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Lai HY, Loh EW, Su CM, Chiang MH, Tam KW. Outcomes of Breast-Conserving Therapy in Patients With Inflammatory Breast Cancer: A Meta-Analysis. J Surg Res 2024; 293:458-467. [PMID: 37820394 DOI: 10.1016/j.jss.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/15/2023] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Currently, patients who respond to neoadjuvant chemotherapy (NAC) are treated with mastectomy and axillary lymph node dissection. This study aimed to synthesize real-world data to evaluate the feasibility of breast-conserving therapy (BCT), sentinel lymph node (SLN), and sentinel lymph node biopsy (SLNB) for patients with IBC who respond to NAC. METHODS PubMed, Embase, and Cochrane Library databases were searched for relevant articles. Clinical studies that compared mastectomy with BCT for IBC treatment were reviewed. The primary outcomes were local recurrence rate and 5-y survival rate in patients with IBC who responded to NAC. Furthermore, the SLN detection rate and false-negative rate (FNR) for SLNB were also evaluated. RESULTS In the final analysis, 17 studies were included. The pooled estimates of the local recurrence rate for mastectomy and no surgical intervention were 18.6% and 15.9%, respectively (P = 0.956). Five-y survival was similar for mastectomy, partial mastectomy, and no surgical intervention (45.8%, 57.1%, and 39.4%, respectively). The pooled estimates of the SLN detection rate and FNR for SLNB were 81.9% and 21.8%, respectively. CONCLUSIONS Among patients with IBC who respond to NAC, the local recurrence and 5-y survival rates in those undergoing BCT are noninferior to the rates in those undergoing mastectomy; therefore, BCT could be a feasible option for surgical management. However, a poor SLN detection rate and a high FNR were found in patients undergoing SLNB. Further large-scale clinical studies are required to confirm our findings.
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Affiliation(s)
- Hui-Ying Lai
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Ming Su
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Hsuan Chiang
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Jungles KM, Holcomb EA, Pearson AN, Jungles KR, Bishop CR, Pierce LJ, Green MD, Speers CW. Updates in combined approaches of radiotherapy and immune checkpoint inhibitors for the treatment of breast cancer. Front Oncol 2022; 12:1022542. [PMID: 36387071 PMCID: PMC9643771 DOI: 10.3389/fonc.2022.1022542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Breast cancer is the most prevalent non-skin cancer diagnosed in females and developing novel therapeutic strategies to improve patient outcomes is crucial. The immune system plays an integral role in the body’s response to breast cancer and modulating this immune response through immunotherapy is a promising therapeutic option. Although immune checkpoint inhibitors were recently approved for the treatment of breast cancer patients, not all patients respond to immune checkpoint inhibitors as a monotherapy, highlighting the need to better understand the biology underlying patient response. Additionally, as radiotherapy is a critical component of breast cancer treatment, understanding the interplay of radiation and immune checkpoint inhibitors will be vital as recent studies suggest that combined therapies may induce synergistic effects in preclinical models of breast cancer. This review will discuss the mechanisms supporting combined approaches with radiotherapy and immune checkpoint inhibitors for the treatment of breast cancer. Moreover, this review will analyze the current clinical trials examining combined approaches of radiotherapy, immunotherapy, chemotherapy, and targeted therapy. Finally, this review will evaluate data regarding treatment tolerance and potential biomarkers for these emerging therapies aimed at improving breast cancer outcomes.
