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Sun GY, Wen G, Zhang YJ, Tang Y, Jing H, Fang H, Wang JY, Zhang JH, Zhao XR, Chen SY, Song YW, Jin J, Liu YP, Tang Y, Qi SN, Li N, Chen B, Lu NN, Li YX, Wang SL. Risk factors to identify the indication for regional nodal irradiation in T1-2N1M0 breast cancer: A joint analysis of 4,243 real-world cases from two institutions. Front Oncol 2022; 12:955381. [PMID: 36605447 PMCID: PMC9807655 DOI: 10.3389/fonc.2022.955381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose The aim of this study is to evaluate the role of regional nodal irradiation (RNI) in patients with T1-2N1M0 breast cancer and to identify the subgroup that could benefit from RNI. Methods and materials A total of 4,243 women with pT1-2N1M0 breast cancer treated at two institutions in China were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test. The association of risk factors with survival outcomes was evaluated using multivariable proportional hazards regression. Results A total of 932 patients (22.0%) received RNI. At a median follow-up of 5.9 years, the 5-year locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS) rates were 4.0% and 7.2% (P = 0.001), 13.2% and 10.6% (P = 0.465), 85.0% and 84.7% (P = 0.131), and 93.9% and 92.8% (P = 0.004) in the RNI and non-RNI groups, respectively. Multivariate analysis revealed that RNI was an independent prognostic factor for lower LRR (P = 0.001) and longer DFS (P = 0.013). Patients were stratified into low-, intermediate-, and high-risk groups based on the eight non-therapeutic risk factors. RNI significantly decreased the 5-year LRR (2.2% vs. 7.0%, P = 0.001) and improved the 5-year DFS (88.8% vs. 84.9%, P = 0.015) and OS (95.8% vs. 93.9%, P = 0.010) in the intermediate-risk group. However, neither the low-risk group nor the high-risk group had survival benefit from RNI. Conclusion T1-2N1M0 breast cancer is a heterogeneous disease. We found that RNI only improved survival in the intermediate-risk group. It might be omitted in low-risk patients, and the role of RNI in high-risk patients needs further study.
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Affiliation(s)
- Guang-Yi Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Wen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China,Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-Jing Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Yang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang-Hu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu-Ran Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Ye Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Ye-Xiong Li, ; Shu-Lian Wang,
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Ye-Xiong Li, ; Shu-Lian Wang,
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Zeng Y, Gao W, Chen X, Shen K. Association of 21-gene recurrence score and locoregional recurrence in early breast cancer patients. Cancer Biomark 2022; 35:111-118. [DOI: 10.3233/cbm-210274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The 21-gene recurrence score (RS) assay has been validated to predict the risk of disease-free survival in estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer patients. However, its relation with locoregional recurrence (LRR) risk is unclear. OBJECTIVE: This study aimed to explore the ability of RS to predict LRR risk. METHODS: Consecutive ER-positive, HER2-negative, pT1, pN0-1, and M0 early breast cancer patients were analyzed retrospectively. According to RS, patients were divided into low- (RS < 18), intermediate- (RS 18–30), and high-risk (RS ⩾ 31) groups. The primary endpoint was LRR. Subgroup analysis was conducted according to different nodal statuses and surgery types. RESULTS: A total of 1558 patients were enrolled: 354 (22.7%), 788 (50.6%), and 416 (26.7%) patients in the low-, intermediate-, and high-risk groups, respectively. The median follow-up time was 53 months, and 2, 8, and 14 LRR events were observed in the low-, intermediate-, and high-risk groups, respectively (P= 0.004). Both univariate (P= 0.009) and multivariate (P= 0.010) analyses demonstrated that 21-gene RS was correlated with LRR. Compared to low-risk patients, high-risk patients were at greater risk of LRR (HR 5.75, 95% CI 1.30–25.31, P= 0.021). Among pN0 (P= 0.033), pN1 (P= 0.049) and postmastectomy patients (P= 0.012), 21-gene RS remained predictive of the risk of LRR. CONCLUSION: The 21-gene RS assay was significantly associated with the risk of LRR in ER-positive, HER2-negative early breast cancer patients. Among patients with different nodal statuses and patients receiving mastectomy, RS remained predictive of the risk of LRR.
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Circ-DONSON Knockdown Inhibits Cell Proliferation and Radioresistance of Breast Cancer Cells via Regulating SOX4. JOURNAL OF ONCOLOGY 2021; 2021:8461740. [PMID: 34853591 PMCID: PMC8629618 DOI: 10.1155/2021/8461740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
Background Circular RNAs have been validated as critical regulators in the development of breast cancer (BC). Circ-DONSON is involved in the progression of glioma and gastric cancer. However, the biological role of circ-DONSON in BC remains unclear, and the aim of this study was to explore the biological role of circ-DONSON in BC. Methods Human tissue samples and BC cell lines were collected in this study. siRNAs against circ-DONSON were transfected into BC cell lines for silencing of circ-DONSON. Quantitative real-time PCR was used to test the circ-DONSON expression. Cell counting kit-8 (CCK-8), 5-bromo-2' deoxyuridine enzyme-linked immunosorbent assay (BrdU-ELISA), colony formation, and caspase-3 activity assays were used to assess cell proliferation, cell survival, and cell viability. Western blotting analysis was used to detect the protein expression levels. Results Our findings showed that circ-DONSON showed high expression in BC tissues and cell lines. CCK-8 and BrdU-ELISA assays showed that circ-DONSON knockdown inhibited BC cell proliferation. Moreover, cell survival, cell viability, and caspase-3 activity assays showed that circ-DONSON knockdown reduced the radioresistance of BC cells. Mechanistically, circ-DONSON regulated BC cell proliferation and radioresistance via SRY-box transcription factor 4 (SOX4). SOX4 overexpression significantly rescued the effect of circ-DONSON knockdown on BC cell proliferation and radioresistance. Moreover, circ-DONSON activated the Wnt/β-catenin pathway in BC cells via SOX4. Conclusion Our study concluded that circ-DONSON knockdown hindered cell proliferation and radioresistance through the SOX4/Wnt/β-catenin pathway in BC.
