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Yuan J, Zhang M, Wang M, Zhang M, Wu K, Chen H. Neoadjuvant radiochemotherapy is safe and feasible for breast conserving surgery or immediate reconstruction. Sci Rep 2024; 14:9208. [PMID: 38649431 PMCID: PMC11035569 DOI: 10.1038/s41598-024-59961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
This study aimed to evaluate the survival outcomes of neoadjuvant radiochemotherapy (NARCT) for early breast cancer. Female patients ≤ 80 years old with unilateral T1-T4 invasive ductal breast cancer treated with neoadjuvant chemotherapy (NAC) and radiation therapy (RT) between 2006 and 2015 were enrolled from SEER database. Baseline differences in clinical and pathological characteristics were evaluated using chi-square test. The survival outcomes were estimated by Kaplan-Meier analysis and compared using Cox hazards models. The effects of baseline differences on survival outcome in patients treated with neoadjuvant radiation therapy (NART) and post-operation radiation therapy (PORT) were circumvented by propensity score matching (PSM). Altogether 14,151 patients receiving NAC and RT were enrolled, among whom 386 underwent NART. Based on a 1:4 PSM cohort, NART was an independent unfavorable prognostic factor for breast cancer-specific survival (BCSS) and overall survival (OS) for the whole cohort. However, among patients receiving breast conserving surgery (BCS) (HR 1.029, P = 0.915 for BCSS; HR 1.003, P = 0.990 for OS) or implant-based immediate breast reconstruction (IBR) (HR 1.039, P = 0.921 for BCSS; HR 1.153, P = 0.697 for OS), those treated with NART had similar survival outcomes compared with patients treated with PORT. In conclusion, NARCT was a safe and feasible approach for patients undergoing BCS and IBR.
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Affiliation(s)
- Jingjing Yuan
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Meilin Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Maoli Wang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mingdi Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hongliang Chen
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
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Shibamoto Y, Takano S. Non-Surgical Definitive Treatment for Operable Breast Cancer: Current Status and Future Prospects. Cancers (Basel) 2023; 15:cancers15061864. [PMID: 36980750 PMCID: PMC10046665 DOI: 10.3390/cancers15061864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
This article reviews the results of various non-surgical curative treatments for operable breast cancer. Radiotherapy is considered the most important among such treatments, but conventional radiotherapy alone and concurrent chemoradiotherapy do not achieve high cure rates. As a radiosensitization strategy, intratumoral injection of hydrogen peroxide before radiation has been investigated, and high local control rates (75-97%) were reported. The authors treated 45 patients with whole-breast radiotherapy, followed by stereotactic or intensity-modulated radiotherapy boost, with or without a radiosensitization strategy employing either hydrogen peroxide injection or hyperthermia plus oral tegafur-gimeracil-oteracil potassium. Stages were 0-I in 23 patients, II in 19, and III in 3. Clinical and cosmetic outcomes were good, with 5-year overall, progression-free, and local recurrence-free survival rates of 97, 86, and 88%, respectively. Trials of carbon ion radiotherapy are ongoing, with promising interim results. Radiofrequency ablation, focused ultrasound, and other image-guided ablation treatments yielded complete ablation rates of 20-100% (mostly ≥70%), but long-term cure rates remain unclear. In these treatments, combination with radiotherapy seems necessary to treat the extensive intraductal components. Non-surgical treatment of breast cancer is evolving steadily, with radiotherapy playing a major role. In the future, proton therapy with the ultra-high-dose-rate FLASH mode is expected to further improve outcomes.
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Affiliation(s)
- Yuta Shibamoto
- Department of Radiation Oncology, Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi 441-8021, Japan
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita-shi 565-0871, Japan
| | - Seiya Takano
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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The Role of Radiotherapy for Patients with Unresectable Locally Advanced Breast Cancer following Neoadjuvant Systemic Therapy. JOURNAL OF ONCOLOGY 2023; 2023:5101078. [PMID: 36844867 PMCID: PMC9957626 DOI: 10.1155/2023/5101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/22/2022] [Accepted: 11/29/2022] [Indexed: 02/19/2023]
Abstract
Background For locally advanced breast cancer (LABC) patients who remained unresectable after neoadjuvant systemic therapy (NST), radiotherapy (RT) is considered as an approach for tumor downstaging. In this study, we attempted to discuss the value of RT for patients with unresectable or progressive disease in the breast and/or regional nodes following NST. Methods Between January 2013 and November 2020, the data for 71 patients with chemo-refractory LABC or de novo bone-only metastasis stage IV BC who received locoregional RT with or without surgical resection were retrospectively analyzed. Factors associated with tumor complete response (CR) were recognized using logistic regression. Locoregional progression-free survival (LRPFS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. The Cox regression model was applied to recognize the recurrence risk factors. Results After RT, 11 patients (15.5%) achieved total cCR. Triple-negative subtype (TNBC) was associated with a lower total cCR rate compared with other subtypes (p = 0.033). 26 patients proceeded to surgery, and the operability rate was 36.6%. 1-year LRPFS and PFS were 79.0% and 58.0%, respectively, for the entire cohort. Surgical cases had an improved 1-year LRPFS (p = 0.015), but not 1-year PFS (p = 0.057), compared with definitive RT cases. Non-any cCR was the most prominent predictor of a shorter LRPFS (p < 0.001) and PFS (p = 0.002) in the multivariate analysis. Higher TNM stage showed a trend toward a shorter LRPFS time (p = 0.058), and TNBC (p = 0.061) showed a trend toward a shorter PFS interval. Conclusions This study demonstrated that RT was an effective tumor downstaging option for chemo-refractory LABC. For patients with favorable tumor regression, surgery following RT might bring survival benefits.
