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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, El-Tamer M. Reply to G.B. Mann et al and S. Sorscher. J Clin Oncol 2024:JCO2400224. [PMID: 38489573 DOI: 10.1200/jco.24.00224] [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] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Reshma Jagsi
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kent A Griffith
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Eleanor E Harris
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jean L Wright
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Abram Recht
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alphonse G Taghian
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lucille Lee
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Meena S Moran
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - William Small
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Candice Johnstone
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Asal Rahimi
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gary Freedman
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mahvish Muzaffar
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Bruce Haffty
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kathleen Horst
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Simon N Powell
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jody Sharp
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michael Sabel
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Anne Schott
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mahmoud El-Tamer
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, El-Tamer M. Omission of Radiotherapy After Breast-Conserving Surgery for Women With Breast Cancer With Low Clinical and Genomic Risk: 5-Year Outcomes of IDEA. J Clin Oncol 2024; 42:390-398. [PMID: 38060195 DOI: 10.1200/jco.23.02270] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Multiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors. METHODS Postmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins ≥2 mm after BCS whose tumors were estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative with Oncotype DX 21-gene recurrence score ≤18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS. RESULTS Between June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer-specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively. CONCLUSION This trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend.
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Affiliation(s)
- Reshma Jagsi
- Emory University, Atlanta, GA
- University of Michigan, Ann Arbor, MI
| | | | | | | | - Abram Recht
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Asal Rahimi
- University of Texas, Southwestern, Dallas, TX
| | | | | | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Talcott WJ, Ford EC, Gillespie EF, Wright JL, Lincoln H, Meyer J, Kim JN, Landers A, Moran MS, Hartvigson P, Kishore M, Burmeister JW, Pawlicki T, Evans SB. A Prospective, Multi-Institutional Study of Problematic Plan Detection during Physician Chart Rounds. Int J Radiat Oncol Biol Phys 2023; 117:e445. [PMID: 37785438 DOI: 10.1016/j.ijrobp.2023.06.1625] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We performed a multi-institutional prospective study to determine the detection rate of problematic treatment plans (PP) at physician chart rounds (CR), and to identify factors associated with PP detection. MATERIALS/METHODS Curative intent PPs with simulated errors (representative of the most common targets of peer review) were generated. Two breast specialists selected twenty appropriate plans for inclusion and assigned them American Association of Physicists in Medicine (AAPM) Task Group 100 severity and detectability scores. The PPs were blinded and embedded at weekly virtual CR at 2 institutions over 12 months. At site A, both breast and lung cases were reviewed by a mix of breast and lung specialists during CR, and at site B, only breast cases were presented and reviewed by breast specialists. At both sites, breast plans were reviewed via slice-by-slice review in the treatment planning system (TPS), and both used a color-coded tool from the TPS to assess adherence to planning directives. Both sites had systematic approaches to case presentation (without a checklist). Site A was usually prospective CR, while site B was exclusively prospective. The following CR elements were recorded: PP detection, time of detection, length of CR, total number of cases presented, plan elements displayed, number and roles of attendees, and detector's role. Analysis was performed using simple statistics with chi-square testing. RESULTS By PP error type classification, 55.0% pertained to "target volume delineation," 25% to "non-target volume delineation or normal tissue sparing," and 20.0% to "dose prescription or written directives." Detectability was rated ≤5 (<5% likelihood of going undetected) for 60% of PPs, and severity was rated ≥7 ("at least potentially serious toxicity or tumor underdose") for only 30% of PPs. CR lasted a median of 64 minutes at site A (IQR 55-82.5) and 70 minutes at site B (IQR 52.5-81.5). PPs were presented at a median of 34 minutes (IQR 22.5-43, site A) and 41.5 minutes (IQR 23.5-56, site B) after CR start. A median of 16 cases (IQR 13-19) at site A and 32 cases (IQR 25-34.5) at site B were presented per CR session, with a median of 1 PP (site A and B) presented per session (range 1-2). The median time spent per case was 4.0 minutes (Site A) and 2.2 minutes (Site B). The median number of attendings at CR was 4 for site A (range 2-6) and 6.5 for Site B (range 5-10). PP detection rate at site A was 20% (n = 4) and at site B was 70% (n = 14) (p = 0.001). Detections were made by an attending physician in 100% (site A, n = 4) and 92.9% (Site B, n = 13) of PP detections. There were no differences in detection rate by PP error type (p = 0.78), detectability (p = 0.60) or severity score (p = 0.68), or by time PP presented after CR start (p = 0.39). CONCLUSION The effectiveness of PP detection at chart rounds can vary greatly between institutions. The study suggests possible areas for improvement but further study is needed to determine best practices.
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Affiliation(s)
- W J Talcott
- Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - E C Ford
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E F Gillespie
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J L Wright
- Johns Hopkins Medicine, Department of Radiation Oncology, Baltimore, MD
| | - H Lincoln
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J N Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A Landers
- University of Washington, Seattle, WA
| | - M S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - P Hartvigson
- University of Washington, Department of Radiation Oncology, Seattle, WA
| | - M Kishore
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | | | - T Pawlicki
- University of California, San Diego, La Jolla, CA
| | - S B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
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Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch AM, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Schneider B, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Wei M, Wisinski KB, Young JS, Yeung K, Dwyer MA, Kumar R. NCCN Guidelines® Insights: Breast Cancer, Version 4.2023. J Natl Compr Canc Netw 2023; 21:594-608. [PMID: 37308117 DOI: 10.6004/jnccn.2023.0031] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer address all aspects of management for breast cancer. The treatment landscape of metastatic breast cancer is evolving constantly. The therapeutic strategy takes into consideration tumor biology, biomarkers, and other clinical factors. Due to the growing number of treatment options, if one option fails, there is usually another line of therapy available, providing meaningful improvements in survival. This NCCN Guidelines Insights report focuses on recent updates specific to systemic therapy recommendations for patients with stage IV (M1) disease.
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Affiliation(s)
| | | | - Jame Abraham
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Rebecca Aft
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Bryan Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | | | | | - Mei Wei
- Huntsman Cancer Institute at the University of Utah
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Moran MS, Ho AY. Radiation Therapy for Low-Risk Breast Cancer: Whole, Partial, or None? J Clin Oncol 2022; 40:4166-4172. [PMID: 36332170 DOI: 10.1200/jco.22.01751] [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: 11/06/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.The following case represents a relatively common clinical scenario of a postmenopausal female patient who presents with low-risk, estrogen receptor-positive/progesterone receptor-positive/human epidermal growth factor receptor 2-negative, early-stage, left-sided breast cancer to discuss the role of postoperative radiation (RT) following wide local excision (WLE) and sentinel node biopsy. The spectrum of choices, ranging from omission of RT, accelerated partial breast irradiation (PBI), whole-breast radiation therapy, and the nuances of various dose/fractionation regimens for each option, are discussed in the context of the Danish Breast Cancer Study Group (DBCSG) PBI trial published in this issue, with additional review of other key trials that inform these treatment recommendations. After consideration of the clinical-pathologic features in the framework of the existing data and an in-depth discussion taking into consideration the patient's preferences/goals, the decision was made to deliver moderately hypofractionated RT (40 Gy/15 fractions) to a PBI volume, in concordance with the DBCSG-PBI trial.
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Affiliation(s)
- Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Smilow Cancer Center; New Haven, CT
| | - Alice Y Ho
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
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6
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Alvarenga J, Moran J, Bulgaru A, Moran MS. Decreasing the Interval Wait Times for Screening Mammogram Results Using the "Reflex Testing" Algorithm. J Breast Imaging 2022; 4:474-479. [PMID: 38416949 DOI: 10.1093/jbi/wbac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/29/2021] [Indexed: 03/01/2024]
Abstract
OBJECTIVE The purpose of this analysis was to determine whether our "reflex testing" (RefT) intervention, implemented to address barriers in scheduling, communication, and diagnostic order placement for resolving BI-RADS 0 screening mammograms, resulted in decreased interval wait times (IWT) for patients with abnormal screening mammograms (abSM). METHODS All BI-RADS 0 cases over two six-month periods (pre-RefT and post-RefT) were analyzed. Timelines were generated for each BI-RADS 0 case. Elapsed days were computed from date of BI-RADS 0 report to the date of biopsy, additional diagnostic testing, and final resolution. The means of each endpoint within the pre-RefT and post-RefT cohorts were statistically analyzed using Pearson chi-square analysis to assess whether IWT differed significantly after RefT implementation. RESULTS The analytic cohort consisted of 1523 BI-RADS 0 cases (n(pre-RefT) = 647, n(post-RefT) = 876). Reflex testing decreased the overall mean IWT from 23.5 to 8.2 days (P < 0.001). For patients not requiring biopsy (1190/1523, 78.1%), the mean IWT from the BI-RADS 0 designation to first diagnostic test or resolution decreased from 29.7 to 10.8 days (P < 0.010). For patients who had biopsy (333/1523, 21.9%), RefT significantly decreased the IWT from BI-RADS 0 to first diagnostic test from 31.4 to 7.7 days (P < 0.001) and also significantly decreased the IWT from first diagnostic test to biopsy (20.9 to 17.7 days; P < 0.013). CONCLUSION Reflex testing intervention streamlines the workflow and significantly decreases IWT for resolving BI-RADS 0 abSM. The RefT intervention could be considered to improve efficiency at other breast centers.