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Affiliation(s)
- Kassidy M. Jungles
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
| | - Erin A. Holcomb
- Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Ashley N. Pearson
- Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kalli R. Jungles
- Department of Biology, Saint Mary’s College, Notre Dame, IN, United States
| | - Caroline R. Bishop
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Lori J. Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Michael D. Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- *Correspondence: Michael D. Green, ; Corey W. Speers,
| | - Corey W. Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, United States
- *Correspondence: Michael D. Green, ; Corey W. Speers,
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Radiotherapy in the Management of Non-Metastatic Inflammatory Breast Cancers: A Retrospective Observational Study. Cancers (Basel) 2021; 14:cancers14010107. [PMID: 35008271 PMCID: PMC8750160 DOI: 10.3390/cancers14010107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Inflammatory breast cancers (IBC) are characterized by a poor prognosis. This retrospective study aims to describe the clinical outcomes of non-metastatic IBC patients treated with a multidisciplinary approach with neo-adjuvant chemotherapy, surgery, and radiotherapy. (2) Methods: This single-center retrospective study included all women patients diagnosed with non-metastatic IBC between January 2010 and January 2018 at the Institut Curie (Paris, France) and treated with neoadjuvant chemotherapy, surgery, and radiotherapy. Overall survival (OS), disease-free survival (DFS), and locoregional free survival (LRRFS) were calculated from the time of diagnosis. Prognostic factors for patient survival were analyzed based on univariate and multivariate regressions. (3) Results: We identified 113 patients with a median age of 51 years. 79.7% had node-positive tumors; triple-negative breast cancers (TNBC) represented 34.6% of the cases. A large majority of patients (91.2%) received adjuvant post-mastectomy while ten patients (8.8%) received preoperative radiotherapy. Non-pathological complete response (non-pCR) was observed in 67.3% of patients. Radiotherapy delivered a median dose of 50 Gy to the breast or the chest wall in 25 fractions. With a median follow-up of 54 months, 5-year OS, DFS and LRRFS were 78% (CI: 70.1-86.8%), 68.1% (59.6-77.7%), and 85.2% (78.4-92.7%), respectively. In multivariate analysis, non-pCR was an adverse prognosis factor for OS, DFS, and LRRFS; pre-operative radiotherapy was an adverse prognosis factor for OS and DFS. Radiation-related adverse events were limited to acute skin toxicity (22% of Grade 2 and 2% of grade 3 dermatitis); no late radiation-induced toxicity was reported. (4) Conclusions: High locoregional control could be achieved with multidisciplinary management of non-metastatic IBC, suggesting the anti-tumor efficacy of radiotherapy in this rare but pejorative clinicopathological presentation. While comparing favorably with historical cohorts, OS and DFS could be potentially improved in the future with the use of new systemic treatments, such as PARP-inhibitors or immunotherapy.
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Bhat V, Pellizzari S, Allan AL, Wong E, Lock M, Brackstone M, Lohmann AE, Cescon DW, Parsyan A. Radiotherapy and radiosensitization in breast cancer: Molecular targets and clinical applications. Crit Rev Oncol Hematol 2021; 169:103566. [PMID: 34890802 DOI: 10.1016/j.critrevonc.2021.103566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022] Open
Abstract
Relatively poor survival outcomes are observed in advanced or metastatic breast cancer, where local control of the primary or metastatic disease may be achieved by surgical resection, local ablative and radiation therapies. Radioresistance, poses a major challenge in achieving durable oncologic outcomes, mandating development of novel management strategies. Although multimodality approaches that combine radiotherapy with chemotherapy, or systemic agents, are utilized for radiosensitization and treatment of various malignancies, this approach has not yet found its clinical application in breast cancer. Some agents for breast cancer treatment can serve as radiosensitizers, creating an opportunity to enhance effects of radiation while providing systemic disease control. Hence, combination of radiotherapy with radiosensitizing agents have the potential to improve oncologic outcomes in advanced or metastatic breast cancer. This review discusses molecular targets for radiosensitization and novel systemic agents that have potential for clinical use as radiosensitizers in breast cancer.
