1
|
Li M, Tang J, Pan X, Zhang D. Predicting the Survival Benefit of Radiotherapy in Elderly Breast Cancer Patients: A Population-Based Analysis. J Surg Res 2024; 297:26-40. [PMID: 38428261 DOI: 10.1016/j.jss.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/30/2023] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study aimed to establish two prediction tools predicting cancer-specific survival (CSS) and overall survival (OS) in elderly breast cancer patients with or without radiotherapy. METHODS Clinicopathological data of breast cancer patients aged more than 70 y from 2010 to 2018 were retrospectively collected from the Surveillance, Epidemiology, and End Results database. Patients were randomly divided into the training and validation cohorts at 7:3, and the Cox proportional risk model was used to construct the nomograms. The concordance index, the area under the receiver operating characteristic curve, and the calibration plot are used to evaluate the discrimination and accuracy of the nomograms. RESULTS One lakh twenty eight thousand two hundred twenty three elderly breast cancer patients were enrolled, including 57,915 who received radiotherapy. The Cox regression model was used to identify independent factors. These independent influencing factors are used to construct the prediction models. The calibration plots reflect the excellent consistency between the predicted and actual survival rates. The concordance index of nomograms for CSS and OS was more than 0.7 in both the radiotherapy group and the nonradiotherapy group, and similar results are also shown in area under the receiver operating characteristic curve. Decision curve analysis showed that the prognostication accuracy of the model was much higher than that of the traditional tumor, node, metastasis staging. CONCLUSIONS Radiotherapy can benefit elderly breast cancer patients significantly. The two prediction tools provide a personalized survival scale for evaluating the CSS and OS of elderly breast cancer patients, which can better provide clinicians with better-individualized management for these patients.
Collapse
Affiliation(s)
- Maoxian Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Jie Tang
- Department of Biostatistics and Epidemiology, Public Health School, Shenyang Medical College, Shenyang, China
| | - Xiudan Pan
- Department of Biostatistics and Epidemiology, Public Health School, Shenyang Medical College, Shenyang, China
| | - Dianlong Zhang
- Women and Children's Hospital, Qingdao University, Qingdao, China.
| |
Collapse
|
2
|
Zhang X, Shi J, Wu X, Li L, Sun W, Zou Y, Chen G, Wu S, Duan S. Dosimetric Comparison of Commonly Used Volumetric Modulated Arc Therapy Field Arrangements Based on Flattening Filter-Free Beams for Synchronous Bilateral Breast Carcinoma Radiation Therapy. Pract Radiat Oncol 2024; 14:e190-e202. [PMID: 37967748 DOI: 10.1016/j.prro.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/14/2023] [Accepted: 11/05/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Flattening filter-free (FFF)-based volumetric modulated arc therapy (VMAT) has been shown to be feasible and significantly improves treatment efficiency and lung protection for synchronous bilateral breast irradiation (SBBI). This research compared the commonly used VMAT field arrangements using FFF beams. METHODS Twenty-eight patients underwent SBBI were retrospectively enrolled to design irradiation plans using tangential arc VMAT (taVMAT), half arc VMAT (haVMAT), and large arc VMAT (laVMAT). Dosimetric and delivery parameters of all designed plans were recorded and compared. RESULTS Comparable target volume coverage was observed for all field arrangements. taVMAT significantly reduced the dose to spinal cord and the volume covered by 5 Gy (V5Gy) and V7Gy of the lungs while decreasing the conformity index of the target volume. It also increased the volume covered by 105% of the prescription dose (V105%) and V107% of the target volume. haVMAT considerably decreased V20 Gy and V30 Gy of the lungs, mean dose (Dmean) and V30 Gy of the heart and the liver. It also notably reduced Dmean and V40 Gy of the left anterior descending coronary artery while increasing the beam-on time. laVMAT significantly reduced the mean treatment time (range, 113-117 seconds) compared with the other field arrangements. CONCLUSIONS There were distinct differences in various dosimetric and delivery parameters for different field arrangements, highlighting the importance of selecting the appropriate field arrangement based on specific treatment goals and considerations. This study contributes valuable insights into the use of FFF-based VMAT techniques in SBBI.
Collapse
Affiliation(s)
- Xingxing Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Juntian Shi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiuxiu Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liting Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Sun
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongmei Zou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guoquan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaokun Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Song Duan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
3
|
Perman M, Johansson KA, Holmberg E, Karlsson P. Doses to the right coronary artery and the left anterior descending coronary artery and death from ischemic heart disease after breast cancer radiotherapy: a case-control study in a population-based cohort. Acta Oncol 2024; 63:240-247. [PMID: 38682458 DOI: 10.2340/1651-226x.2024.19677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/29/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND PURPOSE Doses to the coronary arteries in breast cancer (BC) radiotherapy (RT) have been suggested to be a risk predictor of long-term cardiac toxicity after BC treatment. We investigated the dose-risk relationships between near maximum doses (Dmax) to the right coronary artery (RCA) and left anterior descending coronary artery (LAD) and ischemic heart disease (IHD) mortality after BC RT. PATIENTS AND METHODS In a cohort of 2,813 women diagnosed with BC between 1958 and 1992 with a follow-up of at least 10 years, we identified 134 cases of death due to IHD 10-19 years after BC diagnosis. For each case, one control was selected within the cohort matched for age at diagnosis. 3D-volume and 3D-dose reconstructions were obtained from individual RT charts. We estimated the Dmax to the RCA and the LAD and the mean heart dose (MHD). We performed conditional logistic regression analysis comparing piecewise spline transformation and simple linear modeling for best fit. RESULTS There was a linear dose-risk relationship for both the Dmax to the RCA (odds ratio [OR]/Gray [Gy] 1.03 [1.01-1.05]) and the LAD (OR/Gy 1.04 [1.02-1.06]) in a multivariable model. For MHD there was a linear dose-risk relationship (1,14 OR/Gy [1.08-1.19]. For all relationships, simple linear modelling was superior to spline transformations. INTERPRETATION Doses to both the RCA and LAD are independent risk predictors of long-term cardiotoxicity after RT for BC In addition to the LAD, the RCA should be regarded as an organ at risk in RT planning.
Collapse
Affiliation(s)
- Mats Perman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Karl-Axel Johansson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Sasada S, Nagura N, Shimo A, Ogiya A, Saiga M, Seki H, Mori H, Kondo N, Ishitobi M, Narui K, Nogi H, Yamauchi C, Sakurai T, Shien T. Impact of radiation therapy for breast cancer with involved surgical margin after immediate breast reconstruction: A multi-institutional observational study. Eur J Surg Oncol 2024; 50:108360. [PMID: 38669780 DOI: 10.1016/j.ejso.2024.108360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/26/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Involved surgical margins are risk factors for local recurrence and re-excision is often difficult, particularly in patients with breast cancer undergoing immediate breast reconstruction (IBR). However, the magnitude of the effect of radiation therapy on preventing local recurrence for breast cancers with involved margins has not been sufficiently assessed. MATERIALS AND METHODS We retrospectively assessed sites of involved surgical margins and local recurrence after mastectomy with IBR in patients with early breast cancer between 2008 and 2016. The effect of postoperative radiation therapy was evaluated in patients with involved margins, adjusted for nuclear grade, lymphatic invasion, surgical procedures, and primary systemic therapy. RESULTS A total of 274 (5.8 %) out of 4726 patients who underwent mastectomy with IBR had involved surgical margins: 133, 68, 88, and 26 had involvement of the skin, deep margin, lateral margins, and nipple, respectively (including duplicates). Radiation therapy was administered to 54 patients with involved margins. In patients with involved margins, 7-year cumulative incidences of local recurrence were 1.9 % and 12.6 % with and without radiation therapy, respectively (adjusted hazard ratio, 0.17; 95 % CI, 0.04-0.80). Local recurrence occurred in 28 patients, and the sites were skin, subcutaneous tissue, muscle, and nipple-areola complex in 7, 17, 1, and 3 patients, respectively. Among them, 23 (82.1 %) were associated with involved margin sites. CONCLUSIONS Radiation therapy meaningfully reduced the incidence of local recurrence in patients with breast cancer with margin involvement after mastectomy with IBR. Most local recurrences occurred at involved margin-related sites.
Collapse
Affiliation(s)
- Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Naomi Nagura
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Ayaka Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan; Department of Breast and Endocrine Surgery, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Breast Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Miho Saiga
- Department of Plastic and Reconstructive Surgery, Okayama University Hospital, Okayama, Japan
| | - Hirohito Seki
- Department of Breast Surgery, Saitama Medical Center, Saitama, Japan; Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Makoto Ishitobi
- Department of Breast Surgery, Mie University School of Medicine, Mie, Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Medical Center, Yokohama City University, Kanagawa, Japan
| | - Hiroko Nogi
- Department of Breast and Endocrine Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
| | | | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
5
|
Salvestrini V, Valzano M, Meattini I, Becherini C, Visani L, Francolini G, Morelli I, Bertini N, Orzalesi L, Bernini M, Bianchi S, Simontacchi G, Livi L, Desideri I. Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques. Radiol Med 2024:10.1007/s11547-024-01812-z. [PMID: 38602657 DOI: 10.1007/s11547-024-01812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. METHODS Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as "in field," "marginal" or "out of field." Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. RESULTS Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both "in field" and "out of field." No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. CONCLUSIONS The onset of local-regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed.
Collapse
Affiliation(s)
- Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
| | - Marianna Valzano
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Ilaria Morelli
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| |
Collapse
|
6
|
El Ouardy K, Zerfaoui M, Oulhouq Y, Bahhous K, Rrhioua A, Bakari D. A comparative study of boost dose delivery techniques in breast cancer radiotherapy optimising efficacy and minimising toxicity. Radiat Prot Dosimetry 2024; 200:459-466. [PMID: 38273648 DOI: 10.1093/rpd/ncad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
The present study aims to compare three techniques for delivering a boost absorbed dose: conventional reduced tangential (3D), volumetric modulated arc therapy (VMAT) and fields forward-planned technique boost (3DF). The study included 15 postoperative breast cancer patients who received a boost absorbed dose following breast-conserving surgery. The conformity index and homogeneity index were used to evaluate treatment outcomes, along with the average absorbed dose received by organs at risk (OAR). All the calculated dosimetric plans are carried out using Monaco Treatment Planning System (TPS). VMAT offers superior conformity, dose homogeneity and target coverage, it is associated with higher absorbed doses to OAR such as the heart and lung. In contrast, the 3D and 3DF techniques exhibit advantages in reducing absorbed doses to critical structures, potentially minimising the risk of cardiac and pulmonary complications. Each technique has its advantages and disadvantages. The choice of technique should be individualised, taking into account patient-specific factors and treatment goals and involves a multidisciplinary approach.