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Affiliation(s)
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Anca Bulgaru
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Medicine, Smilow Cancer Center at Waterford, Waterford, CT, USA
| | - Meena S Moran
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Medicine, Smilow Cancer Center at Waterford, Waterford, CT, USA
- Yale School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA
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7
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Johnson SB, Parsons M, Dorff T, Moran MS, Ward JH, Cohen SA, Akerley W, Bauman J, Hubbard J, Spratt DE, Bylund CL, Swire-Thompson B, Onega T, Scherer LD, Tward J, Fagerlin A. Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report. J Natl Cancer Inst 2022; 114:1036-1039. [PMID: 34291289 PMCID: PMC9275772 DOI: 10.1093/jnci/djab141] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [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] [Received: 03/04/2021] [Revised: 05/04/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
There are few data on the quality of cancer treatment information available on social media. Here, we quantify the accuracy of cancer treatment information on social media and its potential for harm. Two cancer experts reviewed 50 of the most popular social media articles on each of the 4 most common cancers. The proportion of misinformation and potential for harm were reported for all 200 articles and their association with the number of social media engagements using a 2-sample Wilcoxon rank-sum test. All statistical tests were 2-sided. Of 200 total articles, 32.5% (n = 65) contained misinformation and 30.5% (n = 61) contained harmful information. Among articles containing misinformation, 76.9% (50 of 65) contained harmful information. The median number of engagements for articles with misinformation was greater than factual articles (median [interquartile range] = 2300 [1200-4700] vs 1600 [819-4700], P = .05). The median number of engagements for articles with harmful information was statistically significantly greater than safe articles (median [interquartile range] = 2300 [1400-4700] vs 1500 [810-4700], P = .007).
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Affiliation(s)
- Skyler B Johnson
- Correspondence to: Skyler B. Johnson, MD, Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Institute, 1950 Circle of Hope Dr, Rm 1570, Salt Lake City, UT 84112, USA (e-mail: )
| | - Matthew Parsons
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tanya Dorff
- Department of Medical Oncology and Developmental, Therapeutics, City of Hope, Duarte, CA, USA
- Department of Medicine, University of Southern California (USC) Keck School of Medicine and Norris Comprehensive Cancer Center (NCCC), Los Angeles, CA, USA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - John H Ward
- Oncology Division, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stacey A Cohen
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jessica Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Carma L Bylund
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Briony Swire-Thompson
- Network Science Institute, Northeastern University, Boston, MA, USA
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tracy Onega
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
| | - Laura D Scherer
- Department of Medicine, Division of Cardiology, University of Colorado, Denver, CO, USA
- VA Denver Center of Innovation, Denver, CO, USA
| | - Jonathan Tward
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Angela Fagerlin
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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8
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Knowlton CA, Jimenez RB, Moran MS. Risk Assessment in the Molecular Era. Semin Radiat Oncol 2022; 32:189-197. [DOI: 10.1016/j.semradonc.2022.01.005] [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: 11/15/2022]
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Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns J, Kumar R. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:691-722. [PMID: 35714673 DOI: 10.6004/jnccn.2022.0030] [Citation(s) in RCA: 287] [Impact Index Per Article: 143.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. These NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.
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Affiliation(s)
| | | | - Jame Abraham
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | - Sara H Javid
- Fred Hutchinson Cancer Research Center/University of Washington
| | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - John H Ward
- Huntsman Cancer Institute at the University of Utah
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10
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Moran MS, Leitch AM. Locoregional Management of Early-Stage Breast Cancer. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2022.5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The latest version of NCCN Guidelines for Breast Cancer on locoregional management of early-stage breast cancer contains numerous updated recommendations, particularly focusing on management of the axilla, locoregional management after neoadjuvant therapy, and radiation delivery. Recommendations for axillary staging have been separated for patients who have undergone breast-conserving surgery and those who have had a mastectomy, creating 2 individual pathways. The section on locoregional treatment after neoadjuvant therapy has been reformatted; optimal management of this patient group continues to evolve. Lastly, specifics regarding the delivery and sequencing of radiotherapy have been updated.
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Bleicher RJ, Moran MS, Ruth K, Edge SB, Dietz JM, Wilke LG, Stearns V, Kurtzman SH, Klein J, Yao KA. The Impact of Radiotherapy Delay in Breast Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures. Ann Surg Oncol 2022; 29:469-481. [PMID: 34324114 PMCID: PMC9059503 DOI: 10.1245/s10434-021-10512-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 04/19/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The Commission on Cancer/National Quality Forum breast radiotherapy quality measure establishes that for women < 70 years, adjuvant radiotherapy after breast conserving surgery (BCS) should be started < 1 year from diagnosis. This was intended to prevent accidental radiotherapy omission or delay due to a long interval between surgery and chemotherapy completion, when radiation is delivered. However, the impact on patients not receiving chemotherapy, who proceed from surgery directly to radiotherapy, remains unknown. PATIENTS AND METHODS Patients aged 18-69, diagnosed with stage I-III breast cancer as their first and only cancer diagnosis (2004-2016), having BCS, for whom this measure would be applicable, were reviewed from the National Cancer Database. RESULTS Among 308,521 patients, the median age was 57.0 years, and > 99% of all patients were compliant with the measure. The cohort of interest included 186,650 (60.5%) patients not receiving chemotherapy, with a mean age of 57.9 years. Of these, 90.5% received external beam radiotherapy (EBRT) and 9.5% brachytherapy. Among them, 24.9% started radiotherapy > 8 weeks after surgery. In a multivariable model, delay from surgery to radiotherapy increased the hazard ratios for overall survival to 9.0% (EBRT) per month and 3.0% (brachytherapy) per week. CONCLUSION While 99.9% of patients undergoing BCS without chemotherapy remain compliant with the current quality measure, 25% have delays > 8 weeks to start radiation, which is associated with impaired survival. These data suggest that the current quality measure should be dichotomized into two, with or without chemotherapy, in order to impel prompt radiotherapy initiation and maximize outcomes in all patients.
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Affiliation(s)
- Richard J Bleicher
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.
- The Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Meena S Moran
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Therapeutic Radiology, Yale University Medical Center, New Haven, CT, USA
| | - Karen Ruth
- The Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen B Edge
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgical Oncology and Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jill M Dietz
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Lee G Wilke
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Vered Stearns
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Scott H Kurtzman
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Waterbury Hospital, Waterbury, CT, USA
| | - Jonah Klein
- The Department of Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Katharine A Yao
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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12
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Kaidar-Person O, Dahn HM, Nichol AM, Boersma LJ, de Ruysscher D, Meattini I, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho AY, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nissen HD, Strnad V, Zissiadis Y, Poortmans PM, Offersen BV. A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer. Radiother Oncol 2021; 164:115-121. [PMID: 34563607 DOI: 10.1016/j.radonc.2021.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Due to the lack of randomised trials evaluating the benefits of bolus, we designed a stepwise project to evaluate the existing evidence about the use of bolus in the setting of PMRT to achieve an international consensus for the indications of bolus in PMRT, based on the Delphi method.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, The Netherlands.
| | - Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, Canada
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi; Florence, Italy
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France, INSERM Unit 955, Creteil, France
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Nuran Bese
- Acibadem Mehmet Ali Aydinlar University, Research Institute of Senology Istanbul, Turkey
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, University Hospital "Maggiore della Carità,", Novara, Italy
| | - Alice Y Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Livia Marrazzo
- Medical Physics Unit, Careggi University Hospital, Florence, Italy
| | - Gustavo N Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Germany
| | | | | | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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13
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Peters GW, Gao SJ, Knowlton C, Zhang A, Evans SB, Higgins S, Wilson LD, Saltmarsh N, Picone M, Moran MS. Benefit of Deep Inspiratory Breath Hold for Right Breast Cancer When Regional Lymph Nodes Are Irradiated. Pract Radiat Oncol 2021; 12:e7-e12. [PMID: 34508890 DOI: 10.1016/j.prro.2021.08.010] [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: 06/03/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although deep inspiratory breath-hold (DIBH) is routinely used for left-sided breast cancers, its benefits for right-sided breast cancer (rBC) have yet to be established. We compared free-breathing (FB) and DIBH treatment plans for a cohort of rBC undergoing regional nodal irradiation (RNI) to determine its potential benefits. METHODS AND MATERIALS rBC patients considered for RNI (internal mammary nodal chains, supraclavicular field, with or without axilla) from October 2017 to May 2020 were included in this analysis. For each patient, FB versus DIBH plans were generated and dose volume histograms evaluated the following parameters: mean lung dose, ipsilateral lung V20/V5 (volumes of lung receiving 20 Gy and 5 Gy, respectively); mean heart dose and heart V5 (volumes of heart receiving 5 Gy); liver V20 absolute /V30 absolute (absolute volume of liver receiving 20 Gy and 30 Gy, respectively), liver Dmax, and total liver volume irradiated (TVIliver). The dosimetric parameters were compared using Wilcoxon signed-rank testing. RESULTS Fifty-four patients were eligible for analysis, comparing 108 FB and DIBH plans. DIBH significantly decreased all lung and liver parameters: mean lung dose (19.7 Gy-16.2 Gy, P < .001), lung V20 (40.7%-31.7%, P < .001), lung V5 (61.2%-54.5%, P < .001), TVIliver (1446 cc vs 1264 cc; P = .006) liver Dmax (50.2 Gy vs 48.9 Gy; P = .023), liver V20 (78.8-23.9 cc, P < .001), and liver V30 (58.1-14.6 cc, P < .001) compared with FB. DIBH use did not significantly improve heart parameters, although the V5Heart trended on significance (1.25-0.6, P = .067). CONCLUSIONS This is the largest cohort to date analyzing DIBH for RNI-rBC. Our findings demonstrate significant improvement in all lung and liver parameters with DIBH, supporting its routine consideration for rBC patients undergoing comprehensive RNI.
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Affiliation(s)
- Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Sarah J Gao
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christin Knowlton
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Andrew Zhang
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Susan Higgins
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas Saltmarsh
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Martha Picone
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
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14
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Bleicher RJ, Moran MS, Ruth K, Edge SB, Dietz JM, Wilke LG, Stearns V, Kurtzman SH, Klein J, Yao KA. ASO Visual Abstract: The Impact of Radiotherapy Delay in Breast-Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures. Ann Surg Oncol 2021. [PMID: 34346019 DOI: 10.1245/s10434-021-10535-8] [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: 11/18/2022]
Affiliation(s)
- Richard J Bleicher
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA. .,Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Meena S Moran
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Therapeutic Radiology, Yale University Medical Center, New Haven, CT, USA
| | - Karen Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen B Edge
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Surgical Oncology and Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jill M Dietz
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Lee G Wilke
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Vered Stearns
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Scott H Kurtzman
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Surgery, Waterbury Hospital, Waterbury, CT, USA
| | - Jonah Klein
- Department of Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Katharine A Yao
- Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.,Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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15
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Dahn HM, Boersma LJ, de Ruysscher D, Meattini I, Offersen BV, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho A, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nichol AM, Nissen HD, Strnad V, Zissiadis YE, Poortmans P, Kaidar-Person O. The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review. Crit Rev Oncol Hematol 2021; 163:103391. [PMID: 34102286 DOI: 10.1016/j.critrevonc.2021.103391] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/23/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Post mastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and breast cancer mortality for selected patients. Bolus overcomes the skin-sparing effect of external-beam radiotherapy, ensuring adequate dose to superficial regions at risk of local recurrence (LR). This systematic review summarizes the current evidence regarding the impact of bolus on LR and acute toxicity in the setting of PMRT. RESULTS 27 studies were included. The use of bolus led to higher rates of acute grade 3 radiation dermatitis (pooled rates of 9.6% with bolus vs. 1.2% without). Pooled crude LR rates from thirteen studies (n = 3756) were similar with (3.5%) and without (3.6%) bolus. CONCLUSIONS Bolus may be indicated in cases with a high risk of LR in the skin, but seems not to be necessary for all patients. Further work is needed to define the role of bolus in PMRT.
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Affiliation(s)
- Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Cynthia Aristei
- Radiation Oncology Section Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France; INSERM Unit 955, Team 21. IMRB, Creteil, France.
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba medical Center, Ramat Gan, Israel.
| | - Nuran Bese
- Department of Clinical Senology, Research Institute of Senology Acibadem, Istanbul, Turkey.
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, University Hospital "Maggiore della Carità, Novara, Italy.
| | - Alice Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, the Netherlands.
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
| | - Livia Marrazzo
- Medical Physics Unit, Careggi University Hospital, Florence, Italy.
| | - Gustavo N Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.
| | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
| | | | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk Antwerp, Belgium.
| | - Orit Kaidar-Person
- Sheba Medical Center, Ramat Gan, Israel GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, the Netherlands; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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16
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Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Matro J, Mayer IA, Mortimer J, O'Regan RM, Patel SA, Pierce LJ, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns JL, Kumar R. NCCN Guidelines® Insights: Breast Cancer, Version 4.2021. J Natl Compr Canc Netw 2021; 19:484-493. [PMID: 34030128 DOI: 10.6004/jnccn.2021.0023] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The NCCN Guidelines for Breast Cancer include up-to-date guidelines for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, male breast cancer, and breast cancer during pregnancy. These guidelines are developed by a multidisciplinary panel of representatives from NCCN Member Institutions with breast cancer-focused expertise in the fields of medical oncology, surgical oncology, radiation oncology, pathology, reconstructive surgery, and patient advocacy. These NCCN Guidelines Insights focus on the most recent updates to recommendations for adjuvant systemic therapy in patients with nonmetastatic, early-stage, hormone receptor-positive, HER2-negative breast cancer.
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Affiliation(s)
| | | | - Jame Abraham
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Chau Dang
- 9Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | - Sara H Javid
- 17Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Janice Lyons
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Jennifer Matro
- 16Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | - Hope S Rugo
- 24UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Karen Lisa Smith
- 25The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - John H Ward
- 29Huntsman Cancer Institute at the University of Utah
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17
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Peters GW, Gao SJ, Knowlton C, Zhang A, Evans SB, Higgins S, Wilson LD, Saltmarsh N, Picone M, Moran MS. CLO21-025: Benefit of Deep Inspiratory Breath Hold for Right Breast Cancer When Regional Lymph Nodes Are Irradiated. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7707] [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: 11/17/2022]
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18
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Zhang H, Zhang N, Moran MS, Li Y, Liang Y, Su P, Haffty BG, Yang Q. Special subtypes with favorable prognosis in breast cancer: A registry-based cohort study and network meta-analysis. Cancer Treat Rev 2020; 91:102108. [PMID: 33075683 DOI: 10.1016/j.ctrv.2020.102108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to explore whether cribriform and adenoid cystic carcinoma had comparable prognoses to mucinous, tubular and papillary carcinoma, which were long recognized as favorable histologies by NCCN guidelines. METHODS A retrospective analysis based on the Surveillance, Epidemiology, and End Results Study (SEER) database (1994-2014) was conducted. The prognostic significance of all clinicopathological factors was calculated using univariate and multivariate analyses. A systematic review based on PubMed and network meta-analysis was conducted. RESULTS From the SEER database, the histologic subtypes of breast cancer (tubular, cribriform, adenoid cystic, mucinous, and papillary) were sorted by overall survival (OS) (94.4%, 91.6%, 90.8%, 87.6%, and 84.2%, respectively) and tubular, cribriform, mucinous, papillary, and adenoid cystic carcinoma by breast cancer-specific survival (BCSS) (99.4%, 98.4%, 97.7%, 95.2%, and 94.9%, respectively). A network meta-analysis combining 11 studies (886,649 patients) was conducted, which demonstrated consistent outcomes. SEER-based analyses revealed that, among the favorable subtypes, systemic chemotherapy did not improve OS or BCSS in hormone receptor-positive, node-negative patients, validating that these subtypes are generally associated with excellent outcomes, for which systemic chemotherapy may not be warranted. CONCLUSIONS Our data are consistent with guidelines suggesting that the mucinous, tubular, and papillary subtypes of breast cancer have favorable histologies. SEER data and meta-analysis supports this favorable category to include adenoid cystic and cribriform carcinoma, whose OS and BCSS outcomes are comparable to the former three. These findings add to the body of data, suggesting that patients with these histologic subtypes confer excellent prognosis, which may guide optimal therapeutic management strategies.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, NJ, USA
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China; Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China.