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Affiliation(s)
- Vasudeva Bhat
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Anatomy & Cell Biology, Western University, London, ON, N6A 3K7, Canada
| | - Sierra Pellizzari
- Department of Anatomy & Cell Biology, Western University, London, ON, N6A 3K7, Canada
| | - Alison L Allan
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Anatomy & Cell Biology, Western University, London, ON, N6A 3K7, Canada; Department of Oncology, Western University, London, ON, N6A 4L6, Canada
| | - Eugene Wong
- Department of Oncology, Western University, London, ON, N6A 4L6, Canada; Department of Physics and Astronomy, Western University, London, ON, N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, N6A 5C1, Canada
| | - Michael Lock
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Oncology, Western University, London, ON, N6A 4L6, Canada
| | - Muriel Brackstone
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Oncology, Western University, London, ON, N6A 4L6, Canada; Department of Surgery, Western University, London, ON, N6A 3K7, Canada
| | - Ana Elisa Lohmann
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Oncology, Western University, London, ON, N6A 4L6, Canada
| | - David W Cescon
- Department of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Armen Parsyan
- London Regional Cancer Program, London Health Science Centre, London, ON, N6A 5W9, Canada; Department of Anatomy & Cell Biology, Western University, London, ON, N6A 3K7, Canada; Department of Oncology, Western University, London, ON, N6A 4L6, Canada; Department of Surgery, Western University, London, ON, N6A 3K7, Canada.
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Shafaee MN, Makawita S, Lim B, Ellis MJ, Ducan DL, Ludwig MS, Duncan DL. Concurrent Chemo-radiation As a Means of Achieving Pathologic Complete Response in Triple Negative Breast Cancer. Clin Breast Cancer 2021; 22:e536-e543. [DOI: 10.1016/j.clbc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
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Pesch AM, Pierce LJ, Speers CW. Modulating the Radiation Response for Improved Outcomes in Breast Cancer. JCO Precis Oncol 2021; 5:PO.20.00297. [PMID: 34250414 DOI: 10.1200/po.20.00297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/12/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Andrea M Pesch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.,Department of Pharmacology, University of Michigan, Ann Arbor, MI.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Corey W Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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[Radiation therapy in inflammatory breast cancer]. Bull Cancer 2018; 105:415-425. [PMID: 29475596 DOI: 10.1016/j.bulcan.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inflammatory breast cancer accounts for 1-5% of all breast cancers. It is associated with a poor prognosis, because of an increased risk to develop metastases in comparison with all breast malignancies. The treatment is multimodal. We have evaluated the role of radiotherapy: indications, techniques and impact for local control and overall survival. METHOD The series of the literature with more than 40 patients irradiated for inflammatory breast cancer published since 1995 were analyzed. RESULTS Chemotherapy was always delivered first. Adjuvant radiotherapy was associated with local control and overall survival at 10 years of 63-92% and 51-64 respectively. Without surgery, local control was 65% and overal survival 38% at 10years. Results of concomitant radiochemotherapy were reported: the studies were heterogenous. Modalities of radiotherapy were detailed with respect to dose and fractionation, target-volumes and technical considerations (including bolus). CONCLUSION The multimodal strategy comprises systematically radiotherapy with an evaluation of tumor response to maximise resecability.
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8
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Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 99:769-776. [DOI: 10.1016/j.ijrobp.2017.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 01/23/2023]
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9
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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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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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[Salvage concomitant chemoradiation therapy for non-metastatic inflammatory breast cancer after chemotherapy failure]. Cancer Radiother 2015; 19:739-45. [PMID: 26597412 DOI: 10.1016/j.canrad.2015.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the surgical possibility following concomitant chemoradiotherapy for inflammatory breast cancer, after unsucessful neoadjuvant chemotherapy. PATIENTS AND METHODS The data from ten patients with inflammatory breast cancer treated between 1996 and 2010 by concomitant chemoradiotherapy after unsucessful neoadjuvant chemotherapy were analysed. All patients had an invasive carcinoma. All patients received a neoadjuvant chemotherapy, including anthracyclin, six patients received taxan and one received trastuzumab. Radiotherapy was delivered to the breast and regional lymph nodes in all patients at a dose of 50Gy; a boost of 20Gy was delivered to one patient. Concomitant chemotherapy was based on weekly cisplatin for six patients, on cisplatin and 5-fluorouracil the first and last weeks of radiotherapy for four patients. RESULTS The median follow-up for all patients was 44 months. Mastectomy was performed in nine patients. Two- and 5-year overall survival rates were respectively 70 % and 60 %. Median local recurrence delay was 5 months; six patients died (all from cancer), seven developped metastasis. Grade 1 and 2 epithelite was respectively observed in six and two patients, grade 2 renal toxicity in three patients, grade 2 neutropenia in one patient. CONCLUSION Concomitant chemoradiotherapy for inflammatory breast cancer after unsucessful neoadjuvant chemotherapy may control the disease in some patients and lead to mastectomy. These results have to be confirmed through a multicentric study with more patients.