Collapse
Affiliation(s)
- Khalid El Ouardy
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Mustapha Zerfaoui
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Yassine Oulhouq
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Karim Bahhous
- Faculty of Science, University Mohammed V in Rabat, Rabat B.P. 1014, Morocco
| | - Abdeslem Rrhioua
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Dikra Bakari
- National School of Applied Sciences, Mohammed First University, Oujda 60000, Morocco
| |
Collapse
|
7
|
Xie SJ, Wang RJ, Wu SG, Zhang FX. 21-gene recurrence score in predicting the outcome of postoperative radiotherapy in T1-2N1 luminal breast cancer after breast-conserving surgery. Breast 2024; 74:103679. [PMID: 38367283 PMCID: PMC10882169 DOI: 10.1016/j.breast.2024.103679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND In those with one to three positive lymph nodes (N1) breast cancer (BC), the 21-gene recurrence score (RS) classification can be referred for decision-making on adjuvant chemotherapy. This study aimed to investigate the effect of RS in predicting the survival benefit of postoperative radiotherapy (PORT) in T1-2N1 BC with estrogen receptor-positive and human epidermal growth factor receptor 2-negative disease after breast-conserving surgery (BCS). METHODS We included patients with BC and available RS data from the Surveillance, Epidemiology, and End Results Oncotype DX database. The chi-square test, Kaplan-Meier method, propensity score matching (PSM) as well as multivariable Cox proportional hazard analyses were used for statistical analyses. RESULTS We included 6509 patients in the analysis. Of these patients, 5302 (85.5%) were treated with BCS + PORT, and 207 (15.5%) had BCS alone. There were 1419 (21.8%), 4319 (66.4%), and 771 (11.8%) patients being low-, intermediate-, and high-risk RS, respectively. After PSM, PORT was significantly associated with a 5-year overall survival (OS) advantage (95.1% vs. 90.5%, P < 0.001) compared to those without PORT, which similar breast cancer-specific survival (BCSS) was found between the treatment arms (P = 0.126). The sensitivity analyses showed that PORT was not associated with a better BCSS (P = 0.472) and OS (P = 0.650) than those without PORT in the low-risk RS cohort. However, PORT was associated with a better BCSS (P = 0.031) and OS (P < 0.001) compared to those without PORT in the intermediate/high-risk RS cohorts. CONCLUSIONS Our study highlights the possible role of the RS in predicting the outcome of PORT in T1-2N1 luminal BC patients undergoing BCS.
Collapse
Affiliation(s)
- Shang-Jin Xie
- Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen, 361005, People's Republic of China
| | - Run-Jie Wang
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China.
| | - Fu-Xing Zhang
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China.
| |
Collapse
|
8
|
Maharaj R, Cave C, Motilal S, Naraynsignh V. Delays in adjuvant radiotherapy for primary breast cancer is harmful, especially in low-income countries. Trop Doct 2024; 54:126-130. [PMID: 37956657 DOI: 10.1177/00494755231212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Our retrospective cohort study of the effects of radiotherapy delay on the oncological outcome of breast cancer patients showed a prolonged radiotherapy waiting interval was associated with a statistically significant increase in the 3-year breast cancer-specific mortality. This research should stimulate setting up protocols geared towards minimizing delays.
Collapse
Affiliation(s)
- Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Christo Cave
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Paraclinical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago
| | - Vijay Naraynsignh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| |
Collapse
|
9
|
Costanzo V, Ratre YK, Andretta E, Acharya R, Bhaskar LVKS, Verma HK. A Comprehensive Review of Cancer Drug-Induced Cardiotoxicity in Blood Cancer Patients: Current Perspectives and Therapeutic Strategies. Curr Treat Options Oncol 2024; 25:465-495. [PMID: 38372853 DOI: 10.1007/s11864-023-01175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/20/2024]
Abstract
OPINION STATEMENT Cardiotoxicity has emerged as a serious outcome catalyzed by various therapeutic targets in the field of cancer treatment, which includes chemotherapy, radiation, and targeted therapies. The growing significance of cancer drug-induced cardiotoxicity (CDIC) and radiation-induced cardiotoxicity (CRIC) necessitates immediate attention. This article intricately unveils how cancer treatments cause cardiotoxicity, which is exacerbated by patient-specific risks. In particular, drugs like anthracyclines, alkylating agents, and tyrosine kinase inhibitors pose a risk, along with factors such as hypertension and diabetes. Mechanistic insights into oxidative stress and topoisomerase-II-B inhibition are crucial, while cardiac biomarkers show early damage. Timely intervention and prompt treatment, especially with specific agents like dexrazoxane and beta-blockers, are pivotal in the proactive management of CDIC.
Collapse
Affiliation(s)
- Vincenzo Costanzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Emanuela Andretta
- Department of Veterinary Medicine and Animal Productions, University of Naples "Federico II", Naples, Italy
| | - Rakesh Acharya
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - L V K S Bhaskar
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of Lungs Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, Neuherberg, 85764, Munich, Germany.
| |
Collapse
|
10
|
Kang NK, Sung SY, Kim SH, Jeon YW, Suh YJ, Lee JH. Hypofractionated Partial Breast Irradiation With Intensity-Modulated Radiotherapy in Early Breast Cancer or Carcinoma In Situ: An Investigational Short-Term Analysis. J Breast Cancer 2024; 27:79-90. [PMID: 38529590 PMCID: PMC11065498 DOI: 10.4048/jbc.2023.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/12/2024] [Accepted: 03/21/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE This study aimed to analyze the treatment outcomes and adverse effects of moderately hypofractionated partial breast irradiation (PBI) in patients with early breast cancer. METHODS In total, 473 patients with early breast cancer or carcinoma in situ were diagnosed with Tis or T1N0 disease and underwent PBI following breast-conserving surgery. All histologic tumor types, close surgical margins within 1 mm of the tumor, and multifocal tumors were included in this study. A radiation dose of 50 Gy in 20 fractions was delivered over 4 weeks using intensity-modulated radiotherapy technique. Dosimetric data, recurrence patterns, survival outcomes, and adverse events were retrospectively analyzed. RESULTS During a median follow-up of 28.9 months, seven patients (1.5%) experienced ipsilateral breast tumor recurrence (IBTR). Two patients had regional recurrence, four patients developed contralateral breast cancer, and no distant metastases were observed. The locoregional recurrence rate in the ipsilateral breast was 1.8%. Two deaths occurred during the follow-up period, but were not attributed to breast cancer. The 2-year disease-free survival and 2-year overall survival rates were was 94.0% and 99.8%, respectively. Acute adverse events occurred in 131 patients (27.1%), and were distributed among all grades, with only two patients (0.4%) experiencing grade 3 events. Late adverse events were noted in 16 patients (3.4%), and were distributed among all grades, including grade 3 events in four patients (0.8%). No grade 4 or 5 events were observed. CONCLUSION Hypofractionated PBI demonstrated favorable IBTR rates in patients with early breast cancer, with low incidence of acute and late toxicities in the short-term analysis.
Collapse
Affiliation(s)
- Nam Kyu Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Yoon Sung
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ye Won Jeon
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jin Suh
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
11
|
Søndergaard SR, Bechmann T, Maae E, Nielsen AWM, Nielsen MH, Møller M, Timm S, Lorenzen EL, Berry LL, Zachariae R, Offersen BV, Steffensen KD. Shared decision making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial. Radiother Oncol 2024; 193:110115. [PMID: 38316191 DOI: 10.1016/j.radonc.2024.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND PURPOSE Shared decision making (SDM) is a patient engaging process advocated especially for preference-sensitive decisions, such as adjuvant treatment after breast cancer. An increasing call for patient engagement in decision making highlights the need for a systematic SDM approach. The objective of this trial was to investigate whether the Decision Helper (DH), an in-consultation patient decision aid, increases patient engagement in decisions regarding adjuvant whole breast irradiation. MATERIAL AND METHODS Oncologists at four radiotherapy units were randomized to practice SDM using the DH versus usual practice. Patient candidates for adjuvant whole breast irradiation after breast conserving surgery for node-negative breast cancer were eligible. The primary endpoint was patient-reported engagement in the decision process assessed with the Shared Decision Making Questionnaire (SDM-Q-9) (range 0-100, 4 points difference considered clinical relevant). Other endpoints included oncologist-reported patient engagement, decisional conflict, fear of cancer recurrence, and decision regret after 6 months. RESULTS Of the 674 included patients, 635 (94.2%) completed the SDM-Q-9. Patients in the intervention group reported higher level of engagement (median 80; IQR 68.9 to 94.4) than the control group (71.1; IQR 55.6 to 82.2; p < 0.0001). Oncologist-reported patient engagement was higher in the invention group (93.3; IQR 82.2 to 100) compared to control group (73.3; IQR 60.0 to 84.4) (p < 0.0001). CONCLUSION Patient engagement in medical decision making was significantly improved with the use of an in-consultation patient decision aid compared to standard. The DH on adjuvant whole breast irradiation is now recommended as standard of care in the Danish guideline.
Collapse
Affiliation(s)
- Stine Rauff Søndergaard
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark.
| | - Troels Bechmann
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Else Maae
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders W Mølby Nielsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette Møller
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Timm
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | - Robert Zachariae
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
12
|
Mücke R, Heim G, Gosenheimer R, Schmitz V, Schulz C, Knoeß P, Fakhrian K, Harvey C, Mücke C, Lochhas G, Metzmann U, Bussmann M, Paschold M. Radiation therapy of breast cancer in the Nahe Breast Center: first results of an analysis in the context of health services research. Strahlenther Onkol 2024; 200:314-319. [PMID: 37947805 DOI: 10.1007/s00066-023-02157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The first evaluation of radiotherapy results in patients with breast cancer treated as part of a multimodal oncologic therapy in the Nahe Breast Center is presented. Analysis of the results was performed using an in-practice registry. PATIENTS AND METHODS From September 2016 to December 2017, 138 patients (median age 62.5 years; range 36-94 years) with breast cancer (right side, n = 67; left side, n = 71) received adjuvant radiation therapy. Of these, 103 patients received gyneco-oncologic care at the Nahe Breast Center, and 35 were referred from outside breast centers. The distribution into stages was as follows: stage I, n = 48; stage II, n = 68; stage III, n = 19; stage IV, n = 3. Neoadjuvant chemotherapy was given to 19 and adjuvant chemotherapy to 50 patients. Endocrine treatment was given to 120 patients. Both 3D conformal (n = 103) and intensity-modulated (n = 35) radiotherapy were performed with a modern linear accelerator. RESULTS With a median follow-up of 60 months (1-67), local recurrence occurred in 4/138 (2.9%) and distant metastasis in 8/138 (5.8%) patients; 7/138 (5.1%) patients died of their tumors during the follow-up period. The actuarial 5‑year local recurrence-free survival of all patients was 97.1%, and the actuarial 5‑year overall survival of all patients was 94.9%. We observed no grade 3 or 4 radiogenic side effects. CONCLUSION The results of radiotherapy for breast carcinoma at the Nahe Breast Center are comparable to published national and international results. In particular, the local recurrence rates in our study, determined absolutely and actuarially, are excellent, and demonstrate the usefulness of radiotherapy.
Collapse
Affiliation(s)
- Ralph Mücke
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany.
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany.
| | - Gabor Heim
- Department of Gynecology, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Robert Gosenheimer
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Volker Schmitz
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | | | - Per Knoeß
- Institute of Pathology, Bad Kreuznach, Germany
| | | | - Christina Harvey
- Department of Internal Medicine, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Christiane Mücke
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Gabriele Lochhas
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Ute Metzmann
- Radiotherapy RheinMainNahe, Mainz-Ruesselsheim-Bad Kreuznach, Mühlenstraße 39a, 55543, Bad Kreuznach, Germany
| | - Matthias Bussmann
- Medical Management Board, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| | - Markus Paschold
- Department of Surgery, Hospital Sankt Marienwoerth, Bad Kreuznach, Germany
| |
Collapse
|
13
|
Alamoodi M. Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis? Eur J Breast Health 2024; 20:81-88. [PMID: 38571693 PMCID: PMC10985578 DOI: 10.4274/ejbh.galenos.2024.2023-12-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 04/05/2024]
Abstract
The advent of taxane-based chemotherapy has revolutionized breast cancer care. This advance has helped improve the response to downstaging tumors that might otherwise be inoperable. It has also helped in rendering clinically (cN+) positive lymph nodes (LNs) pathologically negative (ypN0). The standard of care for cN+ patients included post-mastectomy radiotherapy (PMRT), regardless of the response to neoadjuvant chemotherapy. However, PMRT in patients with 1-3 positive LNs still lacks definitive guidelines. Numerous retrospective results have been inconclusive about the benefit of PMRT on survival in patients with 1-3 positive LNs. This pooled analysis attempts to reach a consensus. The PubMed database was searched through October 2023. The search yielded 27 papers, of which 11 satisfied the inclusion criteria. The locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) for each study were tabulated when given, and two groups were created, the PMRT and NO PMRT, respectively. The results were then pooled for analysis. The total number of patients was 8340, 4136 in the PMRT group, and 4204 in the NO PMRT group, respectively. The LRRFS, DFS, and OS were 96.9%, 82.1%, and 87.3% for the PMRT group and 93.2%, 79.6%, and 84.8% for the NO PMRT group, respectively. There was no statistical significance in LRRFS, DFS, or OS between the two groups (p = 0.61, p = 0.61, and p = 0.38, respectively). PMRT does not seem to confer survival benefits in patients with pN1 rendered ypN0 for stages T1-3. This pooled analysis's findings should be confirmed prospectively with a longer period of follow-up.