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19
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Goetz MP, Gradishar WJ, Anderson BO, Abraham J, Aft R, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Farrar WB, Giordano SH, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, Moran MS, Mortimer J, O'Regan RM, Patel SA, Pierce LJ, Reed EC, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Telli ML, Ward JH, Young JS, Shead DA, Kumar R. NCCN Guidelines Insights: Breast Cancer, Version 3.2018. J Natl Compr Canc Netw 2020; 17:118-126. [PMID: 30787125 DOI: 10.6004/jnccn.2019.0009] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
These NCCN Guidelines Insights highlight the updated recommendations for use of multigene assays to guide decisions on adjuvant systemic chemotherapy therapy for women with hormone receptor-positive, HER2-negative early-stage invasive breast cancer. This report summarizes these updates and discusses the rationale behind them.
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Affiliation(s)
| | | | | | - Jame Abraham
- 4Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Chau Dang
- 9Memorial Sloan Kettering Cancer Center
| | | | - William B Farrar
- 11The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Janice Lyons
- 4Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | | | - Hope S Rugo
- 22UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Karen Lisa Smith
- 23The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - John H Ward
- 26Huntsman Cancer Institute at the University of Utah
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20
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Schnitt SJ, Moran MS, Giuliano AE. Lumpectomy Margins for Invasive Breast Cancer and Ductal Carcinoma in Situ: Current Guideline Recommendations, Their Implications, and Impact. J Clin Oncol 2020; 38:2240-2245. [PMID: 32442067 DOI: 10.1200/jco.19.03213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT
| | - Armando E Giuliano
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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21
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Loganadane G, Truong PT, Taghian AG, Tešanović D, Jiang M, Geara F, Moran MS, Belkacemi Y. Comparison of Nodal Target Volume Definition in Breast Cancer Radiation Therapy According to RTOG Versus ESTRO Atlases: A Practical Review From the TransAtlantic Radiation Oncology Network (TRONE). Int J Radiat Oncol Biol Phys 2020; 107:437-448. [PMID: 32334035 DOI: 10.1016/j.ijrobp.2020.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/05/2023]
Abstract
Regional nodal irradiation has gained interest in recent years with the publication of several important randomized trials and the availability of more conformal techniques. Target volume delineation represents a critical step in the radiation planning process. Adequate coverage of the microscopic tumor spread to regional lymph nodes must be weighed against exposure of critical structures such as the heart and lungs. Among available guidelines for delineating the clinical target volume for the breast/chest wall and regional nodes, the Radiation Therapy Oncology Group and European Society for Radiotherapy and Oncology guidelines are the most widely used internationally. These guidelines have been formulated based on anatomic boundaries of areas historically covered in 2-dimensional field-based radiation therapy but have not been validated by patterns-of-failure studies. In recent years, an important body of data has emerged from mapping studies documenting patterns of local and regional recurrence. We aim to review, discuss, and compare contouring guidelines for breast cancer radiation therapy in the context of contemporary data on locoregional relapse to improve their implementation in modern practice.
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Affiliation(s)
- Gokoulakrichenane Loganadane
- Henri Mondor Breast Center and Department of Radiation Oncology, APHP; University of Paris-Est Creteil (UPEC) and INSERM Unit 955 - Team 21. Creteil, France
| | - Pauline T Truong
- Department of Radiation Oncology, British Columbia Cancer Agency and University of British Columbia, Vancouver, Canada
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dušanka Tešanović
- Medical Faculty of University of Novi Sad, Novi Sad and Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Mawei Jiang
- University Hospital of Xinhua and Jiao Tong University, Shanghai, China
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Meena S Moran
- Department of Radiation Oncology, Yale University School of Medicine, Smilow Cancer Center, New Haven, Connecticut
| | - Yazid Belkacemi
- Henri Mondor Breast Center and Department of Radiation Oncology, APHP; University of Paris-Est Creteil (UPEC) and INSERM Unit 955 - Team 21. Creteil, France.
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22
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Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Krishnamurthy J, Lyons J, Marcom PK, Matro J, Mayer IA, Moran MS, Mortimer J, O'Regan RM, Patel SA, Pierce LJ, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Young JS, Burns JL, Kumar R. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:452-478. [DOI: 10.6004/jnccn.2020.0016] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Several new systemic therapy options have become available for patients with metastatic breast cancer, which have led to improvements in survival. In addition to patient and clinical factors, the treatment selection primarily depends on the tumor biology (hormone-receptor status and HER2-status). The NCCN Guidelines specific to the workup and treatment of patients with recurrent/stage IV breast cancer are discussed in this article.
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Affiliation(s)
| | | | - Jame Abraham
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Chau Dang
- 9Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | - Janice Lyons
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Jennifer Matro
- 17Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Hope S. Rugo
- 23UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Karen Lisa Smith
- 24The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - John H. Ward
- 28Huntsman Cancer Institute at the University of Utah
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23
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Abstract
While there is now Level I data with long-term follow-up supporting the routine use of hypofractionated (HF) whole-breast radiation therapy (WBRT) after breast-conserving surgery, its adoption has been slow and variable. This article will review the literature supporting the efficacy and safety of hypofractionated radiation for breast cancer, discuss the radiobiological rationale specific to breast tumors, and make an argument for justifying the routine adoption of shorter, HF-WBRT courses when delivering breast radiation. Data using HF with regional nodal irradiation and in the post-mastectomy setting will also be reviewed. The aim is to provide an in-depth understanding of the use of hypofractionated radiation therapy for breast cancer, its applicability, and topics warranting future research.
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Affiliation(s)
- Meena S Moran
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Pauline T Truong
- Department of Radiation Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
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Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, McCormick B, Moran MS, O'Regan RM, Patel SA, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Sitapati A, Smith KL, Smith ML, Soliman H, Somlo G, Telli ML, Ward JH, Kumar R, Shead DA. Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019. [PMID: 29523670 DOI: 10.6004/jnccn.2018.0012] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
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MESH Headings
- Breast Neoplasms/diagnosis
- Breast Neoplasms/etiology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Combined Modality Therapy
- Disease Management
- Female
- Humans
- Retreatment
- Treatment Outcome
- Watchful Waiting
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Loganadane G, Kassick M, Kann BH, Young MR, Knowlton CA, Evans SB, Higgins SA, Belkacemi Y, Potenziani M, Saltmarsh N, Wilson LD, Moran MS. Standard Tangential Radiation Fields Do Not Provide Incidental Coverage to the Internal Mammary Nodes. Pract Radiat Oncol 2019; 10:21-28. [PMID: 31394256 DOI: 10.1016/j.prro.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the incidental dose delivered to the internal mammary nodes (IMNs) in patients treated with tangential 3-dimensional conformal radiation therapy and to identify potential parameters that may affect the IMN mean dose. METHODS AND MATERIALS The study cohort consisted of 362 consecutively treated patients with breast cancer in our center between January 2015 and July 2017 who had received adjuvant whole-breast radiation therapy or postmastectomy radiation with or without a supraclavicular ± axillary field and without intentional inclusion of the IMN chain. The clinical target volume (CTV) for the IMNs was contoured per the Radiation Therapy Oncology Group 3509/3510 protocol and was then divided into 3 subregions: upper, mid, and lower thirds. The planning target volume for the IMNs was generated by adding 5 mm to the CTV. The primary endpoint was to assess the V40 (volume receiving 40 Gy) to the IMN planning target volume and its potential influencing parameters using a linear regression model. RESULTS The mean (±standard deviation) dose to the CTV IMN chain was 36% ± 28.7%. The Kruskal-Wallis test demonstrated significant differences in the median dose delivered to each level: upper third (7.2%), mid third (21.5%), and lower third (41.7%) (P < .001). The mean V40 IMN planning target volume was 14.2% (standard deviation, 18.7%). Presternal fat thickness (regression coefficient [RC] = -16.4; P < .001), postmastectomy radiation (RC = 24; P < .001), reconstruction after mastectomy (RC = -22.4; P < .001), and the addition of a supraclavicular field (RC = 8.8; P = .03) were all significantly associated with IMN mean dose. CONCLUSIONS For patients receiving standard breast/chest wall tangential radiation fields, the IMN chain is not incidentally covered with therapeutic doses in the vast majority of cases. Therefore, if regional nodal radiation is intended to include the IMNs, contouring and careful plan review are necessary to ensure adequate therapeutic coverage.