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Thorpe CS, DeWees TA, Laughlin BS, Vallow LA, Seneviratne D, Pockaj BA, Cronin PA, Halyard MY, Vern-Gross TZ, McGee LA, McLaughlin SA, Voss MM, Golafshar MA, Bulman GF, Vargas CE. Pilot/Phase II Trial of Hypofractionated Radiation Therapy to the Whole Breast Alone Before Breast Conserving Surgery. Adv Radiat Oncol 2023; 8:101111. [PMID: 36483068 PMCID: PMC9723298 DOI: 10.1016/j.adro.2022.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Our purpose was to report the results of a phase II trial of patients with breast cancer treated with hypofractionated whole breast radiation therapy (RT) before breast-conserving surgery (BCS). Methods and materials Between 2019 and 2020, patients with cT0-T2, N0, M0 breast cancer were enrolled. Patients were treated with hypofractionated whole breast RT, 25 Gy in 5 fractions, 4 to 8 weeks before BCS. Pathologic assessment was performed using the residual cancer burden (RCB). Toxicities were assessed according to Common Terminology Criteria for Adverse Events (version 4). Quality of life was assessed with Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events, The Breast Cancer Treatment Outcome Scale, Linear Analogue Self-Assessment, and Patient-Reported Outcomes Measurement Information System. Results Twenty-two patients were enrolled. Median follow-up was 7.6 months (range, 0.2-16.8). Seven (32%) and 2 (9%) patients experienced grade 2+ or 3 toxicities, respectively. Overall quality of life Linear Analogue Self-Assessment and Patient-Reported Outcomes Measurement Information System did not change significantly from baseline (P = .21 and P = .72, respectively). There was no clinically significant change (≥1 point) in any of The Breast Cancer Treatment Outcome Scale domains. Only 1 (5%) patient experienced a clinical deterioration that corresponded to a "fair" outcome on the Harvard Cosmesis Scale. At pathologic evaluation, 14 (64%) patients had RCB-0 or RCB-I, including 3 (14%) patients with a pathologic complete response (RCB-0). Eight patients (36%) had RCB-II. No local or distant recurrences have been observed. Conclusions Extremely hypofractionated whole breast RT before BCS is a feasible approach. There were low rates of toxicities and good cosmesis. Further investigation into this approach with RT before BCS is warranted.
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Affiliation(s)
| | - Todd A. DeWees
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dee Seneviratne
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | | | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Molly M. Voss
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Choi HJ, Ryu JM, Lee JH, Bang Y, Oh J, Chae BJ, Nam SJ, Kim SW, Lee JE, Lee SK, Yu J. Is Pathologic Axillary Staging Valid If Lymph Nodes Are Less than 10 with Axillary Lymph Node Dissection after Neoadjuvant Chemotherapy? J Clin Med 2022; 11:jcm11216564. [PMID: 36362792 PMCID: PMC9656978 DOI: 10.3390/jcm11216564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/17/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction: The aim of this study was to evaluate the prognostic value of the number of lymph nodes removed in breast cancer patients who undergo axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC). Methods: We included patients who were diagnosed with invasive breast cancer and cytology with proven involved axillary node metastasis at diagnosis and treated with NAC followed by curative surgery at Samsung Medical Center between January 2007 and December 2015. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Results: Among 772 patients with NAC and ALND, there were 285 ypN0, 258 ypN1, 135 ypN2, and 94 ypN3 cases. The median follow-up duration was 69.0 months. The group with less than 10 lymph nodes number (<10 nodes group) included 123 patients and the group with 10 or more lymph nodes number (≥10 nodes group) included 649 patients. There were no significant differences in DFS (p = 0.501) or OS (p = 0.883) between the two groups. In the ypN0 subgroup, the <10 nodes group had worse DFS than ≥10 nodes group (p = 0.024). In the ypN1 subgroup, there were no significant differences in DFS (p = 0.846) or OS (p = 0.774) between the two groups. In the ypN2 subgroup, the <10 nodes group had worse DFS (p = 0.025) and OS (p = 0.031) than ≥10 nodes group Conclusion: In ypN0 and ypN2 subgroups, breast cancer patients with less than 10 lymph nodes number in ALND after NAC might be considered for additional staging or closer surveillance when compared to patients with 10 or more than lymph node.
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Affiliation(s)
- Hee Jun Choi
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Yoonju Bang
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Jongwook Oh
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Byung-Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-1087; Fax: +82-2-3410-6982
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Ciérvide R, Montero Á, García-Rico E, García-Aranda M, Herrero M, Skaarup J, Benassi L, Barrera MJ, Vega E, Rojas B, Bratos R, Luna A, Parras M, López M, Delgado A, Quevedo P, Castilla S, Feyjoo M, Higueras A, Prieto M, Suarez-Gauthier A, Garcia-Cañamaque L, Escolán N, Álvarez B, Chen X, Alonso R, López M, Hernando O, Valero J, Sánchez E, Ciruelos E, Rubio C. Primary Chemoradiotherapy Treatment (PCRT) for HER2+ and Triple Negative Breast Cancer Patients: A Feasible Combination. Cancers (Basel) 2022; 14:cancers14184531. [PMID: 36139688 PMCID: PMC9496977 DOI: 10.3390/cancers14184531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 12/02/2022] Open
Abstract
Primary systemic treatment (PST) downsizes the tumor and improves pathological response. The aim of this study is to analyze the feasibility and tolerance of primary concurrent radio−chemotherapy (PCRT) in breast cancer patients. Patients with localized TN/HER2+ tumors were enrolled in this prospective study. Radiation was delivered concomitantly during the first 3 weeks of chemotherapy, and it was based on a 15 fractions scheme, 40.5 Gy/2.7 Gy per fraction to whole breast and nodal levels I-IV. Chemotherapy (CT) was based on Pertuzumab−Trastuzumab−Paclitaxel followed by anthracyclines in HER2+ and CBDCA-Paclitaxel followed by anthracyclines in TN breast cancers patients. A total of 58 patients were enrolled; 25 patients (43%) were TN and 33 patients HER2+ (57%). With a median follow-up of 24.2 months, 56 patients completed PCRT and surgery. A total of 35 patients (87.5%) achieved >90% loss of invasive carcinoma cells in the surgical specimen. The 70.8% and the 53.1% of patients with TN and HER-2+ subtype, respectively, achieved complete pathological response (pCR). This is the first study of concurrent neoadjuvant treatment in breast cancer in which three strategies were applied simultaneously: fractionation of RT (radiotherapy) in 15 sessions, adjustment of CT to tumor phenotype and local planning by PET. The pCR rates are encouraging.