Collapse
Affiliation(s)
- Munaser Alamoodi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
14
|
Maraldo MV, Offersen BV. Radiotherapy for breast cancer. Ugeskr Laeger 2024; 186:V02230106. [PMID: 38533873 DOI: 10.61409/v02230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In early breast cancer, adjuvant moderately hypofractionated regimens are recommended for both whole breast, partial breast and locoregional irradiation which abbreviates the overall treatment time, as argued in this review. Gating is recommended as well as the use of a simultaneous integrated boost when indicated. A tangential field set-up is standard, however, for challenging cases volumetric modulated arc therapy techniques, or referral for proton therapy, may be considered. In the metastatic setting, stereotactic radiotherapy is a promising treatment option for oligometastatic disease.
Collapse
Affiliation(s)
- Maja Vestmø Maraldo
- Afdeling for Kræftbehandling, Københavns Universitetshospital - Rigshospitalet
| | - Birgitte Vrou Offersen
- Kræftafdelingen, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Aarhus Universitet
| |
Collapse
|
15
|
Wang JZ, Wang Y, Shao Q, Li JB. Dynamic changes in cardiac biomarkers in radiotherapy for oesophageal cancer and their correlations with cardiac radiation dosimetry. Clin Transl Radiat Oncol 2024; 45:100750. [PMID: 38406646 PMCID: PMC10885730 DOI: 10.1016/j.ctro.2024.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Background and purpose To investigate the dynamic changes in cardiac enzymes, high-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (pro-BNP) and left ventricular ejection fraction (LVEF) during radiotherapy (RT) and 6 months after RT for oesophageal squamous cell carcinoma (ESCC) in the middle and lower locations and to analyse the correlations between these indicators and cardiac radiation dosimetry parameters. Methods For 35 patients with ESCC in the middle and lower locations receiving radical concurrent chemoradiotherapy (cCRT), intensity-modulated RT was performed at 1.8 Gy or 2.0 Gy per day, and the totle dose was 50.4 Gy or 60 Gy. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (α-HBDH), hs-TnT, pro-BNP and LVEF were measured before, during, and at the end of RT and 1, 3 and 6 months after RT, and correlations of these indicators with mean heart dose (MHD) and heart V5-V50 were analysed. Results hs-TnT during, at the end and 6 months after RT for oesophageal cancer showed increasing trends, however, LVEF showed a downward trend. pro-BNP showed an increasing trend during RT and gradually returned to normal after RT. CK and CK-MB showed decreasing trends during RT and continued until one month after RT and then gradually returned to normal. Compared with the low-dose group (MHD < 2000 cGy), the high-dose group (MHD ≥ 2000 cGy) had larger increases in hs-TnT and pro-BNP, a more significant decrease in LVEF, and a longer recovery time for these indicators. MHD and V35 were positively correlated with dynamic changes in hs-TnT. Conclusions Cardiac injury caused by cCRT for ESCC in the middle and lower locations led to increased hs-TnT and pro-BNP levels and a decrease in LVEF in the early stage of treatment, effects that were more pronounced in the high-dose group. MHD and V35 may be potential indicators to predict the degree of cardiac damage. hs-TnT and pro-BNP are sensitive indicators reflecting cardiac injury in RT for oesophageal cancer. Continuous dynamic monitoring of these markers can provide a reference for cardiac protection in clinical RT.
Collapse
Affiliation(s)
- Jin-zhi Wang
- Shandong University Cancer Center, Jinan, Shandong Province 250012, PR China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province 250012, PR China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province 250117, PR China
| | - Yue Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province 250117, PR China
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province 250117, PR China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province 250117, PR China
| | - Jian-bin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province 250117, PR China
| |
Collapse
|
16
|
Mao Y, Di W, Zong D, Mu Z, He X. Machine learning-based radiomics nomograms to predict number of fields in postoperative IMRT for breast cancer. J Appl Clin Med Phys 2024; 25:e14194. [PMID: 37910655 DOI: 10.1002/acm2.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Breast cancer is now the most commonly diagnosed cancer in women worldwide. Radiotherapy is an important part of the treatment for breast cancer, while setting proper number of fields dramatically affects the benefits one can receive. Machine learning and radiomics have been widely investigated in the management of breast cancer. This study aims to provide models to predict the best number of fields based on machine learning and improve the prediction performance by adding clinical factors. METHODS Two-hundred forty-two breast cancer patients were retrospectively enrolled for this study, all of whom received postoperative intensity modulated radiation therapy. The patients were randomized into a training set and a validation set at a ratio of 7:3. Radiomics shape features were extracted for eight machine learning algorithms to predict the number of fields. Univariate and multivariable logistic regression were implemented to screen clinical factors. A combined model of rad-score and clinical factors were finally constructed. The area under receiver operating characteristic curve, precision, recall, F1 measure and accuracy were used to evaluate the model. RESULTS Random Forest outperformed from eight machine learning algorithms while predicting the number of fields. Prediction performance of the radiomics model was better than the clinical model, while the predictive nomogram combining the rad-score and clinical factors performed the best. CONCLUSIONS The model combining rad-score and clinical factors performed the best. Nomograms constructed from the combined models can be of reliable references for medical dosimetrists.
Collapse
Affiliation(s)
- Yichen Mao
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Wenyi Di
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Dan Zong
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Zhongde Mu
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Xia He
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| |
Collapse
|
17
|
Le TP, Le AT, Huynh TND, Huynh KQ, Dao TH, Desgranges P, Bosc R. Duplex Imaging Assessment of the Internal Mammary Arteries in Women after Unilateral Mastectomy and Radiotherapy for Breast Cancer. Ann Vasc Surg 2024; 100:15-24. [PMID: 38110082 DOI: 10.1016/j.avsg.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The effects of incidental radiation exposure on internal mammary arteries remain unclear. The present study was designed to test the hypothesis by comparing diameter and blood flow of the irradiated and nonirradiated internal mammary arteries, using Duplex ultrasound imaging. METHODS The study was designed as a single-center, transversal, comparative study. The main outcomes were diameter and volumetric blood flow of the internal mammary arteries. The Wilcoxon rank-sum test was used to assess the differences between the irradiated and nonirradiated internal mammary arteries with regard to the diameter and volumetric blood flow. RESULTS The diameter (median [interquartile range]) of the irradiated internal mammary arteries (0.170 mm [0.160, 0.180]) was smaller than that of the contralateral nonirradiated ones (0.180 mm [0.170, 0.200], P < 0.0001) and that of the internal mammary arteries in the control group (0.180 mm [0.170, 0.190], P < 0.0001). Similarly, blood flow (median [interquartile range]) of the irradiated internal mammary arteries (52.4 ml/min [37.78, 65.57]) was smaller than that of the contralateral nonirradiated ones (62.7 ml/min [46.87, 84.17], P < 0.0001), as well as of the left (56.7 ml/min [46.88, 72.58], P = 0.02) and the right internal mammary arteries in the control group (61.0 ml/min [47.47, 74.52], P = 0 0.0009). CONCLUSIONS The data indicate that the irradiated internal mammary arteries in patients with a history of total mastectomy followed by radiotherapy for breast cancer had significantly smaller diameter and blood flow compared to the nonirradiated internal mammary arteries.
Collapse
Affiliation(s)
- Thanh-Phong Le
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam; L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France.
| | - Anh T Le
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tan N D Huynh
- Department of Diagnostic Ultrasonography, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Q Huynh
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thu-Ha Dao
- Department of Imaging, Henri Mondor Hospital, Creteil, France
| | - Pascal Desgranges
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France
| | - Romain Bosc
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Plastic, Esthetic and Reconstructive Surgery, George- Pompidou Hospital, Paris, France
| |
Collapse
|
18
|
Shi J, Liu J, Tian G, Li D, Liang D, Wang J, He Y. Association of radiotherapy for stage I-III breast cancer survivors and second primary malignant cancers: a population-based study. Eur J Cancer Prev 2024; 33:115-128. [PMID: 37669169 DOI: 10.1097/cej.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs. METHODS A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000-2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison. RESULTS There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers. CONCLUSIONS Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.
Collapse
Affiliation(s)
- Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jian Liu
- The Service Center of Comprehensive Supervision Health Commission of Hebei Province
| | - Guo Tian
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| |
Collapse
|
19
|
Patel TA, Jain B, Cho HL, Corti C, Vapiwala N, Chino F, Leeman JE, Dee EC. Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting. Clin Oncol (R Coll Radiol) 2024; 36:183-192. [PMID: 38184401 DOI: 10.1016/j.clon.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
AIMS For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT. MATERIALS AND METHODS Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted. RESULTS Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT. CONCLUSIONS In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.
Collapse
Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - B Jain
- Stanford School of Medicine, Stanford, CA, USA
| | - H L Cho
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C Corti
- Breast Oncology Program, Dana-Farber Cancer Centre, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - E C Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
20
|
Ameri MA, Shanbhag NM, Bin Sumaida A, Ansari J, Trad DA, Dawoud EA, Balaraj K. Oncotype DX in Breast Cancer Management: Insights and Outcomes From the United Arab Emirates. Cureus 2024; 16:e56535. [PMID: 38516286 PMCID: PMC10955450 DOI: 10.7759/cureus.56535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Breast cancer remains the most significant cancer affecting women worldwide, with an increasing incidence, especially in developing regions. The introduction of genomic tests like Oncotype DX has revolutionized personalized treatment, allowing for more tailored approaches to therapy. This study focuses on the United Arab Emirates (UAE), where breast cancer is the leading cause of cancer-related deaths among women, aiming to assess the predictive accuracy of the Oncotype DX test in categorizing patients based on recurrence risk. Materials and methods A retrospective cohort study was conducted on 95 breast cancer patients diagnosed at Tawam Hospital between 2013 and 2017 who underwent Oncotype DX testing. Data on patient demographics, tumor characteristics, treatment details, and Oncotype DX scores were collected. Survival analysis was performed using the Kaplan-Meier method, with the chi-square goodness of fit test assessing the model's adequacy. Results The cohort's age range was 27-71 years, with a mean age of 50, indicating a significant concentration of cases in the early post-menopausal period. The Oncotype DX analysis classified 55 patients (57.9%) as low risk, 29 (30.5%) as medium risk, and 11 (11.6%) as high risk of recurrence. The majority, 73 patients (76.8%), did not receive chemotherapy, highlighting the test's impact on treatment decisions. The survival analysis revealed no statistically significant difference in recurrence rates across the Oncotype DX risk categories (p = 0.268231). Conclusion The Oncotype DX test provides a valuable genomic approach to categorizing breast cancer patients by recurrence risk in the UAE. While the test influences treatment decisions, particularly the use of chemotherapy, this study did not find a significant correlation between Oncotype DX risk categories and actual recurrence events. These findings underscore the need for further research to optimize the use of genomic testing in the UAE's diverse patient population and enhance personalized treatment strategies in breast cancer management.