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Affiliation(s)
- Gokoulakrichenane Loganadane
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Department of Radiation Oncology, Assistance publique-Hôpitaux de Paris, University of Paris-Est Créteil and Henri Mondor Breast Center, Créteil Cedex, France
| | - Megan Kassick
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin H Kann
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Melissa R Young
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Susan A Higgins
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Yazid Belkacemi
- Department of Radiation Oncology, Assistance publique-Hôpitaux de Paris, University of Paris-Est Créteil and Henri Mondor Breast Center, Créteil Cedex, France
| | - Mary Potenziani
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas Saltmarsh
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
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Zhang N, Zhang J, Zhang H, Liu Y, Zhao W, Wang L, Chen B, Moran MS, Haffty BG, Yang Q. Individualized Prediction of Survival Benefit from Postmastectomy Radiotherapy for Patients with Breast Cancer with One to Three Positive Axillary Lymph Nodes. Oncologist 2019; 24:e1286-e1293. [PMID: 31315963 DOI: 10.1634/theoncologist.2019-0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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: 02/12/2019] [Accepted: 06/28/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE There still exist some arguments regarding the use of postmastectomy radiotherapy (PMRT) for patients with breast cancer carrying one to three positive axillary lymph nodes considering the heterogeneity of this cohort. Here, we developed a prognostic nomogram to estimate the probability of long-term outcome in patients receiving or not receiving PMRT in order to assist in making individually locoregional treatment decisions for this particular cohort. METHODS Altogether, 20,336 women, aged 18 to 80 years, diagnosed with breast cancer, and carrying one to three positive nodes were identified in the Surveillance, Epidemiology, and End Results (SEER) database. We applied multivariant Cox hazard model to determine the impact of covariates on disease-specific survival (DSS) and overall survival (OS). Then, the nomogram was built accordingly. Internal and external validations were performed to examine the accuracy of nomograms. RESULTS Age of diagnosis, tumor grade, size, estrogen and progesterone receptor status, and number of positive nodes were independent factors of DSS and OS in the multivariate analysis. Incorporating these factors into the constructed nomogram showed high accuracy when predicting 5- and 10-year survival, with internally and externally bootstrap-corrected concordance indexes in the range of 0.6 to 0.8. CONCLUSION Besides the number of involved nodes, extra variables existed as predictors of survival outcomes in this cohort; therefore, the recommendation of PMRT or no PMRT requires comprehensive consideration. This clinically validated nomogram provided a useful tool that could aid decision making by estimating DSS and OS benefits from PMRT, useful in predicting 5- and 10-year DSS and OS for patients with one to three positive nodes after mastectomy. IMPLICATIONS FOR PRACTICE This study evaluated population-based data to identify prognostic factors associated with patients with breast cancer with one to three lymph nodes and help clinicians to weigh the benefit of postmastectomy radiotherapy (PMRT). Surveillance, Epidemiology, and End Results (SEER) data were used to develop a prognostic nomogram to predict the likelihood of long-term survival with and without PMRT in order to optimize the individual locoregional control strategy for this particular cohort. This clinically validated nomogram provides a useful tool to predict 5- and 10-year disease-specific survival and overall survival for patients with one to three positive nodes and can aid tailored clinical decision making by estimating predicted benefit from PMRT.
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Affiliation(s)
- Ning Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Jiashu Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Hanwen Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Ying Liu
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wenjing Zhao
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Lijuan Wang
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Bing Chen
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, New Jersey, USA
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
- Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong Province, People's Republic of China
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Rahimy E, Weidhaas J, Wei W, Lannin D, Horowitz N, Higgins S, Wilson LD, Knowlton C, Moran MS, Young MR, Killelea B, Chagpar A, Yeboa DN, Zelterman D, Evans S. Patient-Reported Outcomes and Cosmesis in a Feasibility Study of 4-Dimensional Simulated Image Guided Accelerated Partial Breast Irradiation. Pract Radiat Oncol 2019; 9:e257-e265. [DOI: 10.1016/j.prro.2019.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 02/05/2023]
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Chowdhary M, Lee A, Gao S, Barry PN, Diaz R, Decker RH, Wilson LD, Evans SB, Moran MS, Knowlton CA, Patel KR. Abstract P3-12-19: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-19] [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
This abstract was withdrawn by the authors.
Citation Format: Chowdhary M, Lee A, Gao S, Barry PN, Diaz R, Decker RH, Wilson LD, Evans SB, Moran MS, Knowlton CA, Patel KR. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-19.
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Affiliation(s)
- M Chowdhary
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - A Lee
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - S Gao
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - PN Barry
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - R Diaz
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - RH Decker
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - LD Wilson
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - SB Evans
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - MS Moran
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - CA Knowlton
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
| | - KR Patel
- Rush University Medical Center, Chicago, IL; SUNY Downstate Medical Center, Brooklyn, NY; Yale School of Medicine, New Haven, CT; Moffitt Cancer Center, Tampa, FL
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Chowdhary M, Lee A, Gao S, Wang D, Barry PN, Diaz R, Bagadiya NR, Park HS, Yu JB, Wilson LD, Moran MS, Higgins SA, Knowlton CA, Patel KR. Is Proton Therapy a "Pro" for Breast Cancer? A Comparison of Proton vs. Non-proton Radiotherapy Using the National Cancer Database. Front Oncol 2019; 8:678. [PMID: 30693271 PMCID: PMC6339938 DOI: 10.3389/fonc.2018.00678] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/29/2018] [Accepted: 12/21/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Limited data exists demonstrating the clinical benefit of proton radiotherapy (PRT) in breast cancer. Using the National Cancer Database, we evaluated predictors associated with PRT use for patients with breast cancer. An exploratory analysis also investigates the impact of PRT on overall survival (OS). Methods: Patients with non-metastatic breast cancer treated with adjuvant radiotherapy from 2004 to 2014 were identified. Patients were stratified based on receipt of PRT or non-PRT (i.e., photons ± electrons). A logistic regression model was used to determine predictors for PRT utilization. For OS, Multivariable analysis (MVA) was performed using Cox proportional hazard model. Results: A total of 724,492 patients were identified: 871 received PRT and 723,621 received non-PRT. 58.3% of the PRT patients were group stage 0–1. Median follow-up time was 62.2 months. On multivariate logistic analysis, the following factors were found to be significant for receipt of PRT (all p < 0.05): academic facility (odds ratio [OR] = 2.50), South (OR = 2.01) and West location (OR = 12.43), left-sided (OR = 1.21), ER-positive (OR = 1.59), and mastectomy (OR = 1.47); pT2-T4 disease predicted for decrease use (OR = 0.79). PRT was not associated with OS on MVA for all patients: Hazard Ratio: 0.85, p = 0.168. PRT remained not significant on MVA after stratifying for subsets likely associated with higher heart radiation doses, including: left-sided (p = 0.140), inner-quadrant (p = 0.173), mastectomy (p = 0.095), node positivity (p = 0.680), N2-N3 disease (p = 0.880), and lymph node irradiation (LNI) (p = 0.767). Conclusions: Receipt of PRT was associated with left-sided, ER+ tumors, mastectomy, South and West location, and academic facilities, but not higher group stages or LNI. PRT was not associated with OS, including in subsets likely at risk for higher heart doses. Further studies are required to determine non-OS benefits of PRT. In the interim, given the high cost of protons, only well-selected patients should receive PRT unless enrolled on a clinical trial.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Sarah Gao
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Parul N Barry
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Roberto Diaz
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Neeti R Bagadiya
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Henry S Park
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - James B Yu
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Susan A Higgins
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale University School of Medicine, New Haven, CT, United States
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Bleicher RJ, Chang C, Wang CE, Goldstein LJ, Kaufmann CS, Moran MS, Pollitt KA, Suss NR, Winchester DP, Tafra L, Yao K. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 2018; 173:603-617. [DOI: 10.1007/s10549-018-5046-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
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DeSnyder SM, Hunt KK, Dong W, Smith BD, Moran MS, Chavez-MacGregor M, Shen Y, Kuerer HM, Lucci A. American Society of Breast Surgeons' Practice Patterns After Publication of the SSO-ASTRO-ASCO DCIS Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation. Ann Surg Oncol 2018; 25:2965-2974. [PMID: 29987598 DOI: 10.1245/s10434-018-6580-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The SSO-ASTRO-ASCO consensus guideline on margins for breast-conserving surgery with whole breast irradiation in ductal carcinoma in situ (DCIS) recommended a 2-mm margin. We sought to determine the impact of guideline publication on clinician practice. METHODS A total of 3081 members of the American Society of Breast Surgeons (ASBrS) received a survey. Respondents' clinical practice type and duration, guideline familiarity, and margin width preferences before and after publication were assessed. Clinical practice pattern differences before and after publication were investigated using McNemar's test. RESULTS A total of 767 (24.9%) of those surveyed responded. Most (92.4%) indicated guideline familiarity. Of those familiar, re-excision preference for DCIS and a positive margin remained the same before (94.4%) and after (94.3%) publication (McNemar's test p = 1.0). Following publication, surgeons were more likely to avoid re-excision to achieve margins wider than 2-mm (82.3% pre versus 87.5% post, p = 0.002). More surgeons performed re-excision for a close margin with pure DCIS (25.9% pre versus 36.5% post, p < 0.001) and with DCIS with microinvasion (DCIS-M) (40.7% pre versus 52.3% post, p < 0.001). For patients with invasive disease with extensive intraductal component (EIC) and a close margin, preference to avoid re-excision was similar (51.2% per versus 55.2% post, p = 0.071). CONCLUSION Since guideline publication, surgeons are less likely to perform re-excision to obtain a margin greater than 2-mm and more likely to perform re-excision to obtain a 2-mm margin for both pure DCIS and DCIS-M. Preference to avoid re-excision with a close margin and EIC was similar before and after publication.
