The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study

Background and Objectives. Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods. Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results. At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions. Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.

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Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

Frontiers in Oncology ◽

10.3389/fonc.2021.723693 ◽

2021 ◽

Vol 11 ◽

Author(s):

Concetta Blundo ◽

Massimo Giroda ◽

Nicola Fusco ◽

Elham Sajjadi ◽

Konstantinos Venetis ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Standard Of Care ◽

First Trimester ◽

Breast Conserving Surgery ◽

Breast Cancers ◽

First Trimester Of Pregnancy ◽

Isolated Local Recurrence ◽

Age Range

Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

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Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.7888 ◽

2006 ◽

Vol 24 (16) ◽

pp. 2437-2443 ◽

Cited By ~ 244

Author(s):

Lori J. Pierce ◽

Albert M. Levin ◽

Timothy R. Rebbeck ◽

Merav A. Ben-David ◽

Eitan Friedman ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Breast Conservation Surgery ◽

Breast Cancers ◽

Mutation Status ◽

High Risk Women ◽

Mutation Carriers ◽

Significant Difference

Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls. Methods A total of 160 BRCA1/2 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls. Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone oophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39% for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05). Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who received tamoxifen, this rate remained significantly greater than in controls. Additional strategies are needed to reduce contralateral cancers in these high-risk women.

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Postoperative radiotherapy after conservative surgery for early breast cancer: 5-year results

Archive of oncology ◽

10.2298/aoo0401029m ◽

2004 ◽

Vol 12 (1) ◽

pp. 29-33

Author(s):

Jasmina Mladenovic ◽

Marko Dozic ◽

Nenad Borojevic

Keyword(s):

Breast Cancer ◽

Survival Rate ◽

Cancer Patients ◽

Early Breast Cancer ◽

Systemic Therapy ◽

Postoperative Radiotherapy ◽

Breast Conserving Surgery ◽

Breast Cancer Patients ◽

Disease Free

BACKGROUND: Breast conserving surgery followed by postoperative radiotherapy, as alternative to radical mastectomy, has been accepted as an optimal method for loco- regional treatment of the majority of women with early stage of breast carcinoma. The aim of the study was to evaluate the results of postoperative radiotherapy after breast conserving surgery in the Institute for oncology and radiology of Serbia. METHODS: During the 3-year period, 109 breast cancer patients with stage I and II were treated with postoperative radiotherapy after breast conserving surgery. Ninety- four patients underwent quadrantectomy with axillary node dissection, and 15 patients underwent only tumorectomy. After surgery all patients received postoperative radiotherapy to the whole breast with tumor dose 50 Gy in 15 fractions every second day. In 52 patients radiotherapy was given to the regional lymphatics with tumor dose 45 Gy in 15 fractions every second day. Twenty-eight patients received a booster dose (10 Gy) to the tumor bed. Adjuvant systemic therapy was administered depending on the nodal involvement and steroid receptors content: 17 patients received adjuvant chemotherapy (CMF or FAC), 18 received adjuvant hormonal therapy (tamoxifen or ovarian ablation), and 6 patients received both chemo- and hormonotherapy. RESULTS: After median follow-up period of 62 months, there was no evidence of loco- regional recurrence in anyone of patients. Distant metastases occurred in 7 patients (6.4%) with median disease free interval of 27.6 months. At last follow-up 91 patients (83.4%) were alive, 4 patients (3.7%) were dead of disease, and the same number was dead of other causes. The 5-year overall survival rate was 92.9% and disease-free survival rate was 92.7%. CONCLUSION: According to our results the combined surgery and radiotherapy approach provides good local control of early breast cancer patients. Postoperative radiotherapy after breast conserving surgery with or without adjuvant systemic therapy has important role in adjuvant treatment of early breast cancer.

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Method of detection of local recurrence in patients following breast conserving surgery and its utility for surveillance

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.611 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 611-611

Author(s):

