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Alamoodi M. Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis? Eur J Breast Health 2024; 20:81-88. [PMID: 38571693 PMCID: PMC10985578 DOI: 10.4274/ejbh.galenos.2024.2023-12-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 04/05/2024]
Abstract
The advent of taxane-based chemotherapy has revolutionized breast cancer care. This advance has helped improve the response to downstaging tumors that might otherwise be inoperable. It has also helped in rendering clinically (cN+) positive lymph nodes (LNs) pathologically negative (ypN0). The standard of care for cN+ patients included post-mastectomy radiotherapy (PMRT), regardless of the response to neoadjuvant chemotherapy. However, PMRT in patients with 1-3 positive LNs still lacks definitive guidelines. Numerous retrospective results have been inconclusive about the benefit of PMRT on survival in patients with 1-3 positive LNs. This pooled analysis attempts to reach a consensus. The PubMed database was searched through October 2023. The search yielded 27 papers, of which 11 satisfied the inclusion criteria. The locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) for each study were tabulated when given, and two groups were created, the PMRT and NO PMRT, respectively. The results were then pooled for analysis. The total number of patients was 8340, 4136 in the PMRT group, and 4204 in the NO PMRT group, respectively. The LRRFS, DFS, and OS were 96.9%, 82.1%, and 87.3% for the PMRT group and 93.2%, 79.6%, and 84.8% for the NO PMRT group, respectively. There was no statistical significance in LRRFS, DFS, or OS between the two groups (p = 0.61, p = 0.61, and p = 0.38, respectively). PMRT does not seem to confer survival benefits in patients with pN1 rendered ypN0 for stages T1-3. This pooled analysis's findings should be confirmed prospectively with a longer period of follow-up.
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Affiliation(s)
- Munaser Alamoodi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Wazir U, Michell MJ, Alamoodi M, Mokbel K. Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis. Cancers (Basel) 2024; 16:1345. [PMID: 38611023 PMCID: PMC11011109 DOI: 10.3390/cancers16071345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
SAVI SCOUT® or radar reflector localisation (RRL) has proven accurate in localising non-palpable breast and axillary lesions, with minimal interference with MRI. Targeted axillary dissection (TAD), combining marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), is becoming a standard post-neoadjuvant systemic therapy (NST) for node-positive early breast cancer. Compared to SLNB alone, TAD reduces the false negative rate (FNR) to below 6%, enabling safer axillary surgery de-escalation. This systematic review evaluates RRL's performance during TAD, assessing localisation and retrieval rates, the concordance between MLNB and SLNB, and the pathological complete response (pCR) in clinically node-positive patients post-NST. Four studies (252 TAD procedures) met the inclusion criteria, with a 99.6% (95% confidence [CI]: 98.9-100) successful localisation rate, 100% retrieval rate, and 81% (95% CI: 76-86) concordance rate between SLNB and MLNB. The average duration from RRL deployment to surgery was 52 days (range:1-202). pCR was observed in 42% (95% CI: 36-48) of cases, with no significant migration or complications reported. Omitting MLNB or SLNB would have under-staged the axilla in 9.7% or 3.4% (p = 0.03) of cases, respectively, underscoring the importance of incorporating MLNB in axillary staging post-NST in initially node-positive patients in line with the updated National Comprehensive Cancer Network (NCCN) guidelines. These findings underscore the excellent efficacy of RRL in TAD for NST-treated patients with positive nodes, aiding in accurate axillary pCR identification and the safe omission of axillary dissection in strong responders.
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Affiliation(s)
| | | | | | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK; (U.W.); (M.J.M.); (M.A.)
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Mokbel K, Alamoodi M. Reassessing treatment strategies for DCIS: analysis of survival and recurrence patterns. Breast Cancer Res Treat 2024:10.1007/s10549-024-07268-z. [PMID: 38361145 DOI: 10.1007/s10549-024-07268-z] [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: 11/18/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Kefah Mokbel
- Princess Grace Hospital, The London Breast Institute, London, W1U 5NY, UK
| | - Munaser Alamoodi
- Princess Grace Hospital, The London Breast Institute, London, W1U 5NY, UK.