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Shaughnessy JN, Meena RA, Dunlap NE, Jain D, Riley EC, Quillo AR, Dragun AE. Efficacy of concurrent chemoradiotherapy for patients with locally recurrent or advanced inoperable breast cancer. Clin Breast Cancer 2014; 15:135-42. [PMID: 25454741 DOI: 10.1016/j.clbc.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to assess the efficacy and safety of chemoradiotherapy (CRT) for locally recurrent or advanced inoperable breast cancer. PATIENTS AND METHODS Twenty patients treated between 2009 and 2013 were reviewed from a prospectively collected database. All patients had symptomatic recurrent or advanced breast cancer and had been deemed not to be ideal operative candidates. Treatment consisted of external beam radiotherapy to the primary tumor in the breast or regional lymph nodes, or both, concurrent with either capecitabine, paclitaxel, or cisplatin/etoposide chemotherapy. The grade of acute and late toxicity was evaluated, as was response to treatment, overall survival (OS), and local relapse-free survival (LRFS). RESULTS Of the 20 patients, 9 (45%) presented with primary disease and 11 (55%) had recurrent disease. A total of 11 (55%) patients had evidence of metastatic disease. The overall clinical response rate was 100%, with a clinical complete response (CR) observed in 65% of patients and a clinical partial response (PR) observed in 35% of patients. At a median follow up of 25.3 months, 2-year LRFS was 73% and 2-year OS was 80%. Local control was significantly better in patients with an initial diagnosis (hazard ratio [HR], 0.139; 95% confidence interval [CI], 0.014-0.935) and in those who had not had previous in-field radiation (HR, 0.011; 95% CI, 0.005-0.512). The only grade ≥ 3 toxicity was acute dermatologic events (30%) and late dermatologic (15%) events. CONCLUSION Concurrent CRT with capecitabine, paclitaxel, or cisplatin/etoposide for recurrent or advanced inoperable breast cancer is well tolerated with impressive clinical response rates and durable local control.
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Affiliation(s)
- Joseph N Shaughnessy
- Department of Radiation Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY.
| | - Richard A Meena
- Department of Radiation Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Dharamvir Jain
- Department of Medical Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Elizabeth C Riley
- Department of Medical Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Amy R Quillo
- Department of Surgical Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Anthony E Dragun
- Department of Radiation Oncology, University of Louisville James Graham Brown Cancer Center, Louisville, KY
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Rosa LMD, Radünz V. Taxa de sobrevida na mulher com câncer de mama: estudo de revisão. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000400031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Revisão integrativa que identificou nas publicações da LILACS, SciELO e PubMed, período 2004-2009, fatores contribuintes para a elevação das taxas de sobrevida em cinco anos e sobrevida livre de doenças em cinco anos das mulheres com câncer de mama. Os resultados, 40 publicações, demonstraram maior incidência da doença nas idades 50-60 e 40-49 anos. Programas de rastreamento, elevação da escolaridade, do padrão socioeconômico, métodos diagnósticos genéticos, imuno-histoquímicos e citológicos, associação das novas terapêuticas com as convencionais são fatores contribuintes para elevação das taxas de sobrevidas, da qualidade de vida e do cuidado à mulher com câncer de mama.