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Affiliation(s)
- Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Meena S Moran
- Department of Radiation Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Mariana Chavez-MacGregor
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zhang N, Zhang H, Liu Y, Su P, Zhang J, Wang X, Sun M, Chen B, Zhao W, Wang L, Wang H, Moran MS, Haffty BG, Yang Q. SREBP1, targeted by miR-18a-5p, modulates epithelial-mesenchymal transition in breast cancer via forming a co-repressor complex with Snail and HDAC1/2. Cell Death Differ 2018; 26:843-859. [PMID: 29988076 DOI: 10.1038/s41418-018-0158-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 12/27/2022] Open
Abstract
The progression of localized breast cancer to distant metastasis results in a poor prognosis and a high mortality rate. In this study, the contributions of miRNAs to tumor progression and the regulatory mechanisms leading to their expression alterations were investigated. Using highly lung-metastatic sub-lines from parental breast cancer cells, miRNA expression profiling revealed that the miR-17-92 cluster is significantly downregulated and the miR-18a-5p is the most evidently decreased. Ectopic expression and inhibition of miR-18a-5p demonstrated its capacity in suppressing migration and invasion of breast cancer cells. Further research identified sterol regulatory element binding transcription protein 1 (SREBP1), the master transcription factor that controls lipid metabolism, as a candidate target of miR-18a-5p. SREBP1 is overexpressed and strongly associated with worse clinical outcomes in breast cancer. Functionally SREBP1 promotes growth and metastasis of breast cancer both in vitro and in vivo. To unravel the underlying mechanism of SREBP1-mediated metastasis, mRNA profiling and subsequent gene set enrichment analyses (GSEA) were performed and SREBP1 was demonstrated to be significantly associated with epithelial-mesenchymal transition (EMT). Furthermore, SREBP1-mediated repression of E-cadherin was found to be deacetylation dependent and was augmented by recruiting Snail/HDAC1/2 repressor complex. In the light of these data, we propose that reduced expression of miR-18a-5p and concomitant overexpression of SREBP1 lead to induction of EMT states that in turn, promote breast cancer progression and metastasis. Taken together, our study reveals the crucial role of miR-18a-5p and SREBP1 in the EMT and metastasis, thus providing promising drug targets for tailored therapy in the advanced breast cancer setting.
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Affiliation(s)
- Ning Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Hanwen Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ying Liu
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Jiashu Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Xiaolong Wang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Mingjuan Sun
- Shandong Cancer Hospital affiliated to Shandong University, Ji'nan, Shandong, China
| | - Bing Chen
- Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Wenjing Zhao
- Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Lijuan Wang
- Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Huiyun Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China. .,Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China.
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Moran MS, Truong PT. Radiation, then On to Surgery. Int J Radiat Oncol Biol Phys 2018; 101:265. [PMID: 29726354 DOI: 10.1016/j.ijrobp.2018.02.156] [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] [Received: 12/13/2017] [Accepted: 02/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Pauline T Truong
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Abstract
Significant technologic advances in radiation treatment delivery now allow for more personalized delivery considerations which incorporate individual patient characteristics (such as tumor location and patient anatomy) and more precise delivery in the breast conservation or post-mastectomy setting. The combined advancements with other treatment modalities (i.e., systemic therapy, surgical management) have had direct effects on local-regional management and outcomes such that currently, local-regional relapses after definitive treatment for localized disease are now rarely experienced. Recent advances in the radiation therapy field have come from careful patient selection for a variety of three-dimensional treatment delivery techniques and alternatives to conventional tangential radiation. These advances have been demonstrated to diminished acute/long-term toxicity, minimized dose to surrounding normal tissue structures such as the heart and lung, and ultimately result in an improvement in the therapeutic ratio for radiation treatment. This chapter discusses recent radiation innovations and appropriate patient selection for their application, for a more personalized approach to radiation therapy for breast cancer patients.
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Affiliation(s)
- Meena S Moran
- Therapeutic Radiology, Yale Radiation Therapy Program, Yale University School of Medicine, New Haven, USA.