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Alamoodi M, Patani N, Mokbel K, Wazir U, Mokbel K. Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from a Meta-Analysis including the SINODAR-ONE Trial. Cancers (Basel) 2024; 16:742. [PMID: 38398133 PMCID: PMC10886895 DOI: 10.3390/cancers16040742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Complete axillary lymph node dissection (cALND) was previously the standard of care for breast cancer (BC) patients with axillary node disease or macro-metastases found via sentinel lymph node biopsy (SLNB). However, due to significant morbidity, contemporary management now considers a more selective approach, influenced by studies like ACOSOG Z0011. This trial showed that cALND could be omitted without compromising local control or survival in patients with low axillary nodal disease burden undergoing breast-conserving therapy, radiotherapy, and systemic therapy. The relevance of this approach for women with low axillary nodal burden undergoing total mastectomy (TM) remained unclear. A PubMed search up to September 2023 identified 147 relevant studies, with 6 meeting the inclusion criteria, involving 4184 patients with BC and low-volume axillary disease (1-3 positive lymph nodes) undergoing TM. Postmastectomy radiotherapy receipt was similar in both groups. After a mean 7.2-year follow-up, both the pooled results and the meta-analysis revealed no significant differences in overall survival. The combined analysis of the published studies, including the subgroup analysis of the SINODAR-One trial, indicates no survival advantage for cALND over SLNB in T1-T2 breast cancer patients with 1-3 positive sentinel lymph nodes (pN1) undergoing mastectomy. This suggests that, following a multidisciplinary evaluation, cALND can be safely omitted. However, the impact of other patient, tumor, and treatment factors on survival requires consideration and therefore further prospective trials are needed for conclusive validation.
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Affiliation(s)
- Munaser Alamoodi
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (N.P.); (K.M.); (U.W.)
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Neill Patani
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (N.P.); (K.M.); (U.W.)
- Institute for Women’s Health, University College London, London WC1N 1DZ, UK
| | - Kinan Mokbel
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (N.P.); (K.M.); (U.W.)
- Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (N.P.); (K.M.); (U.W.)
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK; (M.A.); (N.P.); (K.M.); (U.W.)
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Mokbel K, Alamoodi M. "Enhancing survival outcomes through breast-conserving therapy in ipsilateral breast tumor recurrence: insights into metastasis and treatment strategies". Breast Cancer Res Treat 2024; 204:187. [PMID: 37999917 DOI: 10.1007/s10549-023-07180-y] [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: 10/05/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, W1U 5NY, UK
| | - Munaser Alamoodi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Alamoodi M. Factors Affecting Pathological Complete Response in Locally Advanced Breast Cancer Cases Receiving Neoadjuvant Therapy: A Comprehensive Literature Review. Eur J Breast Health 2024; 20:8-14. [PMID: 38187111 PMCID: PMC10765459 DOI: 10.4274/ejbh.galenos.2023.2023-11-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
Determining pathological complete response (pCR) could be an important step in planning individual treatment, hence improving the prognosis in terms of survival. Achieving breast pCR not only improves survival but is also linked to a disease-free axilla, therefore increasing the likelihood of avoiding axillary surgery safely. The current trend in de-escalating axillary management surgically or in applying radiotherapy to the axilla is dependent primarily on breast cancer (BC) patients achieving pCR. Studies have demonstrated that certain characteristics can predict pCR, even though it is still difficult to identify these elements. A review of the literature was carried out to determine these factors and their clinical applications. A search was carried out in the MEDLINE database using PubMed, Google Scholar, and EMBASE. This yielded 1368 studies, of which 60 satisfied the criteria. The studies were categorized according to the subject they dealt with. These parameters included age, race, subtypes, clinicopathological, immunological, imaging, obesity, Ki-67 status, vitamin D, and genetics. These factors, in combination, can be used for specific subtypes to individualize treatment and monitor response to therapy. The predictors of pCR are diverse and should be utilized to personalize patient treatment, ultimately inducing the best outcomes. These determinants can also be employed for monitoring responses to neoadjuvant therapy, thereby adjusting treatment. The development of standardized markers for the diversity of BC subtypes still needs additional future research. These factors must be applied in concert in order to provide optimal results.
