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Vrancken Peeters NJMC, Kaplan ZLR, Clarijs ME, Mureau MAM, Verhoef C, van Dalen T, Husson O, Koppert LB. Health-related quality of life (HRQoL) after different axillary treatments in women with breast cancer: a 1-year longitudinal cohort study. Qual Life Res 2024; 33:467-479. [PMID: 37889384 PMCID: PMC10850260 DOI: 10.1007/s11136-023-03538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE As life expectancy continues to rise, post-treatment health-related quality of life (HRQoL) of breast cancer patients becomes increasingly important. This study examined the one-year longitudinal relation between axillary treatments and physical, psychosocial, and sexual wellbeing and arm symptoms. METHODS Women diagnosed with breast cancer who received different axillary treatments being axilla preserving surgery (APS) with or without axillary radiotherapy or full axillary lymph node dissection (ALND) with or without axillary radiotherapy were included. HRQoL was assessed at baseline, 6- and 12-months postoperatively using the BREAST-Q and the European Organization for Research and Treatment of Cancer QoL Questionnaire Breast Cancer Module (EORTC QLQ-BR23). Mixed regression models were constructed to assess the impact of axillary treatment on HRQoL. HRQoL at baseline was compared to HRQoL at 6- and at 12-months postoperatively. RESULTS In total, 552 patients were included in the mixed regressions models. Except for ALND with axillary radiotherapy, no significant differences in physical and psychosocial wellbeing were found. Physical wellbeing decreased significantly between baseline and 6- and 12-months postoperatively (p < 0.001, p = 0.035) and psychosocial wellbeing decreased significantly between baseline and 12 months postoperatively (p = 0.028) for ALND with axillary radiotherapy compared to APS alone. Arm symptoms increased significantly between baseline and 6 months and between baseline and 12 months postoperatively for APS with radiotherapy (12.71, 13.73) and for ALND with radiotherapy (13.93, 16.14), with the lowest increase in arm symptoms for ALND without radiotherapy (6.85, 7.66), compared to APS alone (p < 0.05). CONCLUSION Physical and psychosocial wellbeing decreased significantly for ALND with radiotherapy compared to APS alone. Shared decision making and expectation management pre-treatment could be strengthened by discussing arm symptoms per axillary treatment with the patient.
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Affiliation(s)
- N J M C Vrancken Peeters
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Z L R Kaplan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M E Clarijs
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - M A M Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - T van Dalen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - O Husson
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands.
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2
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Che Bakri NA, Kwasnicki RM, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff DR. The Use of Wearable Activity Monitors to Measure Upper Limb Physical Activity After Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy. Ann Surg Oncol 2023; 30:7036-7045. [PMID: 37507555 PMCID: PMC10562272 DOI: 10.1245/s10434-023-13966-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND We suspect that morbidity from both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) has been inadequately evaluated to date. Current methodologies are subjective and susceptible to bias. Objective assessment using wearable activity monitors (WAMs) would allow quantitative analysis of recovery by measuring physical activity (PA) and could provide evidence for axillary de-escalation. PATIENTS AND METHODS A prospective, single center, observational study was conducted from February 2020 to May 2022. Consecutive patients undergoing breast and/or reconstructive surgery and axillary surgeries were identified from the operating schedules. Patients wore WAMs for an average of 3 days prior to surgery and up to 2 weeks following surgery. In total, 56 patients with breast cancer were recruited, of whom 35 underwent SLNB and 21 ALND. RESULTS Patients who underwent ALND experienced significantly worse PA compared with those who underwent SLNB in week 2 (median 66.4% versus 72.7%, p = 0.015). Subgroup analysis revealed significantly lower PA in simple mastectomy (Mx)-ALND versus Mx-SLNB (median 90.3% versus 70.5%, p = 0.015) in week 2. The PA for SLNB did not return to baseline at 2 weeks after surgery. CONCLUSIONS Compared with SLNB, ALND results in a lower PA level in week 2. The findings also indicate that SLNB has a protracted effect on PA levels, which extend to 2 weeks postoperatively. Monitoring recovery objectively following breast cancer surgery provides patients and surgeons with more information regarding the predicted outcomes of their surgery, which can drive the development of a personalized rehabilitation program.
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Affiliation(s)
- Nur Amalina Che Bakri
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
| | - Richard M Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Luqman Tenang
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Naairah Khan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Catharina Moenig
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zoha Imam
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kieran Dhillon
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
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3
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Jung JG, Ahn SH, Lee S, Kim EK, Ryu JM, Park S, Lim W, Jung YS, Chung IY, Jeong J, Chang JH, Shin KH, Chang JM, Moon WK, Han W. No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS]: protocol of a prospective randomized clinical trial. BMC Cancer 2022; 22:189. [PMID: 35184724 PMCID: PMC8859876 DOI: 10.1186/s12885-022-09273-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
Background Following sentinel lymph node biopsy (SLNB), the axillary recurrence rate is very low although SLNB has a false-negative rate of 5–10%. In the ACOSOG Z0011 trial, non-sentinel positive-lymph nodes were found in more than 20% of the axillary dissection group; the SLNB only group did not have a higher axillary recurrence rate. These findings raised questions about the direct therapeutic effect of the SLNB. SLNB has post-surgical complications including lymphedema. Considering advances in imaging modalities and adjuvant therapies, the role of SLNB in early breast cancer needs to be re-evaluated. Methods The NAUTILUS trial is a prospective multicenter randomized controlled trial involving clinical stage T1–2 and N0 breast cancer patients receiving breast-conserving surgery. Axillary ultrasound is mandatory before surgery with predefined imaging criteria for inclusion. Ultrasound-guided core needle biopsy or needle aspiration of a suspicious node is allowed. Patients will be randomized (1:1) into the no-SLNB (test) and SLNB (control) groups. A total of 1734 patients are needed, considering a 5% non-inferiority margin, 5% significance level, 80% statistical power, and 10% dropout rate. All patients in the two groups will receive ipsilateral whole-breast radiation according to a predefined protocol. The primary endpoint of this trial is the 5-year invasive disease-free survival. The secondary endpoints are overall survival, distant metastasis-free survival, axillary recurrence rate, and quality of life of the patients. Discussion This trial will provide important evidence on the oncological safety of the omission of SLNB for early breast cancer patients undergoing breast-conserving surgery and receiving whole-breast radiation, especially when the axillary lymph node is not suspicious during preoperative axillary ultrasound. Trial registration ClinicalTrials.gov, NCT04303715. Registered on March 11, 2020.
