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Nunez JJ, Leung B, Ho C, Bates AT, Ng RT. Predicting the Survival of Patients With Cancer From Their Initial Oncology Consultation Document Using Natural Language Processing. JAMA Netw Open 2023; 6:e230813. [PMID: 36848085 PMCID: PMC9972192 DOI: 10.1001/jamanetworkopen.2023.0813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Predicting short- and long-term survival of patients with cancer may improve their care. Prior predictive models either use data with limited availability or predict the outcome of only 1 type of cancer. OBJECTIVE To investigate whether natural language processing can predict survival of patients with general cancer from a patient's initial oncologist consultation document. DESIGN, SETTING, AND PARTICIPANTS This retrospective prognostic study used data from 47 625 of 59 800 patients who started cancer care at any of the 6 BC Cancer sites located in the province of British Columbia between April 1, 2011, and December 31, 2016. Mortality data were updated until April 6, 2022, and data were analyzed from update until September 30, 2022. All patients with a medical or radiation oncologist consultation document generated within 180 days of diagnosis were included; patients seen for multiple cancers were excluded. EXPOSURES Initial oncologist consultation documents were analyzed using traditional and neural language models. MAIN OUTCOMES AND MEASURES The primary outcome was the performance of the predictive models, including balanced accuracy and receiver operating characteristics area under the curve (AUC). The secondary outcome was investigating what words the models used. RESULTS Of the 47 625 patients in the sample, 25 428 (53.4%) were female and 22 197 (46.6%) were male, with a mean (SD) age of 64.9 (13.7) years. A total of 41 447 patients (87.0%) survived 6 months, 31 143 (65.4%) survived 36 months, and 27 880 (58.5%) survived 60 months, calculated from their initial oncologist consultation. The best models achieved a balanced accuracy of 0.856 (AUC, 0.928) for predicting 6-month survival, 0.842 (AUC, 0.918) for 36-month survival, and 0.837 (AUC, 0.918) for 60-month survival, on a holdout test set. Differences in what words were important for predicting 6- vs 60-month survival were found. CONCLUSIONS AND RELEVANCE These findings suggest that models performed comparably with or better than previous models predicting cancer survival and that they may be able to predict survival using readily available data without focusing on 1 cancer type.
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Affiliation(s)
- John-Jose Nunez
- BC Cancer, Vancouver, British Columbia, Canada
- Department of Computer Science, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cheryl Ho
- BC Cancer, Vancouver, British Columbia, Canada
| | - Alan T. Bates
- BC Cancer, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond T. Ng
- Department of Computer Science, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Loap P, Kirova Y. [The place of radiotherapy]. SOINS. GERONTOLOGIE 2022; 27:18-20. [PMID: 36280367 DOI: 10.1016/j.sger.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Radiation therapy (RT) is a key component of the management of elderly breast cancer patients. However, level I evidence in elderly patients is limited. Patient selection should include comorbidities and geriatric assessment. Advances in radiation planning and delivery are improving target coverage, reducing toxicity, and expanding treatment eligibility. Some alternative techniques, such as treatment in the lateral or prone position, may reduce the risk of toxicity. Shorter cycles of hypofractionated whole breast RT are safe and effective. In some cases, partial breast irradiation may be an option.
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Affiliation(s)
- Pierre Loap
- Institut Curie, 26 rue d'Ulm, 75005 Paris, France
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3
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Morgan JL, Cheng V, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hartup S, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O'Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1510-1519. [PMID: 35410760 DOI: 10.1016/j.ejso.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management. METHODS UK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy. RESULTS 822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February-August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%). For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure. For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy. CONCLUSION This survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.
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Affiliation(s)
- Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - Vinton Cheng
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Ellen Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Rajiv Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Beatrix Elsberger
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | | | - Sue Hartup
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Brian Hogan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Kieran Horgan
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Cliona C Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4BX, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
| | - Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | - Shelley Potter
- Translational Health Sciences, Bristol Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 2LX, UK
| | - Lisa Sheehan
- Wessex Deanery, Southern House, Otterbourne, Winchester, SO21 2RU, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
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Wu HL, Lu YJ, Li JW, Wu SY, Chen XS, Liu GY. Prior Local or Systemic Treatment: A Predictive Model Could Guide Clinical Decision-Making for Locoregional Recurrent Breast Cancer. Front Oncol 2022; 11:791995. [PMID: 35198434 PMCID: PMC8858965 DOI: 10.3389/fonc.2021.791995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Locoregional recurrent breast cancer indicates poor prognosis. No solid prediction model is available to predict prognosis and guide clinical management. Prior local treatment or systemic treatment remains controversial. Methods Locoregional recurrent breast cancer patients operated in Fudan University Shanghai Cancer Center were enrolled as a training cohort. An external validation cohort included breast cancer patients after locoregional recurrence from Ruijin Hospital, Shanghai Jiaotong University. A nomogram predicting overall survival after locoregional recurrence was established using multivariable Cox regression analysis while internal and external validation were performed to evaluate its calibration and discrimination. Results Overall, 346 and 96 breast cancer patients were included in the training cohort and the validation cohort separately. A nomogram was developed, including age, neoadjuvant chemotherapy, breast surgery, pathology type, tumor size, lymph node status, hormonal receptor and Her-2 status, disease-free interval, and sites of locoregional recurrence. It had modest calibration and discrimination in the training cohort, internal validation and external validation (concordance index: 0.751, 0.734 and 0.722, respectively). The nomogram classified 266 and 80 patients into low and high-risk subgroups with distinctive prognosis. Local treatment after locoregional recurrence was associated with improved overall survival in low-risk group (P = 0.011), while systemic therapies correlated with better outcomes only in high-risk group (P < 0.001). Conclusion A nomogram based on clinicopathological factors can predict prognosis and identify low and high-risk patients. Local treatment is a prior choice for low-risk patients whereas systemic treatment needs to be considered for high-risk patients, warranting further validation and exploration.
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Affiliation(s)
- Huai-liang Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-jie Lu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-wei Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Si-yu Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-song Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Guang-yu Liu, ; Xiao-song Chen,
| | - Guang-yu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Guang-yu Liu, ; Xiao-song Chen,
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5
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Bakker A, Tello Valverde CP, van Tienhoven G, Kolff MW, Kok HP, Slotman BJ, Konings IRHM, Oei AL, Oldenburg HSA, Rutgers EJT, Rasch CRN, van den Bongard HJGD, Crezee H. Post-operative re-irradiation with hyperthermia in locoregional breast cancer recurrence: Temperature matters. Radiother Oncol 2021; 167:149-157. [PMID: 34973278 DOI: 10.1016/j.radonc.2021.12.036] [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: 07/01/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the impact of hyperthermia thermal dose (TD) on locoregional control (LRC), overall survival (OS) and toxicity in locoregional recurrent breast cancer patients treated with postoperative re-irradiation and hyperthermia. METHODS In this retrospective study, 112 women with resected locoregional recurrent breast cancer treated in 2010-2017 with postoperative re-irradiation 8frx4Gy (n = 34) or 23frx2Gy (n = 78), combined with 4-5 weekly hyperthermia sessions guided by invasive thermometry, were subdivided into 'low' (n = 56) and 'high' TD (n = 56) groups by the best session with highest median cumulative equivalent minutes at 43 °C (Best CEM43T50) < 7.2 min and ≥7.2 min, respectively. Actuarial LRC, OS and late toxicity incidence were analyzed. Backward multivariable Cox regression and inverse probability weighting (IPW) analysis were performed. RESULTS TD subgroups showed no significant differences in patient/treatment characteristics. Median follow-up was 43 months (range 1-107 months). High vs. low TD was associated with LRC (p = 0.0013), but not with OS (p = 0.29) or late toxicity (p = 0.58). Three-year LRC was 74.0% vs. 92.3% in the low and high TD group, respectively (p = 0.008). After three years, 25.0% and 0.9% of the patients had late toxicity grade 3 and 4, respectively. Multivariable analysis showed that distant metastasis (HR 17.6; 95%CI 5.2-60.2), lymph node involvement (HR 2.9; 95%CI 1.2-7.2), recurrence site (chest wall vs. breast; HR 4.6; 95%CI 1.8-11.6) and TD (low vs. high; HR 4.1; 95%CI 1.4-11.5) were associated with LRC. TD was associated with LRC in IPW analysis (p = 0.0018). CONCLUSIONS High thermal dose (best CEM43T50 ≥ 7.2 min) was associated with significantly higher LRC for patients with locoregional recurrent breast cancer treated with postoperative re-irradiation and hyperthermia, without augmenting toxicity.