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Kayali M, Abi Jaoude J, Mohammed M, Khabsa J, Tfayli A, Poortmans P, Zeidan YH. Post-mastectomy Radiation Therapy in Triple-Negative Breast Cancer Patients: Analysis of the BEATRICE Trial. Ann Surg Oncol 2021; 29:460-466. [PMID: 34324113 DOI: 10.1245/s10434-021-10511-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Post-mastectomy radiation therapy (PMRT) improves locoregional control and overall survival in patients with breast cancer. With the evolution of systemic therapy, the benefit of PMRT in patients with triple-negative disease requires further evaluation. PATIENTS AND METHODS BEATRICE is a phase III randomized clinical trial that examined the efficacy of bevacizumab in patients with triple-negative breast cancer (TNBC). The current study is a retrospective analysis of data on patients enrolled and treated with mastectomy and systemic therapy. The primary endpoint was determining the effect of PMRT on locoregional recurrence rates (LRR). Hazard ratios were estimated using Cox regression, and LRR curves were generated by the Kaplan-Meier method. RESULTS In total, 940 patients were included in our analysis, of whom 359 (38.2%) received PMRT while 581 (61.8%) did not. At median follow-up of 5 years, no significant difference in LRR was noted between the PMRT and no PMRT groups in node-negative patients (HR = 1.09). Patients with N1 disease had 5-year LRR-free survival of 96% for PMRT versus 91% for no PMRT (HR = 0.46). Most N2 patients received PMRT and had 5-year LRR-free survival of 76%. CONCLUSION PMRT benefit in TNBC patients treated with modern systemic therapy is lower than historical reports. Delivery of PMRT in patients with N1 disease enrolled in the BEATRICE trial was not shown to improve local control. As this might be due to patient selection for PMRT, future randomized controlled trials are required to assess the role of PMRT in this patient population.
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Affiliation(s)
- Majd Kayali
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Mohammed
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Philip Poortmans
- Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Youssef H Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon. .,Baptist Health, Lynn Cancer Institute, Boca Raton, FL, USA.
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Oparina N, Erlandsson MC, Fäldt Beding A, Parris T, Helou K, Karlsson P, Einbeigi Z, Bokarewa MI. Prognostic Significance of BIRC5/Survivin in Breast Cancer: Results from Three Independent Cohorts. Cancers (Basel) 2021; 13:cancers13092209. [PMID: 34064473 PMCID: PMC8125570 DOI: 10.3390/cancers13092209] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Survivin, coded by the BIRC5 gene, is the cell death preventing protein, which is important for cell division in normal and cancer cells. It is intensively studied as a cancer biomarker and target for antitumor therapy. In this study we asked if we could get clinically helpful information on how active BIRC5 is in breast cancer patients? We studied the BIRC5 protein level in tumor samples for breast cancer patients from a West Swedish cohort and its mRNA level in two different public gene expression databases. Survival analysis demonstrated that a higher BIRC5 protein or mRNA level was associated with poor survival in all cohorts and for different cancer subtypes. We show that BIRC5 is a promising independent cancer survival marker. Abstract Breast cancer (BC) histological and molecular classifications significantly improved the treatment strategy and prognosis. Inhibitor of apoptosis BIRC5/survivin is often overexpressed in cancers, however, indications of its importance in BC are inconsistent. We integrate BIRC5 protein and mRNA measures with clinical associates and long-term outcome in three independent cohorts Protein levels of BIRC5 were measured in primary lysates of 845 patients of the West Swedish BC cohort (VGR-BC) and linked to 5- and 27-years survival. The results were externally validated in transcriptomic data from METABRIC and SCAN-B cohorts. Survival analysis showed that high levels of BIRC5 were consistently associated with a poor probability of 5-year overall survival. High BIRC5 in VGR-BC contributed negatively to the disease-specific survival at 5 and 27 years. Subsets with different status by ER (estrogen receptor) expression and presence of nodal metastasis supported independent association of high BIRC5 with poor prognosis in all cohorts. In METABRIC and SCAN-B cohorts, high levels of BIRC5 mRNA were associated with the basal-like and luminal B molecular BC subtypes and with increasing histologic grade. BIRC5 is a sensitive survival marker that acts independent of ER and nodal status, and its levels need to be considered when making treatment decisions.
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Affiliation(s)
- Nina Oparina
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg; 40530 Gothenburg, Sweden; (M.C.E.); (M.I.B.)
- Correspondence:
| | - Malin C. Erlandsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg; 40530 Gothenburg, Sweden; (M.C.E.); (M.I.B.)
- Rheumatology Clinic, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Anna Fäldt Beding
- Department of Medicine and Oncology, Southern Älvsborg Hospital, 50182 Borås, Sweden; (A.F.B.); (Z.E.)
| | - Toshima Parris
- Department of Oncology, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (T.P.); (K.H.); (P.K.)
| | - Khalil Helou
- Department of Oncology, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (T.P.); (K.H.); (P.K.)
- The King Gustav Vth Jubilee Clinic, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (T.P.); (K.H.); (P.K.)
- The King Gustav Vth Jubilee Clinic, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Zakaria Einbeigi
- Department of Medicine and Oncology, Southern Älvsborg Hospital, 50182 Borås, Sweden; (A.F.B.); (Z.E.)
- Department of Oncology, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (T.P.); (K.H.); (P.K.)
| | - Maria I. Bokarewa
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg; 40530 Gothenburg, Sweden; (M.C.E.); (M.I.B.)
- Rheumatology Clinic, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Sun GY, Wen G, Zhang YJ, Tang Y, Jing H, Wang JY, Zhang JH, Yang Y, Zhao XR, Chen SY, Jin J, Song YW, Liu YP, Fang H, Ren H, Tang Y, Qi SN, Li N, Chen B, Lu NN, Wang SL, Li YX. Radiotherapy plays an important role in improving the survival outcome in patients with T1-2N1M0 breast cancer - a joint analysis of 4262 real world cases from two institutions. BMC Cancer 2020; 20:1155. [PMID: 33243177 PMCID: PMC7691055 DOI: 10.1186/s12885-020-07646-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background To compare the survival outcomes between breast-conserving surgery (BCS) and modified radical mastectomy (MRM), and to investigate the role of radiotherapy (RT) in patients with pT1–2N1M0 breast cancer. Methods A total of 4262 women with T1–2N1M0 breast cancer treated at two institutions were retrospectively reviewed. A total of 3858 patients underwent MRM, and 832 (21.6%) of them received postoperative RT (MRM + RT). A total of 404 patients received BCS plus postoperative RT (BCS + RT). All patients received axillary lymph node dissection, while 3.8% of them had upfront sentinel node biopsy. The association of survival outcomes with different surgical modalities (BCS vs. MRM) and the role of RT were evaluated using multivariable proportional hazards regression and confirmed by the propensity score-matching (PSM) method. Results At a median follow-up of 71 months (range of 6–230 months), the 5-year overall survival (OS) rates of the BCS and MRM groups were 96.5 and 92.7%, respectively (P = .001), and the corresponding 5-year disease-free-survival (DFS) and locoregional recurrence (LRR) rates were 92.9 and 84.0%, and 2.0 and 7.0% (P = .001), respectively (P < .001). Multivariate analysis revealed that RT was an independent prognostic factor for improved OS (P = .001) and DFS (P = .009), and decreased LRR (P < .001). However, surgery procedure was not independently associated with either OS (P = .495), DFS (P = .204), or LRR (P = .996), which was confirmed by PSM analysis. Conclusion Postoperative radiotherapy rather than the surgery procedures was associated with superior survival outcomes in patients with T1–2N1M0 breast cancer.