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4
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McEvoy AM, Poplack S, Nickel K, Olsen MA, Ademuyiwa F, Zoberi I, Odom E, Yu J, Chang SH, Gillanders WE. Cost-effectiveness analyses demonstrate that observation is superior to sentinel lymph node biopsy for postmenopausal women with HR + breast cancer and negative axillary ultrasound. Breast Cancer Res Treat 2020; 183:251-262. [PMID: 32651755 DOI: 10.1007/s10549-020-05768-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/22/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of axillary observation versus sentinel lymph node biopsy (SLNB) after negative axillary ultrasound (AUS). In patients with clinical T1-T2 N0 breast cancer and negative AUS, SLNB is the current standard of care for axillary staging. However, SLNB is costly, invasive, decreasing in importance for medical decision-making, and is not considered therapeutic. Observation alone is currently being evaluated in randomized clinical trials, and is thought to be non-inferior to SLNB for patients with negative AUS. METHODS We performed cost-effectiveness analyses of observation versus SLNB after negative AUS in postmenopausal women with clinical T1-T2 N0, HR+/HER2- breast cancer. Costs at the 2016 price level were evaluated from a third-party commercial payer perspective using the MarketScan® Database. We compared cost, quality-adjusted life years (QALYs), and net monetary benefit (NMB). Multiple sensitivity analyses varying baseline probabilities, costs, utilities, and willingness-to-pay thresholds were performed. RESULTS Observation was superior to SLNB for patients with N0 and N1 disease, and for the entire patient population (NMB in US$: $655,659 for observation versus $641,778 for SLNB for the entire patient population). In the N0 and N1 groups, observation incurred lower cost and was associated with greater QALYs. SLNB was superior for patients with > 3 positive lymph nodes, representing approximately 5% of the population. Sensitivity analyses consistently demonstrated that observation is the optimal strategy for AUS-negative patients. CONCLUSION Considering both cost and effectiveness, observation is superior to SLNB in postmenopausal women with cT1-T2 N0, HR+/HER2- breast cancer and negative AUS.
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Affiliation(s)
- Aubriana M McEvoy
- Department of Surgery, Section of Endocrine and Oncologic Surgery, Washington University St. Louis, St. Louis, MO, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Steven Poplack
- Department of Diagnostic Radiology, Section of Breast Imaging, Washington, University St. Louis, St. Louis, MO, USA
- Siteman Cancer Center, St. Louis, MO, USA
| | - Katelin Nickel
- Division of Infectious Diseases, Center for Administrative Data Research, Washington University St. Louis, St. Louis, MO, USA
| | - Margaret A Olsen
- Siteman Cancer Center, St. Louis, MO, USA
- Division of Infectious Diseases, Center for Administrative Data Research, Washington University St. Louis, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Science, Washington University St. Louis, St. Louis, MO, USA
| | - Foluso Ademuyiwa
- Siteman Cancer Center, St. Louis, MO, USA
- Department of Medical Oncology, Washington, University St. Louis, St. Louis, MO, USA
| | - Imran Zoberi
- Siteman Cancer Center, St. Louis, MO, USA
- Department of Radiation Oncology, Washington, University St. Louis, St. Louis, MO, USA
| | - Elizabeth Odom
- Division of Plastic Surgery, Washington, University St. Louis, St. Louis, MO, USA
| | - Jennifer Yu
- Department of Surgery, Section of Endocrine and Oncologic Surgery, Washington University St. Louis, St. Louis, MO, USA
| | - Su-Hsin Chang
- Siteman Cancer Center, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Science, Washington University St. Louis, St. Louis, MO, USA
| | - William E Gillanders
- Department of Surgery, Section of Endocrine and Oncologic Surgery, Washington University St. Louis, St. Louis, MO, USA.
- Siteman Cancer Center, St. Louis, MO, USA.
- Department of Surgery, Washington University School of Medicine, Campus Box 8109, 4590 Children's Place, Suite 9600, St. Louis, MO, 63110, USA.
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5
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Arisio R, Borella F, Porpiglia M, Durando A, Bellino R, Bau MG, DE Sanctis C, Danese S, Benedetto C, Katsaros D. Axillary Dissection vs. no Axillary Dissection in Breast Cancer Patients With Positive Sentinel Lymph Node: A Single Institution Experience. In Vivo 2020; 33:1941-1947. [PMID: 31662523 DOI: 10.21873/invivo.11689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Axillary surgery of breast cancer patients is undergoing a paradigm shift, as axillary lymph node dissection's (ALND) usefulness is being questioned in the treatment of patients with tumor-positive sentinel lymph node biopsy (SLNB). The aim of this study was to investigate the overall survival (OS) and relapse-free survival (RFS) of patients with positive SLNB treated with ALND or not. PATIENTS AND METHODS We investigated 617 consecutive patients with cN0 operable breast cancer with positive SLNB undergoing mastectomy or conservative surgery. A total of 406 patients underwent ALND and 211 were managed expectantly. RESULTS No significant difference in OS and RFS was found between the two groups. The incidence of loco-regional recurrence in the SLNB-only group and the ALND group was low and not significant. CONCLUSION The type of breast cancer surgery and the omission of ALND does not improve OS or RSF rate in cases with metastatic SLN.