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Affiliation(s)
- Akke Bakker
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - C Paola Tello Valverde
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - M Willemijn Kolff
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - H Petra Kok
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ben J Slotman
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Inge R H M Konings
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Arlene L Oei
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Emiel J T Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Coen R N Rasch
- Department of Radiation Oncology, LUMC, Leiden, the Netherlands.
| | - H J G Desirée van den Bongard
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Hans Crezee
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Kai M, Marx AN, Liu DD, Shen Y, Gao H, Reuben JM, Whitman G, Krishnamurthy S, Ross MI, Litton JK, Lim B, Ibrahim N, Kogawa T, Ueno NT. A phase II study of talimogene laherparepvec for patients with inoperable locoregional recurrence of breast cancer. Sci Rep 2021; 11:22242. [PMID: 34782633 PMCID: PMC8593093 DOI: 10.1038/s41598-021-01473-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023] Open
Abstract
Talimogene laherparepvec (T-VEC) is an immunotherapy that generates local tumor lysis and systemic antitumor immune response. We studied the efficacy of intratumoral administration of T-VEC as monotherapy for inoperable locoregional recurrence of breast cancer. T-VEC was injected intratumorally at 106 PFU/mL on day 1 (cycle 1), 108 PFU/mL on day 22 (cycle 2), and 108 PFU/mL every 2 weeks thereafter (cycles ≥ 3). Nine patients were enrolled, 6 with only locoregional disease and 3 with both locoregional and distant disease. No patient completed the planned 10 cycles or achieved complete or partial response. The median number of cycles administered was 4 (range, 3-8). Seven patients withdrew prematurely because of uncontrolled disease progression, 1 withdrew after cycle 3 because of fatigue, and 1 withdrew after cycle 4 for reasons unrelated to study treatment. Median progression-free survival and overall survival were 77 days (95% CI, 63-NA) and 361 days (95% CI, 240-NA). Two patients received 8 cycles with clinically stable disease as the best response. The most common grade 2 or higher adverse event was injection site reaction (n = 7, 78%). Future studies could examine whether combining intratumoral T-VEC with concurrent systemic therapy produces better outcomes.
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Affiliation(s)
- Megumi Kai
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela N Marx
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Hui Gao
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Hematopathology Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - James M Reuben
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Hematopathology Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Gary Whitman
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Savitri Krishnamurthy
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Merrick I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Oncology/Medicine, Baylor College of Medicine, 7200 Cambridge St., Houston, TX, 77030, USA
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Takahiro Kogawa
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA.
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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7
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Magnoni F, Colleoni M, Mattar D, Corso G, Bagnardi V, Frassoni S, Santomauro G, Jereczek-Fossa BA, Veronesi P, Galimberti V, Sacchini V, Intra M. Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: Is it Time to Review TNM Cancer Staging? Ann Surg Oncol 2020; 27:4488-4499. [PMID: 32436193 DOI: 10.1245/s10434-020-08605-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral axillary lymph node metastasis (CAM) is an infrequent clinical condition currently considered an M1, stage IV, disease. Due to the absence of shared data on CAM significance and on its therapeutic approach, be it curative or simply palliative, its management is still uncertain and undoubtedly represents a clinical challenge. PATIENTS AND METHODS Patients with pathologically confirmed metachronous CAM were retrospectively evaluated. All patients had been managed at the European Institute of Oncology, Milan, Italy, from 1997. Patients with distant metastases at the time of CAM were excluded. Possible treatments included surgery, systemic therapy and RT (radiotherapy). Outcomes were evaluated as rates of disease-free survival (DFS) and of overall survival (OS). RESULTS Forty-seven patients with CAM were included in the study. Metachronous CAM occurred 73 months (range 5-500 months) after diagnosis of the primary tumor. The median follow-up time was 5.4 years (interquartile range 2.9-7.0 years). The estimated OS was 72% at 5 years (95% CI 54-83), and 61% at 8 years (95% CI 43-75). The estimated DFS was 61% at 5 years (95% CI 44-74), and 42% at 8 years (95% CI 25-59). CONCLUSION These findings, together with those from previous studies, show that CAM outcome, particularly if measured as OS, appear better than at other sites of distant dissemination, when CAM is subjected to surgical and systemic treatments with a curative intent. Therefore, a new clinical scenario is suggested where, in the TNM system, CAM is no longer classified as a stage IV, but as an N3 disease.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - M Colleoni
- Division of Breast Cancer Medical Treatments, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D Mattar
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Corso
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - S Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- Service of Data Management, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - P Veronesi
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - V Sacchini
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - M Intra
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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8
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Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2700. [PMID: 32537356 PMCID: PMC7253268 DOI: 10.1097/gox.0000000000002700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
Excision of the pectoral fascia (PF) is routinely performed in oncological mastectomies. Preservation of the PF may, however, decrease postoperative complication rates for bleeding, infections, and seroma. It may also improve reconstructive outcomes by better prosthesis coverage, thereby reducing implant extrusion rates and improving cosmetic outcomes.
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9
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Krastev T, van Turnhout A, Vriens E, Smits L, van der Hulst R. Long-term Follow-up of Autologous Fat Transfer vs Conventional Breast Reconstruction and Association With Cancer Relapse in Patients With Breast Cancer. JAMA Surg 2019; 154:56-63. [PMID: 30304330 DOI: 10.1001/jamasurg.2018.3744] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. Objective To determine whether exposure to AFT vs conventional breast reconstruction is associated with increased rates of cancer relapse in patients with breast cancer. Design, Setting, and Participants This matched cohort study involved retrospective medical record review to identify all patients in a local patient database receiving AFT between 2006 and 2014. Each AFT case was matched with a nonexposed control patient with similar baseline characteristics. The mean (SD) follow-up of patients receiving AFT was 9.3 (4.9) years including 5.0 (1.7) years following AFT. Control patients were followed up for a mean (SD) of 8.6 (1.8) years from the primary surgery. Patients were identified through the local patient database of the Tergooi Hospital in Hilversum, the Netherlands. A total of 287 patients with breast cancer (300 affected breasts) who received AFT for breast reconstruction after cancer were included in the intervention group. Each AFT case was matched with a respective control patient based on age, type of oncologic surgery, tumor invasiveness, and disease stage. In addition, individual AFT-control pairs were selected to have the same locoregional recurrence-free interval at baseline. Data were analyzed between 2016 and 2017. Exposures Reconstruction with AFT vs conventional breast reconstruction or none. Main Outcomes and Measures Primary end points were the cumulative incidences of oncologic events in AFT and control patients and their respective hazard ratios. Results Of the 587 total patients, all were women and the mean age was 48.1 years for the patients undergoing AFT and 49.4 years for the control patients. Eight locoregional recurrences were observed in the treatment group (287 patients) and 11 among the control group (300 patients), leading to an unadjusted hazard ratio of 0.63 (95% CI, 0.25-1.60; P = .33). No increased locoregional recurrence rates were seen in relevant subgroups based on the type of oncological surgery, tumor invasiveness, or pathological stage. In addition, no increased risks with AFT were detected with respect to distant recurrences or breast cancer-specific mortality. Conclusions and Relevance No significant differences in the locoregional recurrence rates between the AFT and control groups were observed after 5 years of follow-up. These findings confirm the results of previous studies; therefore, clinical evidence suggesting that AFT is associated with increased risk for cancer relapse is still lacking.
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Affiliation(s)
- Todor Krastev
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Arjen van Turnhout
- Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Hilversum, the Netherlands
| | - Eline Vriens
- Department of General Surgery, Tergooi Hospital, Hilversum, Netherlands
| | - Luc Smits
- Department of Statistics and Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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10
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Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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11
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Giarratano T, Miglietta F, Giorgi CA, Tsvetkova V, Michieletto S, Evangelista L, Polico I, Dieci MV, Guarneri V. Exceptional and Durable Responses to TDM-1 After Trastuzumab Failure for Breast Cancer Skin Metastases: Potential Implications of an Immunological Sanctuary. Front Oncol 2018; 8:581. [PMID: 30560092 PMCID: PMC6287048 DOI: 10.3389/fonc.2018.00581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/19/2018] [Indexed: 01/09/2023] Open
Abstract
Breast Cancer (BC) skin metastases represent a challenging clinical scenario. Although they usually arise when other distant metastases are already present, they may also represent a form of locoregional recurrence (LRR). Systemic therapy in this setting may have a role both in case a radical locoregional approach is unfeasible in order to achieve disease control, and as adjuvant strategy after radical removal of cutaneous lesions, in order to prevent or delay subsequent disease spread. Systemic therapy for HER2+ metastatic BC (MBC) currently relies on anti-HER2 targeted agents. In this context TDM1 is an option in trastuzumab-resistant patients.Here we present 2 cases of isolated skin metastases in patients with HER2+ BC progressing during or early after trastuzumab-based therapy, showing impressive responses to TDM1. We hypothesize that the unique properties of skin immune microenvironment may explain the failure of trastuzumab, which exerts its action also through immunological mechanisms, and the subsequent outlier responses to TDM1, that relies on a partially different mechanism of action.