B. Taback ◽

N. Hansen ◽

K. Conway ◽

A. Giuliano

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Cancer Patients ◽

Ductal Carcinoma ◽

Early Stage ◽

Breast Conserving Surgery ◽

Conclusive Evidence ◽

Breast Cancer Patients ◽

Asymptomatic Patients

611 Background: It is estimated that approximately 10% of all breast cancer patients will develop local recurrence (LR) at 10 years. Routine surveillance for detection of early breast cancer recurrence is widely performed despite lack of conclusive evidence for an improvement in patient quality of life or potential for cure. A number of historical studies evaluating the effectiveness of routine screening for LR following treatment for early-stage breast cancer have suggested that the diagnosis of LR is more frequent during a routine visit and occurring in asymptomatic patients. However, differentiating the method of detection is not often elucidated. In this study we evaluated the manner in which patients presented with an isolated LR in clinical practice. Methods: Our routine patient follow-up consists of physical exam and mammogram every 6 mos for the first 2 years following breast conserving surgery (BCS) and yearly thereafter. We queried our prospectively collected breast cancer database (1632 patients from July 1986 - July 2004) for patients with an isolated LR following BCS (n=59 (3.6%); two patients had bilateral LRs). Medical records were not available for three patients. Results: At a median follow-up of 45 mos (range: 5–122 mos) there were 58 evaluable LRs: 15 DCIS, 31 infiltrating ductal carcinoma (IDC), 6 infiltrating lobular (ILC), 2 mixed IDC/ILC, 3 invasive cancers NOS and 1 unknown. Patient presentation was as follows: 25 were diagnosed by self-exam, 28 on screening mammogram, 2 were diagnosed by physician (includes one referral), and 3 unknown. Mammogram detected recurrences were more frequent among patients with DCIS whereas self-detected recurrences were more common in patients with IDC (79% vs 33% and 21% vs 67%, respectively; P<0.2). Mean tumor size was larger in self-presentation (2.1 cm; range: 0.8–4.5 cm) than in mammogram detected group (1.6 cm; range 0.4–6 cm). Conclusions: These findings demonstrate the value of mammography as compared to patient detected LRs. Whether a survival advantage exists remains uncertain. Nevertheless routine physician examination in this setting is highly insensitive and its further utility must be considered when devising cost-effective strategies for surveillance of breast cancer patients. No significant financial relationships to disclose.

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Metastatic male breast cancer (mMBC): Prognosis and survival of 35 patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e12001 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e12001-e12001

Author(s):

R. Foerster ◽

F. G. Foerster ◽

D. Baaske ◽

B. Schubotz ◽

V. Wulff ◽

...

Keyword(s):

Breast Cancer ◽

Male Breast Cancer ◽

Systemic Therapy ◽

Metastatic Breast ◽

Male Breast ◽

Tumor Characteristics ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Radio Therapy

e12001 Background: Only about 1% of breast cancers occur in men, respectively 400–500 new cases per year in Germany. Clinical studies on breast cancer in men are limited for case studies or retrospective analysis. In the recent years no studies have been published on the clinical course of mMBC. Therefore we here present a retrospective cohort study on this topic. Methods: Clinical and pathological tumor characteristics and the follow-up of male breast cancer patients with metastatic disease diagnosed in the region Chemnitz/Zwickau in the state of Saxony between 1995 and 2007 were documented and statistically evaluated. Results: 35 men (median age 64.7 years) were diagnosed with mMBC; 10 (28.6%) of them with primary metastasis. Median survival time: 37 months. 85.7% (n = 30) had an invasive-ductile carcinoma. Most common localizations of metastasis: bones (n = 19), lungs (n = 19), liver (n = 7). Tumor characteristics at the point of diagnosis: 63.9% (n = 22) T2-T4, 38.7% (n = 12) G3, 48.4% (n = 15) N+, 79.3% (n = 23) ER+, 72.4% (n = 21) PgR+, 12.5% (n = 3) HER-2+, 13.8% (n = 4) triple negatives, and 69.2% (n = 9) AR+. The therapy in the metastatic state was very heterogeneous and consisted of systemic endocrine therapy in 45.5% (n = 10), systemic chemo therapy in 9% (n = 2) or a combination of both in 45.5% (n = 10). In 14 (40%) cases a palliative radio therapy was administered. The initial tumor characteristics like tumor size, nodal state and grading were not of any prognostic relevance on a future development of metastasis. Prognostic unfortunate were a negative hormone receptor state (p < 0.001) and triple negative receptor state (n.s.). Patients with primary metastasis showed a tendency towards worse survival than patients who developed the metastasis during follow up (n.s.). If a systemic therapy was given the prognosis was significantly improved (p < 0.005). Conclusions: Patients suffering from metastatic male breast cancer had a comparatively good prognosis and showed significant benefit from systemic therapy in this study. In patients with negative receptor state and without systemic therapy the prognosis was especially worsened. Our data suggest that an up-to-date adequate systemic therapy is capable of improving survival in men with metastatic breast cancer. No significant financial relationships to disclose.

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Understanding the symptom experience of breast cancer outpatients: The validity and utility of the M.D. Anderson Symptom Inventory (MDASI).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9106 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9106-9106

Author(s):

Tito R. Mendoza ◽

Fengmin Zhao ◽

Charles S. Cleeland ◽

Lynne I. Wagner ◽

Linda J. Patrick-Miller ◽

...