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Affiliation(s)
- Riccardo Arisio
- Department of Surgical Sciences, Sant'Anna Hospital, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Porpiglia
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy.,Breast Unit, Sant'Anna Hospital, Turin, Italy
| | - Antonio Durando
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Roberto Bellino
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 2, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria Grazia Bau
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Corrado DE Sanctis
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 3, Sant'Anna Hospital, Turin, Italy
| | - Saverio Danese
- Breast Unit, Sant'Anna Hospital, Turin, Italy.,Gynecology and Obstetrics 4, Sant'Anna Hospital, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Dionyssios Katsaros
- Gynecology and Obstetrics 1, Department of Surgical Sciences, University of Turin, Turin, Italy .,Breast Unit, Sant'Anna Hospital, Turin, Italy
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6
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Kuru B. The Adventure of Axillary Treatment in Early Stage Breast Cancer. Eur J Breast Health 2020; 16:1-15. [PMID: 31912008 DOI: 10.5152/ejbh.2019.5157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/14/2019] [Indexed: 01/12/2023]
Abstract
Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status of axillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accurately stages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND with or without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has been increasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has also been used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated with NAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currently the discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatment which have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breast cancer patients treated with or without NAC.
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Affiliation(s)
- Bekir Kuru
- Department of General Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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7
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Henke G, Knauer M, Ribi K, Hayoz S, Gérard MA, Ruhstaller T, Zwahlen DR, Muenst S, Ackerknecht M, Hawle H, Fitzal F, Gnant M, Mátrai Z, Ballardini B, Gyr A, Kurzeder C, Weber WP. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials 2018; 19:667. [PMID: 30514362 PMCID: PMC6278139 DOI: 10.1186/s13063-018-3021-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background Complete lymph node removal through conventional axillary dissection (ALND) has been standard treatment for breast cancer patients for almost a century. In the 1990s, however, and in parallel with the advent of the sentinel lymph node (SLN) procedure, ALND came under increasing scrutiny due to its association with significant patient morbidity. Several studies have since provided evidence to suggest omission of ALND, often in favor of axillary radiation, in selected clinically node-negative, SLN-positive patients, thus supporting the current trend in clinical practice. Clinically node-positive patients, by contrast, continue to undergo ALND in many cases, if only for the lack of studies re-assessing the indication for ALND in these patients. Hence, there is a need for a clinical trial to evaluate the optimal treatment for clinically node-positive breast cancer patients in terms of surgery and radiotherapy. The TAXIS trial is designed to fill this gap by examining in particular the value of tailored axillary surgery (TAS), a new technique for selectively removing positive lymph nodes. Methods In this international, multicenter, phase-III, non-inferiority, randomized controlled trial (RCT), including 34 study sites from four different countries, we plan to randomize 1500 patients to either receive TAS followed by ALND and regional nodal irradiation excluding the dissected axilla, or receive TAS followed by regional nodal irradiation including the full axilla. All patients undergo adjuvant whole-breast irradiation after breast-conserving surgery and chest-wall irradiation after mastectomy. The main objective of the trial is to test the hypothesis that treatment with TAS and axillary radiotherapy is non-inferior to ALND in terms of disease-free survival of clinically node-positive breast cancer patients in the era of effective systemic therapy and extended regional nodal irradiation. The trial was activated on 31 July 2018 and the first patient was randomized on 7 August 2018. Discussion Designed to test the hypothesis that TAS is non-inferior to ALND in terms of curing patients and preventing recurrences, yet is significantly superior in reducing patient morbidity, this trial may establish a new worldwide treatment standard in breast cancer surgery. If found to be non-inferior to standard treatment, TAS may significantly contribute to reduce morbidity in breast cancer patients by avoiding surgical overtreatment. Trial registration ClinicalTrials.gov, ID: NCT03513614. Registered on 1 May 2018. www.kofam.ch, ID: NCT03513614. Registered on 17 June 2018. EudraCT No.: 2018–000372-14. Electronic supplementary material The online version of this article (10.1186/s13063-018-3021-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007, St.Gallen, Switzerland
| | - Michael Knauer
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Karin Ribi
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland.,IBCSG Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland
| | - Stefanie Hayoz
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | | | - Thomas Ruhstaller
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Graubünden Cantonal Hospital, Loestrasse 170, 7000, Chur, Switzerland
| | - Simone Muenst
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Markus Ackerknecht
- Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Hanne Hawle
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Zoltan Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary
| | | | - Andreas Gyr
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
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8
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Thangarajah F, Malter W, Hamacher S, Schmidt M, Krämer S, Mallmann P, Kirn V. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67. Breast 2016; 30:87-91. [DOI: 10.1016/j.breast.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
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9
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Arraras JI, Manterola A, Asin G, Illarramendi JJ, Cruz SDL, Ibañez B, Delfrade J, Salgado E, Zarandona U, Cambra K, Vera R, Dominguez MA. Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study. Breast 2016; 26:46-53. [PMID: 27017241 DOI: 10.1016/j.breast.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE There is a debate on the role of adjuvant Radiotherapy (RT) in elderly breast cancer patients. The aim is to study Quality of Life (QL) throughout the treatment and follow-up periods in early stages breast cancer patients who have started radiotherapy, and to compare the QL of axillary surgery groups. METHODS 173 patients, ≥65 years completed the EORTC QLQ-C30 and QLQ-BR23, and the Interview for Deterioration in Daily Living Activities in Dementia(IDDD) questionnaires three times throughout treatment and follow-up periods. Linear mixed effect models were used to evaluate longitudinal changes in QL, and whether these changes differed among axillary surgery groups. RESULTS QL scores were high (>70/100 points) in most QL areas, with moderate limitations (>30) in sexual functioning and enjoyment, future perspective and global QL. In six areas there was a decline at the RT sessions end, that after 6 weeks was recovered. For three areas, there was an improvement in the follow-up measurement compared to the previous assessments. Changes in seven areas were <5 points. Axillary node dissection patients had a body image decrease (6 points) in the follow up period. The lymphadenectomy group had more fatigue (10 points, p = 0.078) than the other two axillary surgery groups. CONCLUSIONS Results orientate towards good patients' adaptation to their disease and treatments, and to administering RT in early stages breast cancer patients. QL differences between the axillary surgery groups and in their evolutions were few but have appeared in key QL areas.