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Affiliation(s)
- Guang-Yi Sun
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ge Wen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, China.,Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Yu-Jing Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, China
| | - Yu Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hao Jing
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jian-Yang Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiang-Hu Zhang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xu-Ran Zhao
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Si-Ye Chen
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Jin
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong-Wen Song
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue-Ping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hui Fang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hua Ren
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo Chen
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning-Ning Lu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shu-Lian Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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The effect of postmastectomy radiotherapy in node-positive triple-negative breast cancer. BMC Cancer 2020; 20:1146. [PMID: 33238939 PMCID: PMC7687757 DOI: 10.1186/s12885-020-07639-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background The value of postmastectomy radiotherapy (PMRT) for pathological node-positive triple-negative breast cancers (TNBC) remains debatable. The aim of this population-based retrospective study was to evaluate the effect of PMRT on survival outcomes in this population. Methods Patients diagnosed with stage T1-4N1-N3M0 TNBC between 2010 and 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. We used univariate and multivariate Cox regression hazards method to determine the independent prognostic factors associated with 3-year breast cancer-specific survival (BCSS). The effect of PMRT on 3-year BCSS was analyzed after stratification by pathological staging of groups. Results Of the 4398 patients included in this study, 2649 (60.2%) received PMRT. Younger age, black ethnicity, and advanced tumor (T) and nodal (N) stage were the independent predictors associated with PMRT receipt (all P < 0.05). Patients who received PMRT showed better 3-year BCSS (OR = 0.720, 95% CI = 0.642–0.808, P < 0.001) than those that did not. The effect of PMRT on 3-year BCSS was analyzed after stratification by pathological staging of groups. The results showed that PMRT was associated with better 3-year BCSS in patients with stage T3–4N1 (P = 0.042), T1-4N2 (P < 0.001), and T1-4N3 (P < 0.001), while comparable 3-year BCSS was found between the PMRT and non-PMRT cohorts with T1–2N1 disease (P = 0.191). Conclusions Radiotherapy achieved better 3-year BCSS in TNBC patients with stage T3–4N1 and T1-4N2–3 disease. However, no survival benefit was found with the addition of PMRT in patients with T1–2N1 TNBC.
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8
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De Wilde RL, Devassy R, Torres-de la Roche LA, Krentel H, Tica V, Cezar C. Guidance and Standards for Breast Cancer Care in Europe. J Obstet Gynaecol India 2020; 70:330-336. [PMID: 33041548 PMCID: PMC7515989 DOI: 10.1007/s13224-020-01316-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/13/2020] [Indexed: 01/02/2023] Open
Abstract
The increasing incidence and mortality rates of breast cancer have led to the necessity of initiating and developing clinical practice guidelines in order to optimize cancer control and provide patients with the best care. These guidelines are either national or issued by reputed relevant European societies-like European Society for Medical Oncology. Many of the recommendations are concordant in-between the guidelines. However, there are still considerable discrepancies to be noted between guidelines from different European countries, which could hinder physicians from implementing their recommendations. The present paper summarizes and compares the recommendations included in the various European guidelines.
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Affiliation(s)
- Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, Georgstrasse 12, 26121 Oldenburg, Germany
| | - Rajesh Devassy
- Obstetrician and Gynecologist, Advanced Gynecological Minimal – Access Surgery, Dubai London Clinic and Speciality Hospital, Dubai, United Arab Emirates
| | - Luz Angela Torres-de la Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, Georgstrasse 12, 26121 Oldenburg, Germany
| | - Harald Krentel
- Clinic of Gynecology, Obstetrics, Oncology and Senology, Bethesda Hospital, Duisburg, 47053 Germany
| | - Vlad Tica
- Obstetrics and Gynecology Department, University Regional Hospital, Ovidius University, Constanta, Romania
| | - Cristina Cezar
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, Georgstrasse 12, 26121 Oldenburg, Germany
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Zhao JM, An Q, Sun CN, Li YB, Qin ZL, Guo H, Zeng X, Zhang YT, Wei LL, Han N, Sun SC, Zhang N. Prognostic factors for breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes and the role of postmastectomy radiotherapy in these patients. Breast Cancer 2020; 28:298-306. [PMID: 32940902 DOI: 10.1007/s12282-020-01158-0] [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: 02/09/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to identify independent prognostic factors for breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes, and discuss the role of postmastectomy radiotherapy(PMRT) in these patients. METHODS Between January 2005 and December 2015, the data on 840 eligible patients with breast cancer were retrospectively reviewed. Of these patients, 368 women received PMRT and 472 did not. The endpoints were locoregional recurrence (LRR) and distant metastasis (DM). RESULTS With a median follow-up of 62.0 months, multivariate analysis identified the following independent risk factors for increased LRR: tumor size ≥ 4 cm (HR: 2.994, 95% CI: 1.190-7.535, P = 0.020), ER- and PR-negative tumor (HR: 2.540, 95% CI: 1.165-5.537, P = 0.019), preoperative high neutrophil-to-lymphocyte ratio (NLR) (HR: 4.716, 95% CI: 1.776-12.528, P = 0.002)and low neutrophil-to-monocyte ratio (NMR) (HR: 0.231, 95% CI: 0.084-0.633, P = 0.004). And independent risk factors for increased DM: ER- and PR-negative tumor (HR: 2.540, 95% CI: 1.880-5.625, P = 0.000), high NLR (HR: 2.693, 95% CI: 1.426-5.084, P = 0.002) and low NMR (HR: 0.460, 95% CI: 0.257-0.824, P = 0.009). The high-risk patients (≥ 2 risk factors) had worse LRRFS and DFS than low-risk patients (0-1 risk factor) (all, P < 0.05). In the subgroup analysis, both low- and high-risk patients received PMRT had better LRRFS and DFS than those who without PMRT (all, P < 0.05), and the high-risk patients received PMRT had similar 5-year rates of LRRFS and DFS than low-risk patients who without PMRT (94.5 vs. 94.3%, P = 0.402; 83.4 vs.87.4%, P = 0.877, respectively). CONCLUSIONS Tumor size, ER/PR status, preoperative NLR and NMR were independent predictors of risk of recurrence. PMRT could improve locoregional control even in low-risk subgroup of breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes significantly.