Keyword(s):

Breast Cancer ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Assessment Method ◽

Patient Reported Outcome ◽

Symptom Experience ◽

Breast Cancer Patients ◽

Ecog Performance Status ◽

Patient Reported

9106 Background: Breast cancer and its treatments can produce multiple symptoms that cause distress and impair function. The MDASI, a patient-reported outcome measure of symptoms (sxs) and functional interference has been validated in general oncology and has the potential to inform symptom experience and guide treatment specific to breast cancer patients (pts). Methods: The Eastern Cooperative Oncology Group (ECOG) conducted the Symptom Outcomes and Practice Patterns (SOAPP) study at academic and community medical oncology clinics and included pts with breast cancer of all stages and phases of care. At baseline and 4 weeks, pts completed the MDASI. Symptom experiences and psychometric properties of the MDASI in breast cancer pts (n = 1544) were analyzed. Results: The median age was 58 years, and the race/ethnicity included 11% black and 8% hispanic. 5% had ECOG performance status (PS) ≥2. The 5 most prevalent moderate/severe sxs reported at baseline were fatigue (31%), disturbed sleep (27%), drowsiness (21%), hair loss (22%) and dry mouth (19%); moderate/severe skin rash (6%) and vomiting (4%) were the least prevalent. At follow-up, about 1/3 of patients had moderate/severe fatigue and 19% had moderate/severe pain and distress. Internal consistency and test-retest reliability were good, with Cronbach alphas of ≥0.85 and intraclass correlations of ≥0.76 for all subscales. Among those whose PS was stable or improving, the change scores in sx severity improved most for sleep disturbance, numbness/tingling, and difficulty remembering things. Significantly higher scores and moderately large effects for the severity scale were reported by pts with poorer PS (ES=.61) and those with local/regional/metastatic disease (ES=.67). Results were similar for the interference scale. Pts whose quality of life (QOL) declined showed greater increase in severity (1.1 vs .07, p<.001) from baseline to follow-up than pts whose QOL was unchanged, demonstrating sensitivity to change. Conclusions: Breast cancer pts have significant sx burden despite well-preserved PS. The MDASI is a valid, reliable, and sensitive sx assessment method for research and patient care in breast cancer outpatients.

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Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer?

The American Surgeon ◽

10.1177/0003134820964209 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1248-1253

Author(s):

Sarah Walcott-Sapp ◽

Marissa K. Srour ◽

Minna Lee ◽

Michael Luu ◽

Farin Amersi ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Therapy ◽

Invasive Breast Cancer ◽

Tumor Size ◽

Disease Free Survival ◽

Positive Margin ◽

Breast Conserving Surgery ◽

Breast Cancers ◽

Positive Margin Rate

Optimum tissue resection volume for patients with invasive breast cancer undergoing breast conserving surgery following neoadjuvant therapy (NAT) is not known. We compared positive margin and in-breast tumor recurrence (IBTR) between 2 groups that were created based on radiologic tumor size (RTS (cm3)) at diagnosis, RTS post-NAT, and volume of tissue resected (VTL): Pre-NAT group, patients with VTL closer to RTS at diagnosis, and post-NAT group, patients with VTL closer to post-NAT RTS. 82 patients with 84 breast cancers treated with NAT between 2007 and 2017 who had pre- and post-NAT imaging were identified from a prospectively maintained database. RTS at diagnosis, RTS post-NAT, and VTL were determined. Clinical and treatment characteristics, IBTR, and disease-free survival (DFS) were compared between pre-NAT (n = 51) and post-NAT (n = 33) groups. Compared to post-NAT patients, pre-NAT patients had smaller RTS at presentation (9.2 vs. 33.5 cm3, P < .001) and post-NAT (1.2 vs. 8.2 cm3, P = .024). At median follow-up of 4 years, there were no differences between groups in pathologic tumor size, positive margin rate, adjuvant therapy, IBTR, or DFS. Resection volumes that matched RTS on post-NAT imaging were not associated with increased positive margins or IBTR. It may be appropriate to use post-NAT imaging to guide lumpectomy volume.

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Synchronous and Metachronous Breast Malignancies: A Cross-Sectional Retrospective Study and Review of the Literature

BioMed Research International ◽

10.1155/2014/250727 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 9

Author(s):

Ambrogio P. Londero ◽

Sergio Bernardi ◽

Serena Bertozzi ◽

Vito Angione ◽

Giuliana Gentile ◽

...