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Affiliation(s)
- Raquel Ciérvide
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
- Correspondence: (R.C.); (E.G.-R.); Tel.: +34-669554042 (R.C.); +34-609165218 (E.G.-R.)
| | - Ángel Montero
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Eduardo García-Rico
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
- Correspondence: (R.C.); (E.G.-R.); Tel.: +34-669554042 (R.C.); +34-609165218 (E.G.-R.)
| | | | - Mercedes Herrero
- Department of Gynecology and Obstetrics, HM Hospitales, 28050 Madrid, Spain
| | - Jessica Skaarup
- Department of Gynecology and Obstetrics, HM Hospitales, 28050 Madrid, Spain
| | - Leticia Benassi
- Department of Gynecology and Obstetrics, HM Hospitales, 28050 Madrid, Spain
| | - Maria José Barrera
- Department of Gynecology and Obstetrics, HM Hospitales, 28050 Madrid, Spain
| | - Estela Vega
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Beatriz Rojas
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Raquel Bratos
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Ana Luna
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Manuela Parras
- Department of Radiology, HM Hospitales, 28050 Madrid, Spain
| | - María López
- Department of Radiology, HM Hospitales, 28050 Madrid, Spain
| | - Ana Delgado
- Department of Radiology, HM Hospitales, 28050 Madrid, Spain
| | - Paloma Quevedo
- Department of Radiology, HM Hospitales, 28050 Madrid, Spain
| | | | - Margarita Feyjoo
- Department of Medical Oncology, Hospital Sanitas La Moraleja, 28050 Madrid, Spain
| | - Ana Higueras
- Department of Gynecology and Obstetrics, Hospital Sanitas La Moraleja, 28050 Madrid, Spain
| | - Mario Prieto
- Department of Pathology, HM Hospitales, 28050 Madrid, Spain
| | | | | | - Nieves Escolán
- Department of Plastic Surgery, HM Hospitales, 28050 Madrid, Spain
| | - Beatriz Álvarez
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Xin Chen
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Rosa Alonso
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Mercedes López
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Ovidio Hernando
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Jeannette Valero
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Emilio Sánchez
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Eva Ciruelos
- Department of Medical Oncology, HM Hospitales, 28050 Madrid, Spain
| | - Carmen Rubio
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain
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Haussmann J, Budach W, Nestle-Krämling C, Wollandt S, Tamaskovics B, Corradini S, Bölke E, Krug D, Fehm T, Ruckhäberle E, Audretsch W, Jazmati D, Matuschek C. Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer. Cancers (Basel) 2022; 14:cancers14164031. [PMID: 36011025 PMCID: PMC9406575 DOI: 10.3390/cancers14164031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary This retrospective analysis reports on the treatment outcomes of women diagnosed with high-risk breast cancer treated with chemotherapy in combination with radiotherapy before the surgical removal of the tumor. It is well established that the lack of visible tumor cells in the pathological tumors analysis by the time of surgery (known as pathological complete response, pCR) is a factor that improves survival without the tumor reappearing in the body. However, it is unknown whether that is only true when giving systemic therapy or when pCR is achieved with the help of radiotherapy. We collected patient information and survival times to analyze the outcome in our patient group. We found that women with a pCR treated with chemotherapy in combination with radiotherapy can expect favorable long-term survival. This was true across different types of breast cancer and chemotherapy substances. Abstract Background: Neoadjuvant radiotherapy (naRT) in addition to neoadjuvant chemotherapy (naCT) has been used for locally advanced, inoperable breast cancer or to allow breast conserving surgery (BCS). Retrospective analyses suggest that naRT + naCT might result in an improvement in pathological complete response (pCR rate and disease-free survival). pCR is a surrogate parameter for improved event-free and overall survival (OS) and allows for the adaption of the post-neoadjuvant therapy regimens. However, it is not clear whether pCR achieved with the addition of naRT has the same prognostic value. Patients and methods: We performed a retrospective re-analysis of 356 patients (cT1-cT4/cN0-N+) treated with naRT and naCT with a long-term follow-up. Patients underwent naRT on the breast and regional lymph nodes combined with a boost to the primary tumor. Chemotherapy with different agents was given either sequentially or concomitantly to naRT. We used the Cox proportional hazard regression model to estimate the effect of pCR in our cohort in different subgroups as well as chemotherapy protocols. Clinical response markers correlating with OS were also analyzed. Results: For patients with median follow-ups of 20 years, 10 years, 15 years, 20 years, and 25 years, OS rates were 69.7%, 60.6%, 53.1%, and 45.1%, respectively. pCR was achieved in 31.1% of patients and associated with a significant improvement in OS (HR = 0.58; CI-95%: 0.41–0.80; p = 0.001). The prognostic impact of pCR was evident across breast cancer subtypes and chemotherapy regimens. Multivariate analysis showed that age, clinical tumor and nodal stage, chemotherapy, and pCR were prognostic for OS. Conclusion: NaCT and naRT prior to surgical resection achieve good long-term survival in high-risk breast cancer. pCR after naRT maintains its prognostic value in breast cancer subtypes and across different subgroups. pCR driven by naRT and naCT independently influences long-term survival.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Carolin Nestle-Krämling
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Dusseldorf, 40217 Dusseldorf, Germany
| | - Sylvia Wollandt
- Department of Senology, Sana-Kliniken Duesseldorf-Gerresheim, 40625 Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians University (LMU), 80366 Munich, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
- Correspondence: ; Tel.: +49-0211-81-17990
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Werner Audretsch
- Department of Senology and Breast Surgery, Breast Center at Marien Hospital Cancer Center, 40479 Dusseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
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Aebi S, Karlsson P, Wapnir IL. Locally advanced breast cancer. Breast 2021; 62 Suppl 1:S58-S62. [PMID: 34930650 PMCID: PMC9097810 DOI: 10.1016/j.breast.2021.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022] Open
Abstract
Locally advanced breast cancer (LABC) is defined here as inoperable breast adenocarcinoma without distant metastases. Patients with LABC require a multidisciplinary approach. Given the risk of distant metastasis, staging exams are necessary. The incidence of LABC (stages IIIB and IIIC) has decreased in recent years. LABC has rarely been investigated separately: patients with LABC have participated both in clinical trials of palliative and of neoadjuvant therapy. Most trials did not analyze responses and long-term outcomes independently; thus, the treatment of patients with LABC is extrapolated from studies of patients with less or more advanced disease. Pathologic confirmation and molecular profiling are essential for the choice of neoadjuvant chemotherapy. Preoperative endocrine therapy may be considered in certain clinical situations; the addition of a CDK4/6 inhibitor is being investigated. HER2 positive LABCs are targeted with anti-HER2 agents combined with chemotherapy. PD-1 and PD-L1 antibodies in ‘triple-negative’ LABC are promising. Excellent responses to neoadjuvant therapy enable conservative surgery in many patients; however, inflammatory breast cancer may still indicate mastectomy. Postoperative radiotherapy is usually indicated. Target volumes include breast/chest wall, axillary, supraclavicular and internal mammary nodal basins. Preoperative radiation therapy can be useful in patients without response to systemic therapies. Palliative surgery for poor responders after neoadjuvant systemic and radiation therapy can be considered. Multidisciplinary teams can optimize local control and prevent relapses. However, modest improvement in survival was achieved between 2000 and 2014 underscoring the unmet need in patients with LABC who will benefit from specific research efforts in this disease entity.