Collapse
Affiliation(s)
| | - Nandan M Shanbhag
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
- Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
| | | | | | | | | | - Khalid Balaraj
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
| |
Collapse
|
21
|
Park YI, Cho MS, Chang JS, Kim JS, Kim YB, Lee IJ, Hong CS, Choi SH. Normal tissue complication probability models of hypothyroidism after radiotherapy for breast cancer. Clin Transl Radiat Oncol 2024; 45:100734. [PMID: 38317677 PMCID: PMC10839258 DOI: 10.1016/j.ctro.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose We aimed to develop Lyman-Kutcher-Burman (LKB) and multivariable normal tissue complication probability (NTCP) models to predict the risk of radiation-induced hypothyroidism (RIHT) in breast cancer patients. Materials and methods A total of 1,063 breast cancer patients who underwent whole breast irradiation between 2009 and 2016 were analyzed. Individual dose-volume histograms were used to generate LKB and multivariable logistic regression models. LKB model was fit using the thyroid radiation dose-volume parameters. A multivariable model was constructed to identify potential dosimetric and clinical parameters associated with RIHT. Internal validation was conducted using bootstrapping techniques, and model performance was evaluated using the area under the curve (AUC) and Hosmer-Lemeshow (HL) goodness-of-fit test. Results RIHT developed in 4 % of patients with a median follow-up of 77.7 months. LKB and multivariable NTCP models exhibited significant agreement between the predicted and observed results (HL P values > 0.05). The multivariable NTCP model outperformed the LKB model in predicting RIHT (AUC 0.62 vs. 0.54). In the multivariable model, systemic therapy, age, and percentage of thyroid volume receiving ≥ 10 Gy (V10) were significant prognostic factors for RIHT. The cumulative incidence of RIHT was significantly higher in patients who exceeded the cut-off values for all three risk predictors (systemic therapy, age ≥ 40 years, and thyroid V10 ≥ 26 %, P < 0.005). Conclusions Systemic therapy, age, and V10 of the thyroid were identified as strong risk factors for the development of RIHT. Our NTCP models provide valuable insights to clinicians for predicting and preventing hypothyroidism by identifying high-risk patients.
Collapse
Affiliation(s)
- Ye-In Park
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Seok Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi do, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- BC Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Li J, Yang L, Yao X, Xu L, Zhao L, Bai F. A retrospective study on improving the accuracy of radiotherapy for patients with breast cancer with lymph node metastasis using Styrofoam. Radiol Oncol 2024; 58:124-132. [PMID: 38183274 PMCID: PMC10878773 DOI: 10.2478/raon-2024-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/15/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND To retrospectively analyze the accuracy of radiotherapy using cone beam computed tomography (CBCT), Styrofoam fixation, and breast bracket fixation in the chest wall target area and supraclavicular lymphatic drainage area (supraclavicular target area) of patients with breast cancer.and compare the setting efficiency and comfort satisfaction. PATIENTS AND METHODS A total of 65 patients with postoperative lymphatic metastasis of breast cancer, including 36 cases of Styrofoam fixation and 29 cases of breast bracket fixation, were recruited from March 2021 to August 2022 and retrospectively analyzed. All the patients underwent CBCT scans weekly, and the setup errors of the chest wall and supraclavicular target volume were compared and recorded. The planning target volume (PTV) margins of the two groups were calculated using the correlation MPTV = 2.5Σ + 0.7σ. The setup time and comfort satisfaction scores of the two groups were recorded and analyzed. The correlations among errors in each direction were analyzed using the Pearson correlation analysis. RESULTS There was a significant difference in the left-right direction (X) axis of the chest wall target area between the Styrofoam and breast bracket groups (1.59 ± 1.47 mm vs. 2.05 ± 1.64 mm, P = 0.012). There were statistical differences in the ventrodorsal direction (Z) and bed angle of the supraclavicular target area, the data were (1.36 ± 1.27 mm vs. 1.75 ± 1.55 mm, P = 0.046; 0.47 ± 0.47° vs. 0.66 ± 0.59°, P = 0.006, respectively). In the X, Y, and Z directions, the respective PTV margins of the two groups in the chest wall target area were 5.01 mm, 5.99 mm, and 5.47 mm in the Styrofoam group, while those in the breast bracket group were 6.10 mm, 6.34 mm, and 6.10 mm, respectively. Moreover, the PTV margins of the supraclavicular target in the three directions were 3.69 mm, 3.86 mm, and 4.28 mm in the Styrofoam group, while those in the breast bracket group were 3.99 mm, 3.72 mm, and 5.45 mm, respectively. The setup time of the two groups was 3.4 ± 1.1 min and 5.5 ± 3.1 min (P = 0.007). The subjective comfort satisfaction scores of the two groups were 27.50 ± 1.24 and 25.44 ± 1.23 (P < 0.001). CONCLUSIONS The application of Styrofoam fixation in radiotherapy of breast cancer in the supraclavicular lymph node area has several advantages as compared to breast bracket fixation, including higher positioning accuracy, smaller external expansion boundary, improved work efficiency, and patients' comfort, which might provide a reference for clinical work.
Collapse
Affiliation(s)
- Jie Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| | - Lin Yang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| | - Xiaowei Yao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| | - Linlin Xu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| | - Fei Bai
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University. Xi’an, China
| |
Collapse
|
23
|
Araujo AS, Silva RMV, Souza DN. Evaluation of conventional IMRT and VMAT strategies for postmastectomy radiation therapy after immediate implant-based reconstruction using the new ESTRO-ACROP contouring guidelines. Radiat Environ Biophys 2024; 63:59-70. [PMID: 38300284 DOI: 10.1007/s00411-024-01059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
This study evaluated the usability of conventional templates based on the new contour guidelines of the European Society of Radiation and Oncology and Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) for treatment plans of postmastectomy radiotherapy after immediate implant-based reconstruction. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans generated with two different treatment planning systems (TPSs, Eclipse and Monaco) were examined. Six computed tomography scans of patients aged 35-54 years were retrospectively analysed who had undergone mastectomy and breast reconstruction using silicone implants after being diagnosed with left breast cancer. Six radiation oncologists participated in this study, and each of them contoured the target volume of one left breast using conventional contour (CTV-CONV) and new contour (CTV-ESTRO) methods. This study showed that compared with CTV-CONV, using CTV-ESTRO with objectives and cost functions similar to those of TPSs worsened the target volume coverage and increased the total number of monitor units. Considering the organs at risk, CTV-ESTRO tended to increase the mean dose delivered to the contralateral lung. It is concluded that the approach used for the new ESTRO-ACROP contour method cannot be applied in a manner similar to that for the conventional breast contour method, implying that the new ESTRO-ACROP contour method may require more time for improving plans for a given treatment.
Collapse
Affiliation(s)
- Andreyson S Araujo
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, 49100-000, Brazil
| | | | - Divanizia N Souza
- Departamento de Física, Universidade Federal de Sergipe, São Cristóvão, SE, 49100-000, Brazil.
| |
Collapse
|
24
|
Praveen Kumar A, Vicente D, Liu J, Raj-Kumar PK, Deyarmin B, Lin X, Shriver CD, Hu H. Association of clinicopathologic and molecular factors with the occurrence of positive margins in breast cancer. Breast Cancer Res Treat 2024; 204:15-26. [PMID: 38038766 PMCID: PMC10805852 DOI: 10.1007/s10549-023-07157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To explore the association of clinicopathologic and molecular factors with the occurrence of positive margins after first surgery in breast cancer. METHODS The clinical and RNA-Seq data for 951 (75 positive and 876 negative margins) primary breast cancer patients from The Cancer Genome Atlas (TCGA) were used. The role of each clinicopathologic factor for margin prediction and also their impact on survival were evaluated using logistic regression, Fisher's exact test, and Cox proportional hazards regression models. In addition, differential expression analysis on a matched dataset (71 positive and 71 negative margins) was performed using Deseq2 and LASSO regression. RESULTS Association studies showed that higher stage, larger tumor size (T), positive lymph nodes (N), and presence of distant metastasis (M) significantly contributed (p ≤ 0.05) to positive surgical margins. In case of surgery, lumpectomy was significantly associated with positive margin compared to mastectomy. Moreover, PAM50 Luminal A subtype had higher chance of positive margin resection compared to Basal-like subtype. Survival models demonstrated that positive margin status along with higher stage, higher TNM, and negative hormone receptor status was significant for disease progression. We also found that margin status might be a surrogate of tumor stage. In addition, 29 genes that could be potential positive margin predictors and 8 pathways were identified from molecular data analysis. CONCLUSION The occurrence of positive margins after surgery was associated with various clinical factors, similar to the findings reported in earlier studies. In addition, we found that the PAM50 intrinsic subtype Luminal A has more chance of obtaining positive margins compared to Basal type. As the first effort to pursue molecular understanding of the margin status, a gene panel of 29 genes including 17 protein-coding genes was also identified for potential prediction of the margin status which needs to be validated using a larger sample set.
Collapse
Affiliation(s)
- Anupama Praveen Kumar
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | | | - Jianfang Liu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | - Praveen-Kumar Raj-Kumar
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brenda Deyarmin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | - Xiaoying Lin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Hai Hu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA.
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| |
Collapse
|
25
|
Shaikh PM, Mulherkar R, Khasawneh MT, Clump D, Hazard-Jenkins H, Hafez M, Vargo JA. Treatment of Internal Mammary Nodes is Associated With Improved Overall Survival in Breast Cancer: A Meta-Analysis. Am J Clin Oncol 2024; 47:81-87. [PMID: 37916961 DOI: 10.1097/coc.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
INTRODUCTION The role of internal mammary nodal irradiation (IMNI) as a component of regional nodal radiotherapy is a controversial issue in breast radiation oncology with conflicting results presented in recent landmark trials. We thus created a meta-analysis of available data to better ascertain the potential benefit of IMNI. We hypothesize that with the increased power available within a meta-analysis, IMNI will prove to improve overall survival (OS) in breast cancer. METHODS Literature search was conducted for prospective studies comparing IMNI to no IMNI. Primary endpoint was OS and secondary endpoints included local recurrence, regional recurrence, disease-free survival (DFS), breast cancer mortality (BCM), distant metastasis-free survival (DMFS), grade 2+ skin toxicity, cardiac events, and pneumonitis events. Subgroup analyses were performed for tumor location (medial/central vs. lateral), and nodal status (pN+ vs. pN0). Fixed-effect model was used if there was no heterogeneity, random-effects model otherwise. RESULTS Four studies with a total of 5258 patients (IMNI: n=2592; control: n=2666) were included in the study. Pooled results showed IMNI significantly improved OS for all-comers (hazard ratio [HR]=0.89; 95% CI 0.81-0.97; P =0.008), as well as subgroups of pN+ with medial/central tumor location (HR=0.84; 95% CI 0.73-0.96; P =0.01) and pN+ with lateral tumor location (HR=0.87; 95% CI 0.77-0.99; P =0.04). There was no significant difference in OS for subgroups of pN0 and medial/central tumor location. There was no difference in local recurrence, but regional recurrence was significantly improved ( P =0.04). Endpoints of DFS (HR 0.91, 95% CI 0.84-0.99 P =0.03), BCM (HR 0.87, 95% CI 0.77-0.98, P =0.03), and DMFS (HR=0.87; 95% CI, 0.78-0.98; P =0.02) were all improved with IMNI. Grade 2+ skin toxicity, cardiac events and pneumonitis events were not significantly different between patient in the IMNI and no IMNI groups. CONCLUSION Inclusion of IMN irradiation improves OS, DFS, BCM, and DMFS in breast cancer. Largest effect on OS was noted in the subgroup of patients with pN+ and medial/central tumor location.
