De-escalating Locoregional Therapy for Axillary Micrometastases in Breast Cancer: How Much is Too Much?

The perception that breast cancer in young women is a growing problem in the United States is based on the fact that young women represent a demographic that has enlarged substantially over the past few decades. Population-based data actually reveal relatively stable incidence rates for breast cancer among women in the premenopausal age range. Young women are more likely to be diagnosed with biologically aggressive phenotypes such as triple-negative and HER2/neu-overexpressing breast cancer. Outcomes are optimized by treatment plans focusing on disease stage and targeted to phenotype. Locoregional therapy for breast cancer in young women should be based on patient preferences and disease pattern (as in older patients); young women with breast cancer can be managed safely with breast-conserving surgery. This review contains 3 figures, 2 tables, and 50 references. Key Words: breast cancer, fertility, ovarian suppression, premenopausal, young women; triple negative breast cancer

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Changes in Overall Survival Over Time for Patients With de Novo Metastatic Breast Cancer

10.20944/preprints202105.0093.v1 ◽

2021 ◽

Author(s):

Toshiaki Iwase ◽

Tushaar Vishal Shrimanker ◽

Ruben Rodriguez-Bautista ◽

Onur Sahin ◽

Anjali James ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Metastatic Breast Cancer ◽

De Novo ◽

Metastatic Breast ◽

Locoregional Therapy ◽

Cancer Center ◽

Her2 Positive ◽

Time Periods ◽

Over Time

The purpose of this study was to determine the change in overall survival (OS) for patients with de novo metastatic breast cancer (dnMBC) over time. We conducted a retrospective cohort study with 1981 patients with dnMBC diagnosed between January 1995 and December 2017 at The University of Texas MD Anderson Cancer Center. OS was measured from the date of diagnosis of dnMBC. OS was compared between patients diagnosed during different time periods: 5-year periods and periods defined according to when key agents were approved for clinical use. The median OS was 3.4 years. The 5- and 10-year OS rates improved over time across both types of time periods. A subgroup analysis showed that OS improved significantly over time for the estrogen-receptor-positive/HER2-positive (ER+/HER2+) subtype, and exhibited a tendency toward improvement over time for the ER-negative (ER-)/HER2+ subtype. Median OS was significantly longer in patients with non-inflammatory breast cancer (P = .02) and in patients with ER+ disease, progesterone-receptor-positive disease, HER2+ disease, lower nuclear grade, locoregional therapy, and metastasis to a single organ (all P &lt;.0001). These findings showed that OS at 5 and 10 years after diagnosis in patients with dnMBC improved over time. The significant improvements in OS over time for the ER+/HER2+ subtype and the tendency toward improvement for ER-/HER2+ subtype suggest the contribution of HER2-targeted therapy to survival.

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Tumor Growth Kinetics Versus RECIST to Assess Response to Locoregional Therapy in Breast Cancer Liver Metastases

Academic Radiology ◽

10.1016/j.acra.2014.02.015 ◽

2014 ◽

Vol 21 (8) ◽

pp. 950-957 ◽

Cited By ~ 9

Author(s):

Adeel R. Seyal ◽

Keyur Parekh ◽

Yuri S. Velichko ◽

Riad Salem ◽

Vahid Yaghmai

Keyword(s):

Breast Cancer ◽

Tumor Growth ◽

Liver Metastases ◽

Growth Kinetics ◽

Locoregional Therapy ◽

Tumor Growth Kinetics ◽

Breast Cancer Liver Metastases

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Natural progression and clinical significance of incidentally detected pulmonary nodules in radiotherapy planning CT scans of breast cancer patients: a retrospective cohort

Journal of Radiotherapy in Practice ◽

10.1017/s1460396916000376 ◽

2016 ◽

Vol 15 (4) ◽

pp. 359-363

Author(s):

Sasidharan Balu Krishna ◽

Sunitha Susan Varghese ◽

Paul Gopu Gopurathingal ◽

Venkata Krishna Reddy Pilaka ◽

Selvamani Backianathan

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Clinical Significance ◽

Pulmonary Nodules ◽

Locoregional Therapy ◽

Radiotherapy Planning ◽

Lung Nodules ◽

Breast Cancer Patients ◽

Natural Progression

AbstractAimIndeterminate pulmonary nodules incidentally detected during radiological imaging completed for radiotherapy planning always creates dilemma for the oncologist. The purpose of this study is to evaluate the clinical significance of pulmonary nodules incidentally detected in patients undergoing locoregional radiotherapy for breast cancer and present a retrospective analysis of the natural progression of such nodules.MethodsA retrospective review of computed tomography scans of breast cancer patients who underwent radiotherapy over a period of 3 years to screen out patients with indeterminate lung nodules was undertaken. This was correlated with the patient and tumour characteristics and the status of the disease at last follow-up.ResultsOf the 132 patients reviewed 28 had indeterminate lung nodules. Of the 28 patients, four had progressive lung nodules on follow-up. Subgroup analyses did not show any significant correlation.Discussion and conclusionOne fifth of patients may present with incidentally detected lung nodules. Multiple nodules, ER negative status and locally advanced breast cancer may point to a higher risk of these nodules progressing to metastatic cancer. There is no indication to stop locoregional therapy in the presence of indeterminate nodules, but close follow-up of high-risk group is recommended.