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Affiliation(s)
- Stefan Aebi
- Lucerne Cantonal Hospital and University of Bern, Cancer Center, Division of Medical Oncology, 6000, Lucerne 16, Switzerland.
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
| | - Irene L Wapnir
- Stanford University, Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial. Cancers (Basel) 2021; 13:cancers13205107. [PMID: 34680257 PMCID: PMC8534073 DOI: 10.3390/cancers13205107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T2-3 N0-2 M0 invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3-18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6-84.2] and 71.5% [95% CI 60.5-84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2-95.0] and 92.1% [95% CI 83.7-100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects.
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Breast Cancer Staging: Updates in the AJCC Cancer Staging Manual, 8th Edition, and Current Challenges for Radiologists, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:278-290. [PMID: 33594908 DOI: 10.2214/ajr.20.25223] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The standardization of the AJCC TNM staging system for breast cancer allows physicians to evaluate patients with breast cancer using standard language and criteria, assess treatment response, and compare patient outcomes. Previous editions of the AJCC Cancer Staging Manual relied on the anatomic TNM method of staging that incorporates imaging and uses population-level survival data to predict patient outcomes. Recent advances in therapy based on biomarker status and multigene panels have improved treatment strategies. In the newest edition of the AJCC Cancer Staging Manual (8th edition, adopted on January 1, 2018), breast cancer staging integrates anatomic staging with tumor grade, biomarker data regarding hormone receptor status, oncogene expression, and gene expression profiling to assign a prognostic stage. This article reviews the 8th edition of the AJCC breast cancer staging system with a focus on anatomic staging and the challenges that anatomic staging poses for radiologists. We highlight key imaging findings that impact patient treatment and discuss the role of imaging in evaluating response to neoadjuvant therapy. Finally, we discuss biomarkers and multigene panels and how these impact prognostic stage. The review will help radiologists identify critical findings that affect breast cancer staging and understand ongoing limitations of imaging in staging.
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Ahmed M, Jozsa F, Douek M. A systematic review of neo-adjuvant radiotherapy in the treatment of breast cancer. Ecancermedicalscience 2021; 15:1175. [PMID: 33680089 PMCID: PMC7929768 DOI: 10.3332/ecancer.2021.1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. However, its utilisation in breast cancer has not been explored to the extent of neo-adjuvant chemotherapy (NAC). The evidence for the application of NRT in breast cancer is evaluated. Methods PubMed, Embase and the Cochrane Library databases were searched systematically in August 2020 for studies that addressed the role of NRT in the treatment of breast cancer. Studies were deemed eligible if they reported on objective outcome measurements of OS, disease free-survival (DFS) or pathological complete response (pCR) and attained a satisfactory quality assessment. Findings A total of 23 studies reported upon 3,766 patients who had received NRT of which 3,233 also received NAC concurrently (neo-adjuvant chemo-radiotherapy (NCRT)). The pCR values ranged from 14% to 42%, 5-year DFS 61.4% to 81% and 5-year OS 71.6% to 84.2%. Complications were confined to radiation dermatitis with no cases of implant loss reported during breast reconstruction. The application of NRCT alone showed no significant difference in OS or DFS compared to NCRT followed by surgery. Interpretation Numbers of patients receiving exclusively NRT is small. However, NCRT is oncologically safe with a low side-effect profile including preceding breast reconstruction. Potential benefits include precise cancer volume targeting, chemosensitisation, elimination of delays in adjuvant therapies and alternatives to chemotherapy in oestrogen receptor positive patients. These factors warrant further exploration within randomised controlled-trials.
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Affiliation(s)
- Muneer Ahmed
- Division of Surgery and interventional Science, University College London, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London NW3 2PS, UK
| | - Felix Jozsa
- Division of Surgery and interventional Science, University College London, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London NW3 2PS, UK
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
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Matuschek C, Nestle-Kraemling C, Kühn T, Fehm T, Bölke E, Corradini S, Fastner G, Maas K, Seidel C, Budach W. Neoadjuvant Radio(chemo)therapy for Breast Cancer: An Old Concept Revisited. Breast Care (Basel) 2020; 15:112-117. [PMID: 32398979 DOI: 10.1159/000507041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background: The international standard of care for the treatment of high-risk breast cancer (BC) consists of neoadjuvant chemotherapy (NACT) and surgery followed by adjuvant whole breast/chest wall irradiation. In this setting, the time interval from the start of NACT to the end of radiotherapy (RT) is usually postponed to 6 months or longer. In addition to this, a high percentage of capsular fibrosis may occur when breast implants are irradiated. Most of these disadvantages could be avoided by using preoperative RT (PRT). PRT is already the standard of care in several other tumor entities (rectal cancer, esophagus carcinoma, lung cancer, and soft tissue sarcoma). Nevertheless, PRT in BC has been tested in several trials, but randomized prospective trials using modern radiation technology and systemic therapies are lacking. The available evidence summarized in this review indicates that PRT may improve survival and reduce long-term toxicity in patients with a higher risk of recurrence and should be consequently tested in a randomized trial. Summary: Prospective, randomized trials concerning PRT in high-risk BC are needed. We plan to conduct a NeoRad trial (NACT followed by PRT in high-risk BC). Key Messages: Prospective, randomized studies concerning PRT in high-risk BC are needed.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Carolin Nestle-Kraemling
- Department of Gynecologic and Obstetrics, EVK Dusseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Thorsten Kühn
- Department of Gynecology, Klinikum Esslingen, Esslingen, Germany
| | - Tanja Fehm
- Department of Gynecology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Kitti Maas
- Department of Radiation Oncology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University Hospital, Düsseldorf, Germany
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Long-term quality of life after preoperative radiochemotherapy in patients with localized and locally advanced breast cancer. Strahlenther Onkol 2020; 196:386-397. [PMID: 31919547 DOI: 10.1007/s00066-019-01557-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Preoperative radiotherapy (PRT) or radiochemotherapy (PRCT) is used in different tumor sites. The aim of the study was to examine the long-term quality of life (QoL) of localized / locally advanced breast cancer patients treated with PRT/PRCT followed by breast-conserving surgery (BCS) or mastectomy (ME). METHODS Assessment of QoL was done using EORTC QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. The summary scores were categorized into 4 distinct groups to classify the results. Furthermore, a comparative analysis was performed between the study cohort and a previously published reference cohort of healthy adults. We assessed the impact of different clinical, prognostic, and treatment-related factors on selected items from C30 and BR23 using a dependence analysis. RESULTS Out of 315 patients treated with PRT/PCRT in the years 1991 to 1999, 203 patients were alive at long-term follow-up after a mean of 17.7 years (range 14-21). 37 patients were lost to follow-up and 61 patients refused to be contacted, leading to 105 patients (64 patients after BCS and 41 after ME) being willing to undergo further clinical assessment regarding QoL outcome. Overall, QoL (QLQ-C30) was rated "excellent" or "good" in 85% (mean value) of all patients (BCS 83%, ME 88%). Comparative analysis between the study cohort and a published healthy control group revealed significantly better global health status and physical and role functioning scores in the PRT/PRCT group. The analysis demonstrates no differences in nausea/vomiting, dyspnea, insomnia, constipation, or financial difficulties. According to the dependence analysis, global QoL was associated with age, operation type and ME reconstruction. CONCLUSION We did not detect any inferiority of PRT/PRCT compared to a healthy reference group with no hints of a detrimental long-term effect on general and breast-specific quality of life.
