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Mohrmann S, Kolberg L, Jäger B, Hoffmann J, Nestle-Krämling C, Zwiefel K, Friebe V, Sawicki LM, Bruckmann NM, Jannusch K, Morawitz J, Antoch G, Fehm TN, Kirchner J, Dietzel F. Impact of surgical variables on residual glandular tissue in risk-reducing mastectomies: Results of a retrospective monocentric study from a center of the German consortium for hereditary breast and ovarian cancer. Eur J Surg Oncol 2023; 49:107031. [PMID: 37683424 DOI: 10.1016/j.ejso.2023.107031] [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: 04/24/2023] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Residual glandular tissue (RGT) after risk reducing mastectomy (RRME) is associated with a risk of developing breast cancer for women with a familial predisposition. We aim to examine various surgery-related variables to make risk more easily assessable and to aid in decision-making. MATERIALS AND METHODS Pre- and postoperative breast MRI scans from 2006 to 2021 of patients with proven pathogenic mutation were included. The postoperative remaining skin flap was recorded using distance measurements at 8 equally distributed clockwise points and retromamillary. Each breast was volumetrized, as well as existing RGT. Patient-related covariates were further recorded and their influence on RGT was investigated uni- and multivariately. RESULTS 81 patients (49 with BRCA1, 24 with BRCA2, 9 with other mutations), who were on average 39 years old, had 117 breasts analyzed. The mean follow-up was 71 months. In multivariate analysis, the independent variable skin flap thickness had a positive effect (p ≤ 0.01), while surgeon experience negatively affected RGT (p ≤ 0.05). The incision type was found to impact RGT as well, with nipple-sparing mastectomy (NSM) with inframammary fold incision leading to more RGT (p ≤ 0.01 - p ≤ 0.05), and skin-sparing mastectomy (SSM) with an inverted T incision leading to less (p ≤ 0.01). CONCLUSION Different surgical variables have an impact on postoperative RGT, which is an important tool to quantify the risk of developing breast cancer after RRME. In order to effectively consider these variables in future preoperative/intraoperative management, they must be carefully taken into account.
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Affiliation(s)
- Svjetlana Mohrmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Leoni Kolberg
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany; Department of Obstetrics and Gynecology, Agaplesion Bethesda Krankenhaus Wuppertal, 42109, Wuppertal, Germany.
| | - Bernadette Jäger
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | | | - Karin Zwiefel
- Breast Center, Kliniken der Stadt Köln, 51067, Köln, Germany.
| | - Verena Friebe
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225, Düsseldorf, Germany.
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Dietzel F, Kolberg L, Vesper AS, Hoffmann J, Nestle-Krämling C, Zwiefel K, Friebe V, Sawicki LM, Bruckmann NM, Jannusch K, Morawitz J, Antoch G, Fehm TN, Kirchner J, Mohrmann S. Factors Influencing Residual Glandular Breast Tissue after Risk-Reducing Mastectomy in Genetically Predisposed Individuals Detected by MRI Mammography. Cancers (Basel) 2023; 15:829. [PMID: 36765786 PMCID: PMC9913581 DOI: 10.3390/cancers15030829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/06/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
PURPOSE This study seeks to evaluate MR imaging morphological factors and other covariates that influence the presence of residual glandular tissue after risk-reducing mastectomy in patients with a familial predisposition. METHODS We analyzed women of a high-risk collective with pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). A total of 117 breasts were analyzed, 63 left and 54 right, from a cohort of 81 patients, who were on average 40 years old. The mean follow-up was 63 months (range 12-180 months, SD = 39.67). Retrospective analysis of MR imaging data from 2006-2022 of patients of a high-risk collective (all carriers of a pathogenic mutation) with contralateral (RRCM) or bilateral risk-reducing mastectomy (RRBM) was performed. In the image data the remaining skin flap thickness by distance measurements at eight equally distributed, clockwise points and the retromamillary area, as well as by volumetry of each breast, was elected. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analyzed by uni- and multivariate regressions. RESULTS A significant association with postoperative residual glandular tissue was shown in multivariate analysis for the independent variables breast density, skin flap mean, and surgical method (all p-values < 0.01). A negatively significant association could be seen for the variables preoperative breast volume (p-values < 0.01) and surgeon experience (most p-values < 0.05-<0.1). CONCLUSION Postoperative residual glandular tissue is an important tool for quantifying the risk of developing breast cancer after risk-reducing mastectomy. Different effects on residual glandular tissue were shown for the independent variables breast density, skin flap, surgical method, preoperative breast volume, and surgeon experience, so these should be considered in future surgical procedures preoperatively as well as postoperatively. Breast MRI has proven to be a suitable method to analyze the skin flap as well as the RGT.