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Affiliation(s)
- Tommaso Giarratano
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federica Miglietta
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carlo A Giorgi
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Vassilena Tsvetkova
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Anatomy and Histology Unit, Azienda Ospedaliera di Padua, Padua, Italy
| | | | - Laura Evangelista
- Nuclear Medicine and Molecular Imaging Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Ilaria Polico
- Breast Imaging Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Maria V Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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12
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Utility and Cost Effectiveness of Routine, Histologic Evaluation of the Mastectomy Scar in Two-Stage, Implant-Based Reconstruction during Expander-to-Implant Exchange. Plast Reconstr Surg 2018; 142:836e-839e. [DOI: 10.1097/prs.0000000000004971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Krastev TK, Schop SJ, Hommes J, Piatkowski AA, Heuts EM, van der Hulst RRWJ. Meta-analysis of the oncological safety of autologous fat transfer after breast cancer. Br J Surg 2018; 105:1082-1097. [PMID: 29873061 PMCID: PMC6055707 DOI: 10.1002/bjs.10887] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/09/2018] [Accepted: 04/07/2018] [Indexed: 12/21/2022]
Abstract
Lipofilling ok
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Affiliation(s)
- T K Krastev
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S J Schop
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A A Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E M Heuts
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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14
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Tremblay G, Chandiwana D, Dolph M, Hearnden J, Forsythe A, Monaco M. Matching-adjusted indirect treatment comparison of ribociclib and palbociclib in HR+, HER2- advanced breast cancer. Cancer Manag Res 2018; 10:1319-1327. [PMID: 29861642 PMCID: PMC5968783 DOI: 10.2147/cmar.s163478] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Ribociclib (RIBO) and palbociclib (PALBO), combined with letrozole (LET), have been evaluated as treatments for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer in separate Phase III randomized controlled trials (RCTs), but not head-to-head. Population differences can lead to biased results by classical indirect treatment comparison (ITC). Matching-adjusted indirect comparison (MAIC) aims to correct these differences. We compared RIBO and PALBO in hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer using MAIC. Methods Patient-level data were available for RIBO (MONALEESA-2), while only published summary data were available for PALBO (PALOMA-2). Weights were assigned to MONALEESA-2 patient data such that mean baseline characteristics matched those reported for PALOMA-2; the resulting matched cohort was used in comparisons. Limited by the results reported in PALOMA-2, progression-free survival (PFS) was the primary comparison. Cox regression models were used to calculate adjusted hazard ratios (HRs) for PFS, before indirect treatment comparison (ITC) was performed with 95% confidence intervals. An exploratory analysis was performed similarly for overall survival using earlier PALBO data (PALOMA-1). Grade 3/4 adverse events were also compared. Results Racial characteristics, prior chemotherapy setting, and the extent of metastasis were the most imbalanced baseline characteristics. The unadjusted PFS HRs were 0.556 (0.429, 0.721) for RIBO+LET versus LET alone and 0.580 (0.460, 0.720) for PALBO+LET versus LET alone. MAIC adjustment resulted in an HR of 0.524 (0.406, 0.676) for RIBO+LET versus LET. PFS ITC using unadjusted trial data produced an HR of 0.959 (0.681, 1.350) for RIBO versus PALBO, or 0.904 (0.644, 1.268) with MAIC. Unadjusted overall survival HR of RIBO versus PALBO was 0.918 (0.492, 1.710); while exploratory MAIC was 0.839 (0.440, 1.598). ITC of grade 3/4 adverse events yielded a risk ratio of 0.806 (0.604, 1.076). Conclusion MAIC was performed for RIBO and PALBO in the absence of a head-to-head trial: though not statistically significant, the results favored RIBO.
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Affiliation(s)
| | | | - Mike Dolph
- Purple Squirrel Economics, New York, NY, USA
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15
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Forsythe A, Chandiwana D, Barth J, Thabane M, Baeck J, Shor A, Tremblay G. Is progression-free survival a more relevant endpoint than overall survival in first-line HR+/HER2- metastatic breast cancer? Cancer Manag Res 2018; 10:1015-1025. [PMID: 29765249 PMCID: PMC5942396 DOI: 10.2147/cmar.s162714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-), metastatic breast cancer (MBC) accounts for 73% of all MBCs. Endocrine therapy (ET) is the basis of first-line (1L) therapy for patients with HR+/HER2- MBC. Novel therapies have demonstrated improvements in progression-free survival (PFS) compared to ET. The clinical relevance of PFS is being debated, as there is no proven direct correlation with overall survival (OS) benefit to date. We reviewed studies of HR+/HER2- MBC to assess PFS and other factors that influence OS and treatment response, and health-related quality of life (HRQoL). Methods The Embase®, Medline®, and Cochrane databases were systematically searched to identify studies in adult women with HR+/HER2- MBC, published between January 2006 and January 2017, and written in English. Phase II and III randomized controlled trials (RCTs), observational, and retrospective studies were included. Results Seventy-nine RCTs were identified: 58 (73%) in the 1L+ setting and 21 (27%) in second-line or greater settings. PFS hazard ratios (HRs) were reported in 61 (77%) studies; 31 (39%) reported significant PFS improvements. OS was reported in 44 (41%) studies; 12 (15%) reported significant OS improvements. Significant improvements in both PFS and OS were reported in only 6 (8%) studies (1 Phase II; 5 Phase III). Patients with HER2- MBC received, on average, ≥5 lines of therapy, with no consistent treatment pathway. Baseline characteristics, prior therapies, and the type and number of post-progression therapies significantly impacted OS. PFS, response rates, and HRQoL decreased with each line of therapy (EuroQol 5 Dimensions: 0.78 1L vs. 0.70 post-progression). Conclusion Few RCTs in HR+/HER2- MBC have demonstrated significant improvements in OS. Factors other than choice of 1L therapy impact OS, including post-progression therapies, which cannot be controlled in RCTs. This study emphasizes the importance of PFS improvement in 1L treatment of HR+/HER2- MBC.
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Affiliation(s)
- Anna Forsythe
- Health Technology Assessment Evidence, Purple Squirrel Economics, New York, NY, USA
| | - David Chandiwana
- Global Value and Access, Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Janina Barth
- German Market Access, Novartis Pharma GmbH, Nuremberg, Germany
| | - Marroon Thabane
- Health Policy and Patient Access, Novartis Pharmaceuticals Incorporated, Dorval, QC, Canada
| | - Johan Baeck
- Global Medical Affairs (Oncology Business Unit), Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Anastasiya Shor
- Health Technology Assessment Evidence, Purple Squirrel Economics, New York, NY, USA
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16
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Li ZH, Hu PH, Tu JH, Yu NS. Luminal B breast cancer: patterns of recurrence and clinical outcome. Oncotarget 2018; 7:65024-65033. [PMID: 27542253 PMCID: PMC5323135 DOI: 10.18632/oncotarget.11344] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022] Open
Abstract
In recent years, most studies on breast cancer relapse and metastasis have focused on non-luminal breast cancers (including the basal-like and HER-2 subtypes) because of their poor prognosis. However, the luminal B subtype is more common, but this type has not been investigated as thoroughly. In the current study, we collected data on 258 patients with luminal-B breast cancer patients with recurrence and metastasis served as the observation group, and 189 patients with non-luminal breast cancer during the same period served as the control group. This study aimed to investigate the pattern of recurrence and clinical outcome after follow-up treatment for luminal B breast cancer. We found a higher proportion of local recurrence and single bone metastasis in patients with luminal B breast cancer than in patients in the non-luminal groups. The risk of recurrence and metastasis in patients with luminal B breast cancer during a 2- to 5-year period and after 5 years was still present, but the risk in patients with non-luminal breast cancers had obviously decreased during the same period. Patients with luminal B breast cancer with recurrence or/and metastasis had a better prognosis after reasonable treatment. The recurrence patterns and clinical outcomes of patients with luminal B breast cancer according to HER2 status were also different, to some degree. These results are of potential clinical relevance especially for the monitoring of clinical prognosis and targeted therapy intervention for luminal B breast cancer.
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Affiliation(s)
- Zhi-Hua Li
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory Of Breast Diseases In Jiangxi Province, Nanchang, JiangXi 330009, People's Republic of China
| | - Ping-Hua Hu
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory Of Breast Diseases In Jiangxi Province, Nanchang, JiangXi 330009, People's Republic of China
| | - Jian-Hong Tu
- Department of Pathology, The Third Hospital of Nanchang City, JiangXi Breast Specialist Hospital, Nanchang, JiangXi 330009, People's Republic of China
| | - Ni-Si Yu
- Department of Gynaecology, The Affiliated Hospital of Jiangxi traditional Chinese Medicine University, Nanchang, Jiangxi 330006, People's Republic of China
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17
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Neuman HB, Schumacher JR, Francescatti AB, Adesoye T, Edge SB, Vanness DJ, Yu M, McKellar D, Winchester DP, Greenberg CC. Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and III Breast Cancer (AFT-01). J Clin Oncol 2018; 36:975-980. [PMID: 29384721 DOI: 10.1200/jco.2017.75.5389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose National Comprehensive Cancer Network guidelines recommend systemic staging imaging at the time of locoregional breast cancer recurrence. Limited data support this recommendation. We determined the rate of synchronous distant recurrence at the time of locoregional recurrence in high-risk patients and identified clinical factors associated with an increased risk of synchronous metastases. Methods A stage-stratified random sample of 11,046 patients with stage II to III breast cancer in 2006 to 2007 was selected from the National Cancer Database for participation in a Commission on Cancer special study. From medical record abstraction of imaging and recurrence data, we identified patients who experienced locoregional recurrence within 5 years of diagnosis. Synchronous distant metastases (within 30 days of locoregional recurrence) were determined. We used multivariable logistic regression to identify factors associated with synchronous metastases. Results Four percent experienced locoregional recurrence (n = 445). Synchronous distant metastases were identified in 27% (n = 120). Initial presenting stage ( P = .03), locoregional recurrence type ( P = .01), and insurance status ( P = .03) were associated with synchronous distant metastases. The proportion of synchronous metastases was highest for women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence; 54% received systemic staging imaging within 30 days of a locoregional recurrence. Conclusion These findings support current recommendations for systemic imaging in the setting of locoregional recurrence, particularly for patients with lymph node or chest wall recurrences. Because most patients with isolated locoregional recurrence will be recommended locoregional treatment, early identification of distant metastases through routine systemic imaging may spare them treatments unlikely to extend their survival.
