1
|
Brunelle CL, Boyages J, Jung AW, Suami H, Juhel BC, Heydon-White A, Mackie H, Chou SHS, Paramanandam VS, Koelmeyer L, Taghian AG. Breast lymphedema following breast-conserving treatment for breast cancer: current status and future directions. Breast Cancer Res Treat 2024; 204:193-222. [PMID: 38100015 DOI: 10.1007/s10549-023-07161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE To examine the current evidence on breast lymphedema (BL) diagnosis and treatment after breast-conserving surgery, identify gaps in the literature, and propose future research directions. METHODS A comprehensive literature review was conducted using Ovid, PubMed, and Cochrane, including studies published between 2000 and 2023. References were reviewed manually for eligible studies. Inclusion criteria were as follows: patients who underwent breast conserving treatment (surgery ± radiation) for breast cancer, goals of the paper included analyzing or reviewing BL measurement with ultrasound or tissue dielectric constant, or BL treatment. Twenty-seven manuscripts were included in the review. RESULTS There is variation in incidence, time course, and risk factors for BL. Risk factors for BL included breast size, primary and axillary surgery extent, radiation, and chemotherapy but require further investigation. Diagnostic methods for BL currently rely on patient report and lack standardized criteria. Tissue dielectric constant (TDC) and ultrasound (US) emerged as promising ambulatory BL assessment tools; however, diagnostic thresholds and validation studies with ICG lymphography are needed to establish clinical utility. The evidence base for treatment of BL is weak, lacking high-quality studies. CONCLUSION The natural history of BL is not well defined. TDC and US show promise as ambulatory assessment tools for BL; however, further validation with lymphatic imaging is required. BL treatment is not established in the literature. Longitudinal, prospective studies including pre-radiation measurements and validating with lymphatic imaging are required. These data will inform screening, diagnostic criteria, and evidence-based treatment parameters for patients with BL after breast-conserving surgery and radiation.
Collapse
Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, 15 Parkman Ave, WACC 128, Boston, MA, 02114, USA.
| | - John Boyages
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Icon Cancer Centre, Wahroonga, NSW, Australia
- The ANU School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Amanda W Jung
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroo Suami
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brooke C Juhel
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Asha Heydon-White
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Helen Mackie
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Vincent S Paramanandam
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Louise Koelmeyer
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Pittman SM, Rosen EL, DeMartini WB, Nguyen DH, Poplack SP, Ikeda DM. The Postoperative Breast: Imaging Findings and Diagnostic Pitfalls After Breast-Conserving Surgery and Oncoplastic Breast Surgery. J Breast Imaging 2024; 6:203-216. [PMID: 38262628 DOI: 10.1093/jbi/wbad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Indexed: 01/25/2024]
Abstract
Breast surgery is the cornerstone of treatment for early breast cancer. Historically, mastectomy and conventional breast-conserving surgery (BCS) were the main surgical techniques for treatment. Now, oncoplastic breast surgery (OBS), introduced in the 1990s, allows for a combination of BCS and reconstructive surgery to excise the cancer while preserving or enhancing the contour of the breast, leading to improved aesthetic results. Although imaging after conventional lumpectomy demonstrates typical postsurgical changes with known evolution patterns over time, OBS procedures show postsurgical changes/fat necrosis in locations other than the lumpectomy site. The purpose of this article is to familiarize radiologists with various types of surgical techniques for removal of breast cancer and to distinguish benign postoperative imaging findings from suspicious findings that warrant further work-up.
Collapse
Affiliation(s)
- Sarah M Pittman
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric L Rosen
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy B DeMartini
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dung H Nguyen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven P Poplack
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Debra M Ikeda
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
3
|
Krug D, Vladimirova V, Untch M, Kühn T, Schneeweiss A, Denkert C, Ataseven B, Solbach C, Gerber B, Tesch H, Golatta M, Seiler S, Heil J, Nekljudova V, Holtschmidt J, Loibl S. Breast-conserving surgery is not associated with increased local recurrence in patients with early-stage node-negative triple-negative breast cancer treated with neoadjuvant chemotherapy. Breast 2024; 74:103701. [PMID: 38422624 PMCID: PMC10910157 DOI: 10.1016/j.breast.2024.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/10/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) is routinely used for patients with triple-negative breast cancer (TNBC). Upfront breast-conserving therapy (BCT) consisting of breast-conserving surgery (BCS) and adjuvant radiotherapy (RT) has been shown to be associated with improved outcome in patients with early TNBC as compared to mastectomy. METHODS We identified 2632 patients with early TNBC from the German Breast Group meta-database. Patients with cT1-2 cN0 and ypN0, available surgery and follow-up data were enrolled. Data of 1074 patients from 8 prospective NACT trials were available. Endpoints of interest were locoregional recurrence as first site of relapse (LRR), disease-free survival (DFS) and overall survival (OS). We performed univariate and multivariate Fine-Gray analysis and Cox regression models. RESULTS After a median follow-up of 64 months, there were 94 (8.8%) locoregional events as first site of relapse. Absence of pathologic complete response (pCR) was associated with increased LRR upon uni- and multivariate analysis (hazard ratio [HR] = 2.28; p < 0.001 and HR = 2.22; p = 0.001). Type of surgery was not associated with LRR. Patients in the BCS-group had better DFS and OS (DFS: HR = 0.47; p < 0.001 and OS: HR = 0.40; p < 0.001). BCS was associated with improved DFS and OS upon multivariate analysis (DFS: HR = 0.51; p < 0.001; and OS HR = 0.43; p < 0.001), whereas absence of pCR was associated with worse DFS and OS (DFS: HR = 2.43; p < 0.001; and OS: HR = 3.15; p < 0.001). CONCLUSIONS In this retrospective analysis of patients with early stage node-negative TNBC treated with NACT, BCS was not associated with an increased risk of LRR but with superior DFS and OS.
Collapse
Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | | | | | - Thorsten Kühn
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany; Department of Gynecology and Obstectrics, Die Filderklinik, Filderstadt, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - Beyhan Ataseven
- Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, Germany
| | - Christine Solbach
- Goethe University Frankfurt, Department of Gynecology and Obstetrics, University Hospital, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Hans Tesch
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
| | | | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany; Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121 Heidelberg, Germany
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany; Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| |
Collapse
|
4
|
Sfarad HK, Allweis TM. Postoperative Complications Following Lumpectomy With Intraoperative X-Ray Radiation Therapy: A Retrospective Comparative Study. Clin Breast Cancer 2024; 24:237-242. [PMID: 38233254 DOI: 10.1016/j.clbc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/28/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Lumpectomy with intraoperative radiation (IORT) is a relatively new modality for the treatment of early breast cancer. IORT delivers targeted radiation to the tumor bed and obviates the need for external beam radiation (EBRT) in 85% of the cases. IORT is being used increasingly around the world, however information regarding early and late postoperative complications associated with the procedure is limited. AIM To describe and compare complication rates after lumpectomy and IORT with those seen after lumpectomy and EBRT or lumpectomy alone. METHODS Clinical, demographic, and histopathological data were collected from electronic medical records and a retrospectively maintained database. Postoperative complications were compared for patients undergoing lumpectomy with IORT, lumpectomy with EBRT, and lumpectomy alone over the same period. RESULTS A total of 445 patients were included in the study: 113 underwent lumpectomy with IORT, 253 had lumpectomy followed by EBRT, and 79 had Lumpectomy alone. Postoperative seroma was documented in 74 patients (65%) after IORT,87 (34%) after EBRT, and 9 (11%) after lumpectomy alone (P = .000). Surgical site infection requiring antibiotic treatment was diagnosed in 26 patients (23%) after IORT, 38 (15%) after EBRT, and 5 (6%) after lumpectomy alone (P = .013). Postoperative erythema was documented in 39 patients (34%) after IORT, 40 (16%) after EBRT, and 5 (6%) after lumpectomy alone (P = .000). Postoperative minor complications such as scar and breast deformity, edema, Mondor's syndrome, and chronic tenderness, were documented in 62 patients (55%) after IORT, 119 (47%) after EBRT, and 13 (17%) after lumpectomy alone (P = .000). The average follow-up was 14 months. CONCLUSIONS IORT is associated with an increased rate of postoperative complications compared to EBRT or lumpectomy alone. Most complications are minor and transient. We hypothesize that the increased occurrence of complications may also be attributed to overreporting, which is associated with the introduction of a new technology. Educating physicians and patients about potential complications and their course may help establish expectations and improve the management of postoperative complications.
Collapse
Affiliation(s)
| | - Tanir M Allweis
- Department of Breast Surgery, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
5
|
Meattini I, Kunkler IH. Omission of radiation therapy after breast conserving surgery for older women at low-risk of local recurrence: One option among many. Eur J Surg Oncol 2024; 50:108058. [PMID: 38428108 DOI: 10.1016/j.ejso.2024.108058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
This editorial discusses the evolving landscape of early-stage breast cancer treatment, emphasizing the need to tailor therapies based on disease biology and genomic approaches. The focus is on the reconsideration of postoperative radiation therapy (RT) for older patients with low-risk, hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer. Recent trials show modest long-term local recurrence rates with the omission of RT after BCS in certain cases, challenging the traditional approach. The commentary calls for continued research on predictive tests for treatment response and advocates for a multidisciplinary approach to decision-making, considering factors like quality of life. The nuanced risk/benefit ratio of RT in older patients is explored, emphasizing the importance of comprehensive assessment for optimal therapy.
Collapse
Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M Serio", University of Florence, Florence, Italy; Radiation Oncology & Breast Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Ian H Kunkler
- Edinburgh Cancer Research Centre, Institute of Genetic and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| |
Collapse
|
6
|
Jacobs LM, Helder LS, Albers KI, Kranendonk J, Keijzer C, Joosten LA, Strobbe LJ, Warlé MC. The role of surgical tissue injury and intraoperative sympathetic activation in postoperative immunosuppression after breast-conserving surgery versus mastectomy: a prospective observational study. Breast Cancer Res 2024; 26:42. [PMID: 38468349 PMCID: PMC10926636 DOI: 10.1186/s13058-024-01801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Breast cancer is the second most common cause of death from cancer in women worldwide. Counterintuitively, large population-based retrospective trials report better survival after breast-conserving surgery (BCS) compared to mastectomy, corrected for tumour- and patient variables. More extensive surgical tissue injury and activation of the sympathetic nervous system by nociceptive stimuli are associated with immune suppression. We hypothesized that mastectomy causes a higher expression of plasma damage associated molecular patterns (DAMPs) and more intraoperative sympathetic activation which induce postoperative immune dysregulation. Immune suppression can lead to postoperative complications and affect tumour-free survival. METHODS In this prospective observational study, plasma DAMPs (HMGB1, HSP70, S100A8/A9 and S100A12), intraoperative sympathetic activation (Nociception Level (NOL) index from 0 to 100), and postoperative immune function (plasma cytokine concentrations and ex vivo cytokine production capacity) were compared in patients undergoing elective BCS (n = 20) versus mastectomy (n = 20). RESULTS Ex vivo cytokine production capacity of TNF, IL-6 and IL-1β was nearly absent in both groups one hour after surgery. Levels appeared recovered on postoperative day 3 (POD3), with significantly higher ex vivo production capacity of IL-1β after BCS (p = .041) compared to mastectomy. Plasma concentration of IL-6 was higher one hour after mastectomy (p = .045). Concentrations of plasma alarmins S100A8/A9 and S100A12 were significantly higher on POD3 after mastectomy (p = .003 and p = .041, respectively). Regression analysis showed a significantly lower percentage of NOL measurements ≤ 8 (absence of nociception) during mastectomy when corrected for norepinephrine equivalents (36% versus 45% respectively, p = .038). Percentage of NOL measurements ≤ 8 of all patients correlated with ex vivo cytokine production capacity of IL-1β and TNF on POD3 (r = .408; p = .011 and r = .500; p = .001, respectively). CONCLUSIONS This pilot study revealed substantial early postoperative immune suppression after BCS and mastectomy that appears to recover in the following days. Differences between BCS and mastectomy in release of DAMPs and intraoperative sympathetic activation could affect postoperative immune homeostasis and thereby contribute to the better survival reported after BCS in previous large population-based retrospective trials. These results endorse further exploration of (1) S100 alarmins as potential therapeutic targets in breast cancer surgery and (2) suppression of intraoperative sympathetic activation to substantiate the observed association with postoperative immune dysregulation.