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Affiliation(s)
- Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Leoni Kolberg
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
- Department of Obstetrics and Gynecology, Agaplesion Bethesda Krankenhaus Wuppertal, 42109 Wuppertal, Germany
| | - Anne Sophie Vesper
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | | | - Karin Zwiefel
- Breast Center, Kliniken der Stadt Köln, 51067 Köln, Germany
| | - Verena Friebe
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Lino M. Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Tanja Natascha Fehm
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
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Haussmann J, Budach W, Nestle-Krämling C, Wollandt S, Tamaskovics B, Corradini S, Bölke E, Krug D, Fehm T, Ruckhäberle E, Audretsch W, Jazmati D, Matuschek C. Predictive Factors of Long-Term Survival after Neoadjuvant Radiotherapy and Chemotherapy in High-Risk Breast Cancer. Cancers (Basel) 2022; 14:cancers14164031. [PMID: 36011025 PMCID: PMC9406575 DOI: 10.3390/cancers14164031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary This retrospective analysis reports on the treatment outcomes of women diagnosed with high-risk breast cancer treated with chemotherapy in combination with radiotherapy before the surgical removal of the tumor. It is well established that the lack of visible tumor cells in the pathological tumors analysis by the time of surgery (known as pathological complete response, pCR) is a factor that improves survival without the tumor reappearing in the body. However, it is unknown whether that is only true when giving systemic therapy or when pCR is achieved with the help of radiotherapy. We collected patient information and survival times to analyze the outcome in our patient group. We found that women with a pCR treated with chemotherapy in combination with radiotherapy can expect favorable long-term survival. This was true across different types of breast cancer and chemotherapy substances. Abstract Background: Neoadjuvant radiotherapy (naRT) in addition to neoadjuvant chemotherapy (naCT) has been used for locally advanced, inoperable breast cancer or to allow breast conserving surgery (BCS). Retrospective analyses suggest that naRT + naCT might result in an improvement in pathological complete response (pCR rate and disease-free survival). pCR is a surrogate parameter for improved event-free and overall survival (OS) and allows for the adaption of the post-neoadjuvant therapy regimens. However, it is not clear whether pCR achieved with the addition of naRT has the same prognostic value. Patients and methods: We performed a retrospective re-analysis of 356 patients (cT1-cT4/cN0-N+) treated with naRT and naCT with a long-term follow-up. Patients underwent naRT on the breast and regional lymph nodes combined with a boost to the primary tumor. Chemotherapy with different agents was given either sequentially or concomitantly to naRT. We used the Cox proportional hazard regression model to estimate the effect of pCR in our cohort in different subgroups as well as chemotherapy protocols. Clinical response markers correlating with OS were also analyzed. Results: For patients with median follow-ups of 20 years, 10 years, 15 years, 20 years, and 25 years, OS rates were 69.7%, 60.6%, 53.1%, and 45.1%, respectively. pCR was achieved in 31.1% of patients and associated with a significant improvement in OS (HR = 0.58; CI-95%: 0.41–0.80; p = 0.001). The prognostic impact of pCR was evident across breast cancer subtypes and chemotherapy regimens. Multivariate analysis showed that age, clinical tumor and nodal stage, chemotherapy, and pCR were prognostic for OS. Conclusion: NaCT and naRT prior to surgical resection achieve good long-term survival in high-risk breast cancer. pCR after naRT maintains its prognostic value in breast cancer subtypes and across different subgroups. pCR driven by naRT and naCT independently influences long-term survival.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Carolin Nestle-Krämling
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Dusseldorf, 40217 Dusseldorf, Germany
| | - Sylvia Wollandt
- Department of Senology, Sana-Kliniken Duesseldorf-Gerresheim, 40625 Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians University (LMU), 80366 Munich, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
- Correspondence: ; Tel.: +49-0211-81-17990
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Werner Audretsch
- Department of Senology and Breast Surgery, Breast Center at Marien Hospital Cancer Center, 40479 Dusseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
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Matuschek C, Budach W, Bojar H, Fehm T, Nestle-Krämling C, Corradini S, Fastner G, Seidel C, Krug D, Tamaskovics B, Bölke E, Kühn T, Haussmann J. Präoperative Strahlentherapie (PRT) und Systemtherapie beim Mammakarzinom – welche Faktoren beeinflussen das Gesamtüberleben (OS)? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Matuschek
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - W Budach
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | | | - T Fehm
- Universitätsfrauenklinik Düsseldorf, Frauenklinik
| | | | - S Corradini
- Ludwig-Maximilians-Universität München, Klinik für Strahlentherapie und Radioonkologie
| | - G Fastner
- Universitätsklinik Salzburg, Klinik für Strahlentherapie und Radioonkologie
| | - C Seidel
- Universitätsklinik Leipzig, Klinik für Strahlentherapie und Radioonkologie
| | - D Krug
- Universiätsklinik Schleswig-Holstein, Campus Kiel, Klinik für Strahlentherapie und Radioonkologie
| | - B Tamaskovics
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - E Bölke
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - T Kühn
- Klinikum Esslingen, Frauenklinik
| | - J Haussmann
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
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5
