Rates of margin positive resection with breast conservation for invasive breast cancer using the NCDB

Purpose To identify rates of postoperative radiation therapy (RT) after breast conservation surgery (BCS) in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods The Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01) and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P < .01). In addition, it was found that RT was more likely to have been received in certain geographic locations, including the Metro-North (OR, 2.20; 95% CI, 1.48 to 3.28; P < .01), North (OR, 1.78; 95% CI, 1.20 to 2.64; P < .01), West (OR, 4.04; 95% CI, 2.61 to 6.25; P < .01), and Southwest (OR, 2.79; 95% CI, 1.70 to 4.59; P < .01). Furthermore, patients with tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02) and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03) were found to be significantly less likely to receive RT. Conclusion Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

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2062 Long term results of local recurrence after breast conservation therapy for invasive breast cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(99)90332-2 ◽

1999 ◽

Vol 45 (3) ◽

pp. 309-310

Author(s):

T.H. Doyle ◽

D.J. Schultz ◽

C.A. Peters ◽

L.J. Solin

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Invasive Breast Cancer ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Long Term Results

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The effect of margin status and molecular subtype on women with invasive breast cancer treated with breast-conservation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.83 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 83-83

Author(s):

Jared Forrester ◽

Adam D. Currey ◽

Bonifride Tuyishimire ◽

Jonathan Lin ◽

Amanda L. Kong

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Molecular Subtype ◽

Tumor Biology ◽

Breast Conservation ◽

Margin Status ◽

Stage I ◽

Luminal A ◽

Luminal B ◽

The Impact

83 Background: A consensus statement was recently published by SSO/ASTRO on margins for stage I and II invasive breast cancer treated with breast conserving surgery (BCS). We examined patients with invasive breast cancer who underwent BCS to determine if margin status and molecular subtype influence outcomes. Methods: We the reviewed charts of 754 Stage I-III breast cancer patients treated with BCS from 2003-2010. Margin status was defined as negative ≥ 2mm, close < 2mm and positive as tumor on ink. Conventional receptor analyses were used as markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal). Clinicopathologic variables were tested using the Fisher’s exact, Chi-square, ANOVA F-test, and Kruskal-Wallis tests. A Cox proportional - Hazards model was used to measure the impact of these variables on locoregional recurrence (LRR), breast cancer-specific (BCSS) and overall survival (OS). Results: The median age of the cohort was 58 (range 27-89 years). Most were white (88%), had T1 tumors (76%), luminal A tumors (66%), invasive ductal histology (80%), and were node negative (76%). Of the 754 patients, 26% had close margins, 2% positive margins, and 9% unknown margins. With a median follow-up of 5.2 years, OS was 92%. Twenty eight patients had a LRR with a median time to recurrence of 5.1 years. On multivariate analysis, molecular subtype, pathologic grade (p=0.01), and use of radiation (p<0.0001) were the only significant predictors of LRR. Unknown subtype, compared to Luminal A, was less likely to have a LRR (p=0.04). Basal (p=0.0002), Her2+ (p=0.03), Luminal B (p=0.002) and unknown subtype (p=0.04) had worse BCSS compared to Luminal A tumors. Margins had no impact on LRR or BCSS but those with close margins and unknown margins had worse OS compared to negative margins (p=0.01, p=0.007). Variables predictive of OS were margins, age, race, node status, chemotherapy, anti-endocrine therapy, and radiation. Conclusions: In this cohort treated with BCS, molecular subtype was a predictor of LRR and BCSS but not OS. Margin status did not impact LRR and BCSS. Although margin status was a predictor of OS, tumor biology remains the significant determinant of outcome.