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Affiliation(s)
- Jia-Ming Zhao
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Qi An
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Chao-Nan Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Yu-Bing Li
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Zi-Lan Qin
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Hong Guo
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Xue Zeng
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Yao-Tian Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Lin-Lin Wei
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Ning Han
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Shi-Chen Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China
| | - Na Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, China.
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Luo J, Wang Y, Li W, Long L, Cao H. WITHDRAWN: Analysis of Infection Factors after Radical Mastectomy for Breast Cancer by CT Image and AUTO-plan Intelligent Analysis under Regional Nerve Block. Neurosci Lett 2020:135214. [PMID: 32615250 DOI: 10.1016/j.neulet.2020.135214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Jie Luo
- Department of Anesthesia, The Second Hospital University of South China, Hengyang City, 421001 Hunan Province, China
| | - Youquan Wang
- Department of Breast and Thyroid Surgery, The Second Hospital University of South China, Hengyang City, 421001 Hunan Province, China
| | - Wei Li
- Department of Breast and Thyroid Surgery, The Second Hospital University of South China, Hengyang City, 421001 Hunan Province, China
| | - Lin Long
- Department of Breast and Thyroid Surgery, The Second Hospital University of South China, Hengyang City, 421001 Hunan Province, China
| | - Hong Cao
- Department of Breast and Thyroid Surgery, The Second Hospital University of South China, Hengyang City, 421001 Hunan Province, China.
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11
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Regional nodal irradiation for early breast cancer; clinical benefit according to risk stratification. Breast 2020; 48 Suppl 1:S65-S68. [PMID: 31839164 DOI: 10.1016/s0960-9776(19)31127-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Three recently published prospective trials on regional nodal irradiation (RNI) in early breast cancer showed a reduction on breast cancer mortality, any first breast recurrence and/or distant recurrence rate. The positive outcomes of the modern trials reflect the development in radiotherapy by being more precise nowadays in radiation dose delivery to the lymph nodes, while reducing the radiation dose to heart and lungs. The possibility of axillary radiotherapy (ART) to replace axillary node dissection (ALND) after positive sentinel node (SLNB) biopsy is explored in a few trials. In the AMAROS trial both ALND and ART provide excellent and comparable LRR in SN+ patients. While the lymphedema was 2 times higher after ALND compared to ART. The ACOSOG Z0011 10 years results did not show a significant difference in locoregional recurrence rate or survival. These equal results were seen despite that in 27.4% of the patients had additional positive nodes removed beyond SLN in the patients who received axillary dissection (ALND). The IBCSG 23-01 phase III trial showed that there is no need for extra treatment of the axilla after micro-metastases in SLNB, however in this trial nearly all patients received breast irradiation including part of the axilla, often combined with adjuvant therapy. The introduction of neo- adjuvant systemic treatment (NACT) may lead to less RNI in early breast cancer, especially as NACT leads to pCR in axillary lymph nodes in about one third of the patient.
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12
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Wang X, Xu Y, Guo S, Zhang J, Abe M, Tan H, Wang S, Chen P, Zong L. T1-2N1M0 triple-negative breast cancer patients from the SEER database showed potential benefit from post-mastectomy radiotherapy. Oncol Lett 2019; 19:735-744. [PMID: 31897189 PMCID: PMC6924153 DOI: 10.3892/ol.2019.11139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of post-mastectomy radiotherapy (PMRT) on different subtypes of T1-2N1M0 breast cancer remain controversial. Patients with T1-2N1M0 breast cancer treated by mastectomy or mastectomy and PMRT were identified from the 2010–2013 dataset from the Surveillance, Epidemiology and End Results (SEER) registry. A total of 7,466 patients with the 7th American Joint Committee on Cancer stage (Tumor-Node-Metastasis stages 1–2, 1 and 0, respectively) including 2,760 cases (36.97%) treated by mastectomy and PMRT and 4,706 cases (63.03%) treated by mastectomy alone were analyzed in this study. The follow-up time for patients in the dataset used from the SEER registry was 0–59 months. The breast cancer-specific survival (BCSS) of the patients was derived from the SEER dataset and stratified by treatment approach. A propensity score matching (PSM) analysis (experimental group: Control group ratio, 1:1) was conducted. Using univariate and multivariate analyses Cox proportional hazards analyses, PMRT was identified as an independent prognostic factor for triple-negative breast cancer (TNBC). Before PSM analysis, the BCSS favored PMRT in the hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)+ (P=0.025) and HR−/HER2− groups (P=0.010) but not in the HR+/HER2− (P=0.346) and HR−/HER2+ (P=0.288) groups. Following PSM analysis, BCSS favored PMRT alone in the TNBC (HR−/HER2−) group (P=0.025). Patients with T1-2N1M0 TNBC may benefit from radiotherapy post-mastectomy.
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Affiliation(s)
- Xueying Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Yingying Xu
- Department of General Surgery, Yizhen People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Shanshan Guo
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China.,Department of Oncology, Graduate School of Medicine, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Jiaxin Zhang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo Hospital, Tokyo 113-0033, Japan
| | - Haosheng Tan
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Shaojun Wang
- Department of General Surgery, Yizhen People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Ping Chen
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Liang Zong
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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13
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Clinical-Genomic Models of Node-Positive Breast Cancer: Training, Testing, and Validation. Int J Radiat Oncol Biol Phys 2019; 105:637-648. [DOI: 10.1016/j.ijrobp.2019.06.2546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022]
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14
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Kaššák F, Rossier C, Picardi C, Bernier J. Postmastectomy radiotherapy in T1-2 patients with one to three positive lymph nodes - Past, present and future. Breast 2019; 48:73-81. [PMID: 31561088 DOI: 10.1016/j.breast.2019.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
PAST: The role of post-mastectomy radiotherapy (PMRT) in patients with tumor <5 cm and one to three positive lymph nodes after axillary dissection (ALND) is vigorously debated. Initial doubts over the efficacy and safety of PMRT in these patients were partially overcome by improvement in technology and systemic treatments. Several randomized controlled clinical trials confirmed benefit of PMRT in N1 patients, which were meta-analyzed by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG). This meta-analysis provides the sole high-level evidence to guide clinical decision-making. PRESENT: Nevertheless, concerns have been evoked around these results, most notably concerning the patient selection bias and the era in which the patients were treated. More recent studies, albeit retrospective, are in contrast with this level I evidence, unequivocally reporting inferior recurrence rates in control arms than those of the EBCTCG meta-analysis. Taken together, these results suggest that one solution would not fit all N1 patients and that patient selection for PMRT shall be stratified upon risks factors. Most prominent of such factors identified are: patient age; number and ratio of positive lymph nodes; histological features such as lymphovascular invasion; and hormone receptor expression. FUTURE: A prospective randomized controlled trial SUPREMO will release its final results in 2023 and shed light onto the subject. Genomic tumor cell profiling will likely provide further guidelines in terms of risk stratification. SUPREMO translational sub-study will also offer material for genomic analyses. A cross-field tendency to forgo nodal dissection in favor of sentinel lymph node biopsy followed by nodal irradiation might eventually render the question of PMRT indication after ALND irrelevant.