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Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (EA2108)

Journal of Clinical Oncology ◽

10.1200/jco.21.02006 ◽

2022 ◽

Author(s):

Seema A. Khan ◽

Fengmin Zhao ◽

Lori J. Goldstein ◽

David Cella ◽

Mark Basik ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Metastatic Breast Cancer ◽

Systemic Therapy ◽

Primary Tumor ◽

Metastatic Breast ◽

Primary Site ◽

Locoregional Control ◽

Locoregional Therapy

PURPOSE Distant metastases are present in 6% or more of patients with newly diagnosed breast cancer. In this context, locoregional therapy for the intact primary tumor has been hypothesized to improve overall survival (OS), but clinical trials have reported conflicting results. METHODS Women presenting with metastatic breast cancer and an intact primary tumor received systemic therapy for 4-8 months; if no disease progression occurred, they were randomly assigned to locoregional therapy for the primary site (surgery and radiotherapy per standards for nonmetastatic disease) or continuing sysmetic therapy. The primary end point was OS; locoregional control and quality of life were secondary end points. The trial design provided 85% power to detect a 19.3% absolute difference in the 3-year OS rate in randomly assigned patients. The stratified log-rank test and Cox proportional hazards model were used to compare OS between arms. Cumulative incidence of locoregional progression was compared using Gray's test. Quality-of-life assessment used standard instruments. RESULTS Of 390 participants enrolled, 256 were randomly assigned: 131 to continued systemic therapy and 125 to early locoregional therapy. The 3-year OS was 67.9% without and 68.4% with early locoregional therapy (hazard ratio = 1.11; 90% CI, 0.82 to 1.52; P = .57). The median OS was 53.1 months (95% CI, 47.9 to not estimable) in the systemic therapy arm and 54.9 months (95% CI, 46.7 to not estimable) in the locoregional therapy arm. Locoregional progression was less frequent in those randomly assigned to locoregional therapy (3-year rate: 16.3% v 39.8%; P < .001). Quality-of-life measures were largely similar between arms. CONCLUSION Early locoregional therapy for the primary site did not improve survival in patients presenting with metastatic breast cancer. Although it was associated with improved locoregional control, this had no overall impact on quality of life.

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Cured of breast cancer?

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.1.62 ◽

1995 ◽

Vol 13 (1) ◽

pp. 62-69 ◽

Cited By ~ 24

Author(s):

H Joensuu ◽

S Toikkanen

Keyword(s):

Breast Cancer ◽

Contralateral Breast Cancer ◽

Survival Rates ◽

Locoregional Therapy ◽

Short Term ◽

Node Negative ◽

Node Positive ◽

Node Positive Disease ◽

Histologic Types

PURPOSE That patients can be ultimately cured of breast cancer has been questioned, because late deaths from the disease have been observed even several decades after the diagnosis. The purpose of this study was to investigate late mortality caused by breast cancer. PATIENTS AND METHODS Using the files of local hospitals and the Finnish Cancer Registry, we identified all patients with histologically diagnosed invasive breast cancer in a defined urban area (city of Turku, Finland) from 1945 to 1969 (n = 601). In 563 cases (94%), clinical data and histologic and autopsy slides could be reviewed, and these women had been monitored for a median of 29 years (range, 22 to 44; n = 66) or until death (n = 497). RESULTS Mortality from breast cancer was observed even during the fourth follow-up decade, but if women who were diagnosed with contralateral breast cancer were excluded (n = 30), no deaths from breast cancer were identified after the 27th year of follow-up evaluation. The 30-year survival rates were 62% (95% confidence interval [CI], 54% to 70%), 19% (95% CI, 13% to 25%), and 0% for women with pN0 (node-negative) and pN1 or pN2 (node-positive) disease, respectively. High 30-year survival rates were found in small (pT1N0M0) unilateral cancers (80% alive; 95% CI, 66 to 94%), and in the lobular (45% alive; 95% CI, 31% to 59%) and the special histologic types (81% alive; 95% CI, 67% to 95%). These survival rates were obtained when correcting either for known intercurrent deaths or for mortality in the age- and sex-matched general population. CONCLUSION Breast cancer, node-negative and node-positive, may be permanently cured even if treated with locoregional therapy only. The survival figures listed here may be considered as minimum values, because women with breast cancer diagnosed in the same area from 1970 to 1984 showed significantly improved short-term (< 20 years) survival rates over those diagnosed from 1945 to 1969.

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