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Affiliation(s)
- Juan Ignacio Arraras
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain; Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain.
| | - Ana Manterola
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Gemma Asin
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Jose Juan Illarramendi
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Susana de la Cruz
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Berta Ibañez
- Fundación Miguel Servet-NavarraBiomed, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Irunlarrea 3, 31008 Pamplona, Spain
| | - Josu Delfrade
- Instituto Salud Pública, CIBER Salud Pública, Leyre 3, 31003 Pamplona, Spain
| | - Esteban Salgado
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Uxue Zarandona
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain; Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Koldo Cambra
- Fundación Miguel Servet-NavarraBiomed, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Irunlarrea 3, 31008 Pamplona, Spain
| | - Ruth Vera
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Miguel Angel Dominguez
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
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10
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Matsuzawa F, Omoto K, Einama T, Abe H, Suzuki T, Hamaguchi J, Kaga T, Sato M, Oomura M, Takata Y, Fujibe A, Takeda C, Tamura E, Taketomi A, Kyuno K. Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer: a preliminary clinical trial. SPRINGERPLUS 2015; 4:509. [PMID: 26405629 PMCID: PMC4573976 DOI: 10.1186/s40064-015-1291-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022]
Abstract
Breast cancer is the most common type of cancer in women. The 5-year survival rate in patients with breast cancer ranges from 74 to 82 %. Sentinel lymph node biopsy has become an alternative to axillary lymph node dissection for nodal staging. We evaluated the detection of the sentinel lymph node and metastasis of the lymph node using contrast enhanced ultrasonography with Sonazoid. Between December 2013 and May 2014, 32 patients with operable breast cancer were enrolled in this study. We evaluated the detection of axillary sentinel lymph nodes and the evaluation of axillary lymph nodes metastasis using contrast enhanced computed tomography, color Doppler ultrasonography and contrast enhanced ultrasonography with Sonazoid. All the sentinel lymph nodes were identified, and the sentinel lymph nodes detected by contrast enhanced ultrasonography with Sonazoid corresponded with those detected by computed tomography lymphography and indigo carmine method. The detection of metastasis based on contrast enhanced computed tomography were sensitivity 20.0 %, specificity 88.2 %, PPV 60.0 %, NPV 55.6 %, accuracy 56.3 %. Based on color Doppler ultrasonography, the results were sensitivity 36.4 %, specificity 95.2 %, PPV 80.0 %, NPV 74.1 %, accuracy 75.0 %. Based on contrast enhanced ultrasonography with Sonazoid, the results were sensitivity 81.8 %, specificity 95.2 %, PPV 90.0 %, NPV 90.9 %, accuracy 90.6 %. The results suggested that contrast enhanced ultrasonography with Sonazoid was the most accurate among the evaluations of these modalities. In the future, we believe that our method would take the place of conventional sentinel lymph node biopsy for an axillary staging method.
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Affiliation(s)
- Fumihiko Matsuzawa
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan ; Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo, Hokkaido 060-8638 Japan
| | - Kiyoka Omoto
- Diagnostic Ultrasound Division, Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503 Japan
| | - Takahiro Einama
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Hironori Abe
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Takashi Suzuki
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Jun Hamaguchi
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Terumi Kaga
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Mami Sato
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Masako Oomura
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Yumiko Takata
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Ayako Fujibe
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Chie Takeda
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Etsuya Tamura
- Department of Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo, Hokkaido 060-8638 Japan
| | - Kenichi Kyuno
- Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, 2 East 5 South 9, Obihiro, Hokkaido 080-0805 Japan
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11
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Li CZ, Zhang P, Li RW, Wu CT, Zhang XP, Zhu HC. Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: A meta-analysis. Eur J Surg Oncol 2015; 41:958-66. [PMID: 26054706 DOI: 10.1016/j.ejso.2015.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/21/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In early breast cancer patients with sentinel node metastasis, the effect of axillary lymph node dissection (ALND) is controversial. The purpose of this study is to compare the safety and efficacy of sentinel lymph node biopsy (SLNB) alone versus ALND in patients with early breast cancer and sentinel node metastasis. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1965 to February 2014. All data were analyzed using Review Manager Software 5.2. RESULTS 12 studies, which included 130,575 patients from five randomized controlled trials and seven observational studies, met our inclusion criteria. 26,870 early breast cancer patients underwent SLNB alone and 103,705 underwent ALND. Patients underwent ALND had more paresthesia (risk ratio [RR] 0.26, 95% confidence interval [CI] 0.20-0.33; p < 0.01) and lymphedema (RR 0.28, 95% CI 0.20-0.41; p < 0.01) than those had SLNB alone. There were no significant differences in overall survival (hazard ratio [HR] 0.95, 95% CI 0.85-1.06; p = 0.35), disease-free survival (HR 1.00, 95% CI 0.98-1.02, p = 0.96), and locoregional recurrence (RR 0.92, 95% CI 0.59-1.44; p = 0.73). CONCLUSION Current evidence indicates that axillary dissection may be omitted in early breast cancer patients with sentinel lymph metastasis.
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Affiliation(s)
- C Z Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - P Zhang
- Nursing and Rehabilitation College, Hebei United University, Tangshan 063000, Hebei, China
| | - R W Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - C T Wu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - X P Zhang
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - H C Zhu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China.
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12
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Harder H, Langridge C, Solis-Trapala I, Zammit C, Grant M, Rees D, Burkinshaw L, Jenkins V. Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Matsuzawa F, Einama T, Abe H, Suzuki T, Hamaguchi J, Kaga T, Sato M, Oomura M, Takata Y, Fujibe A, Takeda C, Tamura E, Taketomi A, Kyuno K. Accurate diagnosis of axillary lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid. Mol Clin Oncol 2014; 3:299-302. [PMID: 25798257 DOI: 10.3892/mco.2014.483] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 01/23/2023] Open
Abstract
Axillary lymph node enlargement following sentinel lymph node biopsy (SLNB) is often difficult to accurately diagnose. In keeping with the characteristically tortuous and aberrant pattern of tumor neovasculature, metastatic lymph nodes exhibit peripheral and mixed vascularity, resulting in a microvasculature that is often difficult to visualize. Contrast-enhanced ultrasonography (CEUS) with Sonazoid, a new generation contrast agent for ultrasonography, allows for the visualization of lymph node microvessels and may enable a more accurate evaluation of lymph node metastasis. This is a case report of axillary lymph node enlargement following SLNB, in which CEUS with Sonazoid resulted in an accurate diagnosis. On the basis of our experience with this case, we have initiated a clinical trial to evaluate the detection of lymph node metastasis through the use of CEUS in breast cancer patients.