Keyword(s):

Breast Cancer ◽

Retrospective Study ◽

English Literature ◽

Meta Analysis ◽

Disease Free Survival ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Unilateral Breast Cancer ◽

Cross Sectional

Objective. There is increasing interest in patients with metachronous (MBC) and synchronous breast cancer (SBC). The objective of this study was to evaluate the occurrence and outcome of MBCs and SBCs.Methods. A retrospective study on women operated in our department for breast cancer between 2002 and 2005 was carried out. Patients were divided into three groups: women with MBC, SBC, and unilateral breast cancer (UBC). Moreover, we performed a meta-analysis of the English literature about multiple breast cancers between 2000 and 2011 taking into consideration their prevalence and overall survival (OS).Results. We identified 584 breast cancer patients: 16 women (3%) presented SBC and 40 MBC (7%, second cancer after 72-month follow-up IQR 40–145). Although the meta-analysis showed significant OS differences between MBC or SBC and UBC, we did not observe any significant OS difference among the three groups of our population. Anyway, we found a significant worse disease-free survival in MBC than UBC and a significant higher prevalence of radical surgery in MBC and SBC than UBC.Conclusions.Despite the low prevalence of MBC and SBC, the presence of a long time risk of MBC confirms the crucial role of ipsi- and contralateral mammographies in the postoperative follow-up.

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The impact of COVID-19 pandemic on the rate of newly diagnosed gynecological and breast cancers: a tertiary center perspective

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06259-5 ◽

2021 ◽

Author(s):

Katharina Knoll ◽

Elisabeth Reiser ◽

Katharina Leitner ◽

Johanna Kögl ◽

Christoph Ebner ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Gynecological Cancer ◽

Performance Status ◽

Tumor Stage ◽

Breast Cancers ◽

Newly Diagnosed ◽

Breast Cancer Patients ◽

Tertiary Center ◽

The Impact

Abstract Purpose The aim of the present study was to assess the impact of postponed screening examinations and lockdown measures on gynecological and breast cancer diagnoses throughout the year 2020 in a gynecological oncological center in Austria. Methods Data of 889 patients with either newly diagnosed gynecological or breast cancer between January 2019 and December 2020 were collected. Clinical parameters including symptoms, performance status, comorbidities and referral status were compared in patients, who were newly diagnosed with cancer in the period of the first lockdown from March 2020 to April 2020 and the second lockdown from November 2020 to December 2020 and compared to the same period in 2019. Results Our results showed a strong decline in newly diagnosed cancers during the lockdown periods: −45% in gynecological cancer and -52% in breast cancer compared to the same period in 2019. Compared to the analogue period of 2019, breast cancer patients reported significantly more tumor-associated symptoms (55% vs. 31%, p = 0.013) during and in between (48% vs. 32%, p = 0.022) the lockdowns. During the lockdown, periods in the group of breast cancer patients’ tumor stage varied significantly compared to 2019 (T2–T4; p = 0.047). Conclusion Both lockdowns led to a strong decrease in newly diagnosed gynecological and breast cancers. Treatment delays in potentially curable disease could lead to inferior clinical outcomes, with the risk of missing the optimal treatment window. As the COVID-19 pandemic will be a challenge for some time to come, new strategies in patient care are needed to optimize cancer screening and management during the pandemic.

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Level of Combined Estrogen and Progesterone Receptor Expression Determines the Eligibility for Adjuvant Endocrine Therapy in Breast Cancer Patients

Cancers ◽

10.3390/cancers13195007 ◽

2021 ◽

Vol 13 (19) ◽

pp. 5007

Author(s):

Jee Hyun Ahn ◽

Soon Bo Choi ◽

Jung Min Park ◽

Jee Ye Kim ◽

Hyung Seok Park ◽

...

Keyword(s):

Breast Cancer ◽

Progesterone Receptor ◽

Endocrine Therapy ◽

Adjuvant Endocrine Therapy ◽

Receptor Expression ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Limited Data ◽

Single Receptor

Hormone receptor (HR)-positive breast cancer has a heterogeneous pattern according to the level of receptor expression. Patients whose breast cancers express low levels of estrogen receptor (ER) or progesterone receptor (PgR) may be eligible for adjuvant endocrine therapy, but limited data are available to support this notion. We aimed to determine whether HR expression level is related to prognosis. Tumors from 6042 patients with breast cancer were retrospectively analyzed for combined HR levels of ER and PgR. Low expression was defined as ER 1–10% and PgR 1–20%. Four HR groups were identified by combining ER and PgR expression levels. Patients whose tumors expressed high levels of a single receptor showed the worst survival outcomes, and their risk continuously increased even after the 10-year follow-up. Endocrine therapy had a significant benefit for patients whose tumors expressed high HR levels and a favorable tendency for patients with tumors expressing low HR levels. We established the possible benefit of endocrine therapy for patients whose breast tumors expressed low HR levels. Thus, HR level was a prognostic factor and might be a determinant of extended therapy, especially for patients with high expression of a single receptor.

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