scholarly journals Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast

JAMA Oncology ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. 75 ◽  
Author(s):  
Douglas W. Arthur ◽  
Kathryn A. Winter ◽  
Henry M. Kuerer ◽  
Bruce Haffty ◽  
Laurie Cuttino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Ipsilateral Breast ◽  
3 Dimensional

scholarly journals The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial

2018 ◽  
Vol 25 (10) ◽  
pp. 2858-2866 ◽  
Author(s):  
Kari M. Rosenkranz ◽  
Karla Ballman ◽  
Linda McCall ◽  
Charlotte Kubicky ◽  
Laurie Cuttino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Ipsilateral Breast ◽  
Initial Report

A phase III clinical trial to compare trastuzumab (T) given concurrently with radiation therapy (RT) to RT alone for women with HER2+ DCIS resected by lumpectomy (Lx): NSABP B-43.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS657-TPS657
Author(s):  
Melody A. Cobleigh ◽  
Stewart J. Anderson ◽  
Thomas B. Julian ◽  
Kalliopi P. Siziopikou ◽  
Douglas W. Arthur ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Agent ◽  
Tumor Biology ◽  
Cancer Recurrence ◽  
Breast Conserving Surgery ◽  
Molecular Therapy ◽  
Phase Iii ◽  
Fish Analysis ◽  
Ipsilateral Breast ◽  
Hazard Reduction

TPS657 Background: Asignificant amount of DCIS is ER negative and/or overexpresses HER2. This provides an opportunity to test molecular therapy in DCIS. In xenograft models and cell lines, T boosts RT effectiveness. In T-treated HER2+ patients, apoptosis occurs within 1 wk of single agent T use, with T found in ductal aspirates. Ample safety evidence for T exists. T given during whole breast irradiation (WBI) may improve results for Lx-resected HER2+ DCIS. A trial to examine this question will enhance the understanding of breast tumor biology and the prevention of such tumors and could possibly extend breast-conserving surgery benefits for women with DCIS. Methods: After Lx for pure DCIS, each patient’s DCIS lesion is centrally tested for HER2 by IHC analysis. HER2 2+ tumors undergo FISH analysis. HER2 3+ or FISH+ patients can be randomly assigned to 2 doses of T, 3 weeks apart during WBI or to WBI alone. Women ≥18 yrs. with a margin-clear Lx for pure DCIS, with ECOG status 0/1 who are and clinically or pathologically node negative are eligible. Centrally tested DCIS must be HER2 +. ER and/or PR status must be known before randomization. Primary aims are to determine if T decreases ipsilateral breast cancer recurrence, ipsilateral skin cancer recurrence, or ipsilateral DCIS. Secondary aims are to determine the benefit of T in preventing regional or distant recurrence and contralateral invasive breast cancer or DCIS. B-43 will determine if DFS, recurrence-free interval, and OS can be improved with the use of T. 2000 patients will be accrued over 7.9 yrs, with a definitive analysis of primary endpoints performed at163 ipsilateral breast cancer events (7.5 - 8 yrs. after protocol initiation) with an 80% power to detect a hazard reduction of 36%, from 1.73 ipsilateral breast cancer events per 100 pt-yrs to 1.11 events per 100 pt-yrs. The 36% observed reduction in the hazard of IIBCR-SCR-DCIS on the T arm is based on a projection of 40% hazard reduction if the compliance were perfect, with a 10% noncompliance rate. As of 12-31-11, 763 patients have been randomized. NCT00769379 Grant support: PHS NCI-U10-CA-69651, -12027, and NCI P30-CA-14599 from the US NCI and Genentech, Inc.

scholarly journals The impact of atypical hyperplasia at the margins of breast-conserving surgery on the outcomes of breast cancer in patients treated with neoadjuvant chemotherapy

2021 ◽  
Author(s):  
Heran Deng ◽  
Jing Zhang ◽  
Tingting Hu ◽  
Qian Li ◽  
Yaping Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Breast Conserving Surgery ◽  
Atypical Hyperplasia ◽  
Surgical Margins ◽  
Breast Cancer Patients ◽  
Ipsilateral Breast ◽  
Free Survival ◽  
The Impact

Purpose Women with atypical hyperplasia (AH) is associated with a higher risk of later breast cancer. However, whether AH found at margins in patients with breast-conserving surgery (BCS) and neoadjuvant chemotherapy (NAC) needs re-excision is not well-defined. The aim of the present study was to evaluate the impact of atypical hyperplasia at the surgical margins on the local recurrence and survival outcomes in breast cancer patients treated with NAC and BCS. Methods A retrospective analysis comparing patients who received NAC with AH and received no re-excision to those without AH at the margins of BCS was performed. Results 323 patients were included in this study. The 5-year rates of ipsilateral breast tumor recurrence (IBTR) were 6% and 4.5% in patients with and without AH, respectively. Distant-metastasis-free survival (DMFS) at 5 years was 81.2% in the AH group, and 88.1% in the no-AH group. No significant differences were observed among the two groups in terms of IBTR, DMFS, or OS. Conclusion Our study suggests that AH involved at the surgical margins of BCS in patients who received NAC does not increase the risk of ipsilateral breast cancer, and there is insufficient evidence for surgeon to further resect AH found at the margins of BCS in these patients.

scholarly journals Three-Dimensionally-Precise Breast Conformal Device for IMRT in Breast Cancer Patients Treated With Breast-Conserving Surgery—A Pilot Randomized Controlled Trial

2020 ◽  
Vol 19 ◽  
pp. 153303382097156
Author(s):  
Chunbo He ◽  
Shilin Zhang ◽  
Lei Shi
Keyword(s):  
Breast Cancer ◽  
Controlled Trial ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Conformity Index ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
3 Dimensional ◽  
Novel Device ◽  
Prescription Dose

Objective: To examine the accuracy and efficiency of breast radiotherapy after breast-conserving surgery of a novel 3-dimensional (3D) printing tissue compensator technology, the 3D-precise breast conformer, compared with a usual compensator and an unstructured compensator. Methods: This novel device is patented in China (patent No.: ZL2015 2 0259472.9). Thirty patients with breast cancer after breast-conserving surgery were randomly divided into 2 control groups (no compensator, NST group, and usual compensator, ST group) and 1 study group (3D-precise breast conformer, 3D-BCT group) (n = 10/group). Before radiotherapy, all patients were scanned in the same CT positioning conditions to prepare the treatment plans. Results: The 3D-BCT showed the best homogeneity index (HI) (0.08 ± 0.03) and conformity index (CI) (0.95 ± 0.03), while the NST group showed the worst HI (0.34 ± 0.07) and CI (0.78 ± 0.06), with the ST group between the 2 (HI: 0.15 ± 0.05; CI: 0.87 ± 0.04) (all P < 0.01). The common tissue compensation membrane could lead to 95-100% of the prescription dose covering 85-95% of the target volume, and the uniformity and conformability of the target dose were improved overall compared with the NST group. In the 3D-BCT group, 100% of the prescription dose covered the target volume of 95-100%. Conclusion: The 3D-precision breast conformal device had the highest individualization, uniformity, and conformity. The V95, V98, CI, and HI of PTV were optimal in the 3D-BCT group, and an ideal isodose curve distribution of the breast and clavicle upper and lower target areas was achieved. This device could improve the surface dose and the efficacy of radiotherapy after breast-conserving surgery.

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