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Affiliation(s)
- Heather B Neuman
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Jessica R Schumacher
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Amanda B Francescatti
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Taiwo Adesoye
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Stephen B Edge
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - David J Vanness
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Menggang Yu
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Daniel McKellar
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - David P Winchester
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
| | - Caprice C Greenberg
- Heather B. Neuman, Jessica R. Schumacher, Taiwo Adesoye, David J. Vanness, and Caprice C. Greenberg, University of Wisconsin School of Medicine and Public Health; David J. Vanness and Menggang Yu, University of Wisconsin, Madison, WI; Amanda B. Francescatti and David P. Winchester, American College of Surgeons, Chicago, IL; Stephen B. Edge, Roswell Park Cancer Institute, Buffalo, NY; and Daniel McKellar, Wright State University, Dayton, OH
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18
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Laird J, Lok B, Siu C, Cahlon O, Khan AJ, McCormick B, Powell SN, Cody H, Wen HY, Ho A, Braunstein LZ. Impact of an In Situ Component on Outcome After In-Breast Tumor Recurrence in Patients Treated with Breast-Conserving Therapy. Ann Surg Oncol 2017; 25:154-163. [PMID: 29094250 DOI: 10.1245/s10434-017-6209-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Among all in-breast tumor recurrences (IBTR) following breast-conserving therapy (BCT), some comprise metachronous new primaries (NPs) while others are true recurrences (TRs). Establishing this distinction remains a challenge. METHODS We studied 3932 women who underwent BCT for stage I-III breast cancer from 1998 to 2008. Of these, 115 (2.9%) had an IBTR. Excluding patients with inoperable/unresectable recurrences or simultaneous distant metastases, 81 patients with isolated IBTR comprised the study population. An IBTR was categorized as an NP rather than a TR if it included an in situ component. The log-rank test and Kaplan-Meier method were used to evaluate disease-free survival (DFS) and overall survival (OS), and univariate and multivariate analyses were performed using Cox proportional hazards regression models. RESULTS At a median of 64.5 months from IBTR diagnosis, 28 of 81 patients had DFS events. Five-year DFS was 43.1% in the TR group (p = 0.0001) versus 80.3% in the NP group, while 5-year OS was 59.7% in the TR group versus 91.7% among those with NPs (p = 0.0011). On univariate analysis, increasing tumor size, high grade, positive margins, lymphovascular invasion, node involvement, lack of axillary surgery, chemotherapy, radiation therapy, and IBTR type (TR vs. NP) were significantly associated with worse DFS. Controlling for tumor size and margin status, TRs remained significantly associated with lower DFS (hazard ratio 3.717, 95% confidence interval 1.607-8.595, p = 0.002). CONCLUSION The presence of an in situ component is associated with prognosis among patients with IBTR following BCT and may be useful in differentiating TRs and NPs.
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Affiliation(s)
- James Laird
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,New York University School of Medicine, New York, NY, USA
| | - Benjamin Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chun Siu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hiram Cody
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah Yong Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice Ho
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ramani SK, Rastogi A, Mahajan A, Nair N, Shet T, Thakur MH. Imaging of the treated breast post breast conservation surgery/oncoplasty: Pictorial review. World J Radiol 2017; 9:321-329. [PMID: 28932361 PMCID: PMC5583527 DOI: 10.4329/wjr.v9.i8.321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiological-pathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.
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Affiliation(s)
- Subhash K Ramani
- Department of Radiodiagnosis, JJ Hospital, Mumbai 400008, India
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Ashita Rastogi
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Mumbai 400012, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
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Knuttel FM, Huijsse SEM, Feenstra TL, Moonen CTW, van den Bosch MAAJ, Buskens E, Greuter MJW, de Bock GH. Early health technology assessment of magnetic resonance-guided high intensity focused ultrasound ablation for the treatment of early-stage breast cancer. J Ther Ultrasound 2017; 5:23. [PMID: 28781881 PMCID: PMC5537939 DOI: 10.1186/s40349-017-0101-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) ablation is in development for minimally invasive treatment of breast cancer. Cost-effectiveness has not been assessed yet. An early health technology assessment was performed to estimate costs of MR-HIFU ablation, compared to breast conserving treatment (BCT). METHODS An MR-HIFU treatment model using the dedicated MR-HIFU breast system (Sonalleve, Philips Healthcare) was developed. Input parameters (treatment steps and duration) were based on the analysis of questionnaire data from an expert panel. MR-HIFU experts assessed face validity of the model. Data collected by questionnaires were compared to published data of an MR-HIFU breast feasibility study. Treatment costs for tumours of 1 to 3 cm were calculated. RESULTS The model structure was considered of acceptable face validity by consulted experts, and questionnaire data and published data were comparable. Costs of MR-HIFU ablation were higher than BCT costs. MR-HIFU best-case scenario costs exceeded BCT costs with approximately €1000. Cooling times and breathing correction contributed most to treatment costs. CONCLUSIONS MR-HIFU ablation is currently not a cost-effective alternative for BCT. MR-HIFU experience is limited, increasing uncertainty of estimations. The potential for cost-effectiveness increases if future research reduces treatment durations and might substantiate equal or improved results.
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Affiliation(s)
- Floortje M Knuttel
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sèvrin E M Huijsse
- Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Talitha L Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Chrit T W Moonen
- Center of Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
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21
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Bourke MG, Salwa SP, Sadadcharam M, Whelan MC, Forde PF, Larkin JO, Collins CG, O’Reilly S, O’Sullivan GC, Clover AJ, Soden DM. Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: Ten-year audit of single centre experience. Breast Cancer Res Treat 2016; 161:289-297. [DOI: 10.1007/s10549-016-4046-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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22
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Lee MY, Chang WJ, Kim HS, Lee JY, Lim SH, Lee JE, Kim SW, Nam SJ, Ahn JS, Im YH, Park YH. Clinicopathological Features and Prognostic Factors Affecting Survival Outcomes in Isolated Locoregional Recurrence of Breast Cancer: Single-Institutional Series. PLoS One 2016; 11:e0163254. [PMID: 27648567 PMCID: PMC5029922 DOI: 10.1371/journal.pone.0163254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/05/2016] [Indexed: 01/13/2023] Open
Abstract
Purpose The purpose of this study was to investigate the clinicopathologic features and prognostic factors affecting outcome in patients with isolated locoregional recurrence of breast cancer (ILRR). Methods We retrospectively analyzed the medical records of 104 patients who were diagnosed with ILRR and underwent curative surgery from January 2000 to December 2010 at Samsung Medical Center. Results Among 104 patients, 43 (41%) underwent total mastectomy and 61 (59%) underwent breast-conserving surgery for primary breast cancer. The median time from initial operation to ILRR was 35.7 months (4.5–132.3 months). After diagnosis of ILRR, 45 (43%) patients were treated with mastectomy, 41 (39%) with excision of recurred lesion, and 18 (17%) with node dissection. During a median follow-up of 8.9 years, the 5-year overall survival was 77% and 5-year distant metastasis-free survival (DMFS) was 54%. On multivariate analysis, younger age (< 35 years), higher stage, early onset of elapse (≤ 24 months), lymph node recurrences, and subtype of triple negative breast cancer (TNBC) were found to be independently associated with DMFS. Patients in the no chemotherapy group showed a longer DMFS after surgery for ILRR than those treated with chemotherapy (median 101.5 vs. 48.0 months, p = 0.072) but without statistical significance. Conclusion Our analysis showed that younger age (< 35 years), higher stage, early onset of relapse (≤ 24 months), lymph node recurrence, and subtype of TNBC are the worst prognostic factors for ILRR.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Disease-Free Survival
- Female
- Humans
- Lymph Node Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Prognosis
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Min-Young Lee
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Jin Chang
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Su Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yun Lee
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Gosset M, Hamy AS, Mallon P, Delomenie M, Mouttet D, Pierga JY, Lae M, Fourquet A, Rouzier R, Reyal F, Feron JG. Prognostic Impact of Time to Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery. PLoS One 2016; 11:e0159888. [PMID: 27494111 PMCID: PMC4975471 DOI: 10.1371/journal.pone.0159888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/08/2016] [Indexed: 01/02/2023] Open
Abstract
Background The poor prognosis of patients who experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is established. A short time between primary cancer and IBTR is a prognostic factor but no clinically relevant threshold was determined. Classification of IBTR may help tailor treatment strategies. Purpose We determined a specific time frame, which differentiates IBTR into early and late recurrence, and identified prognostic factors for patients with IBTR at time of the recurrence. Methods We analyzed 2209 patients with IBTR after BCS. We applied the optimal cut-points method for survival data to determine the cut-off times to IBTR. A subgroup analysis was performed by hormone receptor (HR) status. Survival analyses were performed using a Cox proportional hazard model to determine clinical features associated with distant-disease-free survival (DDFS) after IBTR. We therefor built decision trees. Results On the 828 metastatic events observed, the majority occurred within the first 3 months after IBTR: 157 in the HR positive group, 98 in the HR negative group. We found different prognostic times to IBTR: 49 months in the HR positive group, 33 in the HR negative group. After multivariate analysis, time to IBTR was the first discriminant prognostic factor in both groups (HR 0.65 CI95% [0.54–0.79] and 0.42 [0.30–0.57] respectively). The other following variables were significantly correlated with the DDFS: the initial number of positive lymph nodes for both groups, the initial tumor size and grade for HR positive tumors. Conclusion A short interval time to IBTR is the strongest factor of poor prognosis and reflects occult distant disease. It would appear that prognosis after IBTR depends more on clinical and histological parameters than on surgical treatment. A prospective trial in a low-risk group of patients to validate the safety of salvage BCS instead of mastectomy in IBTR is needed.