Collapse
Affiliation(s)
- Lotte Mc Jacobs
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Leonie S Helder
- Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Kim I Albers
- Department of Anaesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Josephine Kranendonk
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands
| | | | - Leo Ab Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania
| | - Luc Ja Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands.
| |
Collapse
|
7
|
Guo G, Li J, Zheng Y, Liu ZX, Lin H. Breast-conserving surgery is associated with a lower incidence of suicide among females with breast cancer in the United States: a population-based retrospective cohort study. Int J Surg 2024; 110:1392-1401. [PMID: 38215250 PMCID: PMC10942248 DOI: 10.1097/js9.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND With comparable overall survival and local recurrence rates with mastectomy, breast-conserving surgery (BCS) has become the cornerstone of therapy for breast cancer; however, the difference in the incidence of suicide between BCS and mastectomy among breast cancer survivors remains unclear. This study evaluated the mortality risk from suicide among breast cancer survivors and compared suicide risk between BCS and mastectomy using a population-based cohort. MATERIALS AND METHODS Female patients newly diagnosed with first primary breast cancer, recorded in the Surveillance, Epidemiology and End Results database, were included. Standardized mortality ratio (SMR) and cumulative mortality rate from suicide among those who underwent BCS and mastectomy were compared. RESULTS A total of 1 190 991 patients with newly diagnosed first primary breast cancer were included in the study, of whom 56.5% underwent BCS and 36.1% underwent mastectomy. During the follow-up period, 667 suicides were recorded. Patients who underwent mastectomy exhibited significantly higher suicide mortality than the general population [mortality rate, 8.16 per 100 000 person-years; SMR 1.18 (95% CI 1.05-1.33)], while there was no significant difference in suicide rate between patients who underwent BCS and the general population [SMR 0.92 (95% CI 0.83-1.02)]. Multivariate Cox analysis revealed that BCS, compared with mastectomy, was associated with a significantly decreased risk of suicide among females with breast cancer [hazard ratio 0.80 (95% CI 0.68-0.95); P = 0.009]. CONCLUSION BCS was associated with a significantly lower incidence of suicide among females with breast cancer. BCS offers a compelling option for improving the quality of life and self-esteem of patients with cancer and provides a novel perspective on cancer management.
Collapse
Affiliation(s)
- Guiping Guo
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
| | - Junteng Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Zheng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Ze-Xian Liu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Huan Lin
- Department of Breast Surgery, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University
| |
Collapse
|
8
|
Chou HY, Tseng LM, Ma H, Perng CK, Huang CC, Tsai YF, Lin YS, Lien PJ, Feng CJ. Clinical outcomes and patient-reported outcomes after oncoplastic breast surgery in breast cancer patients: A matched cohort study. J Chin Med Assoc 2024; 87:320-327. [PMID: 38252489 DOI: 10.1097/jcma.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Surgery is the recommended treatment for breast cancer, the most common cancer in women in Taiwan and the leading cause of cancer-related deaths. Although breast-conserving surgery (BCS) has good prognosis, in some cases, BCS may cause more significant deformities and interfere with the patient's psychosocial well-being. Oncoplastic breast surgery (OBS) is the treatment option in these cases. This study aimed to determine the outcomes of OBS and BCS regardless of clinical and patient-reported esthetic outcomes. METHODS Between 2015 and 2020, 50 patients who underwent OBS at our hospital after complete treatment were enrolled. With 1:2 matched ratios, 100 patients were enrolled in the BCS control group. Clinical outcomes were analyzed. The BREAST-Q questionnaire was then assessed 6 months after the completion of treatment for subjective patient-reported outcomes. RESULTS Due to the matching process, no difference was noted between the two groups in terms of demographic data such as age, comorbidities, or tumor characteristics. There were no significant differences in the local recurrence rate, disease-free survival, overall survival, positive margin rate, rewide excision rate, conversion to mastectomy rate, or complication rate (major or minor) between both groups. However, the OBS group showed higher satisfaction with breasts in the BREAST-Q questionnaire ( p < 0.001). The mean follow-up time was 38.77 ± 14.70 months in the BCS group and 29.59 ± 14.06 months in the OBS group. CONCLUSION OBS seems to be a safe and feasible surgery in breast cancer patients because clinical outcomes are compatible with BCS. Moreover, the OBS group had better patient-reported outcomes in terms of satisfaction.
Collapse
Affiliation(s)
- Hsuan-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan, ROC
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Fang Tsai
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Shu Lin
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Ju Lien
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Jung Feng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
9
|
Spiekerman van Weezelenburg MA, Bakens MJAM, Daemen JHT, Aldenhoven L, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons. Ann Surg Oncol 2024; 31:1643-1652. [PMID: 38038792 DOI: 10.1245/s10434-023-14631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND. METHODS A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding seroma formation, clinically significant seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method. RESULTS A total of 19 articles with 1962 patients were included. Ten different techniques to prevent seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen. CONCLUSIONS To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based guideline is needed.
Collapse
Affiliation(s)
| | - Maikel J A M Bakens
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| |
Collapse
|
10
|
Tekdogan B, Martineau J, Scampa M, Kalbermatten DF, Oranges CM. Oncoplastic reduction mammoplasty: Systematic review and proportional meta-analysis of surgical outcomes. J Plast Reconstr Aesthet Surg 2024; 89:86-96. [PMID: 38159475 DOI: 10.1016/j.bjps.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Breast-conserving surgery is the standard of care for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to address these issues by combining local excision with plastic surgery techniques to improve oncologic and esthetic outcomes. By incorporating breast reduction techniques into cancer surgery, wider margins of excision can be achieved, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This systematic review and meta-analysis aims to provide an updated understanding of the surgical outcomes associated with oncoplastic reduction mammoplasty. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. Articles reporting post-operative outcomes following the oncoplastic reduction mammoplasty were included. A proportional meta-analysis of post-operative complications was performed to obtain their proportions and 95% Confidence Intervals (CIs). RESULTS Eighteen studies met the inclusion criteria, representing a total of 2711 oncoplastic reduction mammoplasty procedures in 2680 patients. The overall complication rate was 20% (95% CI: 15-25%). The positive margin rate following oncoplastic reduction mammoplasty was 11% (95% CI: 6-17%). The re-excision rate was 6% (95% CI: 3-12%). The completion mastectomy rate was 3% (95% CI: 2-6%). CONCLUSIONS Oncoplastic reduction mammoplasty is a safe and effective alternative to mastectomy and traditional breast-conserving surgery in the treatment of early-stage breast cancers.
Collapse
Affiliation(s)
- Boran Tekdogan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Jérôme Martineau
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Matteo Scampa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.
| |
Collapse
|
11
|
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.
Collapse
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
| | | | | | | | | | | | | |
Collapse
|
12
|
Pan YY, Lai TY, Shiau CY, Tseng LM, Lai IC, Liu YM, Huang PI. The effect of radiotherapy on patients with pathological stage IIB breast cancer after breast-conserving surgery or mastectomy: A cohort study. J Chin Med Assoc 2024; 87:202-211. [PMID: 38095582 DOI: 10.1097/jcma.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers in women, and treatment options include surgery, systemic therapies, and radiotherapy (RT). While postoperative RT plays an important role in reducing local recurrence rates and improving survival outcomes, its exact impact on patients with pathological stage IIB breast cancers remains unidentified. METHODS In this retrospective cohort study, patients with newly diagnosed pathological stage IIB breast cancer who underwent surgery and postoperative RT were included. The data were collected from medical records, and survival outcomes were assessed using the Kaplan-Meier method, log-rank tests, and Cox regression models. RESULTS In total, 350 patients participated in this study. Overall survival, locoregional recurrence-free survival, event-free survival, and distant metastasis-free survival rates did not significantly differ between those who received RT and those who did not. Multivariate analyses revealed that patients who received anthracycline or taxane chemotherapy had better survival outcomes. CONCLUSION Our findings demonstrated that postoperative RT had no significant effect on overall survival, locoregional recurrence, event-free survival, or distant metastasis rates in patients with pathological stage IIB breast cancer. However, anthracycline- and taxane-based chemotherapies were associated with improved outcomes. These findings demonstrated the complexities of treating such patient populations with multimodal therapies. Further research is needed to ensure optimal postoperative RT in patients with pathological stage IIB breast cancer. Clinicians must consider individual patient characteristics and incorporate comprehensive treatment approaches to ensure successful outcomes in this population.
Collapse
Affiliation(s)
- Yi-Ying Pan
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Yu Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cheng-Ying Shiau
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Ming Tseng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Chun Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Ming Liu
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pin-I Huang
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
13
|
Wang Y, Peng D, Zhou X, Hu W, Li F. Treatments and Prognosis of the Breast Ductal Carcinoma In Situ. Clin Breast Cancer 2024; 24:122-130.e2. [PMID: 38016910 DOI: 10.1016/j.clbc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION With progress in treatments, breast ductal carcinoma in situ (DCIS) outcomes have substantially improved. However, as various treatment methods are used in different countries and institutions, consensus on the optimal treatment method is lacking. This study aimed to analyze the prognostic factors and provide a reference for optimizing the clinical treatment of DCIS. PATIENTS AND METHODS This retrospective clinical study collected data from DCIS patients at the Sun Yat-sen University Cancer Center from 2010 to 2017. The Kaplan-Meier method and Cox regression model were used to assess disease-free survival (DFS), overall survival (OS), and local control (LC) rates. RESULTS Among the 483 included patients, 83.6% (404) underwent mastectomies. The median follow-up time was 101 months. The number of patients undergoing breast-conserving surgery (BCS) with radiotherapy has gradually increased. Axillary lymph node dissection was the main surgery performed from 2010 to 2015, and the proportion of sentinel lymph node biopsies (SLNBs) has increased. LC and DFS rates with BCS without radiotherapy were significantly lower than those with mastectomy (P = .002; P < .001). Additionally, the patients who did not undergo axillary surgery had worse LC and OS rates than those who underwent SLNB (P = .028 and P = .038). Endocrine therapy (ET) or its duration had no significant effect on prognosis. CONCLUSION In conclusion, BCS without radiotherapy and lack of axillary surgery were independent prognostic factors. We recommend performing BCS with radiotherapy and SLNB more in clinical practice, as well as shortening the ET duration.
Collapse
Affiliation(s)
- Yaxue Wang
- State Key Laboratory of Oncology, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Dingsheng Peng
- Department of Radiation Oncology, Huizhou Central People's Hospital, Huizhou, PR China
| | - Xinhui Zhou
- State Key Laboratory of Oncology, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Wendie Hu
- State Key Laboratory of Oncology, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Fengyan Li
- State Key Laboratory of Oncology, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| |
Collapse
|
14
|
Xiong Z, He J, Zhao X, Ye X, Cui M, Fu J, Liu J, Li Q. The oncological safety and long-term cosmetic effect of free dermal fat graft with epidermis removal for breast defect repair in breast conserving surgery. Breast 2024; 73:103622. [PMID: 38190791 PMCID: PMC10788852 DOI: 10.1016/j.breast.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/10/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Free dermal fat grafts (FDFG) are used for immediate breast defect repair in breast-conserving surgery (BCS), and have achieved satisfactory immediate postoperative cosmetic effects (Sawai et al., 2004) [1]. However, the oncologic safety and long-term cosmetic outcomes of these surgical procedures remain unknown. Therefore, t,in this study, we aim to investigate the oncological safety and long-term cosmetic outcomes of FDFG in patients with breast cancer. METHODS This matched retrospective case-control study included patients with non-special types of breast cancer who underwent FDFG for breast defect repair after BCS or BCS alone at two breast cancer research centers in Guangxi Province, China, from January 2016 to December 2019. The patients were divided into either the FDFG or BCS group. Control cases were screened using propensity score matching, and survival analysis and cosmetic evaluations were performed. RESULTS A total of 442 patients with breast cancer were included in the study. After 1:4 propensity score matching, 53 and 212 patients were included in the FDFG and BCS groups, respectively. The median follow-up time was 49.9 (9.0-76.0) months. The rate of local recurrence in the FDFG group (9.4 %) was significantly higher than that in the BCS group (1.9 %; p < 0.05). The total cosmetic evaluation score was significantly higher in the BCS group 18 months after surgery than in the FDFG group (p < 0.05). CONCLUSIONS In this retrospective study, FDFG was significantly associated with an increased risk of local recurrence. Further prospective studies are required to confirm these results. No significant difference in long-term cosmetic effects were observed for FDFG than for BCS alone for immediate breast defect repair.