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Matuschek C, Bölke E, Haussmann J, Mohrmann S, Nestle-Krämling C, Gerber PA, Corradini S, Orth K, Kammers K, Budach W. The benefit of adjuvant radiotherapy after breast conserving surgery in older patients with low risk breast cancer- a meta-analysis of randomized trials. Radiat Oncol 2017; 12:60. [PMID: 28335784 PMCID: PMC5364687 DOI: 10.1186/s13014-017-0796-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/05/2017] [Indexed: 11/12/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) It is currently unclear whether patients with low risk breast cancer receiving adjuvant endocrine therapy need adjuvant radiation therapy after breast conserving surgery. The data of randomized trials are available. MATERIALS/METHODS In a database search 5 randomized trials including in total 3766 mostly elderly patients with early stage breast cancer treated either with adjuvant endocrine therapy or with endocrine therapy and additional whole breast radiation after breast conserving surgery were identified. Published hazard ratios for time to local recurrence were the basis of our meta-analysis. Meta-analysis of the effect sizes on local recurrence was performed using a random effects model based on parameter estimates of log hazard ratios in Cox models and their standard errors. Furthermore, overall survival was examined. RESULTS Adjuvant hormone therapy alone in mostly older patients with low risk breast cancer resulted in significantly shorter time to local relapse compared to radiation therapy combined with hormone therapy (Hazard Ratio: 6.8, 95% CI: 4.23-10.93, p < 0.0001) . There was no significant difference for overall survival. CONCLUSION Additional radiation therapy to hormone therapy did improve local relapse in breast cancer patients but did not show significant impact on overall survival.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
- Klinik für Strahlentherapie und Radiologische Onkologie, Heinrich Heine Universität, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Gynecologic and Obtresic, Heinrich Heine University, Dusseldorf, Germany
| | | | - Peter Arne Gerber
- Department of Dermatology, Medical Faculty Heinrich Heine University, Dusseldorf, Germany
| | | | - Klaus Orth
- Department of General, Visceral and Thoracic Surgery, Harzkliniken Goslar, Goslar, Germany
| | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
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Nestle-Krämling C, Bölke E, Budach W, Andree C. Erratum to: Breast reconstruction after neoadjuvant radio chemotherapy: review and personal technique IDEAL concept. Eur J Med Res 2016; 21:30. [PMID: 27417214 PMCID: PMC4946236 DOI: 10.1186/s40001-016-0223-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Carolin Nestle-Krämling
- Department of Senology, Sana Kliniken Düsseldorf-Gerresheim, Graeulinger Straße 120, 40625, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Andree
- Department of Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf-Gerresheim, Graeulinger Straße 120, 40625, Düsseldorf, Germany
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Nestle-Krämling C, Bölke E, Budach W, Andree C. Breast reconstruction after neoadjuvant radio chemotherapy: review and personal technique IDEAL concept REV-EJMR-D-15-00268. Eur J Med Res 2016; 21:24. [PMID: 27287332 PMCID: PMC4902933 DOI: 10.1186/s40001-016-0219-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/04/2015] [Accepted: 05/26/2016] [Indexed: 12/31/2022] Open
Abstract
Neoadjuvant radio chemotherapy and immediate reconstruction for breast cancer are still under debate. But there are recent abstracts and articles which show that neoadjuvant radio chemotherapy is feasible and could improve the clinical outcome of breast cancer patients. The aim of this review is to present the authors’ techniques and approaches with regard to neoadjuvant radiation of breast cancer patients. It seems that the concept of immediate implant delayed autologous breast reconstruction could be a safe procedure that is at least equivalent to primary autologous reconstruction.
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Affiliation(s)
- Carolin Nestle-Krämling
- Department of Senology, Sana Kliniken Düsseldorf-Gerresheim, Graeulinger Straße 120, 40625, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Andree
- Department of Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf-Gerresheim, Graeulinger Straße 120, 40625, Düsseldorf, Germany
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8
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Matuschek C, Boelke E, Budach W, Audretsch W, Wollandt S, Speer V, Nestle-Krämling C. Abstract P3-12-09: Neoadjuvant radiochemotherapy in breast cancer- A safe and effect method for patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-09] [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] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND:
Neoaduvant radiochemotherapy (NRT-CHT) is the standard of care for many solid tumors. It could be also an alternative option for treating patients with locally advanced non inflammatory breast cancer (LABC). Surgeons are afraid of wound healing problems and fear bad cosmetic results. The purpose of this investigation was to find out if there are any acute or late side effects in breast conserving and mastectomy patients after NRT-CHX.
PATIENTS AND METHODS:
From 1991 to 1998 a total of 315 LABC patients (cT1-cT4/cN0-N1) were treated with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with a consecutive electron boost in 214 cases or - in case of breast conservation - a 10-Gy interstitial boost with (192)Ir afterloading before EBRT. Chemotherapy was given prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. Also we investigated the acute side effects in 10 patients with NRT-CHX who were treated with this method from 2012-2015.
The cosmetic outcome was assessed by patient questionnaire, panel evaluation, and breast retraction assessment (BRA). Quality-of-life was investigated by EORTC QLQ-C30 and BR23 and acute and late radiation side effects by LENT/SOMA scale
RESULTS:
The long term results of 64 patients after breast conserving surgery and 152 patients after mastectomy were available. Most patients rated their overall cosmetics as excellent or good (94% breast conserving, 55.8% mastectomy). Patient and panel ratings on all cosmetic outcomes were similar between the two groups. After a follow up of 14-23 years we did not detect any grade III or IV fibrosis in any of our groups. The median BRA score after breast conserving surgery was 2.9 and the over-all quality of life (QLQ-C30) was rated "excellent" or good in 82%. Furthermore we did not detect any grade 3 or 4 acute side effects in our 10 patients who were recently treated with NRT-CHX.
CONCLUSION:
NRT-CHX is safe method and it is not associated with severe grade 3 or 4 acute or late side effects.
Citation Format: Matuschek C, Boelke E, Budach W, Audretsch W, Wollandt S, Speer V, Nestle-Krämling C. Neoadjuvant radiochemotherapy in breast cancer- A safe and effect method for patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-09.