Collapse
Affiliation(s)
| | - Ria Mulherkar
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohammad T Khasawneh
- Department of Systems Science and Industrial Engineering at Binghamton University, Binghamton, NY
| | | | | | - Maria Hafez
- Department of Medicine, Division of Hematology/Oncology, West Virginia University, Morgantown, WV
| | - John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
26
|
Zangouri V, Roshanshad A, Ranjbar A, Izadi M, Rajaeifar S, Goodarzi A, Nasrollahi H. Outcomes and complications of intraoperative radiotherapy versus external beam radiotherapy for early breast cancer. Cancer Rep (Hoboken) 2024; 7:e1950. [PMID: 38205671 PMCID: PMC10849931 DOI: 10.1002/cnr2.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/19/2023] [Accepted: 11/12/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) is an alternative for external beam radiotherapy (EBRT) for early stage breast cancer (BC). Herein, we compared outcomes, postoperative and post-radiation complications of IORT and EBRT. METHODS We conducted a cohort study to compare complications of IORT and EBRT in patients. A checklist of the complications of IORT and EBRT, was used to assess and post-radiation complications and outcomes. RESULTS Overall, 264 women (121 in IORT and 143 in EBRT group) with a mean (SD) age of 55 ± 8.6 years analyzed in this study. The IORT group (quadrantectomy + SLNB + IORT) had more severe post-operative pain compared to the EBRT group (quadrantectomy + SLNB) (OR = 1.929, 95% CI: 1.116-3.332). Other postoperative complications, including edema, erythema, seroma, hematoma, and wound complications were not significantly different between the IORT and EBRT groups. EBRT was associated with higher rates post-radiation complications, including erythema (95.8% vs. 21.5%), skin dryness (30.8% vs. 12.4%), pruritus (26.6% vs. 17.4%), hyperpigmentation (48.3% vs. 9.9%), and telangiectasia (1.4% vs. 0.8%). Multivariate analysis showed that erythema, skin dryness and pruritus, and hyperpigmentation were more severe in the EBRT group, while breast induration was higher in the IORT group (OR = 4.109, 95% CI: 2.242-7.531). Excellent, good, and fair cosmetic outcome was seen in 11.2%, 72%, and 16.8% of the patients in the EBRT group and 29.8%, 63.6%, and 6.6% in the IORT group, respectively, suggesting that the cosmetic outcome was significantly better in the IORT group (P < .001). There wasn't statistically significant difference in recurrence-free survival and overall survival rates between two groups of patients who received either IORT or EBRT (P = .953, P = .56). CONCLUSION IORT is considered to have lower post-radiation complications and better cosmetic outcomes in breast cancer patients. Therefore, IORT might be used as the treatment of choice in eligible patients.
Collapse
Affiliation(s)
- Vahid Zangouri
- Surgical Oncology Division, General Surgery DepartmentShiraz University of Medical SciencesShirazIran
- Breast Diseases Research CenterShiraz University of Medical SciencesShirazIran
| | - Amirhossein Roshanshad
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Poostchi Ophthalmology Research CenterShiraz University of Medical SciencesShirazIran
| | - Aliyeh Ranjbar
- Breast Diseases Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mahsa Izadi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Sara Rajaeifar
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ali Goodarzi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Hamid Nasrollahi
- Radiation Oncology, Radio‐Oncology Department, School of MedicineShiraz University of Medical SciencesShirazIran
| |
Collapse
|
27
|
Jin Y, Zhao C, Wang L, Su Y, Shang D, Li F, Wang J, Liu X, Li J, Wang W. Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery. Cancer Med 2024; 13:e6956. [PMID: 38247382 PMCID: PMC10905334 DOI: 10.1002/cam4.6956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.
Collapse
Affiliation(s)
- Ying Jin
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Changhui Zhao
- Department of Oncology, Jinan Third People's HospitalJinan Cancer HospitalJinanChina
| | - Lizhen Wang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Ya Su
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dongping Shang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| |
Collapse
|
28
|
Chua BH. Omission of radiation therapy post breast conserving surgery. Breast 2024; 73:103670. [PMID: 38211516 PMCID: PMC10788792 DOI: 10.1016/j.breast.2024.103670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) after breast conserving surgery decreases the risks of local recurrence and breast cancer mortality in the multidisciplinary management of patients with breast cancer. However, breast cancer is a heterogeneous disease, and the absolute benefit of post-operative RT in individual patients varies substantially. Clinical trials aiming to identify patients with low-risk early breast cancer in whom post-operative RT may be safely omitted, based on conventional clinical-pathologic variables alone, have not provided sufficiently tailored information on local recurrence risk assessment to guide treatment decisions. The majority of patients with early breast cancer continue to be routinely treated with RT after breast conserving surgery. This approach may represent over-treatment for a substantial proportion of the patients. The clinical impact of genomic signatures on local therapy decisions for early breast cancer has been remarkably modest due to the lack of high-level evidence supporting their clinical validity for assessment of the risk of local recurrence. Efforts to personalise breast cancer care must be supported by high level evidence to enable balanced, informed treatment decisions. These considerations underpin the importance of ongoing biomarker-directed clinical trials to generate the high-level evidence necessary for setting the future standard of care in personalised local therapy for patients with early breast cancer.
Collapse
Affiliation(s)
- Boon H Chua
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.
| |
Collapse
|
29
|
Pan YY, Lai TY, Shiau CY, Tseng LM, Lai IC, Liu YM, Huang PI. The effect of radiotherapy on patients with pathological stage IIB breast cancer after breast-conserving surgery or mastectomy: A cohort study. J Chin Med Assoc 2024; 87:202-211. [PMID: 38095582 DOI: 10.1097/jcma.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers in women, and treatment options include surgery, systemic therapies, and radiotherapy (RT). While postoperative RT plays an important role in reducing local recurrence rates and improving survival outcomes, its exact impact on patients with pathological stage IIB breast cancers remains unidentified. METHODS In this retrospective cohort study, patients with newly diagnosed pathological stage IIB breast cancer who underwent surgery and postoperative RT were included. The data were collected from medical records, and survival outcomes were assessed using the Kaplan-Meier method, log-rank tests, and Cox regression models. RESULTS In total, 350 patients participated in this study. Overall survival, locoregional recurrence-free survival, event-free survival, and distant metastasis-free survival rates did not significantly differ between those who received RT and those who did not. Multivariate analyses revealed that patients who received anthracycline or taxane chemotherapy had better survival outcomes. CONCLUSION Our findings demonstrated that postoperative RT had no significant effect on overall survival, locoregional recurrence, event-free survival, or distant metastasis rates in patients with pathological stage IIB breast cancer. However, anthracycline- and taxane-based chemotherapies were associated with improved outcomes. These findings demonstrated the complexities of treating such patient populations with multimodal therapies. Further research is needed to ensure optimal postoperative RT in patients with pathological stage IIB breast cancer. Clinicians must consider individual patient characteristics and incorporate comprehensive treatment approaches to ensure successful outcomes in this population.
Collapse
Affiliation(s)
- Yi-Ying Pan
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Yu Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cheng-Ying Shiau
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Ming Tseng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Chun Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Ming Liu
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pin-I Huang
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
30
|
Hsieh CT, Lee WC, Chiang CJ, Wang CC, Hsu HY, Lin HJ, Yeh TL, Tsai MC, Jhuang JR, Hsiao BY, Chien KL. The Risk of Cancer-Associated and Radiotherapy-Associated Cardiovascular Diseases among Patients with Breast Cancer. Clin Breast Cancer 2024; 24:131-141.e3. [PMID: 38052665 DOI: 10.1016/j.clbc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The cardio-related issues should be emphasized as the survival rates of breast cancer increased. We investigated the risk of coronary artery disease (CAD) and stroke due to breast cancer or radiotherapy. METHODS In this retrospective cohort study, breast cancer patients diagnosed between 2007 and 2016 were recruited from Taiwan Cancer Registry Database and were followed until the end of 2018 by linking with the Taiwan National Health Insurance Database. The general population was randomly selected from the whole population in 2007. Standardized incidence ratios (SIR) were calculated to compare the risk of CAD and stroke between patients and the general population. Within the cohort, we included the patients diagnosed between 2011 and 2016. Cox proportional hazards model and subdistribution hazard function were used to investigate the associations of radiotherapy with the risk of CAD and stroke. RESULTS Overall SIR of CAD was 0.82 (95% confidence interval [CI]: 0.78-0.86), while were 1.43 and 1.08 (95% CI: 1.30-1.55 and 1.00-1.16) 1 and 2 years after diagnosis, respectively. Overall SIR of stroke was 0.63 (95% CI: 0.60-0.67), the results were similar after considering the time since diagnosis. The adjusted hazard ratios (HR) for the associations of radiotherapy with CAD and stroke risk were 0.91 (95% [CI] = 0.76-1.09) and 0.84 (95% CI = 0.68-1.04), respectively. The results were similar by using subdistribution hazard function. CONCLUSIONS The risk of CAD was higher within the first 2 years of breast cancer diagnosis. We found no association between radiotherapy and the risk of CAD and stroke.
Collapse
Affiliation(s)
- Cheng-Tzu Hsieh
- Department of Epidemiology, University of California, Los Angeles, CA
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Taiwan Cancer Registry, Taipei City, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Taiwan Cancer Registry, Taipei City, Taiwan
| | - Chia-Chun Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsin-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Family Medicine, Taipei MacKay Memorial Hospital, Taipei City, Taiwan; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan
| | - Hung-Ju Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan
| | - Ming-Chieh Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Endocrinology, Department of Internal Medicine, Taipei Mackay Memorial Hospital, Taipei City, Taiwan,; Department of Medicine, Mackay Medical Collage, New Taipei City, Taiwan
| | - Jing-Rong Jhuang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Bo-Yu Hsiao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Population Health Research Center, National Taiwan University.
| |
Collapse
|
31
|
Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One 2024; 19:e0297048. [PMID: 38271392 PMCID: PMC10810469 DOI: 10.1371/journal.pone.0297048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. METHODS A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening-NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. RESULTS AND CONCLUSIONS The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50-69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom.