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Affiliation(s)
- Filip Kaššák
- Radiation Oncology Department, Swiss Oncology Network, Genolier Clinic and Oncological Center of Eaux-Vives, Switzerland
| | - Christine Rossier
- Radiation Oncology Department, Swiss Oncology Network, Genolier Clinic and Oncological Center of Eaux-Vives, Switzerland
| | - Cristina Picardi
- Radiation Oncology Department, Swiss Oncology Network, Genolier Clinic and Oncological Center of Eaux-Vives, Switzerland
| | - Jacques Bernier
- Radiation Oncology Department, Swiss Oncology Network, Genolier Clinic and Oncological Center of Eaux-Vives, Switzerland.
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15
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Zhang N, Zhang J, Zhang H, Liu Y, Zhao W, Wang L, Chen B, Moran MS, Haffty BG, Yang Q. Individualized Prediction of Survival Benefit from Postmastectomy Radiotherapy for Patients with Breast Cancer with One to Three Positive Axillary Lymph Nodes. Oncologist 2019; 24:e1286-e1293. [PMID: 31315963 DOI: 10.1634/theoncologist.2019-0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/28/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE There still exist some arguments regarding the use of postmastectomy radiotherapy (PMRT) for patients with breast cancer carrying one to three positive axillary lymph nodes considering the heterogeneity of this cohort. Here, we developed a prognostic nomogram to estimate the probability of long-term outcome in patients receiving or not receiving PMRT in order to assist in making individually locoregional treatment decisions for this particular cohort. METHODS Altogether, 20,336 women, aged 18 to 80 years, diagnosed with breast cancer, and carrying one to three positive nodes were identified in the Surveillance, Epidemiology, and End Results (SEER) database. We applied multivariant Cox hazard model to determine the impact of covariates on disease-specific survival (DSS) and overall survival (OS). Then, the nomogram was built accordingly. Internal and external validations were performed to examine the accuracy of nomograms. RESULTS Age of diagnosis, tumor grade, size, estrogen and progesterone receptor status, and number of positive nodes were independent factors of DSS and OS in the multivariate analysis. Incorporating these factors into the constructed nomogram showed high accuracy when predicting 5- and 10-year survival, with internally and externally bootstrap-corrected concordance indexes in the range of 0.6 to 0.8. CONCLUSION Besides the number of involved nodes, extra variables existed as predictors of survival outcomes in this cohort; therefore, the recommendation of PMRT or no PMRT requires comprehensive consideration. This clinically validated nomogram provided a useful tool that could aid decision making by estimating DSS and OS benefits from PMRT, useful in predicting 5- and 10-year DSS and OS for patients with one to three positive nodes after mastectomy. IMPLICATIONS FOR PRACTICE This study evaluated population-based data to identify prognostic factors associated with patients with breast cancer with one to three lymph nodes and help clinicians to weigh the benefit of postmastectomy radiotherapy (PMRT). Surveillance, Epidemiology, and End Results (SEER) data were used to develop a prognostic nomogram to predict the likelihood of long-term survival with and without PMRT in order to optimize the individual locoregional control strategy for this particular cohort. This clinically validated nomogram provides a useful tool to predict 5- and 10-year disease-specific survival and overall survival for patients with one to three positive nodes and can aid tailored clinical decision making by estimating predicted benefit from PMRT.
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Affiliation(s)
- Ning Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Jiashu Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Hanwen Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Ying Liu
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wenjing Zhao
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Lijuan Wang
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Bing Chen
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, New Jersey, USA
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
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16
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Yin H, Qu Y, Wang X, Ma T, Zhang H, Zhang Y, Li Y, Zhang S, Ma H, Xing E, Liu X, Xu Q. Impact of postmastectomy radiation therapy in T1-2 breast cancer patients with 1-3 positive axillary lymph nodes. Oncotarget 2018; 8:49564-49573. [PMID: 28484094 PMCID: PMC5564788 DOI: 10.18632/oncotarget.17318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/31/2017] [Indexed: 11/25/2022] Open
Abstract
The effect of postmastectomy radiotherapy (PMRT) on T1-2 breast cancer patients with 1-3 positive axillary lymph nodes is controversial up to now. The purpose of this study was to evaluate the impact of postmastectomy radiotherapy for these patients. The prognostic factor effecting locoregional free-survival (LRFS) was also analyzed. In the retrospective clinical data of 1674 eligible patients, survival analysis was performed using the method of Kaplan-Meier and the log-rank test. Cox regression analysis was applied to identify the significant prognostic factors. We found PMRT increased 5-year LRFS (p=0.003), but could not improve 5-year disease-free survival or overall survival statistically. For patients without PMRT, multivariate analysis revealed that age, lymph node ratio and molecule subtype were risk factors effecting LRFS. To further analyze the role of PMRT, we grouped all the patients into low risk group (0 or 1 risk factor) and high risk group (2 or 3 risk factors) depending on these risk factors. We found that in low-risk group, PMRT increased only 5-year LRFS (p=0.012). However, in high-risk group, PMRT increased both 5-year LRFS (p=0.005) and 5-year disease-free survival (p=0.033), but could not improve 5-year overall survival statistically. Thus, these data provide the evidence that PMRT could improve LRFS for T1-2 breast cancer patients with 1-3 positive axillary lymph nodes. Additionally, PMRT could improve LRFS and disease-free survival for high risk patients. Age, lymph node ratio and molecule subtype were high risk factors effecting LRFS in our study.