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Affiliation(s)
- C Matuschek
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - E Boelke
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - W Budach
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - W Audretsch
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - S Wollandt
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - V Speer
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
| | - C Nestle-Krämling
- Heinrich Heine University, Dusseldorf, NRW, Germany; Sana Hospital Dusseldorf, Dusseldorf, NRW, Germany; Marienhospital, Dusseldorf, NRW, Germany
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9
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Otte M, Nestle-Krämling C, Fertsch S, Hagouan M, Munder B, Richrath P, Stambera P, Abu-Ghazaleh A, Andree C. Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap. Gland Surg 2016; 5:24-31. [PMID: 26855905 DOI: 10.3978/j.issn.2227-684x.2015.05.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND With the development of conservative mastectomies, there are an increasing number of women seeking immediate implant based and autologous breast reconstruction. Despite the oncologic safety of the procedures, the focus will be on the timing of reconstruction. METHODS Our plastic surgery unit is focused primarily on autologous breast reconstruction and is part of an interdisciplinary breast center. We offer immediate breast reconstruction (IBR) with autologous tissue for patients with positive BRCA 1 and 2, ductal carcinoma in situ (DCIS), invasive cancer without margin problems to the skin, as well as to correct poor oncologic and aesthetic breast conserving therapy (BCT) outcomes. In the majority of cases we prefer an Immediate-DElayed AutoLogous (IDEAL) breast reconstruction concept with a two-stage procedure. RESULTS Over the last 10 years we performed more than 1,600 breast reconstructions with free flaps, performing the deep inferior epigastric perforator (DIEP) flap as our first choice for autologous tissue. We recommend IDEAL breast reconstruction, however approximately 15% of our cases are immediate one stage conservative mastectomies and breast reconstruction with the DIEP flap. CONCLUSIONS For immediate reconstruction, the aesthetic outcome should not take precedence over oncologic considerations. Immediate one-stage, breast reconstruction with autologous tissue can be offered to the suitable patients which is most likely a healthy women with a small-to-medium sized non ptotic breast receiving a conservative mastectomy. In all other cases, we recommend an IDEAL breast reconstruction approach in order to achieve a final result that is both satisfyingly pleasing and oncologically safe.
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Affiliation(s)
- Maximilian Otte
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Carolin Nestle-Krämling
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Sonia Fertsch
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Mazen Hagouan
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Beatrix Munder
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Philip Richrath
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Peter Stambera
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Alina Abu-Ghazaleh
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Christoph Andree
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
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Budach W, Bölke E, Kammers K, Gerber PA, Nestle-Krämling C, Matuschek C. Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update. Radiat Oncol 2015; 10:258. [PMID: 26691175 PMCID: PMC4687086 DOI: 10.1186/s13014-015-0568-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adjuvant radiotherapy (RT) of regional lymph nodes (LN) in early breast cancer is still a matter of debate. RT increases the Overall survival (OS) rate of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved LN. The contribution of RT to regional LN to this improvement was poorly identified. Recently, the results of three large randomized trials addressing this question were published as full papers. MATERIAL AND METHODS Published data of the MA.20 (n = 1832), the EORTC22922-10925 (EORTC) (n = 4004) trial and the French trial (n = 1334) were the foundation of this meta-analysis. Major eligibility criteria were positive i) axillary LN (all trials), ii) LN negative disease with high risk for recurrence (MA.20), and iii) medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial analyzed the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS). RESULTS Regional RT of MS-LN and IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS [Hazard Ratio (HR) 0.88 (95 % CL 0.78 - 0.99)]. Adding results of the French trial and using a random effects model to respect the different design of the French trial, the effect on OS of regional RT remained significant [HR 0.90 (95 % CL 0.82 - 0.99)]. The absolute benefits in OS were 1 % in the MA.20 trial at 10 years, 1.6 % in the EORTC trial at 10 years, and 3.3 % in the French trial at 10 years (not significant in single trials). Regional RT of MS-LN and IM-LN (MA.20 and EORTC) yielded to a significant improvement of DFS [HR 0.86 (95 % CL 0.78 - 0.95)] and DMFS [HR 0.84 (95 % CL 0.75 - 0.94)]. CONCLUSION Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer.
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Affiliation(s)
- Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.
| | - Kai Kammers
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Peter Arne Gerber
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany.
| | | | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.
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Nestle-Krämling C, Andree C. Treatment Quality in Breast Cancer: Numbers, Age, and Breast Reconstruction. Dtsch Arztebl Int 2015; 112:575-6. [PMID: 26377528 DOI: 10.3238/arztebl.2015.0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carolin Nestle-Krämling
- Department of Senology, Sana Hospital Gerresheim, Düsseldorf, Department of Plastic and Aesthetic Surgery, Sana Hospital Gerresheim, Düsseldorf
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Abstract
BRCA mutation carriers have a life-long breast cancer risk between 55 and 85% and a high risk of developing breast cancer at a very young age, depending on the type of mutation. The risk of developing contralateral breast cancer after a first breast cancer is elevated up to 65%, especially in case of BRCA1 mutation and young age at the first breast cancer. Since bilateral prophylactic mastectomy is associated with a risk reduction of 90-95% of developing primary or contralateral breast cancer, this option is a key point within the counseling process for patient information and shared decision-making of mutation carriers. Although the local control after breast-conserving therapy in mutation carriers seems to be comparable to that of sporadic breast cancer patients, individual patient information and counseling should include all alternative procedures of oncologically adequate mastectomy techniques and immediate reconstruction. Excellent cosmetic results, high levels of life quality, and good patient acceptance can be achieved with the recent developments in reconstructive surgery of the breast.
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Affiliation(s)
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Germany
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Matuschek C, Boelke E, Prisack HB, Budach W, Nestle-Krämling C, Gerber PA, Pagouras C, Bojar H. Abstract P6-05-02: Molecular genetic grading in breast cancer: Development and validation of a prognostic marker. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-02] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Histopathological grading is an important part for the characterization of breast cancer with regard to prognosis and treatment options. 30-60% of breast cancer patients have a grade 2 (G2) malignancy resulting in an intermediate prognosis and the challenge of finding individualized adequate treatment options. Moreover, the lack of objectivity of the grading system is criticized. With the genetic analysis of breast cancer, the deciphering of its genes and gene expression profiling using microarray technology is a new way of classifying breast cancer
Patients, Materials, and Methods. Tumor tissue from 229 breast cancer patients collected from January 2009 - June 2010 was examined. A histological grading of the tumors was determined and gene expression profiling was performed by microarray technology (Agilent Technologies). Gene expression data were reduced and a novel molecular grade index (MGI-9) was defined as a G1 versus G3 classifier by SAM (Significance Analysis of Microarray) and PAM (Prediction Analysis of Microarray). The validity of the newly defined MGI-9 as a prognostic factor was tested by applying it to three published data sets with external follow-up information for a total of 760 patients
Results: The significance analysis of gene expression profiles of 229 breast cancer patients using SAM showed more than 11,000 significantly differentially expressed genes according to the grading classes G1-2-3. The number of differentially expressed genes was reduced to 228 genes by SAM analysis using only the G1 vs. G3 cases (63 patients). PAM analysis resulted in a more reduced classifier of 44 molecular probes and we could show that a subset of 9 genes gave similar classification results and could reliably used in FFPE Material. The new MGI-9 index was tested in thee external data sets (GSE1456, GSE2034 and GSE3494) and could subdivide the histological G2 group in two molecular subgroups G2A and G2B with significant impact on survival in all test scenarios.