Collapse
Affiliation(s)
- Zikui Xiong
- Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Traditional Chinese Medicine Hospital of Guilin, China.
| | - Jindi He
- Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Xin Zhao
- Department of Radiology, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Xinqing Ye
- Department of Pathology, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Manlu Cui
- Department of Pathology, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Juan Fu
- Department of Pathology, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Jianlun Liu
- Department of Pathology, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| | - Qiuyun Li
- Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, China.
| |
Collapse
|
15
|
Kilmer LH, Weidman AA, DeGeorge BR, Stranix JT, Campbell CA. Oncoplastic breast reduction surgery decreases rates of reoperation with no increased medical risk. J Plast Reconstr Aesthet Surg 2024; 88:273-280. [PMID: 38016264 DOI: 10.1016/j.bjps.2023.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
The purpose of this study is to compare the oncologic, medical, and surgical outcomes of lumpectomy versus oncoplastic breast reduction surgery (OBRS) on a national scale. A national insurance-based database was queried for patients who had a lumpectomy with or without a same-day breast reduction by Current Procedural Terminology (CPT) codes. Patients were then matched by obesity, body mass index range, age, region, neoadjuvant chemotherapy, and outcomes were compared. There were 421,455 patients in the lumpectomy group and 15,909 patients in the OBRS group. After matching, 15,134 patients were identified in each group. Repeat lumpectomy or subsequent mastectomy was more common in the lumpectomy group (15.2% vs. 12.2%, p < 0.001). OBRS patients had higher rates of 90-day surgical complications including dehiscence, infection, fat necrosis, breast abscesses, and antibiotic prescription (p < 0.001). Meanwhile, any medical complication was less common in the OBRS group (3.7% vs. 4.5%, p = 0.001). Logistic regression revealed that OBRS was associated with decreased odds of repeat lumpectomy (OR = 0.71, 95% CI 0.66-0.77, p < 0.001) with no significant increased odds of subsequent mastectomy (OR = 1.01, 95% CI 0.91-1.11, p = 0.914). OBRS was found to be associated with decreased risk for reoperation in the form of lumpectomy without increased likelihood of subsequent mastectomy. Although OBRS was associated with increased wound complications, medical complications were found to occur less frequently. This study endorses increased consideration of OBRS when lumpectomy or OBRS is appropriate.
Collapse
Affiliation(s)
- Lee H Kilmer
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Allan A Weidman
- School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Brent R DeGeorge
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - John T Stranix
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Chris A Campbell
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| |
Collapse
|
16
|
Dung HA, Quang LH, Quang LV, Cong BT. Level-2 Oncoplastic Surgical Techniques for Breast Cancer: A Preliminary Vietnamese Report. Med Arch 2024; 78:131-138. [PMID: 38566877 PMCID: PMC10983099 DOI: 10.5455/medarh.2024.78.131-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Background Breast cancer is the most common malignancy and remains the first cause of death related to cancer among Vietnamese women, with an incidence of 21,555 cases in 2020. Most breast cancer patients present with invasive disease and relatively large tumor sizes. While oncoplastic surgery (OPS) are commonly applied in Western countries, data on Asian population remains relatively limited. Objective This study aims to assess the outcomes of level-2 oncoplastic techniques in breast-conserving surgeries at the Vietnam National Cancer Hospital. Methods From January 2017 to June 2021, a cohort of 257 breast cancer patients who underwent breast-conserving surgery with OPS techniques were examined. Surgical complications, cosmetic outcome, recurrence and survival rates were assessed. Results The mean age was 47.6±9.4 years, most patients had breast cup sizes B and C. The mean tumor size upon pathological examination was 2.00 ± 0.74 cm. Only 7 cases required reoperation, resulting in a mastectomy rate of 1.17%. The overall complication rate was low at 11.46%, with 9 cases (3.56%) experiencing delayed complications. Cosmetic results were rated as "excellent" in 20.6% and "good" in 60.5%, with a statistically significant difference. The rates of local recurrence, regional recurrence, and distant metastasis at five years were 2.78%, 1.19%, and 2.36%, respectively. Conclusion The level 2 oncoplastic techniques had low complication rates, favorable oncological outcomes, and cosmetically satisfying results.
Collapse
Affiliation(s)
- Hoang Anh Dung
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Le Hong Quang
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Le Van Quang
- Departement of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Departement of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Bui Tien Cong
- Department of Nuclear Medicine, Hanoi Medical University, Hanoi, Vietnam
- Center of Nuclear Medicine and Oncology, Hanoi, Vietnam
| |
Collapse
|
17
|
Berger LE, Spoer DL, Huffman SS, Drew E, Greenwalt IT, Fan KL. A case of necrotizing fasciitis of the breast following lumpectomy and oncoplastic closure. Wounds 2024; 36:1-7. [PMID: 38417817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND NF is a life-threatening soft tissue infection that most commonly occurs in the lower extremity. While presenting symptoms such as erythema, severe pain, sepsis, and wound crepitation are well documented, diagnosis of NF of the breast often is obscured by a low clinical index of suspicion due to its relative rarity as well as by the breast parenchyma that physically separates the underlying fascia and overlying skin. Several risk factors have previously been identified, such as underlying infection, diabetes, advanced age, and immunosuppression. However, the gross morbidity and high mortality associated with NF warrant continued surveillance of contributing factors across any anatomic location. Fifteen cases in the literature document the development of NF following breast surgery. CASE REPORT The authors of this case report aim to expand on the current literature through the presentation of a unique case of NF of the breast following right breast lumpectomy and oncoplastic closure with left reduction mammaplasty in an immunocompromised patient found to have concurrent perforated sigmoid diverticulitis. CONCLUSION This case exemplifies how frequent postoperative surveillance, a low threshold for intervention, and efficient coordination of care are vital to minimizing the morbidity and mortality risks associated with NF of the breast.
Collapse
Affiliation(s)
- Lauren E Berger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Daisy L Spoer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Eleanor Drew
- Division of Critical Care Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ian T Greenwalt
- Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
18
|
Liu M, Zhou X, Gao L, Wang Z, Li L, Li Y, Sun Q. Considerable Long-Term Aesthetic Outcomes and Oncologic Safety of Breast-Conserving Surgery Via a Periareolar Incision: A Retrospective Study. Clin Breast Cancer 2023; 23:e549-e559.e4. [PMID: 37758558 DOI: 10.1016/j.clbc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/03/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND To investigate the application effect of periareolar incision breast-conserving surgery in patients with early breast cancer. METHODS From January 2017 to November 2021, a clinician in our research center performed a total of 533 breast-conserving surgery. After screening, we collected the information of 209 patients through telephone, online questionnaires, and outpatient follow-up. One hundred seventeen patients with early breast cancer underwent breast-conserving surgery under the periareolar incision, while 92 patients underwent surgery through the tumor surface incision. We compared the differences between the 2 groups in the length of stay, postoperative complications, adjuvant therapy, and other clinical indicators, as well as the subjective and objective evaluation of the long-term postoperative breast aesthetic outcome, local recurrence, distant metastasis, and survival. RESULTS With a mean follow-up of 3.9 years, patients in the periareolar incision group (PAIG) and tumor surface incision group (TSIG) had no significant differences in clinical indicators, local recurrence, distant metastasis, and survival. However, PAIG patients had better subjective satisfaction with postoperative breast appearance. In the evaluation of objective aesthetic outcomes, PAIG was significantly better than TSIG in texture and elasticity, symmetry, sunken degree of the operative side, skin color, surgical scar, and breast compliance difference. CONCLUSION By observing and comparing the clinical indicators, postoperative recurrence, and metastasis of the enrolled patients, this study found that periareolar incision surgery could achieve radical therapeutic effects similar to those achieved through tumor surface incision, and had advantages in improving postoperative aesthetic outcomes, which could provide certain references for clinical practice.
Collapse
Affiliation(s)
- Mohan Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xingtong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Lu Gao
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zihao Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Linrong Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China.
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China.
| |
Collapse
|
19
|
Fasola CE, Sharp HJ, Clavin NW, Sha W, Schepel CR, Trufan SJ, Graham E, Hecksher A, White RL, Hadzikadic-Gusic L. Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer. Ann Surg Oncol 2023; 30:8362-8370. [PMID: 37605081 DOI: 10.1245/s10434-023-14177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the delay in initiating adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer who underwent oncoplastic reduction mammoplasty (ORM) following BCS compared with a matched cohort of patients who did not undergo ORM between BCS and RT. METHODS Medical records of 112 women (56 ORMs and 56 matched non-ORMs) with carcinoma in situ or early-stage breast cancer treated with BCS were reviewed. ORM was performed in a delayed manner following BCS, allowing confirmation of negative surgical margins. Time to RT was defined as time from last oncologic surgery to start of RT. RESULTS The median follow-up time was 6.8 years for the ORM cohort and 6.7 years for the control non-ORM cohort. Patients who underwent ORM following BCS experienced a significant delay in initiating RT (>8 weeks) than matched patients not undergoing ORM (66% vs. 34%; p < 0.001). Wound complications occurred in 44.6% (n = 25) of patients in the ORM cohort, which were mostly minor, including delayed wound healing and/or infection (39%). There was no significant difference in local recurrence between patients in the non-ORM and ORM cohorts (p = 0.32). CONCLUSIONS This study demonstrates that ORM following BCS has the potential to delay RT >8 weeks, largely as a result of increased risk of wound complications; however, this delay did not impact local control. ORM can be safely considered for appropriately selected patients with breast cancer.
Collapse
Affiliation(s)
- Carolina E Fasola
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Hadley J Sharp
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Clavin
- Division of Plastic and Reconstructive Surgery, Atrium Health, Charlotte, NC, USA
| | - Wei Sha
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Courtney R Schepel
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Sally J Trufan
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Elaina Graham
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Anna Hecksher
- Clinical Trials Office, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Richard L White
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| |
Collapse
|
20
|
Sauvage LM, Loap P, Vu-Bezin J, Cao K, Kissel M, Bringer S, Maraadji S, Fourquet A, Kirova Y. Large scale experience of two ultrahypofractionated 5 fractions regimes after breast conserving surgery from a single centre. Acta Oncol 2023; 62:1791-1797. [PMID: 37824092 DOI: 10.1080/0284186x.2023.2267170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Ultra-hypofractionation breast radiotherapy is a safe alternative to moderate hypofractionation. This study reports the results of two ultrahypofractionated regimens used in clinical practice in a high-volume radiotherapy center in terms of efficacy and of tolerance. METHODS we included all patients treated in an adjuvant setting with five fractions after breast conserving surgery (BCS), for a histologically-confirmed invasive or in situ breast carcinoma. Radiotherapy regimens after BCS were either a 5-week schedule with 5 weekly fractions of 5,7 Gy or a one-week schedule with 5 daily fractions of 5,2 Gy. Adverse events were recorded and local-relapse free survival (LRFS), locoregional-relapse free survival (LRRFS), metastasis-free survival (MFS), for breast-cancer specific survival (BCSS) and overall survival (OS) were evaluated. RESULTS Between December 2014 and December 2022, 396 patients (400 breasts) were treated with ultrahypofractionated radiotherapy. Five-year LRFS was 98.8% (95% confidence interval: 97.1%-100%), and 5-year OS was 96.0% (95%CI: 92.6-99.5%). Age was statistically associated with OS in univariate analysis (HR: 1.16, 95%CI: 1.04-1.42, p = .01). Four patients (1.0%) experienced acute grade 3 radiation-induced adverse events, and 8 patients (2.3%) acute grade 2 toxicities. Twenty-three patients (5.8%) experienced late toxicity, all of them being graded as grade 1. The use of the 5.7 Gy-weekly-fraction regimen and the delivery of a tumor bed boost were significantly associated with acute radiodermatitis (p < .01; p = .02; respectively) and late fibrosis (p < .01; p = .049; respectively). CONCLUSIONS ultrahypofractionated radiotherapy was associated with an excellent tumor control rate in our 'real-life' cohort with low-risk breast cancer patients. However, delivery of a tumor bed boost and using weekly 5.7-Gy fractions were associated with an increased risk of acute and late cutaneous toxicities.