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Affiliation(s)
- Munaser Alamoodi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Mokbel K, Alamoodi M. Redefining In-Breast Tumor Recurrence: Unveiling Metastatic Dynamics and Shifting the Focus to Overall Survival in Breast Cancer Surgery Assessment. J Breast Cancer 2023; 26:593-596. [PMID: 38156910 PMCID: PMC10761756 DOI: 10.4048/jbc.2023.26.e50] [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: 11/23/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Munaser Alamoodi
- The London Breast Institute, Princess Grace Hospital, London, UK
- King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia.
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Mokbel K, Alamoodi M. Exploring the interface zone in breast cancer: implications for surgical strategies and beyond. Breast Cancer Res 2023; 25:135. [PMID: 37924119 PMCID: PMC10625299 DOI: 10.1186/s13058-023-01734-0] [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: 10/15/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Kefah Mokbel
- Princess Grace Hospital, The London Breast Institute, London, W1U 5NY, UK.
| | - Munaser Alamoodi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Alamoodi M. Distal jejunal gallstone ileus-an unusual cause of bowel obstruction: a case report. J Surg Case Rep 2023; 2023:rjad557. [PMID: 37854522 PMCID: PMC10581695 DOI: 10.1093/jscr/rjad557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
Gallstone ileus is a rare entity that causes bowel obstruction by gaining access through a cysto-enteric fistula. This is a case report of a 70-year-old man presenting with small bowel obstruction secondary to distal jejunal gallstone ileus impaction. He is not known to have any predisposing factors. He was managed effectively with an enterolithotomy. Early diagnosis is key to a good prognosis. Although other management options are available, enterolithotomy with or without cholecystectomy remains the gold standard of management.
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Affiliation(s)
- Munaser Alamoodi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, 3239 Suliaman Abdullah Suliaman street, Jeddah 21589, Saudi Arabia
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Alamoodi M, Wazir U, Mokbel K, Patani N, Varghese J, Mokbel K. Omitting Sentinel Lymph Node Biopsy after Neoadjuvant Systemic Therapy for Clinically Node Negative HER2 Positive and Triple Negative Breast Cancer: A Pooled Analysis. Cancers (Basel) 2023; 15:3325. [PMID: 37444434 DOI: 10.3390/cancers15133325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Recent advances in systemic treatment for breast cancer have been underpinned by recognising and exploiting subtype-specific vulnerabilities to achieve higher rates of pathologic complete response (pCR) after neo-adjuvant systemic therapy (NAST). This down-staging of disease has permitted safe surgical de-escalation in patients who respond well. Triple-negative (TNBC) or HER2-positive breast cancer is most likely to achieve complete radiological response (rCR) and pCR after NAST. Hence, for selected patients, particularly those who are clinically node-negative (cN0) at diagnosis, the probability of disease in the sentinel node after NAST could be low enough to justify omitting axillary surgery. The aim of this pooled analysis was to determine the rate of sentinel node positivity (ypN+) in patients with TNBC or HER2-positive breast cancer who were initially cN0, achieving rCR and/or pCR in the breast after NAST. MedLine was searched using appropriate search terms. Five studies (N = 3834) were included in the pooled analysis, yielding a pooled ypN+ rate of 2.16% (95% CI: 1.70-2.63). This is significantly lower than the acceptable false negative rate of sentinel lymph node biopsy (SLNB) and supports consideration of omission of SLNB in this subset of patients.
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Affiliation(s)
- Munaser Alamoodi
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
| | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
- Department of Surgery, Khyber Teaching Hospital, Peshawar 25120, Pakistan
| | - Kinan Mokbel
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
- College of Medicine and Health, University of Exeter Medical School, Exeter EX1 2LU, UK
| | - Neill Patani
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
- Department of General Surgery, University College London Hospital, Euston Road, London NW1 2BU, UK
| | - Jajini Varghese
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
- Department of General Surgery, Royal Free Hospital, London NW3 2QG, UK
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK
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