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Affiliation(s)
- Hang Yin
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Yuanyuan Qu
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Xiaoyuan Wang
- The Department of Internal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Tengchuang Ma
- The Department of Nuclear Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Haiyang Zhang
- The Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Zhang
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Yang Li
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Siliang Zhang
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Hongyu Ma
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Enkang Xing
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Xueying Liu
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
| | - Qingyong Xu
- The Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China
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Post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with four or more positive lymph nodes. Oncotarget 2018; 8:42917-42925. [PMID: 28476034 PMCID: PMC5522115 DOI: 10.18632/oncotarget.17170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 03/27/2017] [Indexed: 12/31/2022] Open
Abstract
The efficacy of adjuvant radiotherapy for the treatment of triple negative breast cancer patients with varying numbers of positive lymph nodes is not clear. We assessed the association between adjuvant radiotherapy and survival in 943 T1/T2 triple negative breast cancer patients treated at our institute between 2008 and 2012. We determined that post-operative radiotherapy improved overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in patients with ≥ 4 positive nodes (p = 0.037, p = 0.035, and p = 0.012, respectively). Although Cox regression analysis demonstrated that radiotherapy was a significant prognostic factor in triple negative breast cancer with ≥ 4 positive nodes, post-operative radiotherapy had no clear effect on OS, DFS, or LRFS in patients with 1-3 positive nodes (p = 0.849, p = 0.860, and p = 0.162, respectively). The prognosis (i.e., OS, DFS, and LRFS) of triple negative breast cancer patients without lymph node metastasis who underwent breast-conserving surgery and post-operative radiotherapy was similar to that of patients who underwent mastectomy alone (p = 0.336, p = 0.537, and p = 0.978, respectively). Our findings demonstrate that post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with ≥ 4 positive lymph nodes.
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18
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Zeidan YH, Habib JG, Ameye L, Paesmans M, de Azambuja E, Gelber RD, Campbell I, Nordenskjöld B, Gutiérez J, Anderson M, Lluch A, Gnant M, Goldhirsch A, Di Leo A, Joseph DJ, Crown J, Piccart-Gebhart M, Francis PA. Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial. Int J Radiat Oncol Biol Phys 2018. [PMID: 29534902 DOI: 10.1016/j.ijrobp.2018.01.105] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. METHODS AND MATERIALS The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. RESULTS We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49%) had received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the no-PMRT group (hazard ratio 0.29, 95% confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4% vs 9.1%; P = .02). No significant differences in breast cancer-specific survival (84.3% vs 83.9%) or overall survival (81.7% vs 78.3%) were observed according to receipt of PMRT. CONCLUSION Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks.
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Affiliation(s)
- Youssef H Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Joyce G Habib
- Department of Medical Oncology, Fouad Khoury and Makassed General Hospital, Beirut, Lebanon
| | - Lieveke Ameye
- Data Centre, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Richard D Gelber
- IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard T. H. Chan School of Public Health, Harvard Medical School, and Frontier Science and Technology Research Foundation, Boston, Massachusetts
| | - Ian Campbell
- Department of Surgery, Waikato Hospital, University of Auckland School of Health Sciences, Hamilton, New Zealand
| | - Bo Nordenskjöld
- Swedish Breast Cancer Group and Department of Oncology, Linköping University, Linköping, Sweden
| | - Jorge Gutiérez
- Grupo Oncologico Cooperativo Chileno De Investigacion, Clinica Las Condes, Santiago, Chile
| | - Michael Anderson
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, and Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
| | - Ana Lluch
- Department of Hematology and Medical Oncology, Hospital Clínico Universitario de Valencia/INCLIVA, Universidad de Valencia, Valencia, Spain (on behalf the Grupo Español de Investigación en Cáncer de Mama)
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, and Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Aron Goldhirsch
- European Institute of Oncology, Milan, Italy; International Breast Cancer Study Group, Bern, Switzerland
| | - Angelo Di Leo
- Sandro Pitigliani' Medical Oncology Department, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, University of Western Australia, Genesis Cancer Care, Edith Cowan University, and Breast Cancer Trials Australia & New Zealand, Perth, Australia
| | - John Crown
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | | | - Prudence A Francis
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Centre, Melbourne, Australia; St. Vincents's Hospital, University of Melbourne, Australia; Breast Cancer Trials Australia & New Zealand, University of Newcastle, Newcastle, Australia
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19
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Cao L, Ou D, Shen KW, Cai G, Cai R, Xu F, Zhao SG, Xu C, Grellier Adedjouma N, Kirova YM, Chen JY. Outcome of postmastectomy radiotherapy after primary systemic treatment in patients with clinical T1-2N1 breast cancer. Cancer Radiother 2018; 22:38-44. [PMID: 29306555 DOI: 10.1016/j.canrad.2017.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/23/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The role of postmastectomy radiotherapy following primary systemic treatment in patients with clinical T1-2N1 breast cancer remains a controversial issue. The purpose of this study was to evaluate the benefit of postmastectomy radiotherapy following primary systemic treatment. PATIENTS AND METHODS Between 2005 and 2012, in two independent institutions, female patients with T1-2N1 breast cancer receiving primary systemic treatment followed by mastectomy and lymph node dissection because bad response, then treated with or without chest wall and regional lymph node irradiation have been studied retrospectively. The patients received normofractionated radiotherapy using 3D conformal photons or electron techniques. Locoregional recurrence-free survival, distant metastasis-free survival and disease-free survival were calculated using Kaplan-Meier method. Univariate analysis of potential prognostic factors was performed using log-rank test. RESULTS Eighty-eight patients have been studied. Of them, 75 patients received postmastectomy radiotherapy. At surgery, 53 patients achieved ypN0. Median follow-up was 67 months. Postmastectomy radiotherapy significantly improved locoregional recurrence-free survival, with a 5-year rate of 96.9% versus 78.6% in the group that did not have postmastectomy radiotherapy. In the subgroup of 53 patients achieving ypN0, postmastectomy radiotherapy improved locoregional recurrence-free survival (a 5-year rate of 94.7% vs. 72.9%), distant metastasis-free survival (a 5-year rate of 92.8% vs. 75%) and disease-free survival (a 5-year rate of 92.9% vs. 62.5%). By univariate analysis, postmastectomy radiotherapy was the only significant prognostic factor affecting locoregional recurrence-free survival. CONCLUSIONS For patients with clinical T1-2N1 disease, postmastectomy radiotherapy could significantly improve locoregional recurrence-free survival after primary systemic treatment and be even more therapeutic in the subgroup of patients with good response for primary systemic treatment by improving locoregional recurrence-free, distant metastasis-free and disease-free survival. Larger prospective studies are needed to confirm our findings.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Mastectomy
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Radiotherapy, Adjuvant
- Retrospective Studies
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Affiliation(s)
- L Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - D Ou
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - K-W Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai, China
| | - G Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - R Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - F Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - S-G Zhao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - C Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - N Grellier Adedjouma
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y M Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - J-Y Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China; Shanghai Jiaotong University School of Medicine, Shanghai, China
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20
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Lin J, Li C, Zhang C, Shi F, Wang H. Postmastectomy radiation therapy for breast cancer patients with one to three positive lymph nodes: a propensity score matching analysis. Future Oncol 2017; 13:1395-1404. [PMID: 28381104 DOI: 10.2217/fon-2017-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM Conducting postmastectomy radiation therapy (PMRT) for breast cancer patients with one to three positive lymph nodes is still controversial. METHODS Propensity score matching analysis was applied to balance the clinical baseline characteristics of patients. Cox proportional hazard analysis was used to analyze the survival prognosis factors and perform subgroup analysis. RESULTS There was no statistical difference in overall survival and cancer-specific survival rates (all, p > 0.05) between the PMRT and non-PMRT groups. However, for subgroup patients with tumor size ≥5 cm and the number of positive lymph nodes = 3, PMRT showed a significant survival benefit. CONCLUSION PMRT can improve overall survival and cancer-specific survival only in breast cancer patients whose tumor size is larger than 5 cm and with three positive lymph nodes.
