Regional Nodal Irradiation Considerations in Patients Receiving Neoadjuvant Systemic Therapy

2021 ◽  
pp. 241-265
Author(s):  
Jose G. Bazan ◽  
Julia R. White
Keyword(s):  
Systemic Therapy ◽  
Regional Nodal Irradiation ◽  
Neoadjuvant Systemic Therapy

Long-Term Impact of Regional Nodal Irradiation in Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Systemic Therapy

2018 ◽  
Vol 102 (3) ◽  
pp. 568-577 ◽  
Author(s):  
Shane R. Stecklein ◽  
Minjeong Park ◽  
Diane D. Liu ◽  
Janeiro J. Valle Goffin ◽  
Abigail S. Caudle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Regional Nodal Irradiation ◽  
Node Positive ◽  
Neoadjuvant Systemic Therapy ◽  
Long Term Impact ◽  
Positive Breast Cancer

scholarly journals MRI-Based Radiomics Analysis for the Pretreatment Prediction of Pathologic Complete Tumor Response to Neoadjuvant Systemic Therapy in Breast Cancer Patients: A Multicenter Study

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2447
Author(s):  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey P. Primakov ◽  
Sanaz Samiei ◽  
Thiemo J. A. van Nijnatten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Tumor Response ◽  
Added Value ◽  
Breast Cancer Patients ◽  
Neoadjuvant Systemic Therapy ◽  
Clinical Models ◽  
Combined Models ◽  
Complete Tumor

This retrospective study investigated the value of pretreatment contrast-enhanced Magnetic Resonance Imaging (MRI)-based radiomics for the prediction of pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients. A total of 292 breast cancer patients, with 320 tumors, who were treated with neo-adjuvant systemic therapy and underwent a pretreatment MRI exam were enrolled. As the data were collected in two different hospitals with five different MRI scanners and varying acquisition protocols, three different strategies to split training and validation datasets were used. Radiomics, clinical, and combined models were developed using random forest classifiers in each strategy. The analysis of radiomics features had no added value in predicting pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients compared with the clinical models, nor did the combined models perform significantly better than the clinical models. Further, the radiomics features selected for the models and their performance differed with and within the different strategies. Due to previous and current work, we tentatively attribute the lack of improvement in clinical models following the addition of radiomics to the effects of variations in acquisition and reconstruction parameters. The lack of reproducibility data (i.e., test-retest or similar) meant that this effect could not be analyzed. These results indicate the need for reproducibility studies to preselect reproducible features in order to properly assess the potential of radiomics.

Controversies Concerning the Use of Neoadjuvant Systemic Therapy for Primary Breast Cancer

2012 ◽  
Vol 36 (7) ◽  
pp. 1480-1485 ◽  
Author(s):  
Manfred Kaufmann ◽  
Thomas Karn ◽  
Eugen Ruckhäberle
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Primary Breast Cancer ◽  
Neoadjuvant Systemic Therapy

Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy

2021 ◽  
Author(s):  
Leisha C. Elmore ◽  
Henry M. Kuerer ◽  
Carlos H. Barcenas ◽  
Benjamin D. Smith ◽  
Makesha V. Miggins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Clinical Course ◽  
Breast Cancer Patients ◽  
Neoadjuvant Systemic Therapy

ASO Visual Abstract: Clinical Course of Breast Cancer Patients with Local Regional Progression During Neoadjuvant Systemic Therapy

2021 ◽  
Author(s):  
Leisha C. Elmore ◽  
Henry M. Kuerer ◽  
Carlos H. Barcenas ◽  
Benjamin D. Smith ◽  
Makesha V. Miggins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Clinical Course ◽  
Breast Cancer Patients ◽  
Neoadjuvant Systemic Therapy

Innovative Standards in Surgery of the Breast after Neoadjuvant Systemic Therapy

Breast Care ◽  
2021 ◽  
pp. 1-7
Author(s):  
Tal Hadar ◽  
Michael Koretz ◽  
Mahmood Nawass ◽  
Tanir M. Allweis
Keyword(s):  
Systemic Therapy ◽  
Percutaneous Biopsy ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Response To Therapy ◽  
Neoadjuvant Endocrine Therapy ◽  
Oncoplastic Breast Surgery ◽  
Tumor Bed ◽  
Treatment Indications ◽  
Neoadjuvant Systemic Therapy

<b><i>Background:</i></b> The goal of neoadjuvant systemic therapy (NST) in breast cancer is to downstage tumors and downgrade treatment. Indications are constantly evolving. These changes raise practical questions for planning of surgery after NST. <b><i>Summary:</i></b> In this review we discuss current evolving aspects of surgery of the breast after NST. Breast-conserving surgery (BCS) eligibility increases after NST – both neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy. Adequate margin width in NST and upfront surgery are similar – “no tumor on ink” for invasive cancer. Oncoplastic breast surgery after NST is feasible – both for BCS and mastectomy with reconstruction. There is increasing interest in the possibility of omitting surgery in patients with a complete response to NAC. Several trials are being conducted in aim of achieving acceptable prediction of pathological complete response, by combination of imaging and percutaneous biopsy of the tumor bed, as well as assessing the safety of such an approach. <b><i>Key Messages:</i></b> Surgery of the breast after NST should be determined not only according to biologic and anatomic parameters at diagnosis, but is dynamic, and must be tailored according to the response to therapy. The omission of surgery in exceptional responders after NAC is being explored.

scholarly journals Correlation Between Pathologic Complete Response in the Breast and Absence of Axillary Lymph Node Metastases After Neoadjuvant Systemic Therapy

2020 ◽  
Vol 271 (3) ◽  
pp. 574-580 ◽  
Author(s):  
Sanaz Samiei ◽  
Thiemo J. A. van Nijnatten ◽  
Linda de Munck ◽  
Kristien B. M. I. Keymeulen ◽  
Janine M. Simons ◽  
...  
Keyword(s):  
Lymph Node ◽  
Systemic Therapy ◽  
Lymph Node Metastases ◽  
Axillary Lymph Node ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Neoadjuvant Systemic Therapy ◽  
Node Metastases

Neoadjuvant Systemic Therapy for High-Risk Melanoma Patients

2020 ◽  
pp. 767-793
Author(s):  
Emily Z. Keung ◽  
Rodabe N. Amaria ◽  
Vernon K. Sondak ◽  
Merrick I. Ross ◽  
John M. Kirkwood ◽  
...  
Keyword(s):  
High Risk ◽  
Systemic Therapy ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Neoadjuvant Systemic Therapy ◽  
Melanoma Patients

scholarly journals The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. Whitehead ◽  
◽  
G. W. Irwin ◽  
F. Bannon ◽  
C. E. Coles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Tumour Response ◽  
Multidisciplinary Teams ◽  
Diverse Range ◽  
Radiological Monitoring ◽  
Original Tumour ◽  
Neoadjuvant Systemic Therapy ◽  
Axillary Node Clearance ◽  
The Uk

Abstract Background Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.

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