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Affiliation(s)
- Marie Gosset
- Department of Surgery, Institut Curie, 75005, Paris, France
| | | | - Peter Mallon
- Breast Unit, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland
| | | | | | - Jean-Yves Pierga
- Department of Medical Oncology, 75005, Institut Curie, Paris, France
- Paris Descartes University, 75006, Paris, France
| | - Marick Lae
- Department of Tumor Biology, Institut Curie, 75005, Paris, France
| | - Alain Fourquet
- Department of Radiotherapy, Institut Curie, 75005, Paris, France
| | - Roman Rouzier
- Department of Surgery, Institut Curie, 75005, Paris, France
| | - Fabien Reyal
- Department of Surgery, Institut Curie, 75005, Paris, France
- Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, 75005, Paris, France
- UMR932 Immunity and Cancer, INSERM, Institut Curie, 75005, Paris, France
- * E-mail:
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van Huizum MA, Hage JJ, Rutgers EJ, Hoornweg MJ. Immediate breast reconstruction with a myocutaneous latissimus dorsi flap and implant following skin-sparing salvage mastectomy after irradiation as part of breast-conserving therapy. J Plast Reconstr Aesthet Surg 2016; 69:1080-6. [DOI: 10.1016/j.bjps.2016.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
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25
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Hao Y, Lin PL, Xie J, Li N, Koo V, Ohashi E, Wu EQ, Rogerio J. Real-world effectiveness of everolimus-based therapy versus fulvestrant monotherapy in HR(+)/HER2(-) metastatic breast cancer. J Comp Eff Res 2016; 4:315-26. [PMID: 26274793 DOI: 10.2217/cer.15.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Assessing real-world effectiveness of everolimus-based therapy (EVE) versus fulvestrant monotherapy (FUL) among postmenopausal women with hormone receptor-positive (HR(+))/HER2(-) metastatic breast cancer (mBC) after progression on nonsteroidal aromatase inhibitor (NSAI). DATA & METHODS Medical charts of community-based patients who received EVE or FUL for mBC after NSAI were examined. Progression-free survival (PFS), time on treatment and time to chemotherapy were compared using Kaplan-Meier curves and Cox proportional hazards models adjusting for line of therapy and patient characteristics. RESULTS & CONCLUSION 192 patients received EVE and 156 FUL. After adjusting for patient characteristics, EVE was associated with significantly longer PFS than FUL (hazard ratio: 0.71; p = 0.045). EVE was associated with better PFS than FUL among NSAI-refractory postmenopausal HR(+)/HER2(-) mBC patients.
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Affiliation(s)
- Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | | | - Jipan Xie
- Analysis Group, Inc., New York, NY 10020, USA
| | - Nanxin Li
- Analysis Group, Inc., Boston, MA 02199, USA
| | | | | | - Eric Q Wu
- Analysis Group, Inc., Boston, MA 02199, USA
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26
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Petrella F, Radice D, Borri A, Galetta D, Gasparri R, Casiraghi M, Tessitore A, Pardolesi A, Solli P, Veronesi G, Rizzo S, Martella S, Rietjens M, Spaggiari L. Chest wall resection and reconstruction for locally recurrent breast cancer: From technical aspects to biological assessment. Surgeon 2016; 14:26-32. [DOI: 10.1016/j.surge.2014.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/22/2014] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
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27
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Zevon M, Ganapathy V, Kantamneni H, Mingozzi M, Kim P, Adler D, Sheng Y, Tan MC, Pierce M, Riman RE, Roth CM, Moghe PV. CXCR-4 Targeted, Short Wave Infrared (SWIR) Emitting Nanoprobes for Enhanced Deep Tissue Imaging and Micrometastatic Cancer Lesion Detection. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2015; 11:6347-57. [PMID: 26514367 PMCID: PMC4763715 DOI: 10.1002/smll.201502202] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/24/2015] [Indexed: 05/18/2023]
Abstract
Realizing the promise of precision medicine in cancer therapy depends on identifying and tracking cancerous growths to maximize treatment options and improve patient outcomes. This goal of early detection remains unfulfilled by current clinical imaging techniques that fail to detect lesions due to their small size and suborgan localization. With proper probes, optical imaging techniques can overcome this by identifying the molecular phenotype of tumors at both macroscopic and microscopic scales. In this study, the first use of nanophotonic short wave infrared technology is proposed to molecularly phenotype small lesions for more sensitive detection. Here, human serum albumin encapsulated rare-earth nanoparticles (ReANCs) with ligands for targeted lesion imaging are designed. AMD3100, an antagonist to CXCR4 (a classic marker of cancer metastasis) is adsorbed onto ReANCs to form functionalized ReANCs (fReANCs). fReANCs are able to preferentially accumulate in receptor positive lesions when injected intraperitoneally in a subcutaneous tumor model. fReANCs can also target subtissue microlesions at a maximum depth of 10.5 mm in a lung metastatic model of breast cancer. Internal lesions identified with fReANCs are 2.25 times smaller than those detected with ReANCs. Thus, an integrated nanoprobe detection platform is presented, which allows target-specific identification of subtissue cancerous lesions.
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Affiliation(s)
- Margot Zevon
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
| | - Vidya Ganapathy
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
| | - Harini Kantamneni
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Marco Mingozzi
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
| | - Paul Kim
- Department of Materials Science and Engineering, Rutgers University, 607 Taylor Road, Piscataway, NJ 08855
| | - Derek Adler
- Molecular Imaging Center, 41 Gordon Road (Suite D), Piscataway NJ 08854
| | - Yang Sheng
- Engineering Product Development, Singapore University of Technology and Design, 20 Dover Drive, 138682, Singapore
| | - Mei Chee Tan
- Engineering Product Development, Singapore University of Technology and Design, 20 Dover Drive, 138682, Singapore
| | - Mark Pierce
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
| | - Richard E. Riman
- Department of Materials Science and Engineering, Rutgers University, 607 Taylor Road, Piscataway, NJ 08855
| | - Charles M. Roth
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Prabhas V. Moghe
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854
- Department of Chemical and Biochemical Engineering, Rutgers University, Piscataway, NJ 08854, USA
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Maluta S, Kolff MW. Role of Hyperthermia in Breast Cancer Locoregional Recurrence: A Review. Breast Care (Basel) 2015; 10:408-12. [PMID: 26989361 DOI: 10.1159/000440792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In patients with locoregional recurrences of breast cancer not suitable for resection, subsequent local control is difficult to maintain in previously irradiated areas when reirradiation alone or reirradiation with chemotherapy is used. Due to the limited number of treatment options there is a high risk of subsequent failure and uncontrollable local disease. In this group of patients, local hyperthermia combined with radiotherapy increases the clinical response and local control, adding limited acute and late toxicity, as has been shown in randomized trials. Hyperthermia is an artificial elevation of tissue temperature (range 40-44°C for 30-60 min). If hyperthermia is applied shortly before or after radiation, the effect of radiation is enhanced by influencing intratumoral hypoxia and by inhibiting sublethal damage repair in the tumor. Moreover, hyperthermia combined with radiation reduces the total dose of radiation needed compared to radiation alone, of which a higher dose is needed to obtain the same effect. Few data are available on the combination of radiotherapy and hyperthermia with chemotherapy, although the results of trimodality treatment consisting of reirradiation and hyperthermia together with liposomal doxorubicin are promising. Therefore, this literature review was performed to provide more comprehensive data on the mechanism and use of hyperthermia in locoregional recurrence of breast cancer.