Conclusion: The results show that MGI 9-gene molecular grade index is more informative than the conventional histopathological grading system. In order to validate MGI-9 a prospective, randomized study with long-term follow-up for local recurrence rate and distant metastases is urgently needed.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-02.
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Affiliation(s)
- C Matuschek
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - E Boelke
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - HB Prisack
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - W Budach
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - C Nestle-Krämling
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - PA Gerber
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - C Pagouras
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
| | - H Bojar
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany
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Matuschek C, Boelke E, Nestle-Krämling C, Speer V, Prisack H, Gerber PA, Bojar H, Audretsch W, Roth S, Budach W. Abstract P6-05-03: Evaluation of predictive markers for clinical outcome after neoadjuvant radiochemotherapy in breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-03] [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] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND:
Neoadjuvant radiochemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) is an innovative method in treating patients. Proliferation markers make up the majority of genes included in RNA-based prognostic gene signatures applied for breast cancer patients. In this subgroup analysis long-term clinical outcome data and predictive factors were analyzed.
PATIENTS AND METHODS:
During 1991-1998, a total of 315 LABC patients (cT1-cT4/cN0-N1) were treated with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or -in case of breast conservation- a 10-Gy interstitial boost with (192)Ir after loading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The impact of age, tumor grade, nodal status, hormone and growth factor receptor status (ER, PR, EGFR), p53, ki-67, HER2/neu, and bcl-2 on pathological complete response pCR and disease-free survival were examined in uni- and multivariate terms.
RESULTS:
Hormone receptor status, proliferative activity, bcl-2, EGFR-status and clinical tumor size had a significant impact on predicting neoadjuvant therapy success. Age, cN, grading, p53, and HER2/neu status failed to reach a significant correlation to complete remission. All examined immunohistochemical factors with the exception of EGFR, and all clinical factors displayed an univariately significant impact on DFS (disease free survival). Particularly, while HER-2/neu had no predictive value for pCR it displayed the highest impact on DFS after complete response (n = 92), even in a multivariate setting with clinical tumor size and nodal status. Complementary, p53 was the most superior immunhistochemical factor for prognosis after neoadjuvant incomplete remission (n = 223).
CONCLUSION:
Her2/neu is a predictive marker for overall survival independent from the pCR. It has no predictive value for the pCR. P53 is a prognostic marker for patients with incomplete remission. Prospective studies are needed to evaluate their use for decisions to further individualize adjuvant treatment after neoadjuvant radiochemotherapy.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-03.
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Affiliation(s)
- C Matuschek
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - E Boelke
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - C Nestle-Krämling
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - V Speer
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - H Prisack
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - PA Gerber
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - H Bojar
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - W Audretsch
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - S Roth
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
| | - W Budach
- Heinrich Heine University, Duesseldorf, NRW, Germany; Institute for Molecular Oncology, Duesseldorf, NRW, Germany; Krankenhaus Gerresheim, Duesseldorf, NRW, Germany; Marien Hospital (MHD), Duesseldorf, NRW, Germany
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Haack S, Wollandt S, Nestle-Krämling C. Anwendung von Arista® Wundpuder zur Hämostase in der Brustchirurgie. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1329438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nestle-Krämling C, Haack S, Rezai M, Janni W, Budach W, Boelke E. Bevacizumab in der Brustkrebstherapie – Management schwerer Wundheilungsstörungen. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1329439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Dieterich M, Nestle-Krämling C, Zwiefel K, Dieterich H, Blohmer J, Faridi A, Klein E, Reimer T, Gerber B, Paepke S. Erfahrungen mit TiLoop Bra® im Rahmen der implantatgestützten Sofortrekonstruktion: Eine Multizenterstudie mit 231 Fällen. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1329442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nestle-Krämling C. 2. Stellungnahme von DGGG, AWOgyn, DGPW, DGS und BVF. Ergänzende Empfehlungen zum Umgang mit Brustimplantaten der Firma PIP (einschliesslich Rofil / TiBreeze). Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0031-1298478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Friese K, Nestle-Krämling C, Wallwiener D, Gahr R, Albring C. 1. Gemeinsame Stellungnahme der DGGG, AWOgyn, DGS, DGPW und des BVF. Prophylaktische Entfernung von Brust-implantaten - Empfehlungen zum Umgang mit PIP-, Rofil- und TiBreeze-Implantaten. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0031-1298477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Nestle-Krämling C. Plastische Chirurgie. Brustvergrößerung - wann kann und darf operiert werden? Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0031-1298152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Nestle-Krämling C, Kübler N, Janni W, Braunstein S, Budach W, Bölke E, Matuschek C, Depprich R. Breast cancer in the lower jaw after reconstructive surgery with a pectoralis major myocutaneous flap (PMMC) -- a case report. Eur J Med Res 2011; 16:553-6. [PMID: 22112363 PMCID: PMC3351900 DOI: 10.1186/2047-783x-16-12-553] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
For head and neck as well as for oromaxillofacial surgery, the use of the pectoralis major myocutaneous (PMMC) flap is a standard reconstructive technique after radical surgery for cancers in this region. We report to our knowledge for the first development of breast cancer in the PMMC flap in a 79 year old patient, who had undergone several operations in the past for recurring squamous cell carcinoma of the jaw. The occurrence of a secondary malignancy within the donor tissue after flap transfer is rare, but especially in the case of transferred breast tissue and the currently high incidence of breast cancer theoretically possible. Therefore preoperative screening mammography seems advisable to exclude a preexisting breast cancer in female patients undergoing such reconstruction surgery. Therapy for breast cancer under these circumstances is individual and consists of radical tumor resection followed by radiation if applicable and a standard systemic therapeutic regimen on the background of the patients individual prognosis due to the primary cancer.
