scholarly journals Thermography in the follow-up of breast cancer patients after breast-conserving treatment by tumorectomy and radiation therapy

Cancer ◽  
1990 ◽  
Vol 65 (12) ◽  
pp. 2676-2680 ◽  
Author(s):  
Hans Ulrich Ulmer ◽  
Martina Brinkmann ◽  
Hans-Joachim Frischbier
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Breast Conserving Treatment

Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients.

1998 ◽  
Vol 16 (11) ◽  
pp. 3493-3501 ◽  
Author(s):  
C L Shapiro ◽  
P H Hardenbergh ◽  
R Gelman ◽  
D Blanks ◽  
P Hauptman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Cardiac Events ◽  
Female Population ◽  
Cardiac Effects ◽  
Dose Volume ◽  
Increased Risk

PURPOSE To assess the cardiac effects of two different cumulative doses of adjuvant doxorubicin and radiation therapy (RT) in breast cancer patients. PATIENTS AND METHODS Two hundred ninety-nine breast cancer patients were prospectively randomized to receive either five cycles (CA5) or 10 cycles (CA10) of adjuvant treatment with cyclophosphamide (500 mg/ m2) and doxorubicin (45 mg/m2) administered by intravenous bolus every 21 days. One hundred twenty-two of these patients also received RT. Estimates of the cardiac RT dose-volume were retrospectively categorized as low, moderate, or high. The risk of major cardiac events (congestive heart failure, acute myocardial infarction) was assessable in 276 patients (92%), with a median follow-up time of 6.0 years (range, 0.5 to 19.4). RESULTS The estimated risk (95% confidence interval) of cardiac events per 100 patient-years was significantly higher for CA10 than for CA5 [1.7 (1.0 to 2.8) v 0.5 (0.1 to 1.2); P=.02]. The risk of cardiac events in CA5 patients, irrespective of the cardiac RT dose-volume, did not differ significantly from rates of cardiac events predicted for the general female population by the Framingham Heart Study. In CA10 patients, the incidence of cardiac events was significantly increased (relative risk ratio, 3.6; P < .00003) compared with the Framingham population, particularly in groups that also received moderate and high dose-volume cardiac RT. CONCLUSION Conventional-dose adjuvant doxorubicin as delivered in the CA5 regimen by itself, or in combination with locoregional RT, was not associated with a significant increase in the risk of cardiac events. Higher doses of adjuvant doxorubicin (CA10) were associated with a threefold to fourfold increased risk of cardiac events. This appears to be especially true in patients treated with higher dose-volumes of cardiac RT. Larger studies with longer follow-up periods are needed to confirm these results.

Second Malignancies After Treatment of Early-Stage Breast Cancer: Lumpectomy and Radiation Therapy Versus Mastectomy

2000 ◽  
Vol 18 (12) ◽  
pp. 2406-2412 ◽  
Author(s):  
Edward Obedian ◽  
Diana B. Fischer ◽  
Bruce G. Haffty
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Hormone Therapy ◽  
Detailed Analysis ◽  
Cancer Patients ◽  
Early Stage ◽  
Contralateral Breast ◽  
Second Malignancies ◽  
Breast Cancer Patients

PURPOSE: To determine the risk of second malignancies after lumpectomy and radiation therapy (LRT), and to compare it with that in a similar cohort of early-stage breast cancer patients undergoing mastectomy without radiation (MAST). PATIENTS AND METHODS: Between January 1970 and December 1990, 1,029 breast cancer patients at our institution underwent LRT. A cohort of 1,387 breast cancer patients who underwent surgical treatment by mastectomy (MAST), and who did not receive postoperative radiation during the same time period, served as a comparison group. Second malignancies were categorized as contralateral breast versus nonbreast. In the cohort of patients undergoing LRT, a detailed analysis was carried out with respect to age, disease stage, smoking history, radiation therapy technique, dose, the use of chemotherapy or hormone therapy, and other clinical and/or pathologic characteristics. RESULTS: As of March 1999, the median follow-up was 14.6 years for the LRT group and 16 years for the MAST group. The 15-year risk of any second malignancy was nearly identical for both cohorts (17.5% v 19%, respectively). The second breast malignancy rate at 15 years was 10% for both the MAST and LRT groups. The 15-year risk of a second nonbreast malignancy was 11% for the LRT and 10% for the MAST group. In the subset of patients 45 years of age or younger at the time of treatment, the second breast and nonbreast malignancy rates at 15 years were 10% and 5% for patients undergoing LRT versus 7% and 4% for patients undergoing mastectomy (P, not statistically significant). In the detailed analysis of LRT patients, second lung malignancies were associated with a history of tobacco use. There were fewer contralateral breast tumors in patients undergoing adjuvant hormone therapy, although this did not reach statistical significance. The adjuvant use of chemotherapy did not significantly affect the risk of second malignancies. CONCLUSION: There seems to be no increased risk of second malignancies in patients undergoing LRT using modern techniques, compared with MAST. Continued monitoring of these patient cohorts will be required in order to document that these findings are maintained with even longer follow-up periods. With nearly 15 years median follow-up periods, however, these data should be reassuring to women who are considering LRT as a treatment option.

