Postoperative radiotherapy in women with early operable breast cancer (Scottish Breast Conservation Trial): 30-year update of a randomised, controlled, phase 3 trial

Local recurrence with and without a tumour-bed boost: A post-hoc analysis of the DBCG IMN2 study

BACKGROUND AND PURPOSE

In early-stage breast cancer, a tumour-bed boost (TBB) reduces the risk of local recurrence (LR) by around 50 % but increases the risk of breast induration. LR incidences of 3 % at 5 years and 6 % at 10 years have been proposed as thresholds where benefits outweigh the potentially detrimental effects of a TBB. Therefore, this post-hoc analysis of the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate LR rates according to prognostic risk factors to identify indications for a TBB.

MATERIAL AND METHODS

From the DBCG IMN2 study, 2,430 node-positive patients operated with breast-conserving surgery were included for analysis. They received irradiation to the residual breast and regional nodes with or without internal mammary node irradiation according to laterality. Radiotherapy was 3D-conformal. TBB was delivered sequentially as 10 Gy/5 Fx (41-49 years) and 16 Gy/8 Fx (≤ 40 years or margin < 2 mm). Patients with and without a TBB were analysed separately. Prespecified subgroups included known prognostic risk factors.

RESULTS

Median follow-up was 13.7 years, and the cumulative incidence of LR was 1.7 % (95 % CI, 1.2-2.2) at 5 years and 3.6 % (95 % CI, 2.9-4.3) at 10 years. In patients ≥ 50 years, 1,872 patients were treated without a TBB. Among these, 145 patients with an ER-/HER2- tumour had a 10-year cumulative incidence of LR of 8.3 % (95 % CI, 4.5-13.5). No other subgroups exceeded 6 % at 10 years.

CONCLUSION

Our results suggest that node-positive patients 50 years or older with an ER-/HER2- tumour may obtain a clinically relevant benefit from a TBB.

Association of immediate symmetrizing oncoplastic surgery with patient-reported outcomes in patients with breast cancer - A retrospective cohort study

INTRODUCTION

Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain.

METHODS

Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery.

RESULTS

Of 441 eligible patients, 333 (75.5 ​%) underwent unilateral OPS, while 108 (24.5 ​%) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4-49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs.

CONCLUSION

The present study did not demonstrate any impact of immediate symmetrization on PROs.

Role, mechanisms and effects of Radix Bupleuri in anti‑breast cancer (Review)

The prevalence of breast cancer among women has led to a growing need for innovative anti-breast cancer medications and an in-depth investigation into their molecular mechanisms of action, both of which are essential tactics in clinical intervention. In the clinical practice of Traditional Chinese Medicine, Radix Bupleuri and its active components have shown promise as potential anti-breast cancer agents due to their ability to target multiple pathways, exhibit synergistic effects and reduce toxicity. These compounds are considered to enhance the prognosis of patients with cancer, prolong survival and combat chemotherapy resistance. The present review aimed to delve into the anti-breast cancer properties of Radix Bupleuri and its active ingredients, highlighting their mechanisms, such as inhibition of cell proliferation, promotion of apoptosis, metastasis prevention, microenvironment improvement and synergy with certain chemotherapeutic agents. These findings may provide a scientific rationale for combining Radix Bupleuri and its active components with traditional chemotherapy agents for the management of breast cancer.

Comprehensive network pharmacology and experimental study to investigate the effect and mechanism of solasonine on breast carcinoma treatment

BACKGROUND

Ferroptosis is a therapeutic strategy for breast carcinoma (BC). Solasonine (SS) was linked to ferroptosis as a tumor suppressor. However, whether SS could treat BC by activating ferroptosis and its underlying mechanisms has not been reported.

METHODS

We obtained the intersection of genes targeting SS and BC disease through network pharmacology. Bioinformatics analysis revealed that the intersection genes were primarily enriched in the extracellular signal-regulated kinase 2/mitogen-activated protein kinase (ERK2/MAPK) signaling pathway. The interaction modes of SS with ERK2 and epidermal growth factor receptor (EGFR) were simulated by molecular docking. We further detected the expressions of ERK2 and p-ERK2 in BC patients and the correlation between ERK2/p-ERK2 and ferroptosis. The effects and mechanism of SS on ferroptosis in BC were validated by mutation plasmids construction, immunohistology, wound healing, transwell assay, and western blotting using in vitro and in vivo models.

RESULTS

ERK2 and p-ERK2 were up-regulated in BC patients, and the ERK2/p-ERK2 ratio was negatively correlated with ferroptosis. Molecular docking indicated that SS could bind to ERK2 and EGFR to inhibit the activity of the ERK2/MAPK pathway. In vitro and in vivo experiments confirmed that SS induced ferroptosis by inhibiting the ERK2/MAPK pathway, inhibiting proliferation, migration, and invasion of BC cells.

CONCLUSION

SS could inactivate the ERK2/MAPK pathway, thereby inducing ferroptosis and further inhibiting BC cell proliferation, migration, and invasion. This study clarified the potential mechanism of SS in BC and provided a theoretical basis for its clinical application.

Ginkgetin enhances breast cancer radiotherapy sensitization by suppressing NRF2-HO-1 axis activity

Breast cancer (BC) is a critical threat to women's lives. Radiotherapy (RT) is a pivotal treatment modality for BC, but the failure of RT due to radioresistance is still not well facilitated. Ginkgetin (GK) has a potent anti-tumor activity intimately associated with ferroptosis. This study applied in vitro and in vivo experimental models to ascertain the GK mechanism of action on BC radioresistance. The outcomes reported that GK could inhibit BC cell growth and increase apoptosis. In addition, when BC cells generated radioresistance, GK promoted ferroptosis of radioresistant BC cells by mitigating NRF2 expression, suppressing HO-1 and NQO1 expression, increasing the intracellular content of reactive oxygen species (ROS) and ferrous ions, accelerating the glutathione (GSH) depletion, and decreasing GPX4 expression. Notably, GK can damage intracellular mitochondria and cause a substantial increase in ferrous ions in BC cells. Therefore, GK shows immense potential for enhancing breast cancer radiotherapy sensitivity, which may provide pivotal evidence for subsequent RT sensitization.