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Moran MS, Dear RF. Letter to the Editor: Defining "Standard of Care". J Natl Compr Canc Netw 2017; 15:1295-1296. [PMID: 29118221 DOI: 10.6004/jnccn.2017.0172] [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: 11/17/2022]
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Chagpar AB, Horowitz N, Sanft T, Wilson LD, Silber A, Killelea B, Moran MS, DiGiovanna MP, Hofstatter E, Chung G, Pusztai L, Lannin DR. Does lymph node status influence adjuvant therapy decision-making in women 70 years of age or older with clinically node negative hormone receptor positive breast cancer? Am J Surg 2017; 214:1082-1088. [PMID: 28939252 DOI: 10.1016/j.amjsurg.2017.07.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/10/2017] [Revised: 05/03/2017] [Accepted: 07/07/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Women ≥70 years old with clinically (c) lymph node (LN) negative (-), hormone receptor (HR) positive (+) breast cancer are recommended not to be routinely staged with a sentinel LN biopsy. We sought to determine how this affects adjuvant decision-making. METHODS Statistical analyses were performed to determine the association of LN evaluation with adjuvant chemotherapy and radiation therapy in cLN-, HR + breast cancer patients in the National Cancer Database. RESULTS Between 2004 and 2013, there were 193,728 patients aged 70-90 with cLN-, HR + breast cancer; 15.0% were LN+. LN + patients were more likely to receive chemotherapy (28.3% vs. 5.5%, p < 0.001), hormonal therapy (83.6% vs. 71.4%, p < 0.001), post-lumpectomy radiation therapy (81.4% vs. 73.6%, p < 0.001) and post-mastectomy radiation therapy (30.3% vs. 5.1%, p < 0.001). CONCLUSION 15% of patients aged 70-90 will be LN+. These patients more frequently receive systemic and radiation therapy. LN status may affect treatment in these patients.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Nina Horowitz
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tara Sanft
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Silber
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Brigid Killelea
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael P DiGiovanna
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Erin Hofstatter
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Gina Chung
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Lajos Pusztai
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA
| | - Donald R Lannin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Moran MS, Zhao Y, Ma S, Kirova Y, Fourquet A, Chen P, Hoffman K, Hunt K, Wong J, Halasz LM, Freedman G, Prosnitz R, Yassa M, Nguyen DHA, Hijal T, Haffty BG, Wai ES, Truong PT. Association of Radiotherapy Boost for Ductal Carcinoma In Situ With Local Control After Whole-Breast Radiotherapy. JAMA Oncol 2017; 3:1060-1068. [PMID: 28358936 DOI: 10.1001/jamaoncol.2016.6948] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance The use of a radiotherapy (RT) boost to the tumor bed after whole-breast RT (WBRT) for ductal carcinoma in situ (DCIS) is largely extrapolated from invasive cancer data, but robust evidence specific to DCIS is lacking. Objective To compare ipsilateral breast tumor recurrence (IBTR) in women with DCIS treated with vs without the RT boost after breast-conserving surgery and WBRT. Design, Setting, and Participants This retrospective analysis pooled deidentified patient-level data from 10 academic institutions in the United States, Canada, and France from January 1, 1980, through December 31, 2010. All patients had newly diagnosed pure DCIS (no microinvasion), underwent breast-conserving surgery, and received WBRT with or without the boost with a minimum of 5 years of follow-up required for inclusion in the analysis. Given the limited events after WBRT, an a priori power analysis was conducted to estimate the DCIS sample size needed to detect the anticipated benefit of the boost. Data were uniformly recoded at the host institution and underwent primary and secondary reviews before analysis. Sample size calculations (ratio of patients who received the boost dose to those who did not, 2:1; α = .05; power = 80%) estimated that 2982 cases were needed to detect a difference of at least 3%. The final analysis included 4131 patients (2661 in the boost group and 1470 in the no-boost group) with a median follow-up of 9 years and media boost dose of 14 Gy. Data were collected from July 2011 through February 2014 and analyzed from March 2014 through August 2015. Interventions Radiotherapy boost vs no boost. Main Outcomes and Measures Ipsilateral breast tumor recurrence. Results The analysis included 4131 patients (median [SD] age, 56.1 [10.9] years; range, 24-88 years). Patients with positive margins, unknown estrogen receptor status, and comedo necrosis were more likely to have received an RT boost. For the entire cohort, the boost was significantly associated with lower IBTR (hazard ratio [HR], 0.73; 95% CI, 0.57-0.94; P = .01) and with IBTR-free survival (boost vs no-boost groups) of 97.1% (95% CI, 0.96-0.98) vs 96.3% (95% CI, 0.95-0.97) at 5 years, 94.1% (95% CI, 0.93-0.95) vs 92.5% (95% CI, 0.91-0.94) at 10 years, and 91.6% (95% CI, 0.90-0.93) vs 88.0% (95% CI, 0.85-0.91) at 15 years. On multivariable analysis accounting for confounding factors, the boost remained significantly associated with reduced IBTR (HR compared with no boost, 0.68; 95% CI, 0.50-0.91; P = .01) independent of age and tamoxifen citrate use. Conclusions and Relevance This patient-level analysis suggests that the RT boost confers a statistically significant benefit in decreasing IBTR across all DCIS age groups, similar to that seen in patients with invasive breast cancer. These findings suggest that a DCIS RT boost to the tumor bed could be considered to provide an added incremental benefit in decreasing IBTR after a shared discussion between the patient and her radiation oncologist.
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Affiliation(s)
- Meena S Moran
- Smilow Cancer Center, Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Yinjun Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Youlia Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Alain Fourquet
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Peter Chen
- Department of Radiation Therapy, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Karen Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kelly Hunt
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Julia Wong
- Department of Radiation Oncology, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Lia M Halasz
- Department of Radiation Oncology, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gary Freedman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Robert Prosnitz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Michael Yassa
- Department of Radiation Oncology, University of Montreal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - David H A Nguyen
- Department of Radiation Oncology, University of Montreal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruce G Haffty
- Department of Radiation Therapy, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elaine S Wai
- Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Pauline T Truong
- Department of Radiation Oncology, British Columbia Cancer Agency, Victoria, British Columbia, Canada
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Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, McCormick B, Moran MS, O'Regan RM, Patel SA, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Sitapati A, Smith KL, Smith ML, Soliman H, Somlo G, Telli M, Ward JH, Shead DA, Kumar R. NCCN Guidelines Insights: Breast Cancer, Version 1.2017. J Natl Compr Canc Netw 2017; 15:433-451. [PMID: 28404755 DOI: 10.6004/jnccn.2017.0044] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.
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Affiliation(s)
| | | | | | | | | | - Amy Cyr
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - William B Farrar
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Andres Forero
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | | | | | - Lee S Schwartzberg
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - John H Ward
- Huntsman Cancer Institute at the University of Utah
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Abstract
Nearly all women who receive radiotherapy (RT) for breast cancer experience some degree of radiation dermatitis. However, evidence describing the appropriate management of radiation dermatitis is often lacking or contradictory. Here, we summarize the available literature regarding radiation dermatitis causes, the presentation and timing of symptoms, methods for dermatitis assessment and prevention, and review evidence-based management strategies.
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Affiliation(s)
| | - Lauren Kole
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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Belkacemi Y, Truong PT, Khan AJ, Geara F, Taghian AG, Moran MS. Adjuvant nodal radiotherapy in the era of sentinel node biopsy staging of breast cancer: A review of published guidelines and prospective trials and their implications on clinical practice. Crit Rev Oncol Hematol 2017; 112:171-178. [PMID: 28325257 DOI: 10.1016/j.critrevonc.2017.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/16/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yazid Belkacemi
- APHP; Henri Mondor Breast Center and Department of Radiation Oncology, INSERM U955 Eq 07, University Paris-Est Creteil (UPEC), France.
| | - Pauline T Truong
- British Columbia Cancer Agency, Department of Radiation Oncology and University of British Columbia, BC, Canada
| | - Atif J Khan
- Rutgers Cancer Institute of New Jersey. Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Fady Geara
- American University of Beirut, Department of Radiation Oncology, Beirut, Lebanon, Lebanon
| | - Alphonse G Taghian
- Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Meena S Moran
- Yale University School of Medicine, Smilow Cancer Center, Department of Radiation Oncology, New Haven, CT, USA
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Affiliation(s)
- Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Shuangge Ma
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
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Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, Horton J, Hwang S, Johnson PL, Marinovich ML, Schnitt SJ, Wapnir I, Moran MS. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol 2016; 34:4040-4046. [PMID: 27528719 PMCID: PMC5477830 DOI: 10.1200/jco.2016.68.3573] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). Methods A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. Results Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2 mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2 mm margins. Negative margins less than 2 mm alone are not an indication for mastectomy, and factors known to impact rates of IBTR should be considered in determining the need for re-excision. Conclusion The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.