Coronary artery calcification and cardiovascular outcomes after chest radiation therapy in breast cancer patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Abu Rmilah ◽  
N.A Anevakar ◽  
H.A Jouni ◽  
G.R Lin ◽  
N.A Laack ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Coronary Artery ◽  
Cancer Patients ◽  
Coronary Artery Calcification ◽  
Smoking History ◽  
Breast Cancer Patients ◽  
History Of ◽  
Group 1

Abstract Introduction Coronary artery calcification (CAC) is associated with and identifies patients at higher risk of major adverse cardiovascular events (MACE). However, the prevalence, characteristics, and outcomes of cancer patients with CAC on CT before or after chest radiation therapy (RT) are not well addressed. Methods Retrospective cohort study of all breast cancer patients who underwent chest RT at Mayo Clinic Rochester in 2010. All pre-RT CTs were reviewed and the extent of CAC was recorded in addition to history of pre-RT atherosclerotic risk factors (hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and smoking), history of pre-RT cardiovascular disease (CVD), and RT dosage. MACE (sudden cardiac death (SCD), acute coronary syndrome (ACS), and stroke), and CAC progression in follow-up were recorded. CAC extent was quantified before and on 5-year follow-up CT scan in all patients, and a positive change was considered progression. Patients were divided into 2 groups based on the presence of CAC before RT: present (group 1) or absent (group 2). Results Our cohort was comprised of 244 breast cancer patients who received chest RT. A total of 39 patients (16.9%) had evidence of CAC on CT prior to RT. Compared with patients without CAC before RT (n=205), those with CAC before RT were found to be older (71.8±7.7 vs 58.9±11.3, p&lt;0.01), had higher pre-RT history of HTN (84.6% vs 47.8%); p&lt;0.01), DM (20.5% vs 4.4%; p&lt;0.01), dyslipidemia (74.2% vs 40%; p&lt;0.01), CAD (23.1% vs 3.9%; p&lt;0.01), and stroke (7.69% vs 1.45%; p=0.04). Following RT, patients in group 1 were more likely to exhibit ACS (33.3% vs 2.9%; p&lt;0.01), and stroke (22.6% vs 5.2%; p&lt;0.01). Multinomial logistic regression identified pre-RT CAD pre-RT CAC (β=1.01 (0.33–1.69), OR=7.60 (1.93–29.93); p=0.02) pre-RT CAD (β=0.78 (0.06–1.49), OR=4.74 (1.14–19.74); p=0.03) as independent predictors for the development of MACE after RT. Progression in CAC after RT was found in 61.9% of all patients (13/21) who developed MACE. Conclusion MACE in breast cancer patients undergoing RT can be predicted before RT based on the CV risk factor and disease profile. The strongest predictor for MACE, however, is evidence of CAC before RT. These data provide a unique window for the identification and follow-up of breast cancer RT patients who have a risk of MACE. Funding Acknowledgement Type of funding source: None

ASTRO suitability criteria assessment in early-stage breast cancer patients treated with intraoperative radiation therapy (IORT) plus 21 gene recurrence score (RS) assay result guided adjuvant medical therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12598-e12598
Author(s):  
Barbara Stewart Schwartzberg ◽  
Kathryn T. Howell ◽  
Joyce A Moore ◽  
Devchand Paul
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Medical Therapy ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Single Fraction