Collapse
Affiliation(s)
| | - Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jeremi Vu-Bezin
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Kim Cao
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Solène Bringer
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Safia Maraadji
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
- University of Versailles St Quentin, Paris, France
| |
Collapse
|
21
|
Vasilyeva E, Hamm J, Nichol A, Isaac KV, Bazzarelli A, Brown C, Lohrisch C, McKevitt E. ASO Visual Abstract: Breast-Conserving Therapy is Associated with Improved Survival without an Increased Risk of Locoregional Recurrence Compared to Mastectomy in Both Clinically Node Positive and Node Negative Breast Cancer Patients. Ann Surg Oncol 2023; 30:6425-6426. [PMID: 37516729 DOI: 10.1245/s10434-023-13876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Affiliation(s)
- Elizaveta Vasilyeva
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer, Vancouver, BC, Canada.
| | | | - Alan Nichol
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Kathryn V Isaac
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Amy Bazzarelli
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Carl Brown
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Caroline Lohrisch
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Elaine McKevitt
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| |
Collapse
|
22
|
Pan G, Wang H, Wu B, Zong L. Chylous leakage after breast-conserving surgery: A case report. Asian J Surg 2023; 46:4586-4587. [PMID: 37208265 DOI: 10.1016/j.asjsur.2023.05.020] [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: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Guangrui Pan
- Department of General Surgery (Breast Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongniu Wang
- Graduate School of Medicine, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Bin Wu
- Department of General Surgery (Breast Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Liang Zong
- Department of General Surgery, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province, China.
| |
Collapse
|
23
|
Ghilli M, Mariniello MD, Ferrè F, Morganti R, Perre E, Novaro R, Colizzi L, Camilleri V, Baldetti G, Rossetti E, Coletti L, Scatena C, Ghilardi M, Cossu MC, Roncella M. Quality of life and satisfaction of patients after oncoplastic or traditional breast-conserving surgery using the BREAST-Q (BCT module): a prospective study. Breast Cancer 2023; 30:802-809. [PMID: 37358721 PMCID: PMC10404206 DOI: 10.1007/s12282-023-01474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION The oncoplastic conservative surgery was developed as a natural evolution of traditional surgery, attempting to improve the therapeutic and aesthetic outcomes where tumor resection could be followed by not-adequate results. Our primary aim is to evaluate how patient satisfaction and quality-of-life after conservative oncoplastic surgery, using BREAST-Q (BCT Module), change pre- and post-operatively. The secondary aim is to compare patient-reported outcome after oncoplastic or traditional conservative surgery. PATIENTS AND METHODS We enrolled 647 patients who underwent traditional conservative surgery or oncoplastic surgery from January 2020 to December 2022. Only 232 women (35.9%) completed the BREAST-Q questionnaire on a web-based platform, at the preoperative phase and 3 months after treatment. RESULTS The average score of "Psychosocial well-being" and "Satisfaction with Breasts" 3 months after surgery showed a statistically significant improvement, while the average score for "Physical well-being: Chest" at 3 months showed a worsening compared to the baseline. "Sexual well-being" did not show statistically significant change. A significant difference between the post-operative outcome of oncoplastic surgery and traditional surgery was observed only for Physical well-being (better for traditional surgery). CONCLUSIONS The study showed significant improvement in patient-reported outcomes 3 months after the surgery, except for physical discomfort that increases especially after oncoplastic surgery. Furthermore, our data, as well as many others, point to the appropriateness of using OCS where there is an effective indication, while the perspective of patients cannot find significant superiority over TCS in any of the areas analyzed.
Collapse
Affiliation(s)
- M Ghilli
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy.
| | - M D Mariniello
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - F Ferrè
- Scuola Superiore Sant'Anna of Pisa, Laboratorio Management E Sanità, Istituto di Management, Pisa, Italy
| | - R Morganti
- Unit of Statistics, University Hospital of Pisa, Pisa, Italy
| | - E Perre
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - R Novaro
- Scuola Superiore Sant'Anna of Pisa, Laboratorio Management E Sanità, Istituto di Management, Pisa, Italy
| | - L Colizzi
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - V Camilleri
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - G Baldetti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - E Rossetti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - L Coletti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - C Scatena
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M Ghilardi
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M C Cossu
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M Roncella
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
24
|
Verreck EEF, van Steenhoven JEC, Kuijer A, van Maaren MC, Simons JM, Siesling S, van Dalen T. Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy. Ann Surg Oncol 2023; 30:5623-5632. [PMID: 37225832 PMCID: PMC10409658 DOI: 10.1245/s10434-023-13568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The ACOSOG-Z0011- and the AMAROS-trial obviated the need for axillary surgery in most sentinel node-positive (SLN+) breast cancer patients undergoing breast-conserving surgery (BCS). Data for patients who undergo mastectomy is scarce. The purpose of this study was to investigate patterns of axillary treatment in SLN+ patients treated by mastectomy in the years after the publication of landmark studies regarding axillary treatment in SLN+ breast cancer patients undergoing BCS. METHODS This was a population-based study in cT1-3N0M0 breast cancer patients treated by mastectomy and staged as SLN+ between 2009 and 2018. The performance of an axillary lymph node dissection (ALND) and/or administration of postmastectomy radiotherapy (PMRT) were primary outcomes and were studied over time. RESULTS The study included 10,633 patients. The frequency of ALND performance decreased from 78% in 2009 to 10% in 2018, whereas PMRT increased from 4 to 49% (P < 0.001). In ≥N1a patients, ALND performance decreased from 93 to 20%, whereas PMRT increased to 70% (P < 0.001). In N1mi and N0itc patients, ALND was abandoned during the study period, whereas PMRT increased to 38% and 13% respectively (P < 0.001), respectively. Age, tumor subtype, N-stage, and hospital type affected the likelihood that patients underwent ALND. CONCLUSIONS In this study in SLN+ breast cancer patients undergoing mastectomy, use of ALND decreased drastically over time. By the end of 2018 most ≥N1a patients received PMRT as the only adjuvant axillary treatment, whereas the majority of N1mi and N0itc patients received no additional treatment.
Collapse
Affiliation(s)
| | - Julia E C van Steenhoven
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne Kuijer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Janine M Simons
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
- GROW school for oncology and reproduction, MUMC+, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
25
|
Boughey JC, Rosenkranz KM, Ballman KV, McCall L, Haffty BG, Cuttino LW, Kubicky CD, Le-Petross HT, Giuliano AE, Van Zee KJ, Hunt KK, Hahn OM, Carey LA, Partridge AH. Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance). J Clin Oncol 2023; 41:3184-3193. [PMID: 36977292 PMCID: PMC10256355 DOI: 10.1200/jco.22.02553] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 11/11/2022] [Revised: 01/11/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Breast-conserving therapy (BCT) is the preferred treatment for unifocal breast cancer (BC). The oncologic safety of BCT for multiple ipsilateral breast cancer (MIBC) has not been demonstrated in a prospective study. ACOSOG Z11102 (Alliance) is a phase II, single-arm, prospective trial designed to evaluate oncologic outcomes in patients undergoing BCT for MIBC. PATIENTS AND METHODS Women age 40 years and older with two to three foci of biopsy-proven cN0-1 BC were eligible. Patients underwent lumpectomies with negative margins followed by whole breast radiation with boost to all lumpectomy beds. The primary end point was cumulative incidence of local recurrence (LR) at 5 years with an a priori rate of clinical acceptability of <8%. RESULTS Among 270 women enrolled between November 2012 and August 2016, there were 204 eligible patients who underwent protocol-directed BCT. The median age was 61 years (range, 40-87 years). At a median follow-up of 66.4 months (range, 1.3-90.6 months), six patients developed LR for an estimated 5-year cumulative incidence of LR of 3.1% (95% CI, 1.3 to 6.4). Patient age, number of sites of preoperative biopsy-proven BC, estrogen receptor status and human epidermal growth factor receptor 2 status, and pathologic T and N categories were not associated with LR risk. Exploratory analysis showed that the 5-year LR rate in patients without preoperative magnetic resonance imaging (MRI; n = 15) was 22.6% compared with 1.7% in patients with a preoperative MRI (n = 189; P = .002). CONCLUSION The Z11102 clinical trial demonstrates that breast-conserving surgery with adjuvant radiation that includes lumpectomy site boosts yields an acceptably low 5-year LR rate for MIBC. This evidence supports BCT as a reasonable surgical option for women with two to three ipsilateral foci, particularly among patients with disease evaluated with preoperative breast MRI.
Collapse
Affiliation(s)
| | - Kari M. Rosenkranz
- Dartmouth Hitchcock Medical Center, Dartmouth College—Norris Cotton Cancer Center, Lebanon, NH
| | - Karla V. Ballman
- Alliance Statistics and Data Management Center, Weill Cornell Medicine, New York, NY
| | - Linda McCall
- Alliance Statistics and Data Management Center, Duke University, Durham, NC
| | | | | | - Charlotte D. Kubicky
- Oregon Health and Science University, Legacy Good Samaritan Hospital and Medical Center, Portland, OR
| | | | | | | | - Kelly K. Hunt
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Olwen M. Hahn
- Alliance for Clinical Trials in Oncology Operations Office, Chicago, IL
| | - Lisa A. Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | |
Collapse
|
26
|
Civil YA, Jonker LW, Groot Koerkamp MPM, Duvivier KM, de Vries R, Oei AL, Slotman BJ, van der Velde S, van den Bongard HJGD. Preoperative Partial Breast Irradiation in Patients with Low-Risk Breast Cancer: A Systematic Review of Literature. Ann Surg Oncol 2023; 30:3263-3279. [PMID: 36869253 PMCID: PMC10175515 DOI: 10.1245/s10434-023-13233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Preoperative instead of standard postoperative partial breast irradiation (PBI) after breast-conserving surgery (BCS) has the advantage of reducing the irradiated breast volume, toxicity, and number of radiotherapy sessions and can allow tumor downstaging. In this review, we assessed tumor response and clinical outcomes after preoperative PBI. PATIENTS AND METHODS We conducted a systematic review of studies on preoperative PBI in patients with low-risk breast cancer using the databases Ovid Medline, Embase.com, Web of Science (Core Collection), and Scopus (PROSPERO registration CRD42022301435). References of eligible manuscripts were checked for other relevant manuscripts. The primary outcome measure was pathologic complete response (pCR). RESULTS A total of eight prospective and one retrospective cohort study were identified (n = 359). In up to 42% of the patients, pCR was obtained and this increased after a longer interval between radiotherapy and BCS (0.5-8 months). After a maximum median follow-up of 5.0 years, three studies on external beam radiotherapy reported low local recurrence rates (0-3%) and overall survival of 97-100%. Acute toxicity consisted mainly of grade 1 skin toxicity (0-34%) and seroma (0-31%). Late toxicity was predominantly fibrosis grade 1 (46-100%) and grade 2 (10-11%). Cosmetic outcome was good to excellent in 78-100% of the patients. CONCLUSIONS Preoperative PBI showed a higher pCR rate after a longer interval between radiotherapy and BCS. Mild late toxicity and good oncological and cosmetic outcomes were reported. In the ongoing ABLATIVE-2 trial, BCS is performed at a longer interval of 12 months after preoperative PBI aiming to achieve a higher pCR rate.
Collapse
Affiliation(s)
- Yasmin A Civil
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Lysanne W Jonker
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje P M Groot Koerkamp
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katya M Duvivier
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental Molecular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Susanne van der Velde
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H J G Desirée van den Bongard
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Falcone V, Krotka P, Deutschmann C, Danzinger S, Reischer T, Pfeiler G, Singer C, Koch M. Use of polysaccharide hemostatic agent (HaemoCer™) in breast cancer surgery to reduce postoperative complications: A randomised controlled trial. Int Wound J 2023; 20:925-934. [PMID: 36448255 PMCID: PMC10031209 DOI: 10.1111/iwj.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/05/2022] Open
Abstract
Postoperative wound-site bleeding, tissue inflammation and seroma formation are well-known complications in the field of breast surgery. Hemostatic agents consisting of polysaccharides may be used intra-operatively to minimise postoperative complications. We conducted a prospective randomised-controlled, single-centre study including 136 patients undergoing breast-conserving surgery for invasive or intraductal breast cancer. Of these, 68 patients were randomised to receive an absorbable polysaccharide hemostatic agent into the wound site during surgery, while 68 patients were randomised to the control group and did not receive any hemostatic agent. Primary outcome was the total volume of postoperative drained fluid from the surgical site. Secondary outcomes were the number of days until drain removal and rate of immediate postoperative surgical site infection Patients in the intervention group had significantly higher drainage output volumes compared with the control group 85 mL (IQR 46.25-110) versus 50 mL (IQR 30-75), respectively; (P = .003). Univariable linear regression analyses showed a significant association between the surgical specimen and the primary outcome (P < .001). After multivariable analysis, the use of absorbable polysaccharide hemostatic product was no longer significantly associated with a higher drainage output and only the size of the surgical specimen remained a significant predictor. The number of days until drainage removal and the postoperative seroma formation were higher in the intervention group (P = .004) and (P = .003), respectively. In our study, intraoperative application of polysaccharide hemostatic agent during breast-conserving surgery did not decrease postoperative fluid production. Only the size of the surgical specimen was significantly associated with postoperative drainage volume.