Collapse
Affiliation(s)
- Arn Migowski
- Professional Master’s Program in Health Technology Assessment, Teaching and Research Coordination, Instituto Nacional de Cardiologia (INC), Ministry of Health, Rio de Janeiro, Brazil
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola Nacional de Saúde Pública (ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cid Manso de Mello Vianna
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| |
Collapse
|
32
|
Alaeikhanehshir S, Ajayi T, Duijnhoven FH, Poncet C, Olaniran RO, Lips EH, van 't Veer LJ, Delaloge S, Rubio IT, Thompson AM, Cardoso F, Piccart M, Rutgers EJT. Locoregional Breast Cancer Recurrence in the European Organisation for Research and Treatment of Cancer 10041/BIG 03-04 MINDACT Trial: Analysis of Risk Factors Including the 70-Gene Signature. J Clin Oncol 2024:JCO2202690. [PMID: 38241603 DOI: 10.1200/jco.22.02690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE A number of studies are currently investigating de-escalation of radiation therapy in patients with a low risk of in-breast relapses on the basis of clinicopathologic factors and molecular tests. We evaluated whether 70-gene risk score is associated with risk of locoregional recurrence (LRR) and estimated 8-year cumulative incidences for LRR in patients with early-stage breast cancer treated with breast conservation. METHODS In this exploratory substudy of European Organisation for Research and Treatment of Cancer 10041/BIG 03-04 MINDACT trial, we evaluated women with a known clinical and genomic 70-gene risk score test result and who had breast-conserving surgery (BCS). The primary end point was LRR at 8 years, estimated by cumulative incidences. Distant metastasis and death were considered competing risks. RESULTS Among 6,693 enrolled patients, 5,470 (81.7%) underwent BCS, of whom 98% received radiotherapy. At 8-year follow-up, 189 patients experienced a LRR, resulting in an 8-year cumulative incidence of 3.2% (95% CI, 2.7 to 3.7). In patients with a low-risk 70-gene signature, the 8-year LRR incidence was 2.7% (95% CI, 2.1 to 3.3). In univariable analysis, adjusted for chemotherapy, five of 12 variables were associated with LRR, including the 70-gene signature. In multivariable modeling, adjuvant endocrine therapy and to a lesser extent tumor size and grade remained significantly associated with LRR. CONCLUSION This exploratory analysis of the MINDACT trial estimated an 8-year low LRR rate of 3.2% after BCS. The 70-gene signature was not independently predictive of LRR perhaps because of the low number of events observed and currently cannot be used in clinical decision making regarding LRR. The overall low number of events does provide an opportunity to design trials toward de-escalation of local therapy.
Collapse
Affiliation(s)
- Sena Alaeikhanehshir
- Division of Molecular Pathology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Taiwo Ajayi
- European Organisation for Research and Treatment of Cancer EORTC Headquarters, Brussels, Belgium
| | - Frederieke H Duijnhoven
- Department of Surgical Oncology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer EORTC Headquarters, Brussels, Belgium
| | - Ridwan O Olaniran
- European Organisation for Research and Treatment of Cancer EORTC Headquarters, Brussels, Belgium
| | - Esther H Lips
- Division of Molecular Pathology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Laura J van 't Veer
- Department of Laboratory Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Alastair M Thompson
- Dan L Duncan Comprehensive Cancer Centre, Baylor College of Medicine, Houston, TX
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Martine Piccart
- Department of Research, Jules Bordet Institute, Free University of Brussels, Brussels, Belgium
| | - Emiel J T Rutgers
- Department of Surgical Oncology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| |
Collapse
|
33
|
Lan H, Wu B, Jin K, Chen Y. Beyond boundaries: unraveling innovative approaches to combat bone-metastatic cancers. Front Endocrinol (Lausanne) 2024; 14:1260491. [PMID: 38260135 PMCID: PMC10800370 DOI: 10.3389/fendo.2023.1260491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Evidence demonstrated that bones, liver, and lungs are the most common metastasis sites in some human malignancies, especially in prostate and breast cancers. Bone is the third most frequent target for spreading tumor cells among these organs and tissues. Patients with bone-metastatic cancers face a grim prognosis characterized by short median survival time. Current treatments have proven insufficient, as they can only inhibit metastasis or tumor progression within the bone tissues rather than providing a curative solution. Gaining a more profound comprehension of the interplay between tumor cells and the bone microenvironment (BME) is of utmost importance in tackling this issue. This knowledge will pave the way for developing innovative diagnostic and therapeutic approaches. This review summarizes the mechanisms underlying bone metastasis and discusses the clinical aspects of this pathologic condition. Additionally, it highlights emerging therapeutic interventions aimed at enhancing the quality of life for patients affected by bone-metastatic cancers. By synthesizing current research, this review seeks to shed light on the complexities of bone metastasis and offer insights for future advancements in patient care.
Collapse
Affiliation(s)
- Huanrong Lan
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Bo Wu
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Ketao Jin
- Department of Colorectal Surgery, Affiliated Jinhua Hosptial, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yefeng Chen
- Department of Respiratory Medicine, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| |
Collapse
|
34
|
Konstantinou E, Varveris A, Solomou G, Antoniadis C, Tolia M, Mazonakis M. Radiation Dose to Critical Cardiac Structures from Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques for Left-Sided Breast Cancer. J Pers Med 2024; 14:63. [PMID: 38248764 PMCID: PMC10817491 DOI: 10.3390/jpm14010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
A comparison of the radiation exposure to the left anterior descending artery (LAD) and left ventricle (LV) was performed for twenty-three left breast cancer patients. For each participant, two tangential fields 3D-CRT, two- and seven-field IMRT and two and four partial arcs VMAT plans were created. Dose constraints for CTV, ipsilateral lung and heart were followed. The V40Gy, V30Gy, Dav of LAD and V23Gy, V5Gy, Dav of LV were calculated and extracted from the plans. Parametric and non-parametric tests were applied to compare the parameters derived from the five treatment techniques. All generated plans fulfilled the dose constraints. The Dav ranges of the LAD and LV from all examined techniques were 11.77-14.73 Gy and 5.37-6.40 Gy, respectively. The V40Gy and V30Gy ranges of the LAD were 2.90-12.91% and 10.80-18.51%, respectively. The V23Gy and V5Gy of the LV were 4.29-7.43% and 18.24-30.05%, respectively. The VMAT plans and seven-field IMRT significantly reduced the V40Gy, V30Gy of LAD and V23Gy of LV compared with the two-field treatments (p < 0.05). However, 3D-CRT plans provided statistically lower values for V5Gy of LV over the other techniques (p < 0.05). The presented results provide a detailed dataset of the radiation burden of two critical cardiac structures from five radiotherapy techniques.
Collapse
Affiliation(s)
- Evgenia Konstantinou
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Antonis Varveris
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgia Solomou
- Department of Medical Physics, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Tolia
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| |
Collapse
|
35
|
Yoshida M, Yoshimura RI, Notake R, Shinjo H, Miyaura K, Kuwayama T, Kawanaka T, Shien T, Yoshio K, Shiga T, Kaneyasu Y, Nakagawa T, Kubota K, Nakamura S, Itami J. Feasibility of accelerated partial breast irradiation with strut-adjusted volume implant brachytherapy in Japan focusing on dosimetry and acute toxicity: a Japanese multi-institutional prospective study. Breast Cancer 2024; 31:75-83. [PMID: 37865624 DOI: 10.1007/s12282-023-01513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND A Japanese multi-institutional prospective study was initiated to investigate the effectiveness and safety of accelerated partial breast irradiation (APBI) using strut-adjusted volume implant (SAVI) brachytherapy, with subjects registered between 2016 and 2021. Herein, we report the preliminary results on the feasibility of this treatment modality in Japan, focusing on the registration process, dosimetry, and acute toxicities. PATIENTS AND METHODS Primary registration was conducted before breast-conserving surgery (BCS) and the eligibility criteria included the following: age ≥ 40 years, tumor unifocal and unicentric, ≤ 3 cm in diameter, cN0M0, proven ductal, mucinous, tubular, medullary, or lobular carcinoma by needle biopsy. Secondary registration was conducted after BCS had been performed leaving a cavity for device implantation and pathological evaluations, and the eligibility criteria were as follows: negative surgical margin, tumor ≤ 3 cm in diameter on gross pathological examination, histologically confirmed ductal, mucinous, tubular medullary, colloid, or lobular carcinoma, pN0, L0V0, no extensive ductal component, no initiation of chemotherapy within 2 weeks of the brachytherapy APBI planning with SAVI was performed for the patients successfully entered in the study by the secondary registration process, and the treatment was administered at the dose of 34 Gy in 10 fractions administered twice daily. RESULTS Between 2016 and 2021, 64 women were enrolled in the study through primary registration, of which 19 were excluded from the secondary registration process, and in one, it was deemed impossible to comply with the dose constraints established during treatment planning. After the exclusion of these latter 20 patients, we treated the remaining 44 patients by APBI with SAVI. The dose constraints could be adhered to in all the patients, but re-planning was necessitated in 3 patients because of applicator movement during the treatment period. Grade 2 acute toxicities were observed in 18% of all patients, but more severe acute toxicities than Grade 2 were not observed in any of the patients. CONCLUSION APBI with SAVI brachytherapy is feasible in Japan from the aspects of compliance with dose constraints and frequency of acute toxicities.
Collapse
Affiliation(s)
- Masahiro Yoshida
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan
| | - Ryo-Ichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Ryoichi Notake
- Radiology Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hidenori Shinjo
- Division of Radiation Oncology, Department of Radiology, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Kazunori Miyaura
- Division of Radiation Oncology, Department of Radiology, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Takashi Kuwayama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Takashi Kawanaka
- Department of Radiology and Radiation Oncology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Kotaro Yoshio
- Department of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, Japan
| | - Toshiko Shiga
- Department of Radiology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, Japan
| | - Yuko Kaneyasu
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima, Japan
| | - Tsuyoshi Nakagawa
- Department of Breast Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya 2-1-50, Koshigaya, Saitama, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Jun Itami
- ShinMatsudo Accuracy Radiation Therapy Center, ShinMatsudo Central General Hospital, Matsudo 1-380, Matsudo City, Chiba, Japan
| |
Collapse
|
36
|
Al Husban H, Al Rabadi A, Odeh AH, Abu Rumman K, Alkhawaldeh F, Noures H, Abo Ashoor M, Abu Rumman A, Atmeh M, Bawaneh M. Clinical Characteristics and Management of Triple-Negative Breast Cancer (TNBC) in Jordan: A Retrospective Analysis. Cureus 2024; 16:e53053. [PMID: 38410339 PMCID: PMC10896140 DOI: 10.7759/cureus.53053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Triple-negative breast cancer (TNBC) is known for its aggressive nature and poor prognosis. Despite its responsiveness to chemotherapy, TNBC presents challenges in terms of survival, recurrence, and mortality rates, particularly in diverse populations. Limited research in the Middle East hampers comprehensive understanding and tailored management. Methods A retrospective study at the King Hussein Medical Center in Jordan between the period 2009 to 2023 explored TNBC patients (n=110) who underwent adjuvant chemotherapy after local excision or modified radical mastectomy (MRM). Data encompassed demographics, clinical variables, and operative details. Statistical analysis employed Wilcoxon and chi-squared tests, examining mortality risks and associations between variables. Results Among 110 TNBC patients (mean age 52), 84% underwent MRM, 16% wide local excision and axillary clearance (WLE&AC). Lymphovascular invasion (LVI) was observed in 41%, linked to higher lymph node positivity. Neoadjuvant therapy preceded MRM in 25% of cases. While 75% had grade III tumors, the prevalence of invasive ductal carcinoma was 85%. Conclusions This study contributes crucial insights into TNBC characteristics and management in Jordan. Despite limitations such as retrospective design and sample size, the findings underscore the need for tailored interventions in TNBC patients, emphasizing the importance of neoadjuvant therapy and vigilant consideration of LVI status in treatment planning. Future longitudinal research should delve into disease progression and treatment outcomes in diverse populations, facilitating optimized TNBC management strategies.
Collapse
Affiliation(s)
- Hussein Al Husban
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Anas Al Rabadi
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ala H Odeh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Kahled Abu Rumman
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Feras Alkhawaldeh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Haneen Noures
- Department of Pathology, Jordanian Royal Medical Services, Amman, JOR
| | - Mohammad Abo Ashoor
- Department of Clinical Oncology, Jordanian Royal Medical Services, Amman, JOR
| | - Anas Abu Rumman
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Mousa Atmeh
- Department of Clinical Oncology, Jordanian Royal Medical Services, Amman, JOR
| | - Mohannad Bawaneh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| |
Collapse
|
37
|
Choi S, Dreyfuss I, Taswell CS, Cyriac J, Butkus M, Takita C. Proton Beam Therapy for Breast Cancer. Crit Rev Oncog 2024; 29:67-82. [PMID: 38683154 DOI: 10.1615/critrevoncog.2023050319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Given the radiobiological and physical properties of the proton, proton beam therapy has the potential to be advantageous for many patients compared with conventional radiotherapy by limiting toxicity and improving patient outcomes in specific breast cancer scenarios.
