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Hwang SH, Jeong J, Ahn SG, Lee HM, Lee HD. Clinical outcomes of ductal carcinoma in situ of the breast treated with partial mastectomy without adjuvant radiotherapy. Yonsei Med J 2012; 53:537-42. [PMID: 22476997 PMCID: PMC3343427 DOI: 10.3349/ymj.2012.53.3.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Some recent trials suggest that postoperative adjuvant radiotherapy (RT) may be safely omitted after breast-conserving surgery (BCS) for some patients with ductal carcinoma in situ (DCIS). In this study, we reviewed clinical outcomes of patients with DCIS treated with partial mastectomy (PM) without adjuvant RT. MATERIALS AND METHODS Medical records of 28 patients (29 breasts) with DCIS who were treated with PM, but without RT, between April 1991 and December 2010 were retrospectively analyzed. Based on established criteria (2.0 cm or less in size and no comedonecrosis), 18 patients were treated without RT after PM. Seven patients (8 breasts) who did not receive RT due to refusal were also included in this study. Three other patients were excluded because data concerning comedonecrosis were not available. RESULTS For the 25 patients included in this study, the mean age of the 18 patients who met the criteria was 47.9±6.2 years, and 47.6±12.7 years for the 7 patients who did not. The mean sizes of the primary tumors were 0.6±0.4 cm and 0.9±0.3 cm, respectively, in these two groups. Among these 25 patients (26 breasts) treated without RT, we observed no ipsilateral breast tumor recurrence or mortality within a mean follow-up of 84 months. CONCLUSION Based on this small number of cases, patients with DCIS, who were selected for tumor size less than 2 cm and absence of comedonecrosis, may be treated successfully with BCS; adjuvant RT may be omitted.
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Affiliation(s)
- Seung Hyun Hwang
- Breast Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Breast Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Breast Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Min Lee
- Breast Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hy-De Lee
- Breast Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Scagliotti GV, Pastorino U, Vansteenkiste JF, Spaggiari L, Facciolo F, Orlowski TM, Maiorino L, Hetzel M, Leschinger M, Visseren-Grul C, Torri V. Randomized Phase III Study of Surgery Alone or Surgery Plus Preoperative Cisplatin and Gemcitabine in Stages IB to IIIA Non–Small-Cell Lung Cancer. J Clin Oncol 2012; 30:172-8. [PMID: 22124104 DOI: 10.1200/jco.2010.33.7089] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeThis study aimed to determine whether three preoperative cycles of gemcitabine plus cisplatin followed by radical surgery provides a reduction in the risk of progression compared with surgery alone in patients with stages IB to IIIA non–small-cell lung cancer (NSCLC).Patients and MethodsPatients with chemotherapy-naive NSCLC (stages IB, II, or IIIA) were randomly assigned to receive either three cycles of gemcitabine 1,250 mg/m2days 1 and 8 every 3 weeks plus cisplatin 75 mg/m2day 1 every 3 weeks followed by surgery, or surgery alone. Randomization was stratified by center and disease stage (IB/IIA v IIB/IIIA). The primary end point was progression-free survival (PFS).ResultsThe study was prematurely closed after the random assignment of 270 patients: 129 to chemotherapy plus surgery and 141 to surgery alone. Median age was 61.8 years and 83.3% were male. Slightly more patients in the surgery alone arm had disease stage IB/IIA (55.3% v 48.8%). The chemotherapy response rate was 35.4%. The hazard ratios for PFS and overall survival were 0.70 (95% CI, 0.50 to 0.97; P = .003) and 0.63 (95% CI, 0.43 to 0.92; P = .02), respectively, both in favor of chemotherapy plus surgery. A statistically significant impact of preoperative chemotherapy on outcomes was observed in the stage IIB/IIIA subgroup (3-year PFS rate: 36.1% v 55.4%; P = .002). The most common grade 3 or 4 chemotherapy-related adverse events were neutropenia and thrombocytopenia. No treatment-by-histology interaction effect was apparent.ConclusionAlthough the study was terminated early, preoperative gemcitabine plus cisplatin followed by radical surgery improved survival in patients with clinical stage IIB/IIIA NSCLC.
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Affiliation(s)
- Giorgio V. Scagliotti
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Ugo Pastorino
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Johan F. Vansteenkiste
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Lorenzo Spaggiari
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Francesco Facciolo
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Tadeusz M. Orlowski
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Luigi Maiorino
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Martin Hetzel
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Monika Leschinger
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Carla Visseren-Grul
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
| | - Valter Torri
- Giorgio V. Scagliotti, S. Luigi Hospital, University of Turin, Turin; Ugo Pastorino, National Cancer Institute of Milan; Lorenzo Spaggiari, European Institute of Oncology; Valter Torri, Mario Negri Institute, Milan; Francesco Facciolo, Regina Elena National Cancer Institute, Rome; Luigi Maiorino, San Gennaro Hospital, Naples, Italy; Johan F. Vansteenkiste, University Hospital Gasthuisberg, Leuven, Belgium; Tadeusz M. Orlowski, Institute of Chest Disease, Warsaw, Poland; Martin Hetzel, Red Cross Hospital,
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