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Affiliation(s)
- Sergio Maluta
- Department of Hyperthermia, Serena Medical Center, Padova, Italy
| | - Merel Willemijn Kolff
- Department of Radiotherapy and Hyperthermia, Academic Medical Center, Amsterdam, The Netherlands
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Contralateral lymph node recurrence in breast cancer: Regional event rather than distant metastatic disease. A systematic review of the literature. Eur J Surg Oncol 2015; 41:1128-36. [PMID: 26108737 DOI: 10.1016/j.ejso.2015.05.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/04/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
AIMS After treatment for breast cancer, some patients experience a contralateral lymph node recurrence (CLNR). Traditionally, contralateral nodes are considered a distant site. However, aberrant lymph drainage after previous surgery is common. This might indicate that CLNR is a regional event. This study aimed to review the literature to determine prognosis after CLNR. METHODS PubMed was searched up until July 2014. Articles on CLNR with or without ipsilateral breast tumour recurrence (IBTR), and repeat sentinel node (SN) studies reporting on positive contralateral nodes were included. Exclusion criteria were synchronous contralateral breast cancer and synchronous distant events. RESULTS 24 articles were included, describing 48 patients. Of these 48, 26 patients had an isolated CLNR, 7 IBTR and clinically detected CLNR, and 15 IBTR with a positive contralateral repeat SN. Isolated CLNR occurred earlier (45.9 months) than IBTR with CLNR (126.6 months, p < 0.001) or with a positive contralateral repeat SN (217.2, p = 0.02). Surgical treatment was described for 38 patients, and consisted of axillary lymph node dissection for 34 (89.5%). Information on adjuvant therapy was available for 27 patients, 21 (77.8%) received chemotherapy. Follow-up information after CLNR was available for 23 patients (47.9%). Mean follow-up was 50.3 months. Overall survival and disease-free survival were 82.6% [95% CI 67.1-98.1] and 65.2% [45.7-84.7] respectively at last follow-up. CONCLUSIONS Although observed in a small population, the survival of CLNR is not comparable to distant disease. Most patients received locoregional and systemic treatment suggesting a curative approach. This indicates that CLNR should be regarded as a regional event.
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30
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Zagar TM, Vujaskovic Z, Formenti S, Rugo H, Muggia F, O'Connor B, Myerson R, Stauffer P, Hsu IC, Diederich C, Straube W, Boss MK, Boico A, Craciunescu O, Maccarini P, Needham D, Borys N, Blackwell KL, Dewhirst MW. Two phase I dose-escalation/pharmacokinetics studies of low temperature liposomal doxorubicin (LTLD) and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer. Int J Hyperthermia 2015; 30:285-94. [PMID: 25144817 PMCID: PMC4162656 DOI: 10.3109/02656736.2014.936049] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Unresectable chest wall recurrences of breast cancer (CWR) in heavily pretreated patients are especially difficult to treat. We hypothesised that thermally enhanced drug delivery using low temperature liposomal doxorubicin (LTLD), given with mild local hyperthermia (MLHT), will be safe and effective in this population. Patients and methods This paper combines the results of two similarly designed phase I trials. Eligible CWR patients had progressed on the chest wall after prior hormone therapy, chemotherapy, and radiotherapy. Patients were to get six cycles of LTLD every 21–35 days, followed immediately by chest wall MLHT for 1 hour at 40–42 °C. In the first trial 18 subjects received LTLD at 20, 30, or 40 mg/m2; in the second trial, 11 subjects received LTLD at 40 or 50 mg/m2. Results The median age of all 29 patients enrolled was 57 years. Thirteen patients (45%) had distant metastases on enrolment. Patients had received a median dose of 256 mg/m2 of prior anthracyclines and a median dose of 61 Gy of prior radiation. The median number of study treatments that subjects completed was four. The maximum tolerated dose was 50 mg/m2, with seven subjects (24%) developing reversible grade 3–4 neutropenia and four (14%) reversible grade 3–4 leucopenia. The rate of overall local response was 48% (14/29, 95% CI: 30–66%), with. five patients (17%) achieving complete local responses and nine patients (31%) having partial local responses. Conclusion LTLD at 50 mg/m2 and MLHT is safe. This combined therapy produces objective responses in heavily pretreated CWR patients. Future work should test thermally enhanced LTLD delivery in a less advanced patient population.
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Affiliation(s)
- Timothy M Zagar
- Department of Radiation Oncology, University of North Carolina Hospital , Chapel Hill , North Carolina
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Macalalad AR, Hao Y, Lin PL, Signorovitch JE, Wu EQ, Ohashi E, Zhou Z, Kelley C. Treatment patterns and duration in post-menopausal women with HR+/HER2- metastatic breast cancer in the US: a retrospective chart review in community oncology practices (2004-2010). Curr Med Res Opin 2015; 31:263-73. [PMID: 25350226 DOI: 10.1185/03007995.2014.980885] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines. OBJECTIVE To describe treatment patterns and treatment durations by lines of therapy for ET and CT among post-menopausal HR+/HER2- mBC patients. METHODS Charts were reviewed from a network of community-based oncology practices of eligible patients who had progressed after initiating adjuvant or first-line treatment for mBC between 1 January 2004 and 30 September 2010. Extracted chart data included demographics, treatment histories, and outcomes. Treatment duration was estimated using Kaplan-Meier estimators. RESULTS A total of 144 patients were studied. Patients received a median of two lines of ET, and <10% had three or more lines of ET before receiving CT. From first line to second line, the median treatment duration was 11.6 to 4.9 months for ET overall; 13.8 to 10.5 months for anastrozole; 18.6 to 7.0 months for letrozole; and 5.1 to 2.9 months for fulvestrant. For CT, the median duration was 5.1 months in the first line and 3.7 months and below in subsequent lines. CONCLUSION During the study period (1 January 2004 - 30 September 2012), most patients received <3 lines of ET before receiving CT. The drop in median duration of ET from first to second line suggests that single agent ETs might not be as effective beyond the first line. A key limitation of this study was the small sample size. In addition, more research is needed to further investigate the short treatment duration of fulvestrant across early lines of therapy (which could indicate lack of efficacy).
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Aebi S, Gelber S, Anderson SJ, Láng I, Robidoux A, Martín M, Nortier JWR, Paterson AHG, Rimawi MF, Cañada JMB, Thürlimann B, Murray E, Mamounas EP, Geyer CE, Price KN, Coates AS, Gelber RD, Rastogi P, Wolmark N, Wapnir IL. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol 2014; 15:156-63. [PMID: 24439313 DOI: 10.1016/s1470-2045(13)70589-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with isolated locoregional recurrences (ILRR) of breast cancer have a high risk of distant metastasis and death from breast cancer. We aimed to establish whether adjuvant chemotherapy improves the outcome of such patients. METHODS The CALOR trial was a pragmatic, open-label, randomised trial that accrued patients with histologically proven and completely excised ILRR after unilateral breast cancer who had undergone a mastectomy or lumpectomy with clear surgical margins. Eligible patients were enrolled from hospitals worldwide and were centrally randomised (1:1) to chemotherapy (type selected by the investigator; multidrug for at least four courses recommended) or no chemotherapy, using permuted blocks, and stratified by previous chemotherapy, oestrogen-receptor and progesterone-receptor status, and location of ILRR. Patients with oestrogen-receptor-positive ILRR received adjuvant endocrine therapy, radiation therapy was mandated for patients with microscopically involved surgical margins, and anti-HER2 therapy was optional. The primary endpoint was disease-free survival. All analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00074152. FINDINGS From Aug 22, 2003, to Jan 31, 2010, 85 patients were randomly assigned to receive chemotherapy and 77 were assigned to no chemotherapy. At a median follow-up of 4·9 years (IQR 3·6-6 ·0), 24 (28%) patients had disease-free survival events in the chemotherapy group compared with 34 (44%) in the no chemotherapy group. 5-year disease-free survival was 69% (95% CI 56-79) with chemotherapy versus 57% (44-67) without chemotherapy (hazard ratio 0·59 [95% CI 0·35-0·99]; p=0·046). Adjuvant chemotherapy was significantly more effective for women with oestrogen-receptor-negative ILRR (pinteraction=0·046), but analyses of disease-free survival according to the oestrogen-receptor status of the primary tumour were not statistically significant (pinteraction=0·43). Of the 81 patients who received chemotherapy, 12 (15%) had serious adverse events. The most common adverse events were neutropenia, febrile neutropenia, and intestinal infection. INTERPRETATION Adjuvant chemotherapy should be recommended for patients with completely resected ILRR of breast cancer, especially if the recurrence is oestrogen-receptor negative. FUNDING US Department of Health and Human Services, Swiss Group for Clinical Cancer Research (SAKK), Frontier Science and Technology Research Foundation, Australian and New Zealand Breast Cancer Trials Group, Swedish Cancer Society, Oncosuisse, Cancer Association of South Africa, Foundation for Clinical Research of Eastern Switzerland (OSKK), Grupo Español de Investigación en Cáncer de Mama (GEICAM), and the Dutch Breast Cancer Trialists' Group (BOOG).