Collapse
Affiliation(s)
- Seraphina Choi
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Isabella Dreyfuss
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Jonathan Cyriac
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Michael Butkus
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | |
Collapse
|
38
|
Wooldrik S, van de Voort EMF, Struik GM, Birnie E, van Dalen T, Verhoef C, Klem TMAL. The Effect of Intraoperative Margin Assessment During Breast Conserving Surgery for Breast Cancer in a Dutch Cohort. Clin Breast Cancer 2024; 24:e31-e39. [PMID: 37926663 DOI: 10.1016/j.clbc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Intraoperative specimen radiography is a routinely used procedure to ensure adequate resection of non-palpable breast tumors. Intraoperative digital specimen mammography (IDSM) is an alternative to conventional specimen radiography (CSR) which provides immediate specimen evaluation and can potentially decrease operation time. IDSM may also result in lower positive margin and re-excision rates. IDSM was implemented in our hospital in 2018. The objective of this study was to evaluate the effect of using IDSM versus CSR on operation time, margin status and re-excision rates in breast conserving surgery. METHODS The present study is a single-center retrospective cohort study with 2 patient cohorts: one which underwent CSR (n = 532) and one which underwent IDSM (n = 475). The primary outcome was the operation time. Secondary outcomes were the margin status of the primary surgery, the cavity shaving rate, and the re-excision rate. Differences between cohorts were compared using univariate statistics and multiple regression analyses to adjust for variables that were significantly different between the groups. RESULTS IDSM use was associated with an 8-minute reduction in surgery time (B = -8.034, 95% CI [-11.6, -4.5]; P < .001). Treatment variables independently associated with the operation time included use of IDSM, type of surgery, and performance of cavity shaving. Cavity shaves were more often performed when IDSM was used (24% for IDSM vs. 14% for CSR, P < .001), while the proportion of negative margin rates (93% for IDSM vs. 96% for CSR, P = .070) was comparable. CONCLUSION IDSM was associated with a modest reduction in operation time. Surgeons performed more cavity shaves since the introduction of IDSM, but this increase was not reflected by difference in negative margin rates.
Collapse
Affiliation(s)
- Sophie Wooldrik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Elles M F van de Voort
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Miyasaka Y, ono T, Chai H, Souda H, Lee SH, Ishizawa M, Akamatsu H, Sato H, Iwai T. A robust treatment planning approach for chest motion in postmastectomy chest wall intensity modulated radiation therapy. J Appl Clin Med Phys 2024; 25:e14217. [PMID: 38018758 PMCID: PMC10795451 DOI: 10.1002/acm2.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Chest wall postmastectomy radiation therapy (PMRT) should consider the effects of chest wall respiratory motion. The purpose of this study is to evaluate the effectiveness of robustness planning intensity modulated radiation therapy (IMRT) for respiratory movement, considering respiratory motion as a setup error. MATERIAL AND METHODS This study analyzed 20 patients who underwent PMRT (10 left and 10 right chest walls). The following three treatment plans were created for each case and compared. The treatment plans are a planning target volume (PTV) plan (PP) that covers the PTV within the body contour with the prescribed dose, a virtual bolus plan (VP) that sets a virtual bolus in contact with the body surface and prescribing the dose that includes the PTV outside the body contour, and a robust plan (RP) that considers respiratory movement as a setup uncertainty and performs robust optimization. The isocenter was shifted to reproduce the chest wall motion pattern and the doses were recalculated for comparison for each treatment plan. RESULT No significant difference was found between the PP and the RP in terms of the tumor dose in the treatment plan. In contrast, VP had 3.5% higher PTV Dmax and 5.5% lower PTV V95% than RP (p < 0.001). The RP demonstrated significantly higher lung V20Gy and Dmean by 1.4% and 0.4 Gy, respectively, than the PP. The RP showed smaller changes in dose distribution affected by chest wall motion and significantly higher tumor dose coverage than the PP and VP. CONCLUSION We revealed that the RP demonstrated comparable tumor doses to the PP in treatment planning and was robust for respiratory motion compared to both the PP and the VP. However, the organ at risk dose in the RP was slightly higher; therefore, its clinical use should be carefully considered.
Collapse
Affiliation(s)
- Yuya Miyasaka
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Takuya ono
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hongbo Chai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hikaru Souda
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Sung Hyun Lee
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Miyu Ishizawa
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hiroko Akamatsu
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Hiraku Sato
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Takeo Iwai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| |
Collapse
|
40
|
Whelan TJ, Fyles A, Parpia S, Nielsen T, Levine MN. LUMINA: Using molecular biomarkers to guide decision making for breast radiotherapy. Radiother Oncol 2024; 190:110074. [PMID: 38163484 DOI: 10.1016/j.radonc.2023.110074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
In this opinion piece, we respond to comments about the LUMINA trial by Meattini and colleagues in the Journal. LUMINA was a prospective cohort study which evaluated the omission of radiotherapy after breast conserving surgery (BCS) in patients treated with endocrine therapy with low risk clinico-pathologic features and luminal A breast cancer. We address their areas of concern including the single cohort design that required careful patient selection, the relatively short follow-up period of 5 years, and the limited follow-up on younger patients. The Ki67 biomarker was key to defining the luminal A phenotype. We clarify the evidence supporting the Ki67 criteria used. The compliance with endocrine therapy was high and similar to other contemporary trials. Based on the results of LUMINA, and mounting evidence from other trials, we feel comfortable offering our patients the option of no radiotherapy after BCS if they fit the trial eligibility criteria from LUMINA and have decided to receive adjuvant endocrine therapy. We concur that a patient-centered approach to treatment decision making should be used to make patients aware of all available information including the results of the LUMINA trial when deciding on post-operative breast radiotherapy.
Collapse
Affiliation(s)
- Timothy J Whelan
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Anthony Fyles
- Department of Radiation Oncology, University of Toronto and Princess Margaret Hospital, Toronto, ON, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Torsten Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark N Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
41
|
Pfister P, Müller SLC, Eberhardt AL, Rodriguez M, Menzi N, Haug M, Schaefer DJ, Kappos EA, Ismail T. Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review. J Clin Med 2023; 13:217. [PMID: 38202224 PMCID: PMC10779607 DOI: 10.3390/jcm13010217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.
Collapse
Affiliation(s)
- Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Seraina L. C. Müller
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Anna-Lena Eberhardt
- Department of Radiation Oncology, University Hospital Basel, 4031 Basel, Switzerland
| | - Medea Rodriguez
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Nadia Menzi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Elisabeth A. Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| |
Collapse
|
42
|
Alaimo R, Ippolito E, Falconi R, Perrone Congedi F, Sciommari C, Silipigni S, Pellegrini R, Carnevale A, Greco C, Fiore M, D’Angelillo RM, Ramella S. Breast Volume Is a Predictor of Higher Heart Dose in Whole-Breast Supine Free-Breathing Volumetric-Modulated Arc Therapy Planning. Curr Oncol 2023; 30:10530-10538. [PMID: 38132402 PMCID: PMC10742666 DOI: 10.3390/curroncol30120768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.
Collapse
Affiliation(s)
- Rita Alaimo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Edy Ippolito
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rita Falconi
- Medical Physics Unit, S. Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy;
| | - Francesca Perrone Congedi
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Cecilia Sciommari
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Sonia Silipigni
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | | | - Alessia Carnevale
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michele Fiore
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Sara Ramella
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| |
Collapse
|
43
|
Couto-González I, Fernández-Marcos AÁ, Brea-García B, González-Giménez N, Canseco-Díaz F, García-Arjona B, Mato-Codesido C, Taboada-Suárez A. Silicone Shell Breast Implants in Patients Undergoing Risk-Reducing Mastectomy With a History of Breast-Conserving Surgery and Adjuvant Radiotherapy: A Long-term Study. Aesthet Surg J 2023; 44:NP60-NP68. [PMID: 37706356 DOI: 10.1093/asj/sjad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Indications for breast-conserving surgery and adjuvant radiotherapy (BCSAR) in patients with breast carcinoma are increasing, as are indications for risk-reducing mastectomy (RRM) in healthy subjects. Most of these cases are reconstructed with silicone shell breast implants (SSBIs). OBJECTIVES The aim of this work was to study complications of SSBIs in breast reconstruction in patients undergoing RRM with previous BCSAR. METHODS A prospective cohort study was designed. The study group included cases of RRM reconstructed with SSBI in patients who had previously undergone BCSAR in the same breast. The control group consisted of patients with high-risk breast cancer who had undergone RRM and immediate SSBI reconstruction without previous BCSAR. RESULTS There was a history of BCSAR in 15.8% of cases. The first SSBI used in immediate reconstruction after RRM was replaced in 51.5% of cases with a mean [standard deviation] survival of 24.04 [28.48] months. BCSAR was significantly associated with pathological capsular contracture (P = .00) with this first SSBI (37.5% vs 5.9%). Of the cases requiring the replacement of the first SSBI, 44.23% suffered failure of the second SSBI, with a mean survival of 27.95 [26.53] months. No significant association was found between the consecutive development of capsular contracture in the second SSBI and a previous history of BCSAR (P = .10). CONCLUSIONS BCSAR prior to RRM reconstructed with an SSBI is associated with a significant increase in pathological capsular contracture. Patients should be warned of the high rate of SSBI complications and reconstruction failure. Polyurethane-coated implants may provide an alternative in cases in which alloplastic reconstruction is considered in patients with previous BCSAR. LEVEL OF EVIDENCE: 3
Collapse
|
44
|
Piao Y, Chen H, Yuan F, Fan J, Wu S, Li X, Yang D. Active Breathing Coordinator reduces radiation dose to the stomach in patients with left breast cancer. Acta Oncol 2023; 62:1873-1879. [PMID: 37909907 DOI: 10.1080/0284186x.2023.2275288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/PURPOSE Gastric dose parameters comparison for deep inspiration breath-hold (DIBH) or free breathing (FB) mode during radiotherapy (RT) for left-sided breast cancer patients (LSBCPs) has not been investigated before. This study aimed to analyze the impact of Active Breath Coordinator (ABC)-DIBH technique on the dose received by the stomach during RT for LSBCPs and to provide organ-specific dosimetric parameters. MATERIALS AND METHODS The study included 73 LSBCPs. The dosimetric parameters of the stomach were compared between FB and DIBH mode. The correlation between the stomach volume and dosimetric parameters was analyzed. RESULTS Compared to FB mode, statistically significant reductions were observed in gastric dose parameters in ABC-DIBH mode, including Dmax (46.60 vs 17.25, p < 0.001), D1cc (38.42 vs 9.60, p < 0.001), Dmean (4.10 vs 0.80, p < 0.001), V40Gy (0.50 vs 0.00, p < 0.001), V30Gy (6.30 vs 0.00, p < 0.001), V20Gy (20.80 vs 0.00, p < 0.001), V10Gy (51.10 vs 0.77, p < 0.001), and V5Gy (93.20 vs 9.60, p < 0.001). ABC-DIBH increased the distance between the stomach and the breast PTV when compared to FB, from 1.3 cm to 2.8 cm (p < 0.001). Physiologic decrease in stomach volume was not found from FB to ABC-DIBH (415.54 cm3 vs 411.61 cm3, p = 0.260). The stomach volume showed a positive correlation with V40Gy (r2 = 0.289; p < 0.05), V30Gy (r2 = 0.287; p < 0.05), V20Gy (r2 = 0.343; p < 0.05), V10Gy (r2 = 0.039; p < 0.001), V5Gy (r2 = 0.439; p < 0.001), Dmax (r2 = 0.269; p < 0.05) and D1cc (r2 = 0.278; p < 0.05) in FB mode. While in ABC-DIBH mode, most stomach dosimetric parameters were not correlated with gastric volume. CONCLUSIONS The implementation of ABC-DIBH in LSBCPs radiotherapy resulted in lower irradiation of the stomach. Larger stomach volume was associated with statistically significantly higher dose irradiation in FB mode. To reduce radiotherapy related side effects in FB mode, patients should be fast for at least 2 hours before the CT simulation and treatment.