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Affiliation(s)
| | - Takahiro Einama
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Hironori Abe
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Takashi Suzuki
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Jun Hamaguchi
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Terumi Kaga
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Mami Sato
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Masako Oomura
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Yumiko Takata
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Ayako Fujibe
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Chie Takeda
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Etsuya Tamura
- Clinical Laboratory, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kenichi Kyuno
- Departments of Surgery, Obihiro Hospital, Obihiro, Hokkaido 080-0805
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14
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Hamidou Z, Dabakuyo-Yonli TS, Guillemin F, Conroy T, Velten M, Jolly D, Causeret S, Graesslin O, Gauthier M, Mercier M, Bonnetain F. Impact of response shift on time to deterioration in quality of life scores in breast cancer patients. PLoS One 2014; 9:e96848. [PMID: 24828426 PMCID: PMC4020802 DOI: 10.1371/journal.pone.0096848] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background This prospective multicenter study aimed to study the impact of the recalibration component of response-shift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD. Methods The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD. Results From February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, social-functioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38–0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD. Conclusions Our results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients.
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Affiliation(s)
- Zeinab Hamidou
- Quality of life and Cancer clinical research Platform, Marseille, France
- Public health laboratory, EA 3279-College of Medicine, Marseille, France
- * E-mail:
| | - Tienhan S. Dabakuyo-Yonli
- Quality of life and Cancer clinical research Platform, Marseille, France
- Biostatistic and Quality of Life Unit, Centre Georges François Leclerc, Dijon, France
- EA 4184, College of Medicine, Dijon, France
| | - Francis Guillemin
- Quality of life and Cancer clinical research Platform, Marseille, France
- Inserm, CIC-EC, department of clinical epidemiology and evaluation, university hospital of Nancy, Nancy, France
| | - Thierry Conroy
- Medical oncology department, Centre Alexis Vautrin, Nancy, France
| | - Michel Velten
- Quality of life and Cancer clinical research Platform, Marseille, France
- Epidemiology and public health laboratory, College of Medicine, Strasbourg, France
| | - Damien Jolly
- Quality of life and Cancer clinical research Platform, Marseille, France
- University hospital of Reims, Reims, France
| | - Sylvain Causeret
- Surgery department, Centre Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Gynecology and Obstetrics Department, Mother Child Institute, University hospital of Reims, Reims, France
| | - Mélanie Gauthier
- Quality of life and Cancer clinical research Platform, Marseille, France
- Biostatistic and Quality of Life Unit, Centre Georges François Leclerc, Dijon, France
- EA 4184, College of Medicine, Dijon, France
| | - Mariette Mercier
- Quality of life and Cancer clinical research Platform, Marseille, France
- Cellular and Molecular Biology Laboratory, University hospital of Besançon, Besançon, France
| | - Franck. Bonnetain
- Quality of life and Cancer clinical research Platform, Marseille, France
- Methodology and quality of Life in Oncology unit (EA 3181), University hospital of Besançon, Besançon, France
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15
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Terata K, Motoyama S, Kamata S, Hinai Y, Miura M, Sato Y, Yoshino K, Ito A, Imai K, Saito H, Minamiya Y. Evaluation of the potential for lymph node metastasis using CRP 1846C>T genetic polymorphism in invasive breast cancer. Tumour Biol 2014; 35:5931-5. [PMID: 24633920 DOI: 10.1007/s13277-014-1786-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/21/2014] [Indexed: 01/07/2023] Open
Abstract
Lymph node status is a key indicator of the best approach to treatment of invasive breast cancer. However, the accuracy with which lymph node metastasis is diagnosed is not currently satisfactory. New and more reliable methods that enable one to know who has a greater potential for lymph node metastasis would be highly desirable. We previously reported that lymph node involvement in esophageal and lung cancer may have a genetic component: C-reactive protein (CRP) 1846C>T genetic polymorphism. Here we examined the diagnostic value of CRP 1846C>T polymorphism for assessing the risk of lymph node metastasis in cases of invasive breast cancer. The study participants were 185 women with invasive breast cancer who underwent curative surgery with lymph node dissection. Using DNA from blood samples and polymerase chain reaction-restriction fragment length polymorphism, the utility of CRP genetic 1846C>T polymorphism (rs1205) for assessing the risk of lymph node metastasis was evaluated. Fifty-two (28 %) patients had lymph node metastasis. After the patients were divided into two groups based on their CRP 1846 genotypes (C/C+C/T and T/T), the clinical characteristics did not differ between the groups, but there was a significantly greater incidence of lymph node metastasis among patients in the T/T group. Moreover, the odds ratio for lymph node involvement in patients carrying the 1846 T/T genotype was more than 2.2 in multivariate logistic regression models. CRP genetic polymorphism may be a novel predictor of the risk of lymph node metastasis in invasive breast cancer.