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Affiliation(s)
- C Nestle-Krämling
- Department of Obstetrics, Heinrich Heine University Hospital Düsseldorf, Germany.
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Nestle-Krämling C, Bölke E, Budach W, Peiper M, Niederacher D, Janni W, Eisenberger CF, Knoefel WT, Scherer A, Baldus SE, Lammering G, Gerber PA, Matuschek C. [Hemangiosarcoma after breast-conserving therapy of breast cancer: report of four cases with molecular genetic diagnosis and literature review]. Strahlenther Onkol 2011; 187:656-64. [PMID: 21858416 DOI: 10.1007/s00066-011-2251-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/16/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor. PATIENTS AND METHODS In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature. RESULTS Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients. CONCLUSION Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.
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Brandi L, Rein D, Nestle-Krämling C, Janni W, Fleisch M. Scarless reconstruction of circular umbilical defects after resection of endometriosis. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Nestle-Krämling C, Schönherr A, Vesper A, Wollandt S, Mohrmann S, Janni W. Netzunterstützte, implantatbasierte Sofortrekonstruktion der Brust mit Tiloop Bra ®. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Nestle-Krämling C, Schönherr A, Vesper A, Zwiefel K, Janni W. Implantatbasierte Sofortrekonstruktion mit porciner azellulärer Gewebematrix (Strattice®) nach hautsparender Mastektomie. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Vesper A, Köhler S, Janni W, Nestle-Krämling C. Mastektomie bei extrem großen Mammatumoren und Deckung mit Split-TRAM-Lappen. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hampl M, Nestle-Krämling C, Janni W. Plastische Operationen an der Vulva: Indikationen und Outcome. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Nestle-Krämling C, Janni W, Hampl M. Defektdeckung an der Vulva mit plastisch-rekonstruktiven Verfahren – Indikationen, Techniken und Ergebnisse. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1240641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dieterich M, Dieterich H, Nestle-Krämling C, Gerber B. Der zertifizierte Brustoperateur in Deutschland – Ein Ausbildungskonzept der AWO‐gyn im internationalen Vergleich. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1186257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Fasching PA, Bani MR, Nestle-Krämling C, Goecke TO, Niederacher D, Beckmann MW, Lux MP. Evaluation of mathematical models for breast cancer risk assessment in routine clinical use. Eur J Cancer Prev 2007; 16:216-24. [PMID: 17415092 DOI: 10.1097/cej.0b013e32801023b3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/25/2022]
Abstract
Chemoprevention, prophylactic surgery, and intensified screening can be offered to patients with an increased lifetime risk, p(life), for breast cancer. Estimation of p(life) includes BRCA analysis and risk estimation based on individual risk factors and family history. MENDEL and BRCAPRO are models that estimate the probability of BRCA1/2-mutations, p(mut), and p(life). In this study, the models are compared with Ford and Claus penetrance/frequency functions. The results were compared with the Tyrer-Cuzick model. Genetic analysis of 111 breast cancer-affected patients from 103 kindreds with a family history of breast and/or ovarian cancer (German Consortium for Hereditary Breast and Ovarian Cancer) was carried out by sequencing BRCA1 and BRCA2. p(life) and p(mut) were calculated with MENDEL, BRCAPRO(Claus), BRCAPRO(Ford), as well as the Tyrer-Cuzick model. The accuracy of p(mut) was analyzed by receiver operating characteristics, and p(life) of each model was compared. The strongest correlation of p(life) was shown by BRCAPRO(Ford)/MENDEL, at r=0.69; no correlation was shown by BRCAPRO(Claus)/MENDEL, at r=0.018. The Tyrer-Cuzick model had the strongest correlations with MENDEL and BRCAPRO(Ford). For MENDEL and BRCAPRO, low correlation or p(mut)-prediction was improved by excluding kindreds with ovarian cancer. p(mut) showed the best accuracy for BRCAPRO(Ford) and MENDEL. BRCAPRO and MENDEL are useful tools for calculating p(mut). They can provide support in decision-making for or against genetic analysis. Estimations of p(life) and p(mut) based on a mathematical model should use algorithms and penetrance/frequency data appropriate to the population counseled. Reproductive/hormonal data, should be incorporated as Tyrer-Cuzick does.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany.