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Preoperative radiotherapy: A paradigm shift in the treatment of breast cancer? A review of literature. Crit Rev Oncol Hematol 2019; 141:102-111. [PMID: 31272045 DOI: 10.1016/j.critrevonc.2019.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/12/2019] [Accepted: 06/03/2019] [Indexed: 12/31/2022] Open
Abstract
The standard of care for early-stage breast cancer (BC) consists of breast-conserving surgery followed by postoperative irradiation. Recently, the concept of changing the usual sequence of treatment components in BC RT has been investigated. Potential advantages of preoperative RT in BC include a possible tumor downstaging with improved surgical cosmetic outcomes, accurate tumor site identification and better target volume delineation. Furthermore, preoperative RT could serve as a tool for treatment stratification for de-escalation of treatments in the event of pathological complete response. The present literature review analyzed the available clinical data regarding the potential impact of preoperative RT. Overall, available clinical evidence of preoperative RT in BC remains limited, deriving mostly from retrospective case series. Nevertheless, the experiences prove the feasibility of the preoperative RT approach and confirm the efficacy in almost all analyzed studies, including experiences using higher prescription RT doses or RT in combination with systemic therapy.
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15
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Matuschek C, Nestle-Kraemling C, Haussmann J, Bölke E, Wollandt S, Speer V, Djiepmo Njanang FJ, Tamaskovics B, Gerber PA, Orth K, Ruckhaeberle E, Fehm T, Corradini S, Lammering G, Mohrmann S, Audretsch W, Roth S, Kammers K, Budach W. Long-term cosmetic outcome after preoperative radio-/chemotherapy in locally advanced breast cancer patients. Strahlenther Onkol 2019; 195:615-628. [DOI: 10.1007/s00066-019-01473-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/12/2019] [Indexed: 02/03/2023]
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Abstract
Neoadjuvant chemotherapy (NAC) has become an important treatment approach for stage II/III breast cancers to downsize tumor and enable breast-conserving surgery for patients that may otherwise undergo mastectomy. MR imaging has the potential to identify early response or disease progression, enabling potential modification to NAC regimens. Detection of size and morphologic changes is better appreciated with MR imaging than other modalities and is different between molecular subtypes of breast cancer. The combination of DCE-MR imaging and DWI provides the highest sensitivity and specificity. Other new modalities such as FDG PET/MR imaging and molecular breast imaging are still undergoing research.
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Affiliation(s)
- Huong T Le-Petross
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA.
| | - Bora Lim
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA
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17
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Wang Y, Zhao Y, Liu S, Tang W, Gao H, Zheng X, Hong S, Wang S. Using a novel T-lymph node ratio model to evaluate the prognosis of nonmetastatic breast cancer patients who received preoperative radiotherapy followed by mastectomy: An observational study. Medicine (Baltimore) 2017; 96:e8203. [PMID: 29049205 PMCID: PMC5662371 DOI: 10.1097/md.0000000000008203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate the prognostic value of postpathological characters in nonmetastatic breast cancer (NMBC) patients who received preoperative radiotherapy (PRT) followed by mastectomy (MAST).We conducted retrospective analyses using the data collected from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute. Univariate and multivariate analyses were performed to identify prognostic factors. Disease-specific survival was calculated by the Kaplan-Meier curve and validated by log rank test. The discriminations of independent risk factors and staging systems were compared by the area under receiver operating characteristic curves (AUC) and validated by Harrell concordance index (bootstrapping algorithm). Akaike information criterion (AIC) was applied to compare the difference of model.One thousand three hundred fifty NMBC patients who had received PRT followed by MAST from 1988 to 2013 were included in the study. We found the metastatic lymph node ratio (mLNR) staging was a superior indicator than pN staging. Thus, we proposed a T-lymph node ratio (T-NR) staging system with simplified-T categories (T0-3 and T4) and the mLNR staging. The novel T-NR staging system provided larger AUC (P = .024, .008, respectively) and the smaller AIC (P < .001) value than American Joint Committee on Cancer staging system.The novel T-NR staging system performed more accurate survival prediction and better model fitness for NMBC patients who receive PRT followed by MAST, it may provide a wide applicability in clinical decision-making.
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Affiliation(s)
- Yang Wang
- Department of Head-Neck and Breast Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Provincial Cancer Hospital, Hefei Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Collaborative Innovation Center of Cancer Medicine, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lightowlers SV, Boersma LJ, Fourquet A, Kirova YM, Offersen BV, Poortmans P, Scholten AN, Somaiah N, Coles CE. Preoperative breast radiation therapy: Indications and perspectives. Eur J Cancer 2017; 82:184-192. [PMID: 28692950 DOI: 10.1016/j.ejca.2017.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 05/25/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature and then highlights current clinical trials, with particular attention to combining with novel drugs and optimising associated translational research.
