1002/jso.23594] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/20/2014] [Indexed: 11/06/2022]
Abstract
The optimal margin in breast-conserving surgery is controversial, and re-excision is common. Pathologic margin assessment is not standardized, and tumor biology and the use of systemic therapy have a major impact on local control. A study-level meta-analysis found no difference in local recurrence for margin widths of 1, 2, and 5 mm, leading a multidisciplinary panel to recommend adoption of no ink on tumor as the standard definition of a negative margin.
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Affiliation(s)
- Nehmat Houssami
- Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Royal Hospital for Women, Sydney, Australia
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199
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Pilewskie M, King TA. Magnetic resonance imaging in patients with newly diagnosed breast cancer: a review of the literature. Cancer 2014; 120:2080-9. [PMID: 24752817 DOI: 10.1002/cncr.28700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/21/2014] [Accepted: 03/14/2014] [Indexed: 12/14/2022]
Abstract
The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:120:2080-2089. © 2014 American Cancer Society.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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200
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Kiyingi AK, Macdonald LJ, Shugg SA, Bollard RC. Harmonic dissection versus electrocautery in breast surgery in regional Victoria. ANZ J Surg 2014; 85:358-62. [PMID: 24698128 DOI: 10.1111/ans.12594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Harmonic instruments are an alternative tool for surgical dissection. The aim of this study is to evaluate differences in clinical outcomes relating to harmonic dissection when compared with electrocautery in patients undergoing major breast surgery in a regional centre over a 3-year period. METHODS Retrospective chart analysis was conducted of 52 patients undergoing major breast surgery for carcinoma or ductal carcinoma in situ by a single surgeon in a regional centre from May 2008 to January 2011. Analysis involved the extraction of qualitative data relating to patient demographics, surgery type and specimen histopathology. Quantitative data were extracted relating to duration of surgery, duration of patient-controlled analgesia (PCA) use, length of hospital admission, drainage output and presence of infection, haematoma or seroma. RESULTS Fifty-two patients underwent major breast surgery; harmonic dissection n = 32 and electrocautery n = 20. The two groups were comparable. There was no significant difference identified relating the outcome measures. The median operative duration was shorter in the harmonic dissection group, however, was not of statistical significance. No significant difference was identified between groups relating to length of inpatient stay, duration of PCA use and total volume wound drainage and total days of drainage. Incidence of seroma and infection in the groups was not significantly different. CONCLUSION The harmonic dissection is safe and effective in major breast surgery. The study did not demonstrate any clinical advantage from the use of harmonic dissection in major breast surgery compared with electrocautery, nor was there any difference in the complication rates measured.
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Affiliation(s)
- Andrew K Kiyingi
- Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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