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Albert U, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Kaufmann M, Kreienberg R, Kreipe H, Lebeau A, Loibl S, Nass-Griegoleit I, Nestle-Krämling C, Possinger K, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz K, Schulz-Wendtland R, Wallwiener D, Bender H. Onkologie. Aktuelle Gesundheitsziele zur Sekundärprävention von Brustkrebs in Deutschland. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Nestle-Krämling C, Langer E, Hautzel H, Bender HG, Müller-Mattheis V. 18F‐FDG‐PET (Positronenemissionstomografie) zur Differenzialdiagnostik bei simultaner Retroperitonealfibrose und Lymphknotenmetastasierung nach Ovarialkarzinom. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vodermaier A, Bauerfeind I, Nestle-Krämling C. Prophylaktische Chirurgie bei Brust- und Eierstockkrebsrisiko. Ein Überblick über die internationale Forschungsliteratur zu Einstellungen, Inanspruchnahmeverhalten und Lebensqualität. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vodermaier A, Bauerfeind I, Untch M, Nestle-Krämling C. [Prophylactic mastectomy in women at high risk for breast and ovarian cancer: qualitative analysis of the decision making process and long-term satisfaction of two women carrying a BRCA1-mutation]. Psychother Psychosom Med Psychol 2006; 56:351-61. [PMID: 16804803 DOI: 10.1055/s-2006-940007] [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: 10/24/2022]
Abstract
PURPOSE Bilateral prophylactic mastectomy and oophorectomy are currently the most effective prevention options for female carriers of the BRCA1 or BRCA2 gene. However, especially the mastectomy procedure is very invasive and is chosen rarely among high risk women in Germany. Little is known about how women cope with this surgery and their long-term satisfaction. METHODS Face-to-face interviews were conducted with two BRCA1 mutation carriers, who had undergone prophylactic mastectomy in their twenties 9 and 16 years ago. The process of decision making and long-term satisfaction were analysed using Mayring's qualitative content analysis. RESULTS Both high risk women had a significant family history of breast and ovarian cancer. They were repeatedly confronted with uncontrollable courses of disease in their relatives who died of breast cancer between the age of 20 and 30 and left small children behind. Although both women experienced different decision making and peri- and post-operative complications, both were satisfied with the decision for prophylactic surgery and showed no regret. DISCUSSION Deciding to obtain genetic testing pushed women towards further decision making concerning prophylactic surgery in case they carry a mutation. Information about carrier status reduced uncertainty even if the result was adverse. Both high risk women experienced a decrease in cancer related anxiety which may have heightened tolerance for quality of life related impairments. Implications for counseling are described.
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Affiliation(s)
- Andrea Vodermaier
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Grosshadern, Ludwig-Maximilians-Universität München, Germany.
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Lux MP, Ackermann S, Nestle-Krämling C, Goecke TO, Niederacher D, Bodden-Heidrich R, Bender HG, Beckmann MW, Fasching PA. Use of intensified early cancer detection in high-risk patients with familial breast and ovarian cancer. Eur J Cancer Prev 2005; 14:399-411. [PMID: 16030432 DOI: 10.1097/00008469-200508000-00014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 01/07/2023]
Abstract
A prospective follow-up study was carried out to evaluate the influence of risk and genetic counselling on use of early cancer detection. Five hundred and fifty-six subjects who fulfilled inclusion criteria for a genetic analysis of the BRCA1/2 genes (the high-risk group A) and 205 who did not fulfil the inclusion criteria (the lower risk group B) attended primary consultation in the interdisciplinary cancer genetic clinic. Information about participation in the early cancer detection programme was documented. Information about changes in use after consultation could be evaluated from 349 women (94 group B and 255 group A). Methods such as monthly self-palpation, breast palpation by gynaecologist, ultrasound of the breast, transvaginal ultrasound and pelvic examination had all been commonly used. Consultees at higher risk used mammography less often than women at lower risk. Magnetic resonance imaging of the breast was used rarely. Most methods were used more often at the recommended interval by women at higher risk during the follow-up period. In conclusion, at present intensified early cancer detection programmes for women at risk provide a less invasive option than chemoprevention or prophylactic surgery. Although the methods are used at high frequency it seems feasible to motivate women at risk to participate. This can be done by providing information and counselling in the cancer genetic clinic.
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Affiliation(s)
- M P Lux
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Universitaetsstrasse 21-23, 91054 Erlangen, Germany.
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Lakhani SR, Reis-Filho JS, Fulford L, Penault-Llorca F, van der Vijver M, Parry S, Bishop T, Benitez J, Rivas C, Bignon YJ, Chang-Claude J, Hamann U, Cornelisse CJ, Devilee P, Beckmann MW, Nestle-Krämling C, Daly PA, Haites N, Varley J, Lalloo F, Evans G, Maugard C, Meijers-Heijboer H, Klijn JGM, Olah E, Gusterson BA, Pilotti S, Radice P, Scherneck S, Sobol H, Jacquemier J, Wagner T, Peto J, Stratton MR, McGuffog L, Easton DF. Prediction of BRCA1 status in patients with breast cancer using estrogen receptor and basal phenotype. Clin Cancer Res 2005; 11:5175-80. [PMID: 16033833 DOI: 10.1158/1078-0432.ccr-04-2424] [Citation(s) in RCA: 441] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the proportion of breast cancers arising in patients with germ line BRCA1 and BRCA2 mutations expressing basal markers and developing predictive tests for identification of high-risk patients. EXPERIMENTAL DESIGN Histopathologic material from 182 tumors in BRCA1 mutation carriers, 63 BRCA2 carriers, and 109 controls, collected as part of the international Breast Cancer Linkage Consortium were immunohistochemically stained for CK14, CK5/6, CK17, epidermal growth factor receptor (EGFR), and osteonectin. RESULTS All five basal markers were commoner in BRCA1 tumors than in control tumors (CK14: 61% versus 12%; CK5/6: 58% versus 7%; CK17: 53% versus 10%; osteonectin: 43% versus 19%; EGFR: 67% versus 21%; P < 0.0001 in each case). In a multivariate analysis, CK14, CK5/6, and estrogen receptor (ER) remained significant predictors of BRCA1 carrier status. In contrast, the frequency of basal markers in BRCA2 tumors did not differ significant from controls. CONCLUSION The use of cytokeratin staining in combination with ER and morphology provides a more accurate predictor of BRCA1 mutation status than previously available, that may be useful in selecting patients for BRCA1 mutation testing. The high percentage of BRCA1 cases positive for EGFR suggests that specific anti-tyrosine kinase therapy may be of potential benefit in these patients.