Collapse
Affiliation(s)
- Veronica Falcone
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Pavla Krotka
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of ViennaViennaAustria
| | - Christine Deutschmann
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Sabine Danzinger
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Theresa Reischer
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Georg Pfeiler
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Christian Singer
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| | - Marianne Koch
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and GynecologyMedical University of ViennaViennaAustria
| |
Collapse
|
28
|
van Loevezijn AA, Geluk CS, van den Berg MJ, van Werkhoven ED, Vrancken Peeters MJTFD, van Duijnhoven FH, Hoornweg MJ. Immediate or delayed oncoplastic surgery after breast conserving surgery at the Netherlands Cancer Institute: a cohort study of 251 cases. Breast Cancer Res Treat 2023; 198:295-307. [PMID: 36690822 DOI: 10.1007/s10549-022-06841-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Oncoplastic surgery (OPS) after breast conserving surgery is preferably performed during the same operation. Offering delayed OPS instead of mastectomy to patients with a high risk of tumor-positive margins allows breast conservation with the option of margin re-excision during OPS, without having to dismantle the reconstruction. We aimed to evaluate surgical outcomes after immediate and delayed OPS. METHODS We included early-stage breast cancer patients who underwent OPS at the Netherlands Cancer Institute between 2016 and 2019. Patients were selected for delayed OPS after multidisciplinary consultation if the risk of tumor-positive margins with immediate OPS was considered significant (> 30%). Groups were compared on baseline characteristics and short-term surgical outcomes. RESULTS Of 242 patients with 251 OPS, 130 (52%) OPS had neoadjuvant chemotherapy. Immediate OPS was performed in 176 (70%) cases and delayed OPS in 76 (30%). Selection for delayed OPS was associated with tumor size (OR 1.03, 95% CI 1.01-1.04), ILC (OR 2.61, 95% CI 1.10-6.20), DCIS (OR 3.45, 95% CI 1.42-8.34) and bra size (OR 0.76, 95% CI 0.62-0.94). Delayed and immediate OPS differed in tissue weight (54 vs. 67 g, p = 0.034), tissue replacement (51% vs. 26%, p < .001) and tumor-positive margins (66% vs. 18%, p < .001). Re-excision was performed in 48 (63%) delayed OPS and in 11 (6%) immediate OPS. Groups did not differ in complications (21% vs. 18%, p = 0.333). Breast conservation after immediate and delayed OPS was 98% and 93%, respectively. CONCLUSION Performing delayed OPS in selected cases facilitated simultaneous margin re-excision without increasing complications, and resulted in an excellent breast conservation rate.
Collapse
Affiliation(s)
- Ariane A van Loevezijn
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Charissa S Geluk
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marieke J van den Berg
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Erik D van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marije J Hoornweg
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
29
|
Sato K, Takeda N, Fuchikami H, Natsume N, Kato M, Okawa T. Impact of de-escalating systemic therapy guided by 21-gene assay on locoregional recurrence after partial-breast irradiation. Brachytherapy 2023; 22:381-388. [PMID: 36894345 DOI: 10.1016/j.brachy.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Partial-breast irradiation (PBI) has been performed as alternative to whole-breast irradiation (WBI) in breast-conserving therapy (BCT). Recently, the 21-gene recurrence score (RS) was introduced to determine the adjuvant therapy for estrogen receptor (ER)-positive, and human epidermal growth factor receptor 2 (HER2)-negative diseases. However, the impact of RS-based systemic therapy on locoregional recurrence (LRR) following BCT with PBI remains uninvestigated. METHODS AND MATERIALS Patients with ER-positive, HER2-negative, and node-negative breast cancer who underwent BCT with PBI were examined during May 2012-March 2022. In addition to immunohistochemistry (IHC), RS was available to decide on adjuvant therapy. RESULTS In total, 431 patients were evaluated with a median followup of 48.6 months. The 4-year LRR-free survival rates were 97.3% and 96.4% in the IHC and RS cohorts, respectively (p = 0.50). Ki67 of >20% was significantly associated with LRR in the multivariate analysis (HR 4.39, p < 0.05). For patients with Ki67 > 20%, 29 of 71 (40.8%) and 46 of 59 (78.0%) patients received only endocrine therapy in the IHC and RS cohorts, respectively (p < 0.0001). For patients with Ki67 >20% who received only endocrine therapy, the 4-year LRR-free survival rates were 91.8% in the IHC cohort and 94.6% in the RS cohort (p = 0.29) CONCLUSIONS: Although the introduction of RS increased the number of patients receiving endocrine therapy alone for Ki67 >20% of disease by two times, the LRR-free survival after BCT with PBI could be maintained. However, further studies from multiple institutions with longer followup data are required.
Collapse
Affiliation(s)
- Kazuhiko Sato
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan.
| | - Naoko Takeda
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Hiromi Fuchikami
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Nana Natsume
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Masahiro Kato
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | | |
Collapse
|
30
|
Strnad V, Polgár C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, Łyczek J, Guinot JL, Gutierrez Miguelez C, Slampa P, Allgäuer M, Lössl K, Polat B, Fietkau R, Schlamann A, Resch A, Kulik A, Arribas L, Niehoff P, Guedea F, Dunst J, Gall C, Uter W. Accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy compared with whole-breast irradiation with boost for early breast cancer: 10-year results of a GEC-ESTRO randomised, phase 3, non-inferiority trial. Lancet Oncol 2023; 24:262-272. [PMID: 36738756 DOI: 10.1016/s1470-2045(23)00018-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several randomised, phase 3 trials have investigated the value of different techniques of accelerated partial breast irradiation (APBI) for patients with early breast cancer after breast-conserving surgery compared with whole-breast irradiation. In a phase 3 randomised trial, we evaluated whether APBI using multicatheter brachytherapy is non-inferior compared with whole-breast irradiation. Here, we present the 10-year follow-up results. METHODS We did a randomised, phase 3, non-inferiority trial at 16 hospitals and medical centres in Austria, Czech Republic, Germany, Hungary, Poland, Spain, and Switzerland. Patients aged 40 years or older with early invasive breast cancer or ductal carcinoma in situ treated with breast-conserving surgery were centrally randomly assigned (1:1) to receive either whole-breast irradiation or APBI using multicatheter brachytherapy. Whole-breast irradiation was delivered in 25 daily fractions of 50 Gy over 5 weeks, with a supplemental boost of 10 Gy to the tumour bed, and APBI was delivered as 30·1 Gy (seven fractions) and 32·0 Gy (eight fractions) of high-dose-rate brachytherapy in 5 days or as 50 Gy of pulsed-dose-rate brachytherapy over 5 treatment days. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was ipsilateral local recurrence, analysed in the as-treated population; the non-inferiority margin for the recurrence rate difference (defined for 5-year results) was 3 percentage points. The trial is registered with ClinicalTrials.gov, NCT00402519; the trial is complete. FINDINGS Between April 20, 2004, and July 30, 2009, 1328 female patients were randomly assigned to whole breast irradiation (n=673) or APBI (n=655), of whom 551 in the whole-breast irradiation group and 633 in the APBI group were eligible for analysis. At a median follow-up of 10·36 years (IQR 9·12-11·28), the 10-year local recurrence rates were 1·58% (95% CI 0·37 to 2·8) in the whole-breast irradiation group and 3·51% (1·99 to 5·03) in the APBI group. The difference in 10-year rates between the groups was 1·93% (95% CI -0·018 to 3·87; p=0·074). Adverse events were mostly grade 1 and 2, in 234 (60%) of 393 participants in the whole-breast irradiation group and 314 (67%) of 470 participants in the APBI group, at 7·5-year or 10-year follow-up, or both. Patients in the APBI group had a significantly lower incidence of treatment-related grade 3 late side-effects than those in the whole-breast irradiation group (17 [4%] of 393 for whole-breast irradiation vs seven [1%] of 470 for APBI; p=0·021; at 7·5-year or 10-year follow-up, or both). At 10 years, the most common type of grade 3 adverse event in both treatment groups was fibrosis (six [2%] of 313 patients for whole-breast irradiation and three [1%] of 375 patients for APBI, p=0·56). No grade 4 adverse events or treatment-related deaths have been observed. INTERPRETATION Postoperative APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is a valuable alternative to whole-breast irradiation in terms of treatment efficacy and is associated with fewer late side-effects. FUNDING German Cancer Aid, Germany.
Collapse
Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Oliver J Ott
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | | | - Hellen Knauerhase
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Jarosław Łyczek
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skł odowskej, Warsaw, Poland; Podkarpacki Hospital Cancer Center Brzozów, Brzozów, Poland
| | - Jose Luis Guinot
- Department of Radiation Oncology, Valencian Institute of Oncology Valencia, Valencia, Spain
| | | | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Michael Allgäuer
- Department of Radiation Oncology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Kristina Lössl
- Department of Radiation Oncology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Annika Schlamann
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Alexandra Resch
- Department of Radiation Oncology, University Hospital AKH Wien, Vienna, Austria
| | - Anna Kulik
- Brachytherapy Department, Centrum Onkologii-Instytut im Marii Skł odowskej, Warsaw, Poland
| | - Leo Arribas
- Department of Radiation Oncology, Valencian Institute of Oncology Valencia, Valencia, Spain
| | - Peter Niehoff
- Department of Radiation Oncology, University Hospital Kiel, Kiel, Germany; Department of Radiotherapy, Sana Clinic, Offenbach, Germany
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Kiel, Kiel, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Nuremberg, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Nuremberg, Germany
| |
Collapse
|
31
|
Abstract
BACKGROUND Limited level 1 evidence is available on the omission of radiotherapy after breast-conserving surgery in older women with hormone receptor-positive early breast cancer receiving adjuvant endocrine therapy. METHODS We performed a phase 3 randomized trial of the omission of irradiation; the trial population included women 65 years of age or older who had hormone receptor-positive, node-negative, T1 or T2 primary breast cancer (with tumors ≤3 cm in the largest dimension) treated with breast-conserving surgery with clear excision margins and adjuvant endocrine therapy. Patients were randomly assigned to receive whole-breast irradiation (40 to 50 Gy) or no irradiation. The primary end point was local breast cancer recurrence. Regional recurrence, breast cancer-specific survival, distant recurrence as the first event, and overall survival were also assessed. RESULTS A total of 1326 women were enrolled; 658 were randomly assigned to receive whole-breast irradiation and 668 to receive no irradiation. The median follow-up was 9.1 years. The cumulative incidence of local breast cancer recurrence within 10 years was 9.5% (95% confidence interval [CI], 6.8 to 12.3) in the no-radiotherapy group and 0.9% (95% CI, 0.1 to 1.7) in the radiotherapy group (hazard ratio, 10.4; 95% CI, 4.1 to 26.1; P<0.001). Although local recurrence was more common in the group that did not receive radiotherapy, the 10-year incidence of distant recurrence as the first event was not higher in the no-radiotherapy group than in the radiotherapy group, at 1.6% (95% CI, 0.4 to 2.8) and 3.0% (95% CI, 1.4 to 4.5), respectively. Overall survival at 10 years was almost identical in the two groups, at 80.8% (95% CI, 77.2 to 84.3) with no radiotherapy and 80.7% (95% CI, 76.9 to 84.3) with radiotherapy. The incidence of regional recurrence and breast cancer-specific survival also did not differ substantially between the two groups. CONCLUSIONS Omission of radiotherapy was associated with an increased incidence of local recurrence but had no detrimental effect on distant recurrence as the first event or overall survival among women 65 years of age or older with low-risk, hormone receptor-positive early breast cancer. (Funded by the Chief Scientist Office of the Scottish Government and the Breast Cancer Institute, Western General Hospital, Edinburgh; ISRCTN number, ISRCTN95889329.).