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Affiliation(s)
- Jiamao Lin
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Cheng Li
- Dean's Office, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Chenyue Zhang
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Fang Shi
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Haiyong Wang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
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21
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Abstract
Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany.
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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22
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Reimer T, Stachs A, Nekljudova V, Loibl S, Hartmann S, Wolter K, Hildebrandt G, Gerber B. Restricted Axillary Staging in Clinically and Sonographically Node-Negative Early Invasive Breast Cancer (c/iT1-2) in the Context of Breast Conserving Therapy: First Results Following Commencement of the Intergroup-Sentinel-Mamma (INSEMA) Trial. Geburtshilfe Frauenheilkd 2017; 77:149-157. [PMID: 28331237 DOI: 10.1055/s-0042-122853] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Axillary lymph node status remains an important prognostic factor in early breast cancer. It is regarded as an indicator for (neo)adjuvant systemic treatment and postoperative radiotherapy of the regional lymphatics. Commenced in September 2015, the INSEMA trial is investigating whether operative determination of nodal status as part of breast conserving therapy (BCT) for early stage breast cancer (c/iT1-2 c/iN0) can be avoided without reducing oncological safety. After inclusion of 1001 patients there was general acceptance of the complex study design by patients and study doctors so that recruitment for the first randomisation (axillary sentinel lymph node biopsy [SLNB]: yes or no) achieved predicted case numbers. The second randomisation however (SLNB alone versus complete axillary dissection when one or two macrometastases are present at SLNB) recruited fewer cases than expected for the following three reasons: a) the 13 % rate of one or two macrometastases after SLNB in the INSEMA trial collective was lower than expected; b) around 20 % of patients refused the second randomisation; c) there was delayed inclusion of the Austrian study centres, which only recruited for the second randomisation. Lack of knowledge of nodal status when SLNB is avoided represents a new challenge for the postoperative tumour board. In particular decisions on chemotherapy for luminal-like tumours and irradiation of the lymphatics (excluding axilla) must be guided by tumour biological parameters. The INSEMA trial does not provide answers to some important questions, e.g. it remains unclear whether patients without SLNB can be offered partial breast irradiation alone in low-risk situations and whether SLNB can also be avoided in patients with stage T1-2 tumours who have a mastectomy indication.
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Affiliation(s)
- T Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - A Stachs
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | | | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - S Hartmann
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - K Wolter
- Department of Radiotherapy, University of Rostock, Rostock, Germany
| | - G Hildebrandt
- Department of Radiotherapy, University of Rostock, Rostock, Germany
| | - B Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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23
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Niu S, Wen G, Ren Y, Li Y, Feng L, Wang C, Huang X, Wen B, Zhang Y. Predictive Value of Primary Tumor Site for Loco-regional Recurrence in Early Breast Cancer Patients with One to Three Positive Axillary Lymphadenophy. J Cancer 2017; 8:2394-2400. [PMID: 28819443 PMCID: PMC5560158 DOI: 10.7150/jca.19722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/13/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction: It remains controversial on high risks for early breast cancer patients with one to three axillary nodes after mastectomy who is predisposition to locoregional recurrence. The present study is to investigate the relationship between primary tumor site and loco-regional recurrence (LRR) and explore the predictive value of clinicopathological characteristics in LRR for early breast cancer patients with one to three positive axillary lymph nodes after mastectomy. Methods: We reviewed the clinical data of 656 consecutively diagnosed patients with pT1-2N1M0 breast cancer who were treated in Sun Yat-sen University Cancer Center with radical operation without postoperative radiotherapy between March 1998 and December 2010. The primary tumor sites included outer quadrant in 455 patients (69.36%), inner quadrant in 156 patients (23.78%)and central quadrant in 45 patients (6.86%). LRR and LRR-free survival (LRFS) in combination with clinical and pathological features were analyzed to screen out patients with higher risk of LRR. Results: The median follow-up time was 64.9 months. The 5-, 10-year LRR for the cohort was 8.6% and 12.9%, respectively; the 5-, 10-year LRFS was 86.2% and 76.4%, respectively. Multivariate analyses showed that age of ≤35 years, inner quadrant tumor and non-luminal subtype were independent risk factors for LRR and LRFS. Patients with primary tumor in inner quadrant showed higher LRR and poorer LRFS when risk factors are ≥2 than those with tumors in other sites. Conclusions: Inner quadrant tumor was an independent predictor for LRR and LRFS in patients with early breast cancer and one to three positive axillary lymph nodes, which would be more accurate in combination with other prognostic indexes including patients' age, pathological T stage, Ki67 status, molecular subtypes.