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Affiliation(s)
- Kaori Terata
- Division of Brest Surgery, Akita Red Cross Hospital, Akita, Japan
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16
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Somana-Ehrminger S, Dabakuyo TS, Manckoundia P, Ouédraogo S, Marilier S, Arveux P, Quipourt V. Influence of geriatric oncology consultation on the management of breast cancer in older women: A French population-based study. Geriatr Gerontol Int 2014; 15:111-9. [DOI: 10.1111/ggi.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Sophie Somana-Ehrminger
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
| | - Tienhan S Dabakuyo
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- National Institute of Health and Medical Research INSERM U1093; Motricity-Plasticity: Performance, Dysfunction, Aging and Technology Optimization; University of Burgundy, Faculty of Sport Sciences; Dijon Cedex France
| | - Samiratou Ouédraogo
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Sophie Marilier
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- Coordination Unit in Geriatric Oncology in Burgundy; Hospital of Champmaillot, University Hospital; Dijon Cedex France
| | - Patrick Arveux
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- Coordination Unit in Geriatric Oncology in Burgundy; Hospital of Champmaillot, University Hospital; Dijon Cedex France
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Schipper R, van Roozendaal L, de Vries B, Pijnappel R, Beets-Tan R, Lobbes M, Smidt M. Axillary ultrasound for preoperative nodal staging in breast cancer patients: Is it of added value? Breast 2013; 22:1108-13. [DOI: 10.1016/j.breast.2013.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022] Open
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18
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Impact of sentinel node biopsy on long-term quality of life in breast cancer patients. Br J Cancer 2013; 109:2783-91. [PMID: 24169352 PMCID: PMC3844912 DOI: 10.1038/bjc.2013.658] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to assess long-term quality of life (QoL) over a period of 6 years in women with breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or SLNB followed by ALND. METHODS The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-C30 and the EORTC-QLQ-BR-23 questionnaires were used to assess QoL before surgery, just after surgery, 6, 12 and 72 months later. The longitudinal effect of surgical modalities on QoL was assessed with a mixed model analysis of variance for repeated measurements. RESULTS Five hundred and eighteen BC patients were initially included. The median follow-up was 6 years. During the follow-up, 61 patients died. None of the patients of the SLNB group developed lymphedema during follow-up and the relapse rate was similar in the different groups (P=0.62). Before surgery, global health status (P=0.52) and arm symptoms (BRAS) (P=0.99) QoL scores were similar whatever the surgical procedure. The BRAS score (P=0.0001) was better in the SLNB group 72 months after surgery. Moreover, during follow-up, patients treated with SLNB had lower arm symptoms scores than ALND patients and there was no difference for arm symptoms between patients treated with ALND and those treated with SLNB followed by complementary ALND. CONCLUSION Long-term follow-up showed that SLNB was associated with less morbidity than ALND.
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19
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Delpech Y, Bricou A, Lousquy R, Hudry D, Jankowski C, Willecocq C, Thoury A, Loustalot C, Coutant C, Barranger E. The Exportability of the ACOSOG Z0011 Criteria for Omitting Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy Findings: A Multicenter Study. Ann Surg Oncol 2013; 20:2556-61. [DOI: 10.1245/s10434-013-2917-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Indexed: 11/18/2022]
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20
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Rotonda C, Guillemin F, Bonnetain F, Velten M, Conroy T. Factors associated with fatigue after surgery in women with early-stage invasive breast cancer. Oncologist 2013; 18:467-75. [PMID: 23404818 DOI: 10.1634/theoncologist.2012-0300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Fatigue is one of the most frequent symptoms in patients with cancer. However, the precise determinants of fatigue are still unknown. This study was conducted to investigate factors correlated with cancer-related fatigue before surgery and just before subsequent adjuvant therapy. METHODS Patients completed the Multidimensional Fatigue Inventory (MFI-20), the European Organization for Research and Treatment of Cancer 30-item quality-of-life questionnaire before and after surgery, the Trait Anxiety Inventory and the Life Orientation Test before surgery, and the State Anxiety Inventory before the start of adjuvant therapy. Multiple regression analysis of determinants of change in MFI-20 total score after surgery was conducted. RESULTS A series of 466 eligible patients with stage I-III breast cancer with planned surgery were recruited. An increase in MFI-20 total score after surgery was significantly correlated with higher preoperative fatigue and lower role functioning before surgery; a decrease in role functioning, physical functioning, and cognitive functioning after surgery; an increase in insomnia after surgery; and a higher state anxiety after surgery. Disease stage, lymph node metastases, surgical procedure, and demographic characteristics (e.g., age, marital status, having children, educational level) were not correlated with fatigue in multivariate analysis. CONCLUSION These results suggest that worsening fatigue after surgery for breast cancer is associated with a decrease in physical functioning and an increase in psychological distress rather than with the cancer characteristics. Therefore, screening measures should be implemented at the time of diagnosis-before starting treatment-to identify psychologically vulnerable patients and to offer them professional support.
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21
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Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis. Eur J Cancer 2012; 49:812-25. [PMID: 23084155 DOI: 10.1016/j.ejca.2012.09.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Z0011-study, a landmark randomised controlled trial (RCT) challenged the benefits of complete axillary lymph node dissection (ALND) compared with sentinel lymph node dissection only (SLND) in breast cancer patients with positive sentinel nodes. The study, however, has been criticised for lack of power and low applicability. The aim of this review was to systematically assess the evidence on the comparative benefits and harms of ALND versus SLND for sentinel node positive breast cancer patients. METHODS We systematically searched PubMed, Embase, the Cochrane Library, and reference lists of pertinent review articles from January 2006 to August 2011. We dually reviewed the literature and rated the risk of bias of each study. For effectiveness, we included RCTs and observational studies of at least 1 year follow-up. In addition, we considered studies conducted in sentinel node-negative women to assess the risk of harms. If data were sufficient, we conducted random effects meta-analysis of outcomes of interest. RESULTS Meta-analysis of three studies with 50,120 patients indicated similar 5-year survival and regional recurrence rates between patients treated with ALND or SLND, although prognostic tumour characteristics varied among the 3 study-populations. Results from 6 studies on more than 11,500 patients reported a higher risk for harms for ALND than SLND. Long-term evidence on pertinent health outcomes is missing. CONCLUSION The available evidence indicates that for some women with early invasive breast cancer SLND appears to be a justifiable alternative to ALND. Surgeons need to discuss advantages and disadvantages of both approaches with their patients.