Collapse
Affiliation(s)
- Ian H Kunkler
- From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh
| | - Linda J Williams
- From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh
| | - Wilma J L Jack
- From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh
| | - David A Cameron
- From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh
| | - J Michael Dixon
- From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh
| |
Collapse
|
32
|
Salinas HM, Ainuz BY, Pourmoussa AJ, Levitt EB, Ali A, Bouz A, Treiser MD, Medina MA. Oncoplastic Augmentation Mastopexy in Breast Conservation Therapy: Retrospective Study and Postoperative Complications. Ann Plast Surg 2023; 90:33-40. [PMID: 36534098 DOI: 10.1097/sap.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. METHODS Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. RESULTS Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. CONCLUSIONS Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.
Collapse
Affiliation(s)
- Harry M Salinas
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
| | - Bar Y Ainuz
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Austin J Pourmoussa
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Eli B Levitt
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Aleeza Ali
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Antoun Bouz
- Division of Plastic Surgery, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Matthew D Treiser
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
| | - Miguel A Medina
- From the Department of Plastic and Reconstructive Surgery, Miami Cancer Institute at Baptist Health South Florida, Miami, FL
| |
Collapse
|
33
|
Hasan MT, Hamouda M, Khashab MKE, Elsnhory AB, Elghamry AM, Hassan OA, Fayoud AM, Hafez AH, Al-Kafarna M, Hagrass AI, Rabea RK, Gbreel MI. Oncoplastic versus conventional breast-conserving surgery in breast cancer: a pooled analysis of 6941 female patients. Breast Cancer 2023; 30:200-214. [PMID: 36622565 PMCID: PMC9950210 DOI: 10.1007/s12282-022-01430-5] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Breast cancer is the most prevalent cancer in women. In the past few years, surgical interventions for breast cancer have experienced massive changes from radical excision to conserving approaches. In this study, we aim to compare the two breast surgery interventions, including conventional breast-conserving surgery (CBCS) versus oncoplastic breast-conserving surgery (OPBCS). METHODS We searched on PubMed, Web of Science (WOS), Scopus, Embase, and Cochrane till 2 October 2021. All relevant randomized controlled trials (RCTs) and observational studies were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). RESULTS The pooled meta-analysis of the included studies showed that OPBCS was significantly superior to CBCS in most of the outcomes. Re-excision significantly favoured CBCS (RR = 0.49, 95% CI [0.37, 0.63], P < 0.00001). However, local recurrence (RR = 0.55, 95% CI [0.27, 1.09], P = 0.09), close surgical margins (RR = 0.37, 95% CI [0.14, 1.00], P = 0.05) and end up to the risk of mastectomy (RR = 0.73, 95% CI [0.54, 97], P = 0.06) showed no significant difference between both techniques. Notably, while performing a sensitivity analysis, other outcomes as local recurrence, significantly showed favourable results towards OPBCS. In terms of safety outcomes, there was no significant difference between OPBCS and CBCS. CONCLUSION We recommend the oncoplastic approach rather than the conventional one in females with breast cancer. Re-excision rates showed better results following OPBCS.
Collapse
Affiliation(s)
- Mohammed Tarek Hasan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Hamouda
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammad K El Khashab
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Ahmed Bostamy Elsnhory
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdullah Mohamed Elghamry
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Obada Atef Hassan
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Aya Mamdouh Fayoud
- Faculty of Pharmacy, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdelrahman H Hafez
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohammed Al-Kafarna
- Faculty of Pharmacy, Al-Azhar University-Gaza, Gaza Strip, Palestine
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Abdulrahman Ibrahim Hagrass
- Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Randa Kamal Rabea
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- International Medical Research Association (IMedRA), Cairo, Egypt
| | - Mohamed Ibrahim Gbreel
- Faculty of Medicine, October 6 University, Cairo Governorate, Giza, 11571, Egypt.
- International Medical Research Association (IMedRA), Cairo, Egypt.
| |
Collapse
|
34
|
Hughes RT, Ip EH, Urbanic JJ, Hu JJ, Weaver KE, Lively MO, Winkfield KM, Shaw EG, Diaz LB, Brown DR, Strasser J, Sears JD, Lesser GJ. Smoking and Radiation-induced Skin Injury: Analysis of a Multiracial, Multiethnic Prospective Clinical Trial. Clin Breast Cancer 2022; 22:762-770. [PMID: 36216768 PMCID: PMC10003823 DOI: 10.1016/j.clbc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Smoking during breast radiotherapy (RT) may be associated with radiation-induced skin injury (RISI). We aimed to determine if a urinary biomarker of tobacco smoke exposure is associated with increased rates of RISI during and after breast RT. PATIENTS AND METHODS Women with Stage 0-IIIA breast cancer treated with breast-conserving surgery or mastectomy followed by RT to the breast or chest wall with or without regional nodal irradiation were prospectively enrolled on a multicenter study assessing acute/late RISI. 980 patients with urinary cotinine (UCot) measurements (baseline and end-RT) were categorized into three groups. Acute and late RISI was assessed using the ONS Acute Skin Reaction scale and the LENT-SOMA Criteria. RESULTS Late Grade 2+ and Grade 3+ RISI occurred in 18.2% and 1.9% of patients, respectively-primarily fibrosis, pain, edema, and hyperpigmentation. Grade 2+ late RISI was associated with UCot group (P= 006). Multivariable analysis identified UCot-based light smoker/secondhand smoke exposure (HR 1.79, P= .10) and smoking (HR 1.60, p = .06) as non-significantly associated with an increased risk of late RISI. Hypofractionated breast RT was associated with decreased risk of late RISI (HR 0.51, P=.03). UCot was not associated with acute RISI, multivariable analysis identified race, obesity, RT site/fractionation, and bra size to be associated with acute RISI. CONCLUSIONS Tobacco exposure during breast RT may be associated with an increased risk of late RISI without an effect on acute toxicity. Smoking cessation should be encouraged prior to radiotherapy to minimize these and other ill effects of smoking.
Collapse
Affiliation(s)
- Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Edward H Ip
- Department of Biostatistics & Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States; Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - James J Urbanic
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Jennifer J Hu
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136.
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | | | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208, United States.
| | | | - Luis Baez Diaz
- Puerto Rico Minority Underserved NCI Community Oncology Research Program, 89 De Diego Avenue, PMB #711, Suite 105, San Juan, Puerto Rico 00927.
| | - Doris R Brown
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Jon Strasser
- Helen F Graham Cancer Center, 4701 Ogletown Stanton Rd, Newark, DE 19713, United States.
| | - Judith D Sears
- Piedmont Radiation Oncology, 1010 Bethesda Court, Winston-Salem, NC 27103, United States.
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine.
| |
Collapse
|
35
|
Dave RV, Barrett E, Morgan J, Chandarana M, Elgammal S, Barnes N, Sami A, Masudi T, Down S, Holcombe C, Potter S, Somasundaram SK, Gardiner M, Mylvaganam S, Maxwell A, Harvey J. Wire- and magnetic-seed-guided localization of impalpable breast lesions: iBRA-NET localisation study. Br J Surg 2022; 109:274-282. [PMID: 35089321 PMCID: PMC10364683 DOI: 10.1093/bjs/znab443] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 08/02/2023]
Abstract
BACKGROUND Wire localization is historically the most common method for guiding excision of non-palpable breast lesions, but there are limitations to the technique. Newer technologies such as magnetic seeds may allow some of these challenges to be overcome. The aim was to compare safety and effectiveness of wire and magnetic seed localization techniques. METHODS Women undergoing standard wire or magnetic seed localization for non-palpable lesions between August 2018 and August 2020 were recruited prospectively to this IDEAL stage 2a/2b platform cohort study. The primary outcome was effectiveness defined as accurate localization and removal of the index lesion. Secondary endpoints included safety, specimen weight and reoperation rate for positive margins. RESULTS Data were accrued from 2300 patients in 35 units; 2116 having unifocal, unilateral breast lesion localization. Identification of the index lesion in magnetic-seed-guided (946 patients) and wire-guided excisions (1170 patients) was 99.8 versus 99.1 per cent (P = 0.048). There was no difference in overall complication rate. For a subset of patients having a single lumpectomy only for lesions less than 50 mm (1746 patients), there was no difference in median closest margin (2 mm versus 2 mm, P = 0.342), re-excision rate (12 versus 13 per cent, P = 0.574) and specimen weight in relation to lesion size (0.15 g/mm2versus 0.138 g/mm2, P = 0.453). CONCLUSION Magnetic seed localization demonstrated similar safety and effectiveness to those of wire localization. This study has established a robust platform for the comparative evaluation of new localization devices.
Collapse
Affiliation(s)
- Rajiv V. Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Barrett
- Department of Medical Statistics, Manchester University Hospitals NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Mihir Chandarana
- Breast Unit, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Suzanne Elgammal
- Breast Unit, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Nicola Barnes
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amtul Sami
- Breast Unit, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Tahir Masudi
- Breast screening and assessment unit, Rotherham General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sue Down
- Breast Unit, James Paget University Hospital, Great Yarmouth, UK
| | - Chris Holcombe
- Breast Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | | | - Matthew Gardiner
- Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Senthurun Mylvaganam
- Health Education West Midlands, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anthony Maxwell
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - James Harvey
- Correspondence to: Consultant Oncoplastic Breast Surgeon, The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK (e-mail: )
| | | |
Collapse
|
36
|
Shimizu N, Myojin M, Tamura M, Nishiyama N, Yamashiro K, Yuyama Y, Okazaki Y, Suzuki Y, Takahashi M. Significance of boost radiotherapy in early invasive ductal breast cancer with ductal carcinoma in situ component under negative surgical margins. J Radiat Res 2022; 63:80-87. [PMID: 34718690 PMCID: PMC8776689 DOI: 10.1093/jrr/rrab103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/08/2021] [Indexed: 06/13/2023]
Abstract
We hypothesize that there is a risk of ipsilateral breast tumor recurrence (IBTR) in surgical margin-free invasive ductal carcinoma (IDC) in the presence of ductal carcinoma in situ (DCIS) component affecting surgical margins in early stage. From 1990 to 2014, 343 patients with IDC in which the DCIS component constitute have received radiotherapy (RT) following breast-conserving surgery (BCS). All patients received whole breast irradiation with a prescribed dose of 50 Gy in 20 fractions (four times a week). This one-arm cohort with boost RT (253 patients) was compared for IBTR with a non-cohort group receiving no boost RT because of freedom from positive margins (90 patients). Median observation months were 98 (boost group) vs 119 (no boost group), respectively. The 15-year local recurrence-free survival (LRFS) rates were 98.5% and 85.6% in the boost and no boost groups, respectively (Cox proportional hazards model univariate analysis; p = 0.013, HR 0.13). Similarly, for other background factors, there was a significant difference in the LRFS between age groups. The 15-year LRFS rate was 91.8% in patients aged 45 years or younger and 94.6% in patients older than 46 years (p = 0.031, HR 0.21), respectively. Only these two factors were independently significant in Cox proportional hazards model multivariate analysis. IBTR risk in margin-free IDC with DCIS component was independently decreased by boost RT in the cohort setting. Tumor size, extensive intraductal component (EIC), boost dose, the presence of lymph node (LN) metastasis and hormonal therapy were not IBTR risk factors in this study.
Collapse
Affiliation(s)
| | - Miyako Myojin
- Corresponding author. Department of Radiation Oncology, Keiyukai Sapporo Hospital, 14-kita1-1 Hondori Shiroishi-ku, Sapporo, Hokkaido 003-0027, Japan, Telephone: +81-11-863-2101,
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Wu F, Zhang X. Effect of fluorouracil and plastic breast-conserving surgery in young patients with early breast cancer. Pak J Pharm Sci 2021; 34:2365-2370. [PMID: 35039275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To explore the effect of fluorouracil and plastic breast-conserving surgery on the immune level, psychological status and quality of life of young patients with early breast cancer. Seventy-six young patients with early breast cancer admitted to Cangzhou Central Hospital from January 2016 to January 2017 were selected and divided into a control group (n=38, conventional breast-conserving surgery) and an observation group (n=38, Fluorouracil and plastic breast-conserving surgery). The observation group had shorter operation time and hospital stay and less intraoperative blood loss in comparison to the control group (P<0.05); the CD4+, CD8+ and IL-8 of the observation group were higher, and the CD4+/CD8+ and IL-10 were lower (P<0.05); the HAMD and HAMA scores of the observation group were significantly lower (P<0.05); the physiological, emotional, and family, functional, and additional concerns were lower in the observation group (P<0.05); the postoperative breast shape satisfaction was higher in the observation group (P<0.05). Fluorouracil combined with plastic breast-conserving surgery has a better treatment effect on young patients with early breast cancer, which can promote postoperative recovery, maintain normal breast morphology, reduce the immune function damage caused by the surgery, improve patients' psychological status and quality of life, and reduce the incidence of postoperative complications and deaths.