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Affiliation(s)
- Stefan Aebi
- Luzerner Kantonsspital, Lucerne, Switzerland; University of Berne, Berne, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland.
| | - Shari Gelber
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - Stewart J Anderson
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - István Láng
- National Institute of Oncology, Budapest, Hungary
| | - André Robidoux
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | | | - Beat Thürlimann
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland; Breast Center, Kantonsspital, St Gallen, Switzerland
| | - Elizabeth Murray
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Charles E Geyer
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Karen N Price
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - Alan S Coates
- International Breast Cancer Study Group, Bern, Switzerland; University of Sydney, Sydney, Australia
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - Priya Rastogi
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Norman Wolmark
- Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
| | - Irene L Wapnir
- Stanford University School of Medicine, Stanford, CA, USA
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Is routine histological examination of mastectomy scars justified? An analysis of 619 scars. J Plast Reconstr Aesthet Surg 2012; 66:182-6. [PMID: 23044349 DOI: 10.1016/j.bjps.2012.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/31/2012] [Accepted: 09/13/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The increasing incidence of breast cancer is paralleled by an increasing demand for post-mastectomy breast reconstruction. At the time of breast reconstruction routine submission of mastectomy scars has been considered appropriate clinical practice to ensure that no residual cancer exists. However, this practice has been challenged by some and has become the topic of controversy. In a retrospective analysis we wished to assess whether routine submission of mastectomy scars altered treatment. METHODS Utilizing the Stanford Translational Research Integrated Database Environment (STRIDE) all patients who underwent implant-based breast reconstruction with routine histological analysis of mastectomy scars were identified. The following parameters were retrieved and analyzed: age, cancer histology, cancer stage (according to the American Joint Committee on Cancer staging system), receptor status (estrogen receptor [ER], progesterone receptor [PR], Her2neu), time interval between mastectomy and reconstruction, and scar histology. RESULTS A total of 442 patients with a mean age of 45.9 years (range, 22-73 years) were included in the study. Mastectomy with subsequent reconstruction was performed for in-situ disease and invasive cancer in 83 and 359 patients, respectively. A total of 619 clinically unremarkable mastectomy scars were sent for histological analysis, with the most common finding being unremarkable scar tissue (i.e. collagen fibers). Of note, no specimen revealed the presence of carcinoma. CONCLUSION According to published reports routine histological examination of mastectomy scars may detect early local recurrence. However, we were not able to detect this benefit in our patient population. As such, particularly in the current health-care climate the cost-effectiveness of this practice deserves further attention. A more selective use of histological analysis of mastectomy scars in patients with tumors that display poor prognostic indicators may be a more reasonable utilization of resources.
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Early-stage breast cancer conservative treatment: high-dose-rate brachytherapy boost in a single fraction of 700 cGy to the tumour bed. Clin Transl Oncol 2012; 14:362-8. [PMID: 22551542 DOI: 10.1007/s12094-012-0809-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Conservative treatment represents the current therapy for early-stage breast cancer. When risk factors for local relapse exist, a tumour bed boost is required. Retrospectively, we evaluated the prognostic factors influencing local recurrence (LR), overall survival (OS) and disease-free survival (DFS). MATERIAL AND METHODS After conservative treatment, 210 patients received a single-dose HDR brachytherapy (HDRBT) boost between June 1996 and December 2005. Mean age was 57 years; 75% had invasive ductal carcinoma. The most frequent surgery was lumpectomy (55.7%); 39.4% were G3, 18.6% intraductal component >25% and only 22% had negative margins. RESULTS With a mean follow-up of 85 months, at 5 and 10 years the OS was 93% and 88%, DFS 92% and 89%, and LR 3.6% and 5.3%, respectively. For LR, the risk factors were carcinoma in situ, N+ and involved margins, whereas for metastasis, the risk factors were T2 tumours, stage III, N+ and the presence of local recurrence. CONCLUSIONS HDR-BT boost in one fraction is an effective, simple and safe method for reducing LR. The outpatient setting and shorter treatment duration represent undeniable advantages.
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Maaskant-Braat AJG, Roumen RMH, Voogd AC, Pijpers R, Luiten EJT, Rutgers EJT, Nieuwenhuijzen GAP. Sentinel Node and Recurrent Breast Cancer (SNARB): results of a nationwide registration study. Ann Surg Oncol 2012; 20:620-6. [PMID: 22941173 DOI: 10.1245/s10434-012-2625-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Knowledge of regional lymph node involvement is important in patients with recurrent breast cancer for obtaining better locoregional control and predicting prognosis. To determine technical feasibility, validity, aberrant drainage rates, and clinical consequences of performing repeat sentinel node biopsy (SNB) in patients with locally recurrent breast cancer we conducted the "Sentinel Node and Recurrent Breast Cancer (SNARB)" study. METHODS A total of 150 patients with locally recurrent breast cancer underwent lymphatic mapping and SNB. In case of an intact axillary lymph node basin, ipsilateral axillary lymph node dissection (ALND) was performed subsequently. RESULTS A total of 41 patients previously underwent breast conserving therapy (BCT) with SNB, 82 patients BCT with ALND, and 21 patients a mastectomy, of which 9 with SNB and 12 with ALND. In 95 patients (63.3 %) a sentinel node was identified and in 78 patients (52 %) the sentinel node was successfully removed. In 18 patients (22.8 %) a (micro)metastasis was found on pathologic examination. Confirmation ALND in 18 patients showed no axillary lymph node metastases. Aberrant drainage pathways were visualized in 58.9 % of the patients, significantly more frequently after a previous ALND (79.3 %) than after a previous SNB (25.0 %) (P < .0001). Overall, the result of this repeat SNB led to a change in the adjuvant treatment plan in 16.5 % of the patients with a successful repeat SNB. CONCLUSIONS Repeat SNB is technically feasible and provides reliable results in patients with locally recurrent breast cancer, leading to change in management in 1 of 6 patients.
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Incidence of skin recurrence after breast cancer surgery. Radiother Oncol 2012; 103:275-7. [DOI: 10.1016/j.radonc.2011.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 12/28/2011] [Indexed: 11/23/2022]
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Shen SC, Liao CH, Lo YF, Tsai HP, Kuo WL, Yu CC, Chao TC, Chen MF, Chang HK, Lin YC, Shen WC, Ueng SH, Lee LY, Hsueh S, Huang YT, Chen SC. Favorable outcome of secondary axillary dissection in breast cancer patients with axillary nodal relapse. Ann Surg Oncol 2011; 19:1122-8. [PMID: 21969085 DOI: 10.1245/s10434-011-2082-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Little evidence can be found about the long-term outcome of breast cancer patients after axillary lymph node recurrence (ALNR) and its survival benefit after different kinds of management. The present study intends to evaluate the risk factors associated with axillary recurrence after definite surgery for primary breast cancer. The prognosis after ALNR and particularly outcome of different management methods also were studied. METHODS We retrospectively reviewed data from 4,473 patients who were diagnosed with primary breast cancer and received surgical intervention in a single institute from January 1990 to December 2002. Medical files were reviewed and data on survival were updated annually. Risk factors and prognosis of patients with axillary recurrence were analyzed. Breast-cancer-specific survival of patients with ALNR and outcomes after different management methods also were studied. RESULTS After a median follow-up of 70.2 months, axillary recurrence developed in 0.8% of patients. Factors associated with ALNR included: age younger than 40 years, medial tumor location, no initial standard level I & II axillary dissection, and not receiving hormonal therapy. The 5-year breast-cancer-specific survival after ALNR was 57.9%. For patients who received further axillary dissection, the 5-year survival rate was 82.5% compared with 44.9% for patients who did not receive further dissection. CONCLUSIONS ALNR is a rare event in treating breast cancer. Young age at diagnosis and medially located tumor are associated with higher risk, but standardized initial axillary dissection to level II and adjuvant hormonal therapy is protective against ALNR. In patients with ALNR, the outcome is not dismal and survival may be improved if further axillary dissection is given.
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Affiliation(s)
- Shih-Che Shen
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
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Isolated sternal involvement in breast cancer: is it truly stage IV disease? Clin Breast Cancer 2011; 11:191-4. [PMID: 21665140 DOI: 10.1016/j.clbc.2011.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/06/2011] [Accepted: 02/07/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE There is no consensus regarding treatment for patients with breast cancer and isolated sternal involvement. Though classified as AJCC stage IV, this group of patients may have prolonged distant disease free survival. PATIENTS AND METHODS Retrospective case series of 8 patients with isolated sternal recurrence. Information regarding age, menopausal status, hormonal receptor status, HER2 status, initial treatment, time to sternal recurrence, treatment of sternal involvement, and outcome was obtained. RESULTS Median follow-up, 6 years. Seven of 8 diagnosed with metachronous sternal recurrence at a median of 3 years from initial breast cancer diagnosis, 1 with sternal involvement at initial diagnosis. Seven of 8 are alive, with one death from metastatic breast cancer 10 years after sternal recurrence. Six of 8 are without evidence of distant spread, 2 in continuous complete remission (CR) at 7 and 14 years from sternal recurrence. CONCLUSION While a small cohort, the excellent survival of the group identifies this as a distinct subset of metastatic disease, requiring special treatment considerations. Isolated sternal involvement could represent direct local-regional extension rather than systemic spread.