e12598 Background: A patient subset consented in an institutional review board-approved single institution clinical trial designed to determine the efficacy and outcome of single fraction IORT received adjuvant medical therapy recommendations based on their RS results. Patients were categorized according to American Society for Radiation Oncology (ASTRO) suitability criteria for accelerated partial breast irradiation. Comparison was made between ASTRO suitability criteria, RS and post-IORT outcomes. Methods: Outcome of pts completing single fraction (20Gy) IORT per protocol using disposable balloon electronic brachytherapy and RS assessment were reviewed. Data collection included demographics, pathology, RS, medical therapy, local (LR) and axillary (AR) recurrences, and survival. Results: From Nov 2011 – Jan 2016, 115 pts (aged 43 – 84, mean 63 years) completed both IORT per protocol and RS assessment. Pts with estrogen receptor positive invasive carcinomas (range 0.2 – 2.4 cm, median size 0.9 cm) and RS results were categorized by ASTRO suitability criteria, LR and AR, as shown in Table 1. The recurrence rate at mean follow-up of 6.8 years was 3.5%. There were 3 LR (RS 0, 17, 18) and 1 AR (RS 19). There has been no breast cancer related death. Adjuvant endocrine therapy was recommended to all pts. Twenty-three (20%) patients received chemotherapy, including 12 (71%) pts in the high RS (RS >25) groups. Chemotherapy was not given to any pt with a RS <18. One LR (RS 0, ASTRO Suitable, age 65, 1.5 cm) declined endocrine therapy. Ten (19%) pts with RS of 11 – 25 received chemotherapy. One LR (RS 17, ASTRO suitable, age 64, 1.5 cm) and 1 axillary recurrence (RS 19, ASTRO Suitable, age 66, 1.3 cm), neither receiving chemotherapy, were compliant with endocrine therapy. One LR (RS 18, ASTRO Suitable, age 51, 0.6 cm) was treated with cyclophosphamide and docetaxel. Seven (78%) pts with RS of 26 - 30 and 5 (63%) pts with RS >30 received chemotherapy, with no recurrences in these groups. Conclusions: One hundred fifteen pts treated with single fraction IORT per protocol and RS guided adjuvant medical therapy at a single institution were found to have a 3.5% recurrence rate at mean follow-up of 6.8 years. ASTRO suitability criteria and high RS results (RS > 25) did not correlate with recurrence. The success of IORT observed in this trial as local therapy for early-stage breast cancer patients was independent of genomic factors or patient suitability criteria. Recurrence rates were comparable to those reported in IORT peer-reviewed published data and treatments using breast conserving surgery plus whole breast radiation therapy. [Table: see text]

P695Impact of atrial fibrillation on 10y all-cause mortality in curatively treated breast cancer patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Jacobs ◽  
W L'hoyes ◽  
M Beckx ◽  
C Weltens ◽  
S Janssens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Atrial Fibrillation ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Treated Breast ◽  
Atrial Fibrillation And Flutter ◽  
Treated Breast Cancer

Abstract Background Contemporary treatment options for breast cancer have significantly improved survival during the last two decades. To estimate cancer survival, current practice typically relies on cancer size and the presence of metastases, whereas cardiovascular comorbidities such as atrial arrhythmias are typically not taken into account. Aim To evaluate the incidence of atrial fibrillation and flutter among curatively treated breast cancer patients and assess its impact on survival in an all-comer population at a tertiary care centre. Methods In a large, single centre, retrospective study we enrolled all patients with a diagnosis of breast cancer in 2007 and 2008 who received radiation therapy as part of their curative treatment regimen. We performed Kaplan-Meier and Cox survival analyses to calculate mortality risk over 10-year follow up. Results We included 1338 patients, 1326 (99.1%) of whom were women. Mean age (± standard deviation) at diagnosis was 57.6±13.4 years and the distribution of left sided breast cancer versus right sided or bilateral breast cancer was 655 (49.0%) patients versus 645 (48.2%) and 38 (2.9%) patients, respectively. A total of 805 (60.1%) patients had at least one ECG recorded during the 10 year follow up. In this subgroup, atrial fibrillation or flutter was present in 70 (8.7%); 23 patients had pre-existing atrial fibrillation or flutter (32.9%), 26 patients had had radiation therapy for left sided breast cancer (37.1%) versus 21 patients for right sided breast cancer (30%; p=0.375 for left versus right sided radiation therapy). Of the total cohort, 327 (24.4%) patients died during 10 year follow-up. In the subgroup with at least a single ECG recording, mortality equaled 44.3% (31/70) in patients with one or more documented episodes of atrial fibrillation or flutter during follow-up, compared to 21.9% (161/735) in patients who remained in sinus rhythm (p<0.0001). In patients with pre-existing atrial fibrillation or flutter, mortality equaled 47.8% (11/23) versus 42.6% (20/47) in patients with atrial fibrillation or flutter manifesting after treatment initiation (p=0.683). Survival Atrial Fibrillation/Flutter Conclusion Atrial fibrillation and flutter are common in patients with curative breast cancer treatment and have a significant impact on overall survival. Our study highlights the impact of cardiac comorbidities on overall survival following cancer treatment and emphasizes the importance of a dedicated cardiac follow-up in cancer survivors.

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