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Affiliation(s)
- S V Lightowlers
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - L J Boersma
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Y M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - A N Scholten
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Somaiah
- The Institute of Cancer Research, London, United Kingdom
| | - C E Coles
- Oncology Centre, University of Cambridge, United Kingdom
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19
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Aoyama N, Ogawa Y, Yasuoka M, Ohgi K, Iwasa H, Miyatake K, Yoshimatsu R, Yamanishi T, Hamada N, Tamura T, Kobayashi K, Murata Y, Miyamura M, Yamagami T. Therapeutic results of a novel enzyme-targeting radiosensitization treatment, Kochi oxydol-radiation therapy for unresectable carcinomas II, in patients with stage I primary breast cancer. Oncol Lett 2017; 13:4741-4747. [PMID: 28599475 PMCID: PMC5453170 DOI: 10.3892/ol.2017.6074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/26/2017] [Indexed: 12/02/2022] Open
Abstract
Linac-based stereotactic radiotherapy has little effect on the majority of advanced neoplasms. Therefore, the novel radiosensitizer Kochi oxydol-radiation therapy for unresectable carcinomas (KORTUC) II, which contains hydrogen peroxide and sodium hyaluronate, was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases, recurrent breast cancer and stage IV primary breast cancer has previously been demonstrated. The present study evaluated the safety and efficacy of KORTUC II for patients with stage I primary breast cancer. A total of 15 patients (age range, 40–76 years) were enrolled. The injection of 3 ml of KORTUC II agent was initiated from the sixth radiotherapy fraction and was performed twice a week, under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT and/or MRI examinations prior to and following KORTUC II treatment. All patients exhibited complete responses and the overall survival rate was 100% after a follow-up period of five years. The mean duration of follow-up at the end of March 2015 was 53 months. Based on these results, KORTUC II treatment exhibited marked therapeutic effects with satisfactory treatment outcomes and an acceptable extent of adverse events.
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Affiliation(s)
- Nobutaka Aoyama
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Yasuhiro Ogawa
- Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Hyogo 675-0003, Japan
| | - Miki Yasuoka
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Kenta Ohgi
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Norihiko Hamada
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Taiji Tamura
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Kana Kobayashi
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Yoriko Murata
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Mitsuhiko Miyamura
- Department of Pharmacy, Medical School Hospital, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology and Radiation Oncology, Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
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Preoperative Radiotherapy Is Not Associated with Increased Post-mastectomy Short-term Morbidity: Analysis of 77,902 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1108. [PMID: 28458959 PMCID: PMC5404430 DOI: 10.1097/gox.0000000000001108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy. Methods: We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011 datasets. ACS-NSQIP is a prospective, risk-adjusted, outcomes-based registry. Data included demographic and perioperative factors. Outcomes studied included surgical site (wound and prosthesis/flap complications), systemic (cardiac, respiratory, neurological, urinary, and venous thromboembolism events), and overall morbidity. Logistic regression was used to estimate the unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) between NRT and postoperative 30-day morbidity. Results: The study population included 77,902 women, of which 61,039 (78.4%) underwent mastectomy only and 16,863 (21.6%) underwent mastectomy with immediate breast reconstruction. NRT was administered to 266 (0.4%) mastectomy-only and 75 (0.4%) immediate breast reconstruction patients. In the mastectomy-only group, there were no significant differences in the rates of postoperative surgical site morbidity (aOR = 1.41; 95% confidence interval (CI): 0.76–2.63; P = 0.276), systemic morbidity (aOR = 0.72; 95% CI: 0.40–1.26; P = 0.252), and overall morbidity (aOR = 0.85; 95% CI: 0.54–1.33; P = 0.477) between NRT and control groups. Similarly, no significant differences were found for these three outcomes in the immediate breast reconstruction population. Statistical power for every comparison was >80%. Conclusions: This study suggests that NRT is not associated with significantly higher 30-day postoperative complications among breast cancer patients undergoing mastectomy with or without immediate breast reconstruction.
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Duma MN, Heinrich C, Schönknecht C, Chizzali B, Mayinger M, Devecka M, Kampfer S, Combs SE. Helical TomoTherapy for locally advanced or recurrent breast cancer. Radiat Oncol 2017; 12:31. [PMID: 28129767 PMCID: PMC5273793 DOI: 10.1186/s13014-016-0736-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose We report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk. Patients and methods We retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival. Results Median PTV was 2276 cm3 (1476–6837 cm3) with a median cranio-caudal extension of 28 cm (15–52 cm). The median dose to PTV was 40 Gy (32–60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group). Conclusions HT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.
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Affiliation(s)
- M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
| | - C Heinrich
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Praxis für Strahlentherapie, Hausham, Germany
| | - C Schönknecht
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - B Chizzali
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany
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Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction : An alternative treatment option for locally advanced breast cancer. Strahlenther Onkol 2017; 193:324-331. [PMID: 28124093 DOI: 10.1007/s00066-017-1100-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal sequence of mastectomy with immediate breast reconstruction (IBR) and radiotherapy (RT) for the treatment of locally advanced breast cancer (LABC) is still under debate. Increased rates of postoperative complications are described following postmastectomy RT. Neoadjuvant RT aims to improve the aesthetic results and simplify the reconstructive pathway. PATIENTS A total of 22 patients diagnosed with LABC and treated with neoadjuvant RT followed by mastectomy and IBR between 04/2012 and 03/2015 were retrospectively analyzed. RT consisted of external beam RT to the breast and the regional lymphatics, if indicated. Both implant-based and autologous tissue-transfer reconstruction techniques were used. RESULTS At the time of RT, 10 patients had no prior surgery and 12 patients had previously undergone breast-conserving surgery (BCS) with positive resection margins without the possibility to perform a second BCS. Additional neoadjuvant chemotherapy was administered in 18 patients prior to RT. A complete pathological response was achieved in 55.0% of patients. The 2‑year overall survival rate was 89.3%, the 2‑year disease-free-survival 79.8% and the local-recurrence-free survival was 95.2%. The cosmetic result was excellent or good in 66% of the patients treated with upfront mastectomy and 37% of the patients who had previously undergone BCS. Among patients who received implant-based IBR, 4 patients developed serious wound-healing problems with implant loss. The most satisfactory results were achieved with autologous tissue reconstruction. CONCLUSION A sequential neoadjuvant chemo-/radiotherapy to allow IBR following mastectomy in selected cases of LABC seems feasible and can be safely attempted. Careful patient selection, close monitoring, and continuous patient support is mandatory to ensure compliance in this treatment strategy.