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Preoperative Therapy in Invasive Breast Cancer: Pathologic Assessment and Systemic Therapy Issues in Operable Disease

Journal of Clinical Oncology ◽

10.1200/jco.2007.15.3510 ◽

2008 ◽

Vol 26 (5) ◽

pp. 814-819 ◽

Cited By ~ 246

Author(s):

Julie R. Gralow ◽

Harold J. Burstein ◽

William Wood ◽

Gabriel N. Hortobagyi ◽

Luca Gianni ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Systemic Therapy ◽

Cancer Biology ◽

Tumor Response ◽

Breast Conservation ◽

Operable Breast Cancer ◽

Preoperative Therapy ◽

Pathologic Assessment ◽

State Of The Science

PurposeTo review the state of the science with respect to preoperative systemic therapy and pathologic assessment in operable breast cancer.MethodsThis article reviews data presented at the National Cancer Institute State of the Science Conference on Preoperative Therapy in Invasive Breast Cancer as well as supporting published data.ResultsPreoperative chemotherapy in operable breast cancer has been shown to improve breast conservation rates as a result of tumor response to therapy. When patients are given preoperative systemic therapy, regimens should be the same as those established as safe and active in the adjuvant setting. At present, there are no data to suggest that systemic treatment should be tailored based on initial tumor response, or based on the extent of residual disease. In operable breast cancer, there seems to be no survival advantage from initiation of systemic therapy before surgery. A variety of clinical, imaging, and pathologic measurements are available to gauge tumor response to treatment. There is a clear correlation between tumor response in the breast and lymph nodes and both disease-free and overall survival. Pathologic complete response and other pathologic measures may be useful as surrogate end points in evaluating and understanding new therapies.ConclusionIn operable breast cancer, preoperative systemic therapy is effective and can improve breast conservation rates. Unless the tumor is large or the patient is in a clinical trial, postoperative adjuvant systemic therapy is the standard of care. To achieve optimal outcomes, preoperative systemic therapy must be administered as part of a coordinated, multimodality treatment program. The preoperative setting provides a unique opportunity to study the impact of systemic therapies on breast cancer biology.

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The Use of Radiation As a Component of Breast Conservation Therapy in National Comprehensive Cancer Network Centers

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.3127 ◽

2006 ◽

Vol 24 (3) ◽

pp. 361-369 ◽

Cited By ~ 62

Author(s):

Thomas A. Buchholz ◽

Richard L. Theriault ◽

Joyce C. Niland ◽

Melissa E. Hughes ◽

Rebecca Ottesen ◽

...

Keyword(s):

Breast Cancer ◽

National Comprehensive Cancer Network ◽

Invasive Breast Cancer ◽

Systemic Therapy ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Stage I ◽

Cancer Management ◽

Cancer Network ◽

Radiation Use

Purpose Benchmark data regarding quality measures of breast cancer management are needed. We investigated rates of radiation use after breast conservation therapy (BCT) for patients treated for ductal carcinoma-in-situ (DCIS) or invasive breast cancer at National Comprehensive Cancer Network (NCCN) centers. Patients and Methods We studied 3,333 consecutive patients treated between 1997 and 2002 with BCT for DCIS (n = 587) or for stage I or II breast cancer (n = 2,746) in eight NCCN centers. Results The overall rate of radiation therapy use was 91%, with a lower frequency of radiation use in DCIS versus invasive breast cancers (82% v 94%; odds ratio [OR] = 0.31; P < .0001). In a multivariable analysis of the patients with DCIS, the only factor significantly associated with lower rates of radiation use was low/intermediate grade (OR = 0.19; P = .0003). For patients with invasive breast cancer, significant factors were presence of comorbidity (OR = 0.53; P = .0005), tubular histology (OR = 0.39; P = .02), type of health insurance (P = .0072), and the NCCN institution (P = .0005). The model also showed lower rates of radiation use in patients with stage II disease who did not receive systemic therapy (OR = 0.01; P = .0001), younger patients who did not receive systemic therapy (P = .003); and older patients with stage I disease (P < .0001). Conclusion Radiation use as a component of BCT was high for patients seen at NCCN centers; however, there was variability in practice patterns noted across institutions. Radiation was most commonly omitted in patients with favorable disease characteristics, patients with comorbidities, and patients who also did not receive guideline-recommended systemic treatment.

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