Collapse
Affiliation(s)
- Feng Wu
- Department of Day Operation Treatment, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xiaoyu Zhang
- Thyroid Breast External Three Departments, Cangzhou Central Hospital, Cangzhou, Hebei, China
| |
Collapse
|
38
|
Tenna S, Morelli Coppola M, Salzillo R, Barone M, Brunetti B, Cagli B, Cogliandro A, Persichetti P. Delayed Mastopexy Following Breast-Conserving Surgery and Radiation Therapy: A Case-Control Study to Evaluate Safety and Versatility of the Central Mound Technique. Aesthetic Plast Surg 2021; 46:2164-2173. [PMID: 34599353 DOI: 10.1007/s00266-021-02615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breast remodeling following breast-conserving surgery (BCS) and radiation therapy (RT) is challenging and often burdened by complications due to irradiated tissue atrophy. The authors present a case-control study to compare the central mound mastopexy (CMM) to more conventional techniques, applying it to different patterns of skin excision. METHODS A variation of the original central mound technique is presented separately addressing glandular and cutaneous deformities. Between 2012 and 2018, 17 consecutive patients presenting defects following unilateral BCS and RT underwent breast remodeling with CMM technique. Immediate and long-term complications together with patient-reported outcomes were evaluated and compared to a matched control group of sixteen patients who underwent superior pedicle mammoplasty. Two independent plastic surgeons reviewed pre- and postoperative photographs and rated the cosmetic outcomes on a visual analog scale from 1 to 5. RESULTS In the study group, different patterns of skin excision, i.e., inverted-T pattern (41.2%), circumareolar (23.5%), skin-sparing type V (17.65%), omega (11.77%), and J (5.88%), were used to correct various breast deformities, and a decisional algorithm was developed. No major complications were registered. Retraction recurrence rate was higher in the control group (p = 0.037). Cosmetic results were considered more satisfying in the CMM group by both patients (4.18 vs 3.00, p<0.001) and surgeons (4.06 vs 2.69, p=0.001). CONCLUSIONS The CMM technique is an advanced approach that addresses breast remodeling after BCS-RT surgery yielding reliable results. Following our algorithm, several patterns of skin excision, tailored to pre-existing scars, can be considered and safely performed. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Mauro Barone
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| |
Collapse
|
39
|
Sun ZH, Chen C, Kuang XW, Song JL, Sun SR, Wang WX. Breast surgery for young women with early-stage breast cancer: Mastectomy or breast-conserving therapy? Medicine (Baltimore) 2021; 100:e25880. [PMID: 33951002 PMCID: PMC8104198 DOI: 10.1097/md.0000000000025880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
Whether breast-conserving therapy (BCT) should be chosen as a local treatment for young women with early-stage breast cancer is controversial. This study compared the survival benefits of BCT or mastectomy in young women under 40 with early-stage breast cancer and further explored age-stratified outcomes. This study investigated whether there is a survival benefit when young women undergo BCT compared with mastectomy.The characteristics and prognosis of white women under 40 with stage I-II breast cancer from 1988 to 2016 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. These women were either treated with BCT or mastectomy. The log-rank test of the Kaplan-Meier survival curve and Cox proportional risk regression model were used to analyze the data and survival. The analysis was stratified by age (18-35 and 36-40 years).A total of 23,810 breast cancer patients were included, of whom 44.9% received BCT and 55.1% underwent mastectomy, with a median follow-up of 116 months. Patients undergoing mastectomy had a higher tumor burden and younger age. By the end of the 20th century, the proportion of BCT had grown from nearly 35% to approximately 60%, and then gradually fell to 35% into the 21st century. Compared with the mastectomy group, the BCT group had improved breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.917; 95% CI, 0.846-0.995, P = .037) and overall survival (OS) (HR 0.925; 95% CI, 0.859-0.997, P = .041). In stratified analysis according to the different ages, the survival benefit of BCT was more pronounced in the slightly older (36-40 years) group while there was no significant survival difference in the younger group (18-35 years).In young women with early-stage breast cancer, BCT showed survival benefits that were at least no worse than mastectomy, and these benefits were even better in the 36 to 40 years age group. Young age may not be a contraindication for BCT.
Collapse
Affiliation(s)
- Zhi-Hong Sun
- Department of General Surgery
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xin-Wen Kuang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | | |
Collapse
|
40
|
Kouwenberg CAE, Mureau MAM, Kranenburg LW, Rakhorst H, de Leeuw D, Klem TMAL, Koppert LB, Ramos IC, Busschbach JJ. Cost-utility analysis of four common surgical treatment pathways for breast cancer. Eur J Surg Oncol 2020; 47:1299-1308. [PMID: 33349523 DOI: 10.1016/j.ejso.2020.11.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/28/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim was to evaluate the cost-utility of four common surgical treatment pathways for breast cancer: mastectomy, breast-conserving therapy (BCT), implant breast reconstruction (BR) and autologous-BR. METHODS Patient-level healthcare consumption data and results of a large quality of life (QoL) study from five Dutch hospitals were combined. The cost-effectiveness was assessed in terms of incremental costs and quality adjusted life years (QALYs) over a 10-year follow-up period. Costs were assessed from a healthcare provider perspective. RESULTS BCT resulted in comparable QoL with lower costs compared to implant-BR and autologous-BR and showed better QoL with higher costs than mastectomy (€17,246/QALY). QoL outcomes and costs of especially autologous-BR were affected by the relatively high occurrence of complications. If reconstruction following mastectomy was performed, implant-BR was more cost-effective than autologous-BR. CONCLUSION The occurrence of complications had a substantial effect on costs and QoL outcomes of different surgical pathways for breast cancer. When this was taken into account, BCT was most the cost-effective treatment. Even with higher costs and a higher risk of complications, implant-BR and autologous-BR remained cost-effective over mastectomy. This pleas for adapting surgical pathways to individual patient preferences in the trade-off between the risks of complications and expected outcomes.
Collapse
Affiliation(s)
- Casimir A E Kouwenberg
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Hospital Medisch Spectrum Twente/ Hospital Group Twente, Enschede, the Netherlands
| | - Daniëlle de Leeuw
- Department of Surgery, Hospital Group Twente, Almelo, the Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
41
|
Godden AR, O'Connell RL, Barry PA, Krupa KCD, Wolf LM, Mohammed K, Kirby AM, Rusby JE. 3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment. Breast Cancer 2020; 27:1126-1136. [PMID: 32562188 PMCID: PMC7717038 DOI: 10.1007/s12282-020-01117-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Two-thirds of patients with early breast cancer undergo breast-conserving treatment (BCT). Aesthetic outcome is important and has long term implications for psychosocial wellbeing. The aesthetic goal of BCT is symmetry for which there is no gold-standard measure. Panel scoring is the most widely adopted assessment but has well-described limitations. This paper describes a model to objectively report aesthetic outcome using measures derived from 3-dimensional surface images (3D-SI). METHOD Objective measures and panel assessment were undertaken independently for 3D-SI of women who underwent BCT 1-5 years previously. Univariate analysis was used to test for association between measures and panel score. A forward stepwise multiple linear regression model was fitted to identify 3D measurements that jointly predicted the mean panel score. The fitted model coefficients were used to predict mean panel scores for an independent validation set then compared to the mean observed panel score. RESULTS Very good intra-panel reliability was observed for the training and validation sets (wκ = 0.87, wκ = 0.84). Six 3D-measures were used in the multivariate model. There was a good correlation between the predicted and mean observed panel score in the training (n = 190) and validation (n = 100) sets (r = 0.68, r = 0.65). The 3D model tended to predict scores towards the median. The model was calibrated which improved the distribution of predicted scores. CONCLUSION A six-variable objective aesthetic outcome model for BCT has been described and validated. This can predict and could replace panel assessment, facilitating the independent and unbiased evaluation of aesthetic outcome to communicate and compare results, benchmark practice, and raise standards.
Collapse
Affiliation(s)
- Amy R Godden
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Rachel L O'Connell
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Peter A Barry
- Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | | | - Lisa M Wolf
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Kabir Mohammed
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Anna M Kirby
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
- Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Jennifer E Rusby
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| |
Collapse
|
42
|
Fitzpatrick SE, Lam TC. Occult Breast Carcinoma Is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:117e-126e. [PMID: 32740565 DOI: 10.1097/prs.0000000000006965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens. METHODS The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer. RESULTS Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001). CONCLUSIONS Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.
Collapse
Affiliation(s)
| | - Thomas C Lam
- From the Plastic and Reconstructive Surgery Department, Westmead Private Hospital
| |
Collapse
|
43
|
Kawamura M, Itoh Y, Kamomae T, Sawaki M, Kikumori T, Tsunoda N, Ito J, Shimoyama Y, Satake H, Naganawa S. A phase I/II trial of intraoperative breast radiotherapy in an Asian population: 10-year results with critical evaluation. J Radiat Res 2020; 61:602-607. [PMID: 32494808 PMCID: PMC7336551 DOI: 10.1093/jrr/rraa029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/12/2020] [Indexed: 06/11/2023]
Abstract
Although phase III trials have been published comparing whole breast irradiation (WBI) with accelerated partial breast irradiation (APBI) using intraoperative radiotherapy (IORT), long-term follow-up results are lacking. We report the 10-year follow-up results of a prospective phase I/II clinical trial of IORT. The inclusion criteria were as follows: (i) tumor size <2.5 cm, (ii) desire for breast-conserving surgery, (iii) age >50 years, (iv) negative margins after resection and (v) sentinel lymph node-negative disease. A single dose of IORT (19-21 Gy) was delivered to the tumor bed in the operation room just after wide local excision of the primary breast cancer using a 6-12 MeV electron beam. Local recurrence was defined as recurrence or new disease within the treated breast and was evaluated annually using mammography and ultrasonography. A total of 32 patients were eligible for evaluation. The median patient age was 65 years and the median follow-up time was 10 years. Two patients experienced local recurrence just under the nipple, out of the irradiated field, after 8 years of follow-up. Three patients had contralateral breast cancer and one patient experienced bone metastasis after 10 years of follow-up. No patient experienced in-field recurrence nor breast cancer death. Eight patients had hypertrophic scarring at the last follow-up. There were no lung or heart adverse effects. This is the first report of 10-year follow-up results of IORT as APBI. The findings suggest that breast cancer with extended intraductal components should be treated with great caution.
Collapse
Affiliation(s)
- Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Toyone Kikumori
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobuyuki Tsunoda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Junji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Hiroko Satake
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
44
|
Ozmen V, Ilgun S, Celet Ozden B, Ozturk A, Aktepe F, Agacayak F, Elbuken F, Alco G, Ordu C, Erdogan Iyigun Z, Emre H, Pilancı K, Soybir G, Ozmen T. Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates. World J Surg Oncol 2020; 18:87. [PMID: 32370753 PMCID: PMC7201547 DOI: 10.1186/s12957-020-01858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. PATIENTS AND METHODS The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. RESULTS A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14-116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). DISCUSSION The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
Collapse
Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Istanbul, Turkey
| | - Serkan Ilgun
- Department of General Surgery, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Burcu Celet Ozden
- Department of Plastic and Reconstructive Surgery, School of Medicine, Altinbas University, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, School of Medicine, Biruni University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Department of Physical Therapy and Rehabilitation, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Hocaoglu Emre
- Department of Plastic & Reconstructive Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban Pilancı
- Department of Medical Oncology, Bahcesehir Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Tolga Ozmen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| |
Collapse
|
45
|
Urano M, Nishikawa H, Goto T, Shiraki N, Matsuo M, Denewar FA, Kondo N, Toyama T, Shibamoto Y. Digital Mammographic Features of Breast Cancer Recurrences and Benign Lesions Mimicking Malignancy Following Breast-Conserving Surgery and Radiation Therapy. Kurume Med J 2020; 65:113-121. [PMID: 31723078 DOI: 10.2739/kurumemedj.ms654005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mammography after breast-conserving surgery and radiation therapy is an important tool for followup. Early diagnosis of local recurrence enables prompt treatment decisions, which may affect patient prognosis. For complicated post-treatment changes, radiologists sometimes have difficulties in interpreting follow-up mammography. Fat necrosis, dystrophic calcifications, suture calcification features, breast edema, seroma and distorted breast are benign changes related to treatment. These findings may mimic or hide tumor recurrence making it difficult to diagnose recurrences or prevent inappropriate biopsies. Recurrent tumors in follow-up mammography show several typical findings such as increasing asymmetric density, enlarging mass, reappearance of breast edema, and micro-calcifications. The purpose of this pictorial review is to demonstrate and discuss mammographic findings of recurrent tumors and important post-treatment changes that may mimic benign or malignant lesions, also using breast ultrasound images or breast magnetic resonance images. Recognizing post-treatment changes may help radiologists to more effectively identify candidates for suspected local recurrences.