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Aoyama N, Ogawa Y, Yasuoka M, Iwasa H, Miyatake K, Yoshimatsu R, Yamanishi T, Hamada N, Tamura T, Kobayashi K, Murata Y, Yamagami T, Miyamura M. Therapeutic response to a novel enzyme-targeting radiosensitization treatment (KORTUC II) for residual lesions in patients with stage IV primary breast cancer, following induction chemotherapy with epirubicin and cyclophosphamide or taxane. Oncol Lett 2016; 13:69-76. [PMID: 28123524 PMCID: PMC5245061 DOI: 10.3892/ol.2016.5456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/25/2016] [Indexed: 12/03/2022] Open
Abstract
Linac-based radiotherapy has a negligible effect on the majority of advanced neoplasms. Therefore, a novel radiosensitization treatment Kochi Oxydol Radiation Therapy for Unresectable Carcinomas II (KORTUC II), which utilizes hydrogen peroxide and sodium hyaluronate was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases and recurrent breast cancers has previously been demonstrated. The present study evaluated the safety and efficacy of KORTUC II in patients with stage IV primary breast cancer. Seven patients (age range, 36–65 years) were enrolled. All patients received induction chemotherapy prior to KORTUC II treatment and underwent positron emission tomography-computed tomography (PET-CT) examinations prior to and 2–7 months following KORTUC II treatment, and every six months thereafter where possible. The radiotherapy regimen (x-ray irradiation) was 2.75 gray (Gy)/fraction, 5 fractions/week for 16–18 fractions with a total radiation dose of 44–49.5 Gy. Administration of the KORTUC II agent (3–6 ml: 3 ml for a lesion <3 cm in diameter and 6 ml for a lesion ≥3 cm) was initiated from the sixth radiotherapy fraction, and was conducted twice a week under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT examinations prior to and following KORTUC II treatment. Of the seven lesions from the seven patients, five exhibited complete responses, two exhibited partial responses and none exhibited stable disease or progressive disease. The overall survival rate was determined to be 100% at 1 and 86% at 2 years post-treatment. The mean duration of follow-up by December 2014 was 51 months. The results of the PET-CT studies indicated that KORTUC II treatment demonstrated marked therapeutic effects with satisfactory treatment outcomes and acceptable adverse effects.
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Affiliation(s)
- Nobutaka Aoyama
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Yasuhiro Ogawa
- Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Hyogo 675-8555, Japan
| | - Miki Yasuoka
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Norihiko Hamada
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Taiji Tamura
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Kana Kobayashi
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Yoriko Murata
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Mitsuhiko Miyamura
- Department of Pharmacy, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
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Budach W, Matuschek C, Bölke E, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Wenz F, Wenz F, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer V: Therapy for locally advanced and inflammatory breast cancer, as well as local therapy in cases with synchronous distant metastases. Strahlenther Onkol 2015; 191:623-33. [PMID: 25963557 PMCID: PMC4516860 DOI: 10.1007/s00066-015-0843-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/09/2015] [Indexed: 12/14/2022]
Abstract
AIM The purpose of this work is to give practical guidelines for radiotherapy of locally advanced, inflammatory and metastatic breast cancer at first presentation. METHODS A comprehensive survey of the literature using the search phrases "locally advanced breast cancer", "inflammatory breast cancer", "breast cancer and synchronous metastases", "de novo stage IV and breast cancer", and "metastatic breast cancer" and "at first presentation" restricted to "clinical trials", "randomized trials", "meta-analysis", "systematic review", and "guideline" was performed and supplemented by using references of the respective publications. Based on the German interdisciplinary S3 guidelines, updated in 2012, this publication addresses indications, sequence to other therapies, target volumes, dose, and fractionation of radiotherapy. RESULTS International and national guidelines are in agreement that locally advanced, at least if regarded primarily unresectable and inflammatory breast cancer should receive neoadjuvant systemic therapy first, followed by surgery and radiotherapy. If surgery is not amenable after systemic therapy, radiotherapy is the treatment of choice followed by surgery, if possible. Surgery and radiotherapy should be administered independent of response to neoadjuvant systemic treatment. In patients with a de novo diagnosis of breast cancer with synchronous distant metastases, surgery and radiotherapy result in considerably better locoregional tumor control. An improvement in survival has not been consistently proven, but may exist in subgroups of patients. CONCLUSION Radiotherapy is an important part in the treatment of locally advanced and inflammatory breast cancer that should be given to all patients regardless to the intensity and effect of neoadjuvant systemic treatment and the extent of surgery. Locoregional radiotherapy in patients with primarily distant metastatic disease should be prescribed on an individual basis.
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Affiliation(s)
- Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, University Hospital, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany,
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25
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Treatment for locally advanced breast cancer: a global challenge, personalized medicine or both? Curr Opin Support Palliat Care 2014; 8:30-2. [PMID: 24346237 DOI: 10.1097/spc.0000000000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this special issue of Current Opinion in Supportive and Palliative Care, we are delighted to bring together key, internationally recognized experts in the field of breast cancer care for a special issue on locally advanced breast cancer (LABC). To place this disease in context, we have deliberately tried to keep the chapter headings pertinent to the real world issues facing both patients and their healthcare providers.
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Miller E, Lee HJ, Lulla A, Hernandez L, Gokare P, Lim B. Current treatment of early breast cancer: adjuvant and neoadjuvant therapy. F1000Res 2014; 3:198. [PMID: 25400908 PMCID: PMC4224200 DOI: 10.12688/f1000research.4340.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in women. The latest world cancer statistics calculated by the International Agency for Research on Cancer (IARC) revealed that 1,677,000 women were diagnosed with breast cancer in 2012 and 577,000 died. The TNM classification of malignant tumor (TNM) is the most commonly used staging system for breast cancer. Breast cancer is a group of very heterogeneous diseases. The molecular subtype of breast cancer carries important predictive and prognostic values, and thus has been incorporated in the basic initial process of breast cancer assessment/diagnosis. Molecular subtypes of breast cancers are divided into human epidermal growth factor receptor 2 positive (HER2 +), hormone receptor positive (estrogen or progesterone +), both positive, and triple negative breast cancer. By virtue of early detection via mammogram, the majority of breast cancers in developed parts of world are diagnosed in the early stage of the disease. Early stage breast cancers can be completely resected by surgery. Over time however, the disease may come back even after complete resection, which has prompted the development of an adjuvant therapy. Surgery followed by adjuvant treatment has been the gold standard for breast cancer treatment for a long time. More recently, neoadjuvant treatment has been recognized as an important strategy in biomarker and target evaluation. It is clinically indicated for patients with large tumor size, high nodal involvement, an inflammatory component, or for those wish to preserve remnant breast tissue. Here we review the most up to date conventional and developing treatments for different subtypes of early stage breast cancer.