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Affiliation(s)
- Shaoqing Niu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Ge Wen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P. R. China
| | - Yufeng Ren
- Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Yiyang Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
- Department of Oncology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510060, P.R. China
| | - Lingling Feng
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Chengtao Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Xiaobo Huang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Bixiu Wen
- Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
- ✉ Corresponding authors: Yujing Zhang, M.D., Ph.D. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China. E-mail: ; Tel: (8620) 87343702; Fax: (8620) 87343392 and Bixiu Wen, M.D., Ph.D. Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China. E-mail: ; Tel: (8620) 87755766 x8425; Fax:(8620)87750632
| | - Yujing Zhang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
- ✉ Corresponding authors: Yujing Zhang, M.D., Ph.D. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China. E-mail: ; Tel: (8620) 87343702; Fax: (8620) 87343392 and Bixiu Wen, M.D., Ph.D. Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China. E-mail: ; Tel: (8620) 87755766 x8425; Fax:(8620)87750632
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24
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Sarin R, Wadasadawala T, Kannan S, Gudi S, Rishi A, Budrukkar A, Parmar V, Shet T, Desai S, Gupta S, Badwe R. Predicting loco-regional recurrence risk in T1, T2 breast cancer with 1–3 positive axillary nodes postmastectomy: Development of a predictive nomogram. Indian J Cancer 2017; 54:352-357. [DOI: 10.4103/ijc.ijc_178_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Headon H, Kasem A, Almukbel R, Mokbel K. Improvement of survival with postmastectomy radiotherapy in patients with 1-3 positive axillary lymph nodes: A systematic review and meta-analysis of the current literature. Mol Clin Oncol 2016; 5:429-436. [PMID: 27699038 DOI: 10.3892/mco.2016.971] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/21/2016] [Indexed: 11/06/2022] Open
Abstract
In breast cancer with >4 positive axillary lymph nodes, it is common practice to deliver radiotherapy to the affected site following mastectomy. However, less is known regarding the benefits this may confer on women with 1-3 positive lymph nodes. In this meta-analysis, we aimed to assess whether post-mastectomy radiotherapy (PMRT) was beneficial for such patients. A literature review was conducted using the PubMed and Ovid databases. Selected studies were analysed and data regarding overall survival (OS) and locoregional recurrence (LRR) rates were extracted. Statistical analysis was then conducted in order to develop a combined risk ratio (RR) for both OS and LRR in the setting of PMRT in women with breast cancer with 1-3 positive lymph nodes. PMRT in women with 1-3 positive lymph nodes significantly reduced the risk of LRR, with a RR of 0.3 [95% confidence interval (CI): 0.23-0.38] and also showed a minor benefit in terms of OS (RR=1.03, 95% CI: 1.00-1.07). Therefore, in breast cancer patients with 1-3 positive lymph nodes, PMRT significantly reduced the risk of LRR and was associated with a minor OS benefit. Until the results of ongoing randomised controlled trials are published, PMRT should be recommended in this group of patients following a careful multidisciplinary discussion.
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Affiliation(s)
- Hannah Headon
- The London Breast Institute, The Princess Grace Hospital, W1U 5NY London, UK
| | - Abdul Kasem
- The London Breast Institute, The Princess Grace Hospital, W1U 5NY London, UK
| | - Reham Almukbel
- The London Breast Institute, The Princess Grace Hospital, W1U 5NY London, UK
| | - Kefah Mokbel
- The London Breast Institute, The Princess Grace Hospital, W1U 5NY London, UK
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26
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Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ. Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 2015; 26:1533-46. [PMID: 25939896 PMCID: PMC4511219 DOI: 10.1093/annonc/mdv221] [Citation(s) in RCA: 1218] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/16/2022] Open
Abstract
The 14th St Gallen International Breast Cancer Conference (2015) reviewed substantial new evidence on locoregional and systemic therapies for early breast cancer. Further experience has supported the adequacy of tumor margins defined as 'no ink on invasive tumor or DCIS' and the safety of omitting axillary dissection in specific cohorts. Radiotherapy trials support irradiation of regional nodes in node-positive disease. Considering subdivisions within luminal disease, the Panel was more concerned with indications for the use of specific therapies, rather than surrogate identification of intrinsic subtypes as measured by multiparameter molecular tests. For the treatment of HER2-positive disease in patients with node-negative cancers up to 1 cm, the Panel endorsed a simplified regimen comprising paclitaxel and trastuzumab without anthracycline as adjuvant therapy. For premenopausal patients with endocrine responsive disease, the Panel endorsed the role of ovarian function suppression with either tamoxifen or exemestane for patients at higher risk. The Panel noted the value of an LHRH agonist given during chemotherapy for premenopausal women with ER-negative disease in protecting against premature ovarian failure and preserving fertility. The Panel noted increasing evidence for the prognostic value of commonly used multiparameter molecular markers, some of which also carried prognostic information for late relapse. The Panel noted that the results of such tests, where available, were frequently used to assist decisions about the inclusion of cytotoxic chemotherapy in the treatment of patients with luminal disease, but noted that threshold values had not been established for this purpose for any of these tests. Multiparameter molecular assays are expensive and therefore unavailable in much of the world. The majority of new breast cancer cases and breast cancer deaths now occur in less developed regions of the world. In these areas, less expensive pathology tests may provide valuable information. The Panel recommendations on treatment are not intended to apply to all patients, but rather to establish norms appropriate for the majority. Again, economic considerations may require that less expensive and only marginally less effective therapies may be necessary in less resourced areas. Panel recommendations do not imply unanimous agreement among Panel members. Indeed, very few of the 200 questions received 100% agreement from the Panel. In the text below, wording is intended to convey the strength of Panel support for each recommendation, while details of Panel voting on each question are available in supplementary Appendix S2, available at Annals of Oncology online.
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MESH Headings
- Anthracyclines/administration & dosage
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Axilla
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Chemotherapy, Adjuvant/methods
- Female
- Humans
- Lymph Node Excision/methods
- Mastectomy/methods
- Mastectomy, Segmental/methods
- Neoplasm Staging
- Platinum Compounds/administration & dosage
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant/methods
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Tamoxifen/administration & dosage
- Taxoids/administration & dosage
- Trastuzumab/administration & dosage
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Affiliation(s)
- A S Coates
- International Breast Cancer Study Group, University of Sydney, Sydney, Australia
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Goldhirsch
- International Breast Cancer Study Group, Program of Breast Health (Senology), European Institute of Oncology, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Piccart-Gebhart
- Internal Medicine/Oncology, Institut Jules Bordet, Brussels, Belgium
| | - B Thürlimann
- Breast Center, Kantonsspital St Gallen, St Gallen
| | - H-J Senn
- Tumor and Breast Center ZeTuP, St Gallen, Switzerland
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