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Affiliation(s)
| | - Vera Radünz
- Universidade Federal de Santa Catarina, Brasil
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14
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Scotti V, Desideri I, Meattini I, Di Cataldo V, Cecchini S, Petrucci A, Franzese C, Greto D, Livi L, Bonomo P, Biti G. Management of inflammatory breast cancer: focus on radiotherapy with an evidence-based approach. Cancer Treat Rev 2012; 39:119-24. [PMID: 22564719 DOI: 10.1016/j.ctrv.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 04/03/2012] [Indexed: 11/29/2022]
Abstract
Inflammatory breast cancer represents a rare and extremely aggressive subtype of breast cancer. Due to its rarity, prospective studies are a difficult goal to obtain in this field. Nowadays a multimodal approach seems to be the standard approach. Role and timing of surgery, radiotherapy and chemotherapy are still debated issues. In this scenario interest is rising in molecular and target therapies. We performed a review analyzing the management of this unfavorable disease focusing on the role of radiotherapy, with particular emphasis on levels of evidence.
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Affiliation(s)
- Vieri Scotti
- Department of Radiation-Oncology, University of Florence, Florence, Italy.
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15
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Harrison AM, Zendejas B, Ali SM, Scow JS, Farley DR. Lessons learned from an unusual case of inflammatory breast cancer. JOURNAL OF SURGICAL EDUCATION 2012; 69:350-354. [PMID: 22483137 DOI: 10.1016/j.jsurg.2011.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/11/2011] [Accepted: 10/27/2011] [Indexed: 05/31/2023]
Abstract
Inflammatory breast cancer (IBC) is a rare breast malignancy that is associated with poor long-term outcomes despite aggressive surgical and chemotherapeutic interventions. We recently treated a 56-year-old woman with right-sided IBC and biopsy-proven cutaneous metastases to her back and left breast. She underwent chemotherapy, bilateral modified radical mastectomy, and radiation therapy. One year after diagnosis, she is currently disease-free based on positron-emission tomography (PET) imaging and repeat skin biopsies. To provide insight into the management of IBC, we present this interesting case with a reflection on important lessons to be learned.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy, Needle
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Diagnostic Imaging/methods
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Inflammatory Breast Neoplasms/diagnosis
- Inflammatory Breast Neoplasms/therapy
- Magnetic Resonance Imaging/methods
- Mammography/methods
- Mastectomy, Modified Radical/methods
- Mastectomy, Segmental
- Middle Aged
- Monitoring, Physiologic/methods
- Neoadjuvant Therapy/methods
- Neoplasm Staging
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/therapy
- Positron-Emission Tomography/methods
- Radiotherapy, Adjuvant
- Risk Assessment
- Skin Neoplasms/diagnosis
- Skin Neoplasms/therapy
- Treatment Outcome
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16
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Karasawa K, Saito M, Hirowatari H, Izawa H, Furuya T, Ozawa S, Ito K, Suzuki T, Mitsuhashi N. The role of chemoradiotherapy in patients with unresectable T4 breast tumors. Breast Cancer 2012; 20:254-61. [PMID: 22274798 DOI: 10.1007/s12282-012-0336-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/03/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE Unresectable T4 tumors of the breast are usually treated with systemic therapies, while the role of local therapies remains debatable. This study aims to evaluate the effectiveness of chemoradiotherapy as a part of T4 breast cancer treatment, and to assess the role of local radiotherapies in patients with unresectable T4 breast tumors. MATERIALS/METHODS Between February 1998 and June 2010, 39 unresectable T4 breast tumors were treated with chemoradiotherapy at our institutes. Clinical stages included stage IIIB (n = 15), stage IIIC (n = 3), and stage IV (n = 21). Twenty-one cases had undergone previous systemic therapies, whereas the remaining 18 cases reported no history of previous treatment. Radiation doses of 59-66 Gy (median 60 Gy) were administered to the breast in addition to concurrent chemotherapies. Acute adverse effects were assessed on a weekly basis during treatment to 2 weeks after completion of treatment, and