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Chockalingam P, Astrow A, Klein P, Huang Y, Reichman •, Citron M. Isolated Sternal Involvement in Breast Cancer: Is it Truly Stage IV Disease? Clin Breast Cancer 2011. [DOI: 10.1016/j.clbc.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Breast Cancer Recurrence Following Postmastectomy Reconstruction Compared to Mastectomy With No Reconstruction. Ann Plast Surg 2011; 66:466-71. [DOI: 10.1097/sap.0b013e318214e575] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rajendran S, O'Hanlon D, Morrissey D, O'Donovan T, O'Sullivan GC, Tangney M. Preclinical evaluation of gene delivery methods for the treatment of loco-regional disease in breast cancer. Exp Biol Med (Maywood) 2011; 236:423-34. [DOI: 10.1258/ebm.2011.010234] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Preclinical results with various gene therapy strategies indicate significant potential for new cancer treatments. However, many therapeutics fail at clinical trial, often due to differences in tissue physiology between animal models and humans, and tumor phenotype variation. Clinical data relevant to treatment strategies may be generated prior to clinical trial through experimentation using intact patient tissue ex vivo. We developed a novel tumor slice model culture system that is universally applicable to gene delivery methods, using a realtime luminescence detection method to assess gene delivery. Methods investigated include viruses (adenovirus [Ad] and adeno-associated virus), lipofection, ultrasound (US), electroporation and naked DNA. Viability and tumor populations within the slices were well maintained for seven days, and gene delivery was qualitatively and quantitatively examinable for all vectors. Ad was the most efficient gene delivery vector with transduction efficiency >50%. US proved the optimal non-viral gene delivery method in human tumor slices. The nature of the ex vivo culture system permitted examination of specific elements. Parameters shown to diminish Ad gene delivery included blood, regions of low viability and secondary disease. US gene delivery was significantly reduced by blood and skin, while tissue hyperthermia improved gene delivery. US achieved improved efficacy for secondary disease. The ex vivo model was also suitable for examination of tissue-specific effects on vector expression, with Ad expression mediated by the CXCR4 promoter shown to provide a tumor selective advantage over the ubiquitously active cytomegalovirus promoter. In conclusion, this is the first study incorporating patient tissue models in comparing gene delivery from various vectors, providing knowledge on cell-type specificity and examining the crucial biological factors determining successful gene delivery. The results highlight the importance of in-depth preclinical assessment of novel therapeutics and may serve as a platform for further testing of current, novel gene delivery approaches.
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Affiliation(s)
- Simon Rajendran
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr. Laboratory, University College Cork
- Department of Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Deirdre O'Hanlon
- Department of Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - David Morrissey
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr. Laboratory, University College Cork
| | - Tracey O'Donovan
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr. Laboratory, University College Cork
| | - Gerald C O'Sullivan
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr. Laboratory, University College Cork
| | - Mark Tangney
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr. Laboratory, University College Cork
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D’Aiuto M, Cicalese M, D’Aiuto G, Rocco G. Surgery of the Chest Wall for Involvement by Breast Cancer. Thorac Surg Clin 2010; 20:509-17. [DOI: 10.1016/j.thorsurg.2010.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Angarita FA, Acuna SA, Fonseca A, Crystal P, Escallon J. Impact of Preoperative Breast MRIs on Timing of Surgery and Type of Intervention in Newly Diagnosed Breast Cancer Patients. Ann Surg Oncol 2010; 17 Suppl 3:273-9. [DOI: 10.1245/s10434-010-1239-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 11/18/2022]
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Kim HJ, Kwak JY, Choi JW, Bae JH, Shin KM, Lee HJ, Kim GC, Jung JH, Park JY. Impact of US surveillance on detection of clinically occult locoregional recurrence after mastectomy for breast cancer. Ann Surg Oncol 2010; 17:2670-6. [PMID: 20422455 DOI: 10.1245/s10434-010-1087-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study investigated the efficacy of locoregional ultrasonography (LRUS) for the detection of recurrence in asymptomatic patients who underwent mastectomy and the impact of LRUS on prognosis. MATERIALS AND METHODS A total of 1796 LRUSs were performed in 874 asymptomatic patients who showed no clinical evidence of recurrence after mastectomy. Ultrasonography (US) results were considered positive when US detected any masses at the mastectomy bed or suspicious regional lymph nodes. The final diagnosis of each patient was based on cytopathology results or data collected during the follow-up. The median follow-up was 37 months. We evaluated diagnostic performance of LRUS at the detection of locoregional recurrence (LRR) and compared overall survival of asymptomatic patients with recurrences to that of symptomatic patients with recurrences. RESULTS Of 874 asymptomatic patients, 57 patients (6.5%) had suspicious LRR on LRUS. The positive predictive value (PPV) of LRUS was 26.3% with 15 recurrences diagnosed in 15 patients (cancer detection rate, 1.7% per patient and 0.8% per examination). Asymptomatic patients with recurrences had better survival compared with symptomatic patients with recurrences (P = .034). CONCLUSIONS LRUS during breast US after mastectomy for breast cancer was helpful for the early detection of recurrence and may lead to a better prognosis for patients.
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Affiliation(s)
- Hye Jung Kim
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea
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Abstract
The occurrence of a solitary sternal metastasis from breast cancer is relatively uncommon, and its treatment is controversial. Most case reports on the role of sternal resection in what is termed a "solitary sternal metastasis" tend to present a rather optimistic outcome.Here, we report the case of a premenopausal woman with axillary lymph node-positive, triple-negative breast cancer treated with mastectomy followed by adjuvant chemotherapy and radiation therapy. She developed a radiologically isolated sternal recurrence 3 years later, which was treated with partial sternectomy. The present case report reviews the use of sternectomy for breast cancer recurrence and highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic disease before extensive surgery is undertaken.
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Affiliation(s)
- L Lee
- Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON
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Sarasqueta C, Martínez-Camblor P, Mendiola A, Martínez-Pueyo I, Michelena MJ, Basterretxea M, Recio J, Alvarez I, Larrañaga N. Supervivencia relativa en cáncer de mama después de la primera recidiva y factores pronóstico asociados. Med Clin (Barc) 2009; 133:489-95. [DOI: 10.1016/j.medcli.2009.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 03/05/2009] [Indexed: 11/28/2022]
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Cutuli B. Radiothérapie du cancer du sein chez le sujet âgé. Cancer Radiother 2009; 13:615-22. [DOI: 10.1016/j.canrad.2009.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
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Greenwood-Haigh L. Mammographic surveillance in the follow up of early primary breast cancer in England: A cross-sectional survey. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mastectomy scars following breast reconstruction: should routine histologic analysis be performed? Plast Reconstr Surg 2009; 123:1141-1147. [PMID: 19337082 DOI: 10.1097/prs.0b013e31819f25d5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is some debate in the recent literature regarding the routine submission of mastectomy scars for histologic analysis when performing delayed breast reconstructions. The aim of this study was to review the relevant publications and evaluate the practice of routine histologic examination of mastectomy scars. METHODS The authors conducted a retrospective review, across three regional plastic and reconstructive surgery units, of 433 patients who had 455 scars routinely sent for histologic examination following delayed breast reconstruction between January of 2000 and December of 2006. Patients with clinical evidence of recurrent carcinoma were excluded. RESULTS Data from 433 patients revealed an average age at reconstruction of 49.9 years (range, 25 to 77 years). The mean interval from primary breast surgery to reconstruction was 3.9 years (range, 2 months to 32 years), and the average length of patient follow-up, from primary surgery, was 6.4 years (range, 1 to 40 years). The majority of the initial operations were carried out for invasive carcinoma (89 percent). Four mastectomy scars in three patients were positive for carcinoma recurrence. CONCLUSIONS The publications related to the practice of routine histologic analysis of mastectomy scars provide conflicting conclusions. As a proportion of patients may benefit from the early detection and treatment of locoregional recurrence, the authors suggest that the routine submission of mastectomy scars will allow for the earlier detection of soft-tissue recurrences that may affect long-term outcome. In keeping with cancer surgery principles, the authors recommend routine histologic examination of mastectomy scars following delayed breast reconstruction.
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Lee SJ, Hwang SO, Jung JH, Park HY, Lee JH, Eun YA. Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.5.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seung Jae Lee
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Oook Hwang
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Hyuk Lee
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Young A Eun
- Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
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