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Affiliation(s)
| | - Hee Jin Lee
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 138-736, Korea, South
| | - Amriti Lulla
- Department of Hematology/Oncology, Penn State College of Medicine, Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Liz Hernandez
- Department of Hematology/Oncology, Penn State College of Medicine, Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Prashanth Gokare
- Department of Hematology/Oncology, Penn State College of Medicine, Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Bora Lim
- Department of Hematology/Oncology, Penn State College of Medicine, Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
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27
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Fastner G, Reitsamer R, Ziegler I, Zehentmayr F, Fussl C, Kopp P, Peintinger F, Greil R, Fischer T, Deutschmann H, Sedlmayer F. IOERT as anticipated tumor bed boost during breast-conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer--results of a case series after 5-year follow-up. Int J Cancer 2014; 136:1193-201. [PMID: 24995409 DOI: 10.1002/ijc.29064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/18/2014] [Indexed: 11/10/2022]
Abstract
To evaluate retrospectively rates of local (LCR) and locoregional tumor control (LRCR) in patients with locally advanced breast cancer (LABC) who were treated with preoperative chemotherapy (primary systemic treatment, PST) followed by breast-conserving surgery (BCS) and either intraoperative radiotherapy with electrons (IOERT) preceding whole-breast irradiation (WBI) (Group 1) or with WBI followed by an external tumor bed boost (electrons or photons) instead of IOERT (Group 2). From 2002 to 2007, 83 patients with clinical Stage II or III breast cancer were enrolled in Group 1 and 26 in Group 2. All patients received PST followed by BCS and axillary lymph node dissection. IOERT boosts were applied by single doses of 9 Gy (90% reference isodose) versus external boosts of 12 Gy (median dose range, 6-16) in 2 Gy/fraction (ICRU). WBI in both groups was performed up to total doses of 51-57 Gy (1.7-1.8 Gy/fraction). The respective median follow-up times for Groups 1 and 2 amount 59 months (range, 3-115) and 67.5 months (range, 13-120). Corresponding 6-year rates for LCR, LRCR, metastasis-free survival, disease-specific survival and overall survival were 98.5, 97.2, 84.7, 89.2 and 86.4% for Group 1 and 88.1, 88.1, 74, 92 and 92% for Group 2, respectively, without any statistical significances. IOERT as boost modality during BCS in LABC after PST shows a trend to be superior in terms of LCR and LRCR in comparison with conventional boosts.
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Affiliation(s)
- Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
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Kaidar-Person O, Kuten A, Belkacemi Y. Primary systemic therapy and whole breast irradiation for locally advanced breast cancer: a systematic review. Crit Rev Oncol Hematol 2014; 92:143-52. [PMID: 24881492 DOI: 10.1016/j.critrevonc.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/18/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022] Open
Abstract
The current management of locally advanced breast cancer (LABC) is based on tri-modality treatment including chemotherapy, radiotherapy and surgery. The concept of preoperative concurrent or sequential chemoradiation for LABC was initially reported more than a decade ago; however this concept did not gain popularity because of the low benefit/risk ratio and the lack of strong data supporting the concept. The purpose of the current systematic review was to explore the published data about preoperative chemoradiation (sequential and/or concurrent) using whole breast irradiation in terms of toxicity and outcome.
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Affiliation(s)
- Orit Kaidar-Person
- Division of Oncology, Rambam Health Care Campus, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Yazid Belkacemi
- AP-HP. Depratmentof Radiation Onconology and Breast Center of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Creteil, France.
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29
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Chow TL, Louie AV, Palma DA, D'Souza DP, Perera F, Rodrigues GB, Warner A, Chambers AF, Brackstone M. Radiation-induced lung injury after concurrent neoadjuvant chemoradiotherapy for locally advanced breast cancer. Acta Oncol 2014; 53:697-701. [PMID: 24456500 DOI: 10.3109/0284186x.2013.871387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Tiffany L Chow
- Division of Radiation Oncology, London Regional Cancer Program, University of Western Ontario , London, Ontario , Canada
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30
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Chira C, Kirova YM, Liem X, Campana F, Peurien D, Amessis M, Fournier-Bidoz N, Pierga JY, Dendale R, Bey P, Fourquet A. Helical tomotherapy for inoperable breast cancer: a new promising tool. BIOMED RESEARCH INTERNATIONAL 2013; 2013:264306. [PMID: 24078909 PMCID: PMC3775426 DOI: 10.1155/2013/264306] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/07/2013] [Accepted: 07/11/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND We investigated the feasibility of helical tomotherapy (HT) for inoperable large breast tumors, after failing to achieve adequate treatment planning with conformal radiation techniques. MATERIAL AND METHODS Five consecutive patients with locally advanced breast cancer (LABC) were treated by preoperative HT. All patients received up-front chemotherapy before HT. Irradiated volumes included breast and nodal areas (45-50 Gy) in 4 patients. One patient received a simultaneous integrated boost (55 Gy) to gross tumor volume (GTV) without lymph node irradiation. Acute toxicity was assessed with Common Toxicity Criteria for Adverse Events v.4. Patients were evaluated for surgery at the end of treatment. RESULTS Patients were staged IIB to IIIC (according to the AJCC staging system 2010). HT was associated in 4 patients with concomitant chemotherapy (5-fluorouracil and vinorelbine). Two patients were scored with grade 3 skin toxicity (had not completed HT) and one with grade 3 febrile neutropenia. One patient stopped HT with grade 2 skin toxicity. All patients were able to undergo mastectomy at a median interval of 43 days (31-52) from HT. Pathological partial response was seen in all patients. CONCLUSIONS HT is feasible with acceptable toxicity profiles, potentially increased by chemotherapy. These preliminary results prompt us to consider a phase II study.
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Affiliation(s)
- Ciprian Chira
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Youlia M. Kirova
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Xavier Liem
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - François Campana
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Dominique Peurien
- Department of Medical Physics, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Malika Amessis
- Department of Medical Physics, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Pierre Bey
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
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Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall. Strahlenther Onkol 2013; 189:387-93. [PMID: 23549781 DOI: 10.1007/s00066-013-0316-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/16/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients. PATIENTS AND METHODS RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n = 18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n = 1). Treatment consisted of surgery followed by reRT + HT (n = 8), reRT + HT followed by surgery (n = 3) or reRT + HT alone (n = 13). Patients received a mean radiation dose of 35 Gy (32-54 Gy) and 3-6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT). RESULTS The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45-212 months). Following reRT + HT, the complete response (CR) rate was 56 %. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46 %, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22 %, respectively. Late grade 4 RT toxicity was seen in 2 patients. CONCLUSION The present study shows that reRT + HT treatment--either alone or combined with surgery--improves LC rates in patients with RAS.
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