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Affiliation(s)
- Sunil R Lakhani
- The Breakthrough Toby Robins Breast Cancer Research Centre, Institute of Cancer Research, London, United Kingdom.
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Fleisch M, Nestle-Krämling C, Benthin M, Stoff-Khalili M, Dall P. Erste Erfahrungen mit dem Einsatz des LigaSure™-Versiegelungssystems bei abdominellen und abdominovaginalen gynäkoonkologischen Operationen. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-40476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Beckmann MW, Jap D, Djahansouzi S, Nestle-Krämling C, Kuschel B, Dall P, Brumm C, Bender HG. Hormone replacement therapy after treatment of breast cancer: effects on postmenopausal symptoms, bone mineral density and recurrence rates. Oncology 2001; 60:199-206. [PMID: 11340370 DOI: 10.1159/000055319] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [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: 11/19/2022]
Abstract
PURPOSE Breast cancer (BC) is the most frequent female carcinoma and the major cause of death in women aged 35--50 years. The total number of patients surviving BC and especially the morbidity rate of patients below the age of 55 years has increased significantly in the last several years. As a consequence, the number of BC patients suffering from the long-term effects of estrogen deficiency due to adjuvant treatment is increasing. At present, hormone replacement therapy (HRT) following BC treatment is applied individually and mainly depends on the severity of postmenopausal symptoms (PMS) experienced by these patients. PATIENTS AND METHODS In a retrospective study (total n = 185 BC patients, 64 with and 121 without HRT), the effect of HRT during or after adjuvant therapy [chemotherapy and/ or (anti-) hormonotherapy] has been investigated. The surveillance period was up to 60 months. Evaluated were HRT effects on (1) PMS measured by a comprehensive life quality questionnaire, (2) bone mineral density (BMD) measured by osteodensitometry and (3) morbidity as well as mortality rates. RESULTS Both groups did not differ with regard to tumor stage, lymph node involvement, metastasis, grading, and steroid hormone receptor status. A reduction in PMS was significant in women taking HRT (p < 0.001), especially in the subgroup of women < or =50 years (p < 0.0001). For both age groups, the median reduction in BMD (z-score) was less in women receiving HRT (< or =50 years: without HRT -1.99 vs. with HRT -0.95, p < 0.05; >50 years: without HRT -2.29 vs. with HRT -1.19, p < 0.01). There were no statistically significant differences regarding morbidity and mortality (p = 0.29). CONCLUSION In this study of BC patients, the use of HRT shows positive effects on PMS and BMD. There was no significant influence on morbidity or mortality. However, a reevaluation of HRT in the routine management of BC patients should await the results of prospective randomized trials.
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Affiliation(s)
- M W Beckmann
- Department of Obstetrics and Gynecology, Friedrich Alexander University, Erlangen, Germany
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Betz B, Larbig D, Goecke TO, Nestle-Krämling C, Bender HG, Niederacher D. Mutation detection in familial and sporadic breast cancers by denaturing high-performance liquid chromatography (DHPLC). Breast Cancer Res 2001. [PMCID: PMC3300592 DOI: 10.1186/bcr409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hess A, Flüβ MO, Nestle-Krämling C, Bender HG, Dall P. Sentinel lymph node biopsies in breast cancer. Breast Cancer Res 2001. [PMCID: PMC3300540 DOI: 10.1186/bcr357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Hess
- Institut für Frauenheilkunde und Geburtshilfe
| | - MO Flüβ
- Institut für Nuklearmedizin, Universität Düsseldorf, Germany
| | | | - HG Bender
- Institut für Frauenheilkunde und Geburtshilfe
| | - P Dall
- Institut für Frauenheilkunde und Geburtshilfe
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Rezai M, Nestle-Krämling C. Oncoplastic surgical techniques in breast-conserving therapy for carcinoma of the breast. Gynäkologe 1999. [DOI: 10.1007/pl00003213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Konecny G, Untch M, Bauerfeind I, Piche E, Nestle-Krämling C. Adjuvant high dose epirubicin and cyclophosphamide with G-CSF support in patients with locally advanced breast cancer. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)99939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nestle-Krämling C, Untch M, Hagen D, Fields K, Funke I, Konecny G. Detection of tumor cells in the bone marrow of breast cancer patients by cytokeratin 19 — reverse-transcriptase — polymerase chain reaction (RT-PCR). Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)99934-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Untch M, Nestle-Krämling C, Konecny G, Harbeck N, Funke I, Kimmig R, Hepp H. [Prognostic value of tumor cells in bone marrow in breast cancer]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:308-10. [PMID: 8118327 DOI: 10.1159/000272278] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Untch
- Univ.-Frauenklinik München-Grosshadern
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Untch M, Sevin BU, Untch A, Konecny G, Nestle-Krämling C, Korell M, Hepp H. [Testing chemosensitivity of cancer cell lines and gynecologic tumors with the ATP assay]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:311-3. [PMID: 7906979 DOI: 10.1159/000272279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Untch
- Univ.-Frauenklinik München-Grosshadern
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Konecny G, Nestle-Krämling C, Untch M. [Use of G-CSF in dose-intensified chemotherapy of breast cancer with FEC (500/75/500 mg/m2 KO) in the adjuvant and metastatic situation]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:301-2. [PMID: 7509677 DOI: 10.1159/000272274] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G Konecny
- Univ.-Frauenklinik München Grosshadern
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