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22
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Cluze C, Retornaz F, Rey D, Meresse M, Rousseau F, Bouhnik AD, Giorgi R. Inequality in sentinel lymph node dissection for elderly women with early stage breast cancer: Results from a French prospective cohort study. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Poirier AL, Kwiatkowski F, Commer JM, D'Aillières B, Berger V, Mercier M, Bonnetain F. Health-related quality of life in cancer patients at the end of life, translation, validation, and longitudinal analysis of specific tools: study protocol for a randomized controlled trial. Trials 2012; 13:39. [PMID: 22520742 PMCID: PMC3349579 DOI: 10.1186/1745-6215-13-39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/20/2012] [Indexed: 11/11/2022] Open
Abstract
Background The end of life for cancer patients is the ultimate stage of the disease, and care in this setting is important as it can improve the wellbeing not only of patients, but also the patients' family and close friends. As it is a matter of profoundly personal concerns, patients' perception of this phase of the disease is difficult to assess and has thus been insufficiently studied. Nonetheless, caregivers are required to provide specific care to help patients and to treat them in order to improve their wellbeing during this period. While tools to assess health-related quality of life (QoL) in cancer patients at the end of life exist in English, to our knowledge, no validated tools are available in French. Methods/design This randomized multicenter cohort study will be carried out to cross-culturally adapt and validate a French version of the English QUAL-E and the Missoula Vitas Quality Of Life Index (MVQOLI) questionnaires for advanced cancer patients in a palliative setting. A randomized clinical trial component in addition to a cohort study is implemented in order to test psychometric hypotheses: order effect and improvement of sensibility to change. The validation procedure will ensure that the psychometric properties are maintained. The main criterion to assess the reliability of the questionnaires will be reproducibility (test-retest method) using intraclass correlation coefficients. It will be necessary to include 372 patients. The sensitivity to change, discriminant capability as well as convergent validity will be also investigated. Discussion If the cross-cultural validation of the MVQOLI and QUAL-E questionnaires for advanced cancer patients in a palliative setting have satisfactory psychometric properties, it will allow us to assess the specific dimensions of QoL at the end of life. Trial registration Current Controlled Trials NCT01545921.
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Affiliation(s)
- Anne-Lise Poirier
- Centre d'Evaluation Clinique en Oncologie, Centre Paul Papin, Angers, France.
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Dabakuyo TS, Guillemin F, Conroy T, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Gauthier M, Bonnetain F. Response shift effects on measuring post-operative quality of life among breast cancer patients: a multicenter cohort study. Qual Life Res 2012; 22:1-11. [PMID: 22383104 DOI: 10.1007/s11136-012-0135-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To characterize response shift effects in patients with breast cancer (BC). METHODS The QLQ-C30, BR23, and EurQOL-EQ-5D were assessed at baseline and at the end of the first hospitalization. We used the then-test approach to characterize changes in internal standards by calculating the mean difference between the then-test (retrospective measure) and pre-test baseline QoL assessments. The Ideal Scale Approach was also used to assess changes in standards by comparing health and QoL expectancies between baseline and the end of the first hospitalization. Successive Comparison Approach was used to assess changes in values through the longitudinal assessment of the relative importance of EuroQOL dimensions. RESULTS The results of this study showed that recalibration RS effects occurred early after the first hospitalization for 6/15 dimensions of QLQ-C30 (emotional, cognitive, fatigue, insomnia, appetite loss, diarrhea) and 2/8 of BR-23 (future perspective, systemic therapy side effects). Moreover, health and QoL expectancies changed between the baseline and the end of the first hospitalization, and changes in values were seen for the self-care and usual activities dimensions of the EuroQOL-EQ-5D. CONCLUSIONS The occurrence of RS early after the first hospitalization suggests that it needs to be taken into account to interpret QoL changes in BC.
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Affiliation(s)
- T S Dabakuyo
- Biostatistics and Epidemiology Unit, Centre Georges François Leclerc, 1 rue Professeur Marion, 21000, Dijon, France.
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Hamidou Z, Dabakuyo TS, Mercier M, Fraisse J, Causeret S, Tixier H, Padeano MM, Loustalot C, Cuisenier J, Sauzedde JM, Smail M, Combier JP, Chevillote P, Rosburger C, Arveux P, Bonnetain F. Time to deterioration in quality of life score as a modality of longitudinal analysis in patients with breast cancer. Oncologist 2011; 16:1458-68. [PMID: 21948650 DOI: 10.1634/theoncologist.2011-0085] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This prospective multicenter study explored different definitions of time to deterioration (TTD) in quality of life (QoL) scores, according to different cutoffs of the minimal clinically important difference (MCID) as a modality for longitudinal QoL assessment in breast cancer patients. METHODS QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR-23 before surgery, after surgery, and 6 and 12 months later. The global health score, arm symptoms score (BRAS), and breast symptoms score were analyzed. For a given baseline score, QoL was considered to have deteriorated if this score decreased by ≥5 points at any time point after baseline. Analyses were repeated using an MCID of 10 points and taking the score after surgery as the reference score (to explore the occurrence of response shift). TTD was calculated using the Kaplan-Meier method and Cox regression was used to identify independent factors associated with TTD. RESULTS Two hundred thirty-five patients underwent axillary lymph node dissection (ALND), 222 underwent sentinel lymph node biopsy (SLNB), and 61 underwent SLNB plus ALND. Patients who underwent SLNB had a significantly longer TTD for the BRAS dimension than those who underwent ALND. Cox multivariate analyses showed that treatment using SLNB and age >59 years were independently associated with longer TTD for the BRAS, whereas surgery elsewhere than at the Centre Georges François Leclerc was associated with a shorter TTD. CONCLUSION Exploration of different definitions of TTD in QoL provides meaningful longitudinal QoL results for clinicians.