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Affiliation(s)
- Monica Morrow
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Kimberly J Van Zee
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Lawrence J Solin
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Mariana Chavez-MacGregor
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Jay R Harris
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Janet Horton
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Shelley Hwang
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Peggy L Johnson
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - M Luke Marinovich
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Stuart J Schnitt
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Irene Wapnir
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Meena S Moran
- Monica Morrow and Kimberly J. Van Zee, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY; Lawrence J. Solin, Albert Einstein Healthcare Network, Philadelphia, PA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Jay R. Harris and Stuart J. Schnitt, Harvard Medical School, Boston, MA; Janet Horton and Shelley Hwang, Duke University Medical Center, Durham, NC; Peggy L. Johnson, Advocate in Science, Susan G. Komen, Kansas City, KS; Irene Wapnir, Stanford University School of Medicine, Stanford, CA; Meena S. Moran, Yale School of Medicine, Yale University, New Haven, CT; and Nehmat Houssami and M. Luke Marinovich, Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
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Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, Horton J, Hwang S, Johnson PL, Marinovich ML, Schnitt SJ, Wapnir I, Moran MS. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol 2016; 23:3801-3810. [PMID: 27527714 PMCID: PMC5047939 DOI: 10.1245/s10434-016-5449-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Indexed: 11/30/2022]
Abstract
Purpose Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation. Methods A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7,883 patients and other published literature as the evidence base for consensus. Results Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision. Conclusion Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Nehmat Houssami
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Mariana Chavez-MacGregor
- Departments of Medical Oncology and Health Service Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay R Harris
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Janet Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - M Luke Marinovich
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Stuart J Schnitt
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Irene Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
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Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, Horton J, Hwang S, Johnson PL, Marinovich ML, Schnitt SJ, Wapnir I, Moran MS. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ. Pract Radiat Oncol 2016; 6:287-295. [PMID: 27538810 DOI: 10.1016/j.prro.2016.06.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/11/2016] [Accepted: 06/21/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation. METHODS AND MATERIALS A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. RESULTS Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision. CONCLUSION Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA
| | - Nehmat Houssami
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney NSW 2006, Australia
| | - Mariana Chavez-MacGregor
- Departments of Medical Oncology and Health Service Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay R Harris
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - Janet Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - M Luke Marinovich
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney NSW 2006, Australia
| | | | - Irene Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT
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Moran MS. WITHDRAWN: La Danse d'un Cygne (The Dance of a Swan). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2451] [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: 11/17/2022]
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Abstract
The more aggressive biologic characteristics and the current lack of targeted therapy for triple-negative breast cancer (TNBC) make local-regional management decisions challenging for physicians. TNBC is associated with patients of younger age, black race and BRCA1 mutation carriers. Distinctions between BRCA1-associated and sporadic TNBC include increased lifetime risk of ipsilateral and contralateral breast cancer after breast cancer therapy (BCT) for BRCA carriers, which is not shared by sporadic TNBC. However, the presence of a BRCA mutation should not preclude a breast-conservation approach in patients who are otherwise appropriate candidates for BCT. Data suggest that local-regional relapse (LRR) at baseline after BCT appears to be comparable for TNBC and the HER2-positive subgroups, but is about 50% greater than luminal tumors. LRR appears to be similarly increased after mastectomy; thus, TNBC should not be a contra-indication for BCT. Recent hypothesis-generating data suggest less LRR after BCT (where radiation is routinely delivered) than with mastectomy for early-stage TNBC. To date, no specific local-regional guideline recommendations for TNBC exist. Level I outcome data for TNBC using accelerated partial breast irradiation (APBI) and hypofractionated whole-breast irradiation (hWBRT) are lacking. TNBC should be treated with APBI only on clinical trials. Although hWBRT may be considered in TNBC, its association with younger age, advanced disease and use of systemic chemotherapy often precludes its use for this subtype. Until definitive treatment strategies are validated in large datasets and confirmed in randomized trials, TNBC subtype, in and of itself, should not direct local-regional management treatment decisions.
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Affiliation(s)
- Meena S Moran
- From the Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Jhaveri K, Teplinsky E, Silvera D, Valeta-Magara A, Arju R, Giashuddin S, Sarfraz Y, Alexander M, Darvishian F, Levine PH, Hashmi S, Zolfaghari L, Hoffman HJ, Singh B, Goldberg JD, Hochman T, Formenti S, Esteva FJ, Moran MS, Schneider RJ. Hyperactivated mTOR and JAK2/STAT3 Pathways: Molecular Drivers and Potential Therapeutic Targets of Inflammatory and Invasive Ductal Breast Cancers After Neoadjuvant Chemotherapy. Clin Breast Cancer 2015; 16:113-22.e1. [PMID: 26774497 DOI: 10.1016/j.clbc.2015.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 06/17/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Inflammatory breast cancer (IBC) is an aggressive and rare cancer with a poor prognosis and a need for novel targeted therapeutic strategies. Preclinical IBC data showed strong activation of the phosphatidylinositide-3-kinase/mammalian target of rapamycin (mTOR) and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways, and expression of inflammatory cytokines and tumor-associated macrophages (TAMs). PATIENTS AND METHODS Archival tumor tissue from 3 disease types (IBC treated with neoadjuvant chemotherapy [NAC], n = 45; invasive ductal carcinoma [IDC] treated with NAC [n = 24; 'treated IDC'; and untreated IDC [n = 27; 'untreated IDC']) was analyzed for the expression of biomarkers phospho-S6 (pS6) (mTOR), phospho-JAK2 (pJAK2), pSTAT3, interleukin (IL)-6, CD68 (monocytes, macrophages), and CD163 (TAMs). Surrounding nontumor tissue was also analyzed. RESULTS Biomarker levels and surrogate activity according to site-specific phosphorylation were shown in the tumor tissue of all 3 disease types but were greatest in IBC and treated IDC and least in untreated IDC for pS6, pJAK2, pSTAT3, and IL-6. Of 37 IBC patients with complete biomarker data available, 100% were pS6-positive and 95% were pJAK2-positive. In nontumor tissue, biomarker levels were observed in all groups but were generally greatest in untreated IDC and least in IBC, except for JAK2. CONCLUSION IBC and treated IDC display similar levels of mTOR and JAK2 biomarker activation, which suggests a potential mechanism of resistance after NAC. Biomarker levels in surrounding nontumor tissue suggested that the stroma might be activated by chemotherapy and resembles the oncogenic tumor-promoting environment. Activation of pS6 and pJAK2 in IBC might support dual targeting of the mTOR and JAK/STAT pathways, and the need for prospective studies to investigate combined targeted therapies in IBC.
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Affiliation(s)
- Komal Jhaveri
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY.
| | - Eleonora Teplinsky
- Division of Hematology & Medical Oncology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Deborah Silvera
- Department of Microbiology, New York University School of Medicine, New York, NY
| | - Amanda Valeta-Magara
- Department of Microbiology, New York University School of Medicine, New York, NY
| | - Rezina Arju
- Department of Microbiology, New York University School of Medicine, New York, NY
| | - Shah Giashuddin
- Department of Pathology, The Brooklyn Hospital Center, Brooklyn, NY
| | - Yasmeen Sarfraz
- Department of Microbiology, New York University School of Medicine, New York, NY
| | | | | | - Paul H Levine
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC
| | - Salman Hashmi
- Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Ladan Zolfaghari
- Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Heather J Hoffman
- Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Baljit Singh
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC
| | - Judith D Goldberg
- Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Tsivia Hochman
- Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY
| | - Francisco J Esteva
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY
| | - Meena S Moran
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Robert J Schneider
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY; Department of Microbiology, New York University School of Medicine, New York, NY
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DeSnyder SM, Hunt KK, Smith BD, Moran MS, Klimberg S, Lucci A. Assessment of Practice Patterns Following Publication of the SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer. Ann Surg Oncol 2015. [PMID: 26202554 DOI: 10.1245/s10434-015-4666-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The recently published SSO-ASTRO consensus guideline on margins concluded "no ink on tumor" is the standard for an adequate margin. This study was conducted to determine how this guideline is aligned with current clinical practice. METHODS A survey was sent to 3057 members of the American Society of Breast Surgeons. Questions assessed respondents' clinical practice type and duration, familiarity with the guideline, and preferences for margin re-excision. RESULTS Of those surveyed, 777 (25%) responded. Most (92%) indicated familiarity with the guideline. Of these respondents, the majority (n = 678, or 94.7%) would re-excise all or most of the time when tumor extended to the inked margin. Very few (n = 9, or 1.3%) would re-excise all or most of the time when tumor was within 2 mm of the margin. Over 12 % (n = 90) would re-excise all or most of the time for a triple-negative tumor within 1 mm of the margin, whereas 353 (49.6%) would re-excise all or most of the time when imaging and pathology were discordant, and tumor was within 1 mm of multiple margins. Finally, 330 (45.8%) would re-excise all or most of the time when multiple foci of ductal carcinoma in situ extended to within 1 mm of multiple inked margins. CONCLUSIONS Surgeons are in agreement to re-excise margins when tumor touches ink and generally not to perform re-excisions when tumor is close to (but not touching) the inked margin. For more complex scenarios, surgeons are utilizing their individual clinical judgment to determine the need for re-excision.
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Affiliation(s)
- Sarah M DeSnyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wobb JL, Chen PY, Shah C, Moran MS, Shaitelman SF, Vicini FA, Mbah AK, Lyden M, Beitsch P. Nomogram for Predicting the Risk of Locoregional Recurrence in Patients Treated With Accelerated Partial-Breast Irradiation. Int J Radiat Oncol Biol Phys 2015; 91:312-8. [DOI: 10.1016/j.ijrobp.2014.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/04/2014] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
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Truong PT, Smith SL, Moran MS. Perspectives in breast cancer treatment: APBI and breast-conserving surgery. In reply to Morgan and Vaidya. Int J Radiat Oncol Biol Phys 2014; 90:967-8. [PMID: 25585789 DOI: 10.1016/j.ijrobp.2014.07.047] [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] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Pauline T Truong
- British Columbia Cancer Agency, University of British Columbia, Victoria, British Columbia, Canada
| | - Sally L Smith
- British Columbia Cancer Agency, University of British Columbia, Victoria, British Columbia, Canada
| | - Meena S Moran
- Yale University School of Medicine, New Haven, Connecticut
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