Collapse
Affiliation(s)
- Ying Piao
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Hongtao Chen
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Fengshun Yuan
- Sichuan Provincial Center for Disease Control and Prevention, Center for AIDS/STD Control and Prevention, Chengdu, Sichuan, People's Republic of China
| | - Juan Fan
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Shihai Wu
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Xianming Li
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Dong Yang
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| |
Collapse
|
45
|
Moslemi D, Ramezany S, Moghadamnia AA, Ebrahimian S. Efficacy of sesame oil versus placebo in the management of acute radiation-induced dermatitis in breast cancer patients: A double-blind randomized clinical trial. Asia Pac J Clin Oncol 2023; 19:747-751. [PMID: 37620987 DOI: 10.1111/ajco.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
AIM Considering the anti-inflammatory and positive effects of sesame oil in treating skin diseases, the present research aimed to study its therapeutic effects on acute radiotherapy dermatitis in such patients. METHODS Forty women with breast cancer during radiotherapy (for 5 weeks) were randomly grouped into two categories: sesame oil (20 patients) and placebo (20 patients). After each radiotherapy session, they were asked to use 3cc of the ointment on the treating field and continue the treatment until the end. They were examined weekly according to the staging criteria of the radiation therapy oncology group. RESULTS No significant difference was observed in the first 3 weeks. In the fourth week, dermatitis grade 0 was 35%, grade 1 was 65%, and grade 2 was 0% in the intervention (case) group, while in the control group, they were 10%, 75%, and 15%, respectively. This difference was statistically significant (p = 0.046). Also, in the fifth week in the case group, dermatitis grade 0 was 25%, grade 1 was 70%, and grade 2 was 5%, while in the control group, they were 0%, 80%, and 20%, respectively. This difference was also statistically significant (p = 0.032). CONCLUSION Based on the findings, sesame oil, as a cheap and available herbal treatment, may be utilized in treating acute dermatitis caused by radiotherapy. However, an investigation with a larger sample size in several centers should be conducted to examine sesame oil effects in treating acute radio dermatitis more comprehensively.
Collapse
Affiliation(s)
- Dariush Moslemi
- Department of Radiotherapy & Oncology, Babol University of Medical Sciences, Babol, Iran
| | - Sepehr Ramezany
- Department of Surgery, Babol University of Medical Sciences, Babol, Iran
| | | | - Saba Ebrahimian
- Department of Surgery, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
46
|
Fasola CE, Sharp HJ, Clavin NW, Sha W, Schepel CR, Trufan SJ, Graham E, Hecksher A, White RL, Hadzikadic-Gusic L. Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer. Ann Surg Oncol 2023; 30:8362-8370. [PMID: 37605081 DOI: 10.1245/s10434-023-14177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the delay in initiating adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer who underwent oncoplastic reduction mammoplasty (ORM) following BCS compared with a matched cohort of patients who did not undergo ORM between BCS and RT. METHODS Medical records of 112 women (56 ORMs and 56 matched non-ORMs) with carcinoma in situ or early-stage breast cancer treated with BCS were reviewed. ORM was performed in a delayed manner following BCS, allowing confirmation of negative surgical margins. Time to RT was defined as time from last oncologic surgery to start of RT. RESULTS The median follow-up time was 6.8 years for the ORM cohort and 6.7 years for the control non-ORM cohort. Patients who underwent ORM following BCS experienced a significant delay in initiating RT (>8 weeks) than matched patients not undergoing ORM (66% vs. 34%; p < 0.001). Wound complications occurred in 44.6% (n = 25) of patients in the ORM cohort, which were mostly minor, including delayed wound healing and/or infection (39%). There was no significant difference in local recurrence between patients in the non-ORM and ORM cohorts (p = 0.32). CONCLUSIONS This study demonstrates that ORM following BCS has the potential to delay RT >8 weeks, largely as a result of increased risk of wound complications; however, this delay did not impact local control. ORM can be safely considered for appropriately selected patients with breast cancer.
Collapse
Affiliation(s)
- Carolina E Fasola
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Hadley J Sharp
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Clavin
- Division of Plastic and Reconstructive Surgery, Atrium Health, Charlotte, NC, USA
| | - Wei Sha
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Courtney R Schepel
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Sally J Trufan
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Elaina Graham
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Anna Hecksher
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Richard L White
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| |
Collapse
|
47
|
Wittmann A, Bartels A, Alkotub B, Bauer L, Kafshgari MH, Multhoff G. Chronic inflammatory effects of in vivo irradiation of the murine heart on endothelial cells mimic mechanisms involved in atherosclerosis. Strahlenther Onkol 2023; 199:1214-1224. [PMID: 37658922 PMCID: PMC10673733 DOI: 10.1007/s00066-023-02130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Radiotherapy is a major pillar in the treatment of solid tumors including breast cancer. However, epidemiological studies have revealed an increase in cardiac diseases approximately a decade after exposure of the thorax to ionizing irradiation, which might be related to vascular inflammation. Therefore, chronic inflammatory effects were examined in primary heart and lung endothelial cells (ECs) of mice after local heart irradiation. METHODS Long-lasting effects on primary ECs of the heart and lung were studied 20-50 weeks after local irradiation of the heart of mice (8 and 16 Gy) in vivo by multiparameter flow cytometry using antibodies directed against cell surface markers related to proliferation, stemness, lipid metabolism, and inflammation, and compared to those induced by occlusion of the left anterior descending coronary artery. RESULTS In vivo irradiation of the complete heart caused long-lasting persistent upregulation of inflammatory (HCAM, ICAM‑1, VCAM-1), proliferation (CD105), and lipid (CD36) markers on primary heart ECs and an upregulation of ICAM‑1 and VCAM‑1 on primary ECs of the partially irradiated lung lobe. An artificially induced heart infarction induces similar effects with respect to inflammatory markers, albeit in a shorter time period. CONCLUSION The long-lasting upregulation of prominent inflammatory markers on primary heart and lung ECs suggests that local heart irradiation induces chronic inflammation in the microvasculature of the heart and partially irradiated lung that leads to cardiac injury which might be related to altered lipid metabolism in the heart.
Collapse
Affiliation(s)
- Andrea Wittmann
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Anna Bartels
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Bayan Alkotub
- Institute of Biological Medical Imaging, Helmholtz-Zentrum München (HMGU), Neuherberg, Munich, Germany
| | - Lisa Bauer
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Morteza Hasanzadeh Kafshgari
- Center for Translational Cancer Research (TranslaTUM), Heinz-Nixdorf-Chair for Biomedical Electronics, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany.
| |
Collapse
|
48
|
Lai TY, Hu YW, Wang TH, Chen JP, Shiau CY, Huang PI, Lai IC, Tseng LM, Huang N, Liu CJ. Association of radiation dose to cardiac substructures with major ischaemic events following breast cancer radiotherapy. Eur Heart J 2023; 44:4796-4807. [PMID: 37585426 DOI: 10.1093/eurheartj/ehad462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/18/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND AIMS Patients with left-sided breast cancer receive a higher mean heart dose (MHD) after radiotherapy, with subsequent risk of ischaemic heart disease. However, the optimum dosimetric predictor among cardiac substructures has not yet been determined. METHODS AND RESULTS This study retrospectively reviewed 2158 women with breast cancer receiving adjuvant radiotherapy. The primary endpoint was a major ischaemic event. The dose-volume parameters of each delineated cardiac substructure were calculated. The risk factors for major ischaemic events and the association between MHD and major ischaemic events were analysed by Cox regression. The optimum dose-volume predictors among cardiac substructures were explored in multivariable models by comparing performance metrics of each model. At a median follow-up of 7.9 years (interquartile range 5.6-10.8 years), 89 patients developed major ischaemic events. The cumulative incidence rate of major ischaemic events was significantly higher in left-sided disease (P = 0.044). Overall, MHD increased the risk of major ischaemic events by 6.2% per Gy (hazard ratio 1.062, 95% confidence interval 1.01-1.12; P = 0.012). The model containing the volume of the left ventricle receiving 25 Gy (LV V25) with the cut-point of 4% presented with the best goodness of fit and discrimination performance in left-sided breast cancer. Age, chronic kidney disease, and hyperlipidaemia were also significant risk factors. CONCLUSION Risk of major ischaemic events exist in the era of modern radiotherapy. LV V25 ≥ 4% appeared to be the optimum parameter and was superior to MHD in predicting major ischaemic events. This dose constraint could aid in achieving better heart protection in breast cancer radiotherapy, though a further validation study is warranted.
Collapse
Affiliation(s)
- Tzu-Yu Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Yu-Wen Hu
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ti-Hao Wang
- Department of Radiation Oncology, China Medical University Hospital, 404327 Taichung, Taiwan
- Department of Medicine, China Medical University, 404333 Taichung, Taiwan
- Everfortune.AI, 403020 Taichung, Taiwan
| | - Jui-Pin Chen
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Cheng-Ying Shiau
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Pin-I Huang
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - I Chun Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ling-Ming Tseng
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Chia-Jen Liu
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 112201 Taipei, Taiwan
| |
Collapse
|
49
|
Taylor C, Dodwell D, McGale P, Hills RK, Berry R, Bradley R, Braybrooke J, Clarke M, Gray R, Holt F, Liu Z, Pan H, Peto R, Straiton E, Coles C, Duane F, Hennequin C, Jones G, Kühn T, Oliveros S, Overgaard J, Pritchard KI, Suh CO, Beake G, Boddington C, Davies C, Davies L, Evans V, Gay J, Gettins L, Godwin J, James S, Kerr A, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Nakahara M, Read S, Taylor H, Ferguson J, Scheurlen H, Zurrida S, Galimberti V, Ingle J, Valagussa P, Veronesi U, Anderson S, Tang G, Fisher B, Fossa S, Valborg Reinertsen K, Host H, Muss H, Holli K, Albain K, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, García-Sáenz JA, Gelber R, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas E, Martín M, McIntosh S, Mukai H, Nekljudova V, Norton L, Ohashi Y, Piccart M, Pierce L, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Salgado R, Slamon D, Spanic T, Sparano J, Steger G, Toi M, Tutt A, Viale G, Wang X, Wilcken N, Wolmark N, Yu KD, Cameron D, Bergh J, Swain S, Whelan T, Poortmans P. Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials. Lancet 2023; 402:1991-2003. [PMID: 37931633 DOI: 10.1016/s0140-6736(23)01082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras. METHODS In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals. FINDINGS We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067). INTERPRETATION Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s. FUNDING Cancer Research UK, Medical Research Council.
Collapse
|
50
|
Levine MN. Effective and safe regional node irradiation in early breast cancer. Lancet 2023; 402:1943-1945. [PMID: 37931630 DOI: 10.1016/s0140-6736(23)01614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Mark N Levine
- Department of Oncology, McMaster University, Hamilton ON, Canada; Escarpment Cancer Research Institute, Hamilton, ON, Canada L8V 1C3.
| |
Collapse
|