were scored by the Common Terminology Criteria for Adverse Events v3.0. Treatment response was assessed at 1 month after completion of chemoradiotherapy. Statistical analysis of survival was calculated using the Kaplan-Meier method. RESULTS Chemoradiotherapy was completed in all cases. Greater than grade 3 hematological toxicities were observed with regard to lymphocytes (33%), platelets (8%), neutrophils (3%), and hemoglobin (3%). Greater than grade 3 nonhematologic toxicities included chemoradiation dermatitis (23%) and pneumonitis (5%). Sixteen T4 tumors (41%) achieved complete response, whereas 23 (59%) achieved partial response. All patients were treated with chemotherapy and/or endocrine therapy following chemoradiotherapy. The median follow-up period was 20 months (range 3-96 months). Nineteen patients died because of progressive breast cancer. Infield recurrence or relapse was observed in 11 cases during the course of treatment, but only 3 cases were symptomatic. The 2-year overall local control rate was 73.6%, and the survival rate was 65.9%. CONCLUSION Chemoradiotherapy represents a viable option for local treatment of unresectable T4 breast tumors.
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Affiliation(s)
- Kumiko Karasawa
- Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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17
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Abrous-Anane S, Savignoni A, Daveau C, Pierga JY, Gautier C, Reyal F, Dendale R, Campana F, Kirova YM, Fourquet A, Bollet MA. Management of inflammatory breast cancer after neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys 2010; 79:1055-63. [PMID: 20478662 DOI: 10.1016/j.ijrobp.2009.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 12/05/2009] [Accepted: 12/08/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the benefit of breast surgery for inflammatory breast cancer (IBC). METHODS AND MATERIALS This retrospective series was based on 232 patients treated for IBC. All patients received primary chemotherapy followed by either exclusive radiotherapy (118 patients; 51%) or surgery with or without radiotherapy (114 patients; 49%). The median follow-up was 11 years. RESULTS The two groups were comparable apart from fewer tumors <70 mm (43% vs. 33%, p = 0.003), a higher rate of clinical stage N2 (15% vs. 5%, p = 0.04), and fewer histopathologic Grade 3 tumors (46% vs. 61%, p <0.05) in the no-surgery group. The addition of surgery was associated with a significant improvement in locoregional disease control (p = 0.04) at 10 years locoregional free interval 78% vs. 59% but with no significant difference in overall survival rates or disease-free intervals. Late toxicities were not significantly different between the two treatment groups except for a higher rate of fibrosis in the no-surgery group (p <0.0001) and more lymphedema in the surgery group (p = 0.002). CONCLUSION Our data suggest an improvement in locoregional control in patients treated by surgery, in conjunction with chemotherapy and radiotherapy, for IBC. Efforts must be made to improve overall survival.
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Abstract
Breast tumours exhibit a wide range of morphological phenotypes, and specific histopathological types have particular prognostic and clinical characteristics. The management of uncommon premalignant and malignant lesions is often controversial due to the lack of large single-institution studies or randomised trials to define optimal treatments. In the era of frequent use of treatment guidelines, only a low level of evidence exists for the management of rare histological types of breast tumours. This review is divided into two parts: Firstly, the favourable histological subtypes like tubular, mucinous, medullary breast cancers, and phyllodes tumour (benign, borderline, and malignant) are discussed. The prognosis of these selected lesions is believed to be better than for invasive ductal carcinoma so that in some cases even less aggressive treatment should be considered. Patients with these specific histological types should be informed of this relatively favourable prognosis. Secondly, management recommendations for special situations like Paget's disease (tumour of the nipple) and inflammatory breast carcinoma are presented.
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Affiliation(s)
- Toralf Reimer
- Department of Obstetrics and Gynaecology, University of Rostock, Klinikum Suedstadt, Germany
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