Collapse
Affiliation(s)
- Misugi Urano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Norio Shiraki
- Department of Radiology, Nagoya City West Medical Center
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medical Sciences
| | | | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| |
Collapse
|
46
|
Zaha H, Motonari T, Abe N, Unesoko M. Fat necrosis in level I oncoplastic breast-conserving surgery focusing on a modified round block technique. Breast Cancer 2020; 27:567-572. [PMID: 31933122 DOI: 10.1007/s12282-020-01046-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
The modified round block technique (MRBT) is a level I oncoplastic breast-conserving surgery (OBCS), which contains a very wide glandular flap created by extensive dual-plane undermining that is achieved by entire subcutaneous dissection and approximately 50% dissection of the breast parenchyma from the pectoralis muscle. A retrospective analysis was performed for 100 patients who underwent OBCS using MRBT from February 2009 to October 2017. The incidence of positive margin was 7.0% (seven cases), and there has been no local recurrence during a median follow-up period of 68 months. Short- and long-term complications included fat necrosis (11.0%), infection (4.0%), and hematoma formation (4.0%). When patients were divided into two groups based upon the preoperative mammography findings, fat necrosis occurred in 5.2% of the patients with extremely dense or heterogeneously dense mammography, and in 19.0% of patients with scattered fibroglandular or entire fat mammography, which showed a statistically significant difference. Therefore, in level I OBCS, the extent of dual-plane undermining should be minimized to less than 50% of the total parenchyma in fatty breasts.
Collapse
Affiliation(s)
- Hisamitsu Zaha
- Department of Breast Surgery, Nakagami Hospital, Noborikawa, Okinawa City, Okinawa, 904-2195, Japan.
| | - Tokiwa Motonari
- Department of Breast Surgery, Nakagami Hospital, Noborikawa, Okinawa City, Okinawa, 904-2195, Japan
| | - Norie Abe
- Department of Breast Surgery, Nakagami Hospital, Noborikawa, Okinawa City, Okinawa, 904-2195, Japan
| | - Mikiko Unesoko
- Department of Breast Surgery, Nakagami Hospital, Noborikawa, Okinawa City, Okinawa, 904-2195, Japan
| |
Collapse
|
47
|
Burrah R, James K, Lund J, Vinayagam R. Breast conservation surgery by round block mammoplasty. Eur J Surg Oncol 2019; 46:240-244. [PMID: 31699338 DOI: 10.1016/j.ejso.2019.10.034] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/13/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Round block mammoplasty (RBM) is a type of Oncoplastic procedure to facilitate breast conservation surgery for breast cancer. METHODS Retrospective study of 270 patients who underwent this surgery. The surgical and oncological outcomes of RBM were studied. RESULTS The median age was 61 years and median follow-up 39 months. Most cancers (59%) were screen-detected. The location of the cancer was commonly in the upper outer quadrant followed by upper inner quadrant (20%). The average tumor size was 18 mm and in 48% of patients the whole tumor size increased to 23.5 mm due to associated DCIS. The median specimen weight was 41 gm. Forty patients (14.8%) had positive margins. Postoperative complications were seen in 18 patients (6.6%). There were 4 local and 1 axillary recurrences, and 8 distant metastasis. Contralateral symmetrising surgery was required in 13 patients (4.8%). CONCLUSION RBM is a robust and easily adaptable technique which provides good exposure for a safe oncological excision. The surgical and oncological outcomes are good and contralateral symmetrising surgery is rarely required.
Collapse
Affiliation(s)
- Rajaram Burrah
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK.
| | - Karen James
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
| | - Jonathan Lund
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
| | - Raman Vinayagam
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
| |
Collapse
|
48
|
Behluli I, Le Renard P, Rozwag K, Oppelt P, Kaufmann A, Schneider A. Oncoplastic breast surgery versus conventional breast-conserving surgery: a comparative retrospective study. ANZ J Surg 2019; 89:1236-1241. [PMID: 30990940 PMCID: PMC6849881 DOI: 10.1111/ans.15245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/19/2019] [Accepted: 03/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND In addition to conventional breast-conserving surgery (BCS), oncoplastic breast surgery (OBS) is an operation technique that strives simultaneously to increase oncological safety and patient's satisfaction. It is the combination of the best-proven techniques in plastic surgery with surgery for breast cancer. In a growing number of indications, OBS overcomes the limit of conventional BCS by allowing larger resection volumes while avoiding deformities. The aim of our retrospective study (2012-2014) was to compare oncological outcomes of OBS versus BCS. METHODS We compared two groups of patients with primary non-metastatic breast tumours: group A (n = 291), where BCS was performed, versus group B (n = 52), where OBS was performed. Surgical interventions were performed in German and Swiss teaching hospital settings. The surgeon for group B had subspecialist training in OBS. We assessed outcome in term of re-excision rates, resection margin and complications. RESULTS Groups were homogenous (no significant differences in terms of age, tumour size, tumour type or grade). The resection margin was larger in group B (7 mm) than in group A (3 mm). Re-excision rate of group B (8%) was significantly lower than in group A (31%). Complication rates were comparably low in groups A and B. CONCLUSION Despite the limits of retrospective design, our study confirms that OBS is safe and reduces the re-excision rates and the need for further surgery. OBS has the potential to improve oncological care and should be more widely adopted.
Collapse
Affiliation(s)
- Ilmi Behluli
- Department of Gynaecology and Gynaecological OncologyCharité University Medicine BerlinBerlinGermany
- Department of GynaecologyKantonsspital BasellandLiestalSwitzerland
- Department of Gynaecology, Obstetrics and Gynaecological Endocrinology, Kepler University HospitalJohannes Kepler University LinzLinzAustria
| | - Pol‐Edern Le Renard
- Department of Gynaecology, Obstetrics and Gynaecological Endocrinology, Kepler University HospitalJohannes Kepler University LinzLinzAustria
| | - Kamila Rozwag
- Department of Gynaecology and Gynaecological OncologyCharité University Medicine BerlinBerlinGermany
| | - Peter Oppelt
- Department of Gynaecology, Obstetrics and Gynaecological Endocrinology, Kepler University HospitalJohannes Kepler University LinzLinzAustria
| | - Andreas Kaufmann
- Department of Gynaecology and Gynaecological OncologyCharité University Medicine BerlinBerlinGermany
| | - Achim Schneider
- Department of Gynaecology and Gynaecological OncologyCharité University Medicine BerlinBerlinGermany
- Medizinisches Versorgungszentrum im Fürstenberg‐Karree Berlin (MVZ)BerlinGermany
| |
Collapse
|
49
|
Mészáros N, Farkas G, Székely G, Kocsis ZS, Kelemen PB, Fodor J, Polgár C, Jurányi Z. Progressive breast fibrosis caused by extreme radiosensitivity: Oncocytogenetic diagnosis and treatment by reconstructive flap surgery. Cancer Rep (Hoboken) 2019; 2:e1126. [PMID: 32721122 PMCID: PMC7941586 DOI: 10.1002/cnr2.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/27/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fibrosis, a proliferative response of fibrocytes after tissue injury, is a common sequela of external radiotherapy and can vary greatly among patients even in the absence of DNA repair syndromes, due to their different intrinsic radiosensitivity. Fibrosis is also a serious cosmetic problem for patients, and in some cases it can also imply pain. CASE Here, we report a case of a severe fibrosis 2 years after breast conserving surgery and postoperative 3D conformal breast irradiation. Furthermore, our patient had the suspicion of tumour recurrence. Our examinations were aimed at diagnosing recurrence or the lack of recurrence and investigating whether the symptoms occurred due to overdosing or extreme intrinsic radiosensitivity. Therefore, examining the patients' radiosensitivity, a cytogenetic test was performed, which revealed the patient's increased susceptibility to ionizing radiation, and therefore we rejected the prospect of overdosage. As a solution for the fibrosis, mastectomy was effectuated, and a latissimus dorsi musculocutaneous flap was used for reconstruction. CONCLUSIONS We suggest a multi-disciplinary approach to manage fibrosis and propose cytogenetic markers to be used as predictors to identify patients who most likely benefit from a certain therapeutic regimen in terms of reduction of therapy-related side effects.
Collapse
Affiliation(s)
- Norbert Mészáros
- Centre of RadiotherapyNational Institute of OncologyBudapestHungary
- Department of OncologySemmelweis University, Faculty of MedicineBudapestHungary
| | - Gyöngyi Farkas
- Department of Radiobiology and Diagnostic Onco‐Cytogenetics, Centre of RadiotherapyNational Institute of OncologyBudapestHungary
| | - Gábor Székely
- Department of Radiobiology and Diagnostic Onco‐Cytogenetics, Centre of RadiotherapyNational Institute of OncologyBudapestHungary
| | - Zsuzsa S. Kocsis
- Department of Radiobiology and Diagnostic Onco‐Cytogenetics, Centre of RadiotherapyNational Institute of OncologyBudapestHungary
| | - Péter B. Kelemen
- Department of Breast and Sarcoma SurgeryNational Institute of OncologyBudapestHungary
| | - János Fodor
- Centre of RadiotherapyNational Institute of OncologyBudapestHungary
| | - Csaba Polgár
- Centre of RadiotherapyNational Institute of OncologyBudapestHungary
- Department of OncologySemmelweis University, Faculty of MedicineBudapestHungary
| | - Zsolt Jurányi
- Department of Radiobiology and Diagnostic Onco‐Cytogenetics, Centre of RadiotherapyNational Institute of OncologyBudapestHungary
| |
Collapse
|
50
|
Ganju RG, Savvides G, Korentager S, Ward MJ, TenNapel M, Amin A, Wagner J, Mitchell M. Incidence of breast lymphedema and predictors of its development in patients receiving whole breast radiation therapy after breast-conservation surgery. Lymphology 2019; 52:126-133. [PMID: 31874124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
One common adverse effect following breast-conservation surgery and adjuvant radiation is lymphedema. While lymphedema of the arm has been well-characterized, there has been less investigation into lymphedema of the breast. We sought to characterize rates of breast lymphedema (BLE) in women with early-stage breast cancer and identify potential predictors in its development. Two hundred and thirty consecutive patients treated with lumpectomy and adjuvant whole breast radiation therapy (WBRT) from January 2016 - June 2017 were included. All patients were seen in our lymphedema monitoring clinic for baseline and at least one follow-up lymphedema measurement. BLE grades were assigned by trained nurses in the lymphedema clinic. Data regarding patient demographic and treatment factors were extracted from the electronic medical record. Comparisons between groups were made using Chi-Square analysis performed in SAS. The median age of the sample was 62 (range 31-90). Median follow-up from surgery was 15.3 months. Forty-three patients were diagnosed with lymphedema of the breast (18.7%). Rates of grade 1 and 2 BLE were 93% and 7%, respectively; there were no cases of severe lymphedema. Sixty-three percent of cases resolved by last follow-up with treatment recommendations. There was no association between development of BLE and patient factors investigated, including age, T stage, radiation dose and fractionation, lymph node biopsy, number of lymph nodes removed, development of arm lymphedema, and use of chemotherapy. Tumor subtype was found to be significant (P = 0.04) and there was a trend towards significance for receipt of trastuzumab (P = 0.09). BLE is a distinct entity from arm lymphedema and is a common finding in women treated with breast-conserving surgery and adjuvant WBRT. It is a generally mild and self-limiting process. There were no treatment or patient-related factors that correlated with increased risk of lymphedema development in our sample except for HER-2 positive disease and receipt of trastuzamab.
Collapse
Affiliation(s)
- R G Ganju
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - G Savvides
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - S Korentager
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - M J Ward
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - M TenNapel
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - A Amin
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - J Wagner
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - M Mitchell
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas USA
| |
Collapse
|