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Affiliation(s)
- Zeinab Hamidou
- Unité de Biostatistiques et d’Épidémiologie, Centre Georges Franc¸ois Leclerc, Dijon, France
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Shiller SM, Weir R, Pippen J, Punar M, Savino D. The sensitivity and specificity of sentinel lymph node biopsy for breast cancer at Baylor University Medical Center at Dallas: a retrospective review of 488 cases. Proc (Bayl Univ Med Cent) 2011; 24:81-5. [PMID: 21566748 DOI: 10.1080/08998280.2011.11928687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Sentinel lymph node (SLN) biopsy has become the standard of care for breast carcinoma management, as it precludes the negative morbid effects-including decreased shoulder range of motion, lymphedema, and paresthesias-of unnecessary axillary lymph node dissection. However, the method of pathologic evaluation of the lymph node has been scrutinized to obtain the greatest sensitivity, specificity, and negative predictive value, ultimately for the benefit of the patient. This retrospective study analyzed 488 biopsies completed by two surgeons and read by multiple pathologists affiliated with Pathologists Biomedical Laboratories. When metastatic disease was not grossly obvious, analysis of the SLN began with touch imprint cytology and, if necessary, a frozen section analysis. On the subsequent day, three levels of the SLN were analyzed with hematoxylin and eosin stain and immunohistochemistry with cytokeratin AE1-3 and the appropriate control. Touch imprint cytology and/or frozen section analysis (where applicable) correctly identified 78 of 89 macrometastases, with a sensitivity of 88%, specificity of 100%, and negative predictive value of 97%. Sensitivity was 72% for micrometastases and 60% for isolated tumor cells, each with 100% specificity. In conclusion, the sensitivity and specificity of SLN biopsy at our institution compares with the higher end of percentages reported in the literature.
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Affiliation(s)
- S Michelle Shiller
- Department of Pathology (Shiller, Weir, Punar, Savino) and Oncology (Pippen), Baylor University Medical Center at Dallas and Baylor Charles A. Sammons Cancer Center at Dallas. Dr. Shiller is now at the Mayo Clinic, Rochester, Minnesota
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Wang Z, Wu LC, Chen JQ. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis. Breast Cancer Res Treat 2011; 129:675-89. [DOI: 10.1007/s10549-011-1665-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022]
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Bonnetain F. Qualité de vie relative à la santé et critères de jugement en cancérologie. Cancer Radiother 2010; 14:515-8. [DOI: 10.1016/j.canrad.2010.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
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Comparison of early and delayed lymphoscintigraphy images of early breast cancer patients undergoing sentinel node mapping. Nucl Med Commun 2010. [DOI: 10.1097/mnm.0b013e328337eea8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Straver ME, Meijnen P, van Tienhoven G, van de Velde CJH, Mansel RE, Bogaerts J, Duez N, Cataliotti L, Klinkenbijl JHG, Westenberg HA, van der Mijle H, Snoj M, Hurkmans C, Rutgers EJT. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol 2010; 17:1854-61. [PMID: 20300966 PMCID: PMC2889289 DOI: 10.1245/s10434-010-0945-z] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Indexed: 01/07/2023]
Abstract
Background The randomized EORTC 10981-22023 AMAROS trial investigates whether breast cancer patients with a tumor-positive sentinel node biopsy (SNB) are best treated with an axillary lymph node dissection (ALND) or axillary radiotherapy (ART). The aim of the current substudy was to evaluate the identification rate and the nodal involvement. Methods The first 2,000 patients participating in the AMAROS trial were evaluated. Associations between the identification rate and technical, patient-, and tumor-related factors were evaluated. The outcome of the SNB procedure and potential further nodal involvement was assessed. Results In 65 patients, the sentinel node could not be identified. As a result, the sentinel node identification rate was 97% (1,888 of 1,953). Variables affecting the success rate were age, pathological tumor size, histology, year of accrual, and method of detection. The SNB results of 65% of the patients (n = 1,220) were negative and the patients underwent no further axillary treatment. The SNB results were positive in 34% of the patients (n = 647), including macrometastases (n = 409, 63%), micrometastases (n = 161, 25%), and isolated tumor cells (n = 77, 12%). Further nodal involvement in patients with macrometastases, micrometastases, and isolated tumor cells undergoing an ALND was 41, 18, and 18%, respectively. Conclusions With a 97% detection rate in this prospective international multicenter study, the SNB procedure is highly effective, especially when the combined method is used. Further nodal involvement in patients with micrometastases and isolated tumor cells in the sentinel node was similar—both were 18%.
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Affiliation(s)
- Marieke E Straver
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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de Vries M, Hoekstra HJ, Hoekstra-Weebers JEHM. Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma. Ann Surg Oncol 2009; 16:2840-7. [PMID: 19639366 PMCID: PMC2749179 DOI: 10.1245/s10434-009-0602-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 06/09/2009] [Accepted: 06/18/2009] [Indexed: 01/15/2023]
Abstract
Background The aim of this study was to asses quality of life (QoL) after axillary or inguinal sentinel lymph node biopsy (SLNB) with or without completion lymph node dissection (CLND) in patients with cutaneous melanoma by comparing patients to a norm group of the general population and by comparing QoL between four patient groups depending on surgical procedure and location, i.e., patients receiving an axillary or groin SLNB, or an axillary or groin CLND. Methods Between 1995 and 2003, a total of 242 axillary and inguinal SLNBs were performed. Of the 127 patients eligible for the study, 116 patients participated (91%). QoL was measured by the 30-item European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the McGill Pain Questionnaire and the Groningen Activity Restriction Scale. Results Median age at diagnosis was 50 (range, 18–77) years; median Breslow thickness 2.0 (range, 1–13) mm; median follow-up 56 (range, 4–94) months. SLNB only was performed in 89 patients (77%): 48 in the groin and 41 in the axilla. CLND was performed in 27 patients (23%): 13 in the axilla and 14 in the groin. More postoperative complications (13 vs. 5; P < 0.001) and lymphedema (10 vs. 8; P < 0.001) occurred in the CLND group than in the SLNB group. The total group of patients reported better physical (P < 0.001), role (P < 0.001), emotional (P < 0.001), and social functioning (P = 0.049), global QoL (P < 0.001), and less fatigue (P < 0.001) and pain (P < 0.001) than a German norm group. Analysis of variance revealed significant differences in role functioning (P = 0.02) and tendencies toward physical problems (P = 0.051) and fatigue (P = 0.051) between the four groups. Post hoc Bonferroni tests showed that the axillary CLND group had more problems than the axillary and inguinal SLNB groups. Kruskal-Wallis tests showed that the axillary CLND group reported most pain. Conclusions QoL in melanoma survivors after axillary or inguinal SLNB with or without CLND was better than that in a norm group. Patients who underwent CLND in the axilla after SLNB reported most problems.
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Affiliation(s)
- Mattijs de Vries
- Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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