An IMRT technique to increase therapeutic ratio of breast irradiation in patients with early stage left breast cancer: Limiting second malignancies

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10791-10791 ◽  
Author(s):  
R. S. Ahmed ◽  
J. B. Fiveash ◽  
R. A. Popple ◽  
S. A. Spencer ◽  
J. F. De Los Santos
Keyword(s):  
Breast Cancer ◽  
Low Dose ◽  
Early Stage ◽  
Breast Conservation ◽  
Left Breast ◽  
Breast Conservation Surgery ◽  
Adjuvant Radiation ◽  
Target Coverage ◽  
Second Malignancy ◽  
Dose Levels

10791 Background: The clinical application of IMRT for adjuvant treatment of breast cancer has been the subject of increasing study in recent years. IMRT plans have improved target coverage and reduced dose inhomogeneities observed within the breast in standard plans. IMRT was able to reduce doses delivered to the heart, lungs, and right breast at clinically significant doses, but this has been at the cost of larger volumes of low dose radiation to these structures and thus, increasing the risk for second malignancy. Our goal was to develop an IMRT beam arrangement that did not result in additional low dose spill to risk organs while maintaining equal or better target coverage. Methods: Five patients with early stage left-sided breast cancer, who underwent breast conservation surgery, and adjuvant radiation using standard wedged tangential fields, were chosen for this comparative study. An IMRT plan consisting of 6 tangential beams (3 medial and 3 lateral) was generated by using the gantry, collimator and table angles of the standard plan used for the conventional radiation (CRT), and moving the table +10 and −10 degrees on each side. The prescription dose for both CRT and IMRT plans was 45 Gy, 1.8 Gy/fraction, prescribed to the isocenter which was placed near the center of the breast. Results: IMRT plans provided significantly better coverage of the left breast than CRT plans, (p=0.03). Although dose heterogeneity was greater with the IMRT plans, the difference was not significant (p = 0.68). The mean volumes of the heart, lung, and right breast were lower in patients planned with IMRT at all dose levels from 5% to 100% dose (5% increments). This difference was significant for volumes receiving 2.25 Gy for the heart (p = 0.003), volumes receiving 2.25 Gy, 4.5 Gy, 6.75 Gy, 33.75 Gy, 36 Gy, 38.25 Gy, and 42.75 Gy for the lung (p = 0.014, 0.04, 0.044, 0.05, 0.049, 0.045, 0.05, respectively). Surprisingly, breast IMRT resulted in significantly lower right breast volumes irradiated at all dose levels compared to CRT. Conclusions: A six-tangential field IMRT technique achieved significantly better left breast coverage while maintaining lower doses to risk organs at all dose levels and therefore, reducing the potential for induction of a second malignancy. No significant financial relationships to disclose.

Trends in rates of modified radical mastectomies and bilateral mastectomies in unilateral breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 569-569
Author(s):  
Ajaz Bulbul ◽  
Tareq Braik ◽  
Sadaf Rashad ◽  
Emilio Araujo Mino ◽  
Adrianna Bautista ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Early Stage ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Breast Conservation Surgery ◽  
Bilateral Mastectomy ◽  
Unilateral Breast Cancer

569 Background: Women with unilateral breast cancer (BC) without genetic predisposition have a low risk for local and contralateral recurrence with breast conservation surgery (BCS) and adjuvant treatment. We aimed to study the pattern of surgical care across centers in rural New Mexico and its correlation to clinical outcomes. Methods: We retrospectively evaluated 533 patients with Stage 1-3 BC diagnosed between January 1989 to October 2015. Clinical Outcomes with BCS, sentinel lymph node dissection (SLND), simple mastectomy (SM), modified radical mastectomy (MRM) and Bilateral Mastectomy (BM) were studied. Descriptive statistics were performed to describe the proportion of surgery types. Predictors of clinical outcomes were evaluated by multivariate logistic regression. Results: Out of 533 patients, 510 (82%) had early stage (0-3) resectable BC. Among these, 48% (246/510) had either MRM (209/510) or BM (37/510). MRM was performed in 3% of stage 0 (6/209), 23% (49/209) stage I, 46%(97/209) of stage II and 27% (57/209) of Stage III patients. Overall, the rate of SLND was 42% among Early stage Breast cancer. Of 41 patients treated with bilateral mastectomy, 10 were positive for BRCA mutation, 6 for family history and 3 for contralateral disease. Median age of BM was 53 +12 y. The local recurrence rate was 8.8% (45/510), and metastatic recurrence rate was 15.5% (79/510). Lymphedema rate was 9.2% (47/510). Using MRM as reference, the Odds Ratio (OR) for lymphedema after BM and BCT were 2.15 (95% CI, 0.84-5.50) and 0.58 (0.28-1.22), respectively. With 9.6 years of median follow up, the predictive probabilities of lymphedema after BCT, SM, MRM and BM were 1%, 4%, 9% and 18%. The OR for local recurrence in women with BCT were 1.46 (95th C/I: 0.72-2.95), SM 0.27 (0.03-2.13), BM 2.06 (95th C/I:0.70-6.06). Conclusions: Less BCT and more aggressive procedures are being performed, and the latter is associated with more lymphedema. No significant differences were noted in local recurrences. Presence of a genetic mutation was not the sole indicator of BM’s in our patient population. There is a need for evidence-based shared decision-making and surgical management of breast cancer, especially in a rural community setting.

Predictors of adjuvant radiation therapy in the treatment of male breast cancer and its impact on outcomes: A propensity matched analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12516-e12516
Author(s):  
Veli Bakalov ◽  
Thejus Thayyil Jayakrishnan ◽  
Stephen Abel ◽  
Christie Hilton ◽  
Bindu Rusia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Male Breast Cancer ◽  
Cox Regression ◽  
Breast Conservation ◽  
Male Breast ◽  
Breast Conservation Surgery ◽  
P Value ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

e12516 Background: Male breast cancer (MBC) accounts for 1% of all breast cancers and there is a paucity of data on factors impacting the treatment strategies and outcomes. We hypothesized that adjuvant radiation therapy (Adj-RT) may improve survival outcomes and sought to examine predictive factors for Adj-RT receipt. Methods: We queried the National Cancer Database (NCDB) for patients with stages I-III MBC treated with surgery (breast conservation surgery- BCS or mastectomy-MS) within 180 days of diagnosis (years 2004-2015). Multivariable logistic regression identified predictors of adjuvant radiation therapy receipt. Multivariable Cox regression evaluated predictors of survival. Propensity matching for adj-RT accounted for indication biases. Results: We identified 6,217 patients meeting the eligibility criteria (1457 BCS vs. 4760 MS). The majority of patients were white (85%) and within the age range of 50-80 years (74%). Although Adj-RT was omitted for 30% of BCS patients, the utilization was higher compared to MS (OR=26, p-value=0.001). The predictors of Adj-RT use were – African American race, higher stage, higher grade, presence of lymphovascular invasion and ER/Her-2 positivity for the entire cohort and higher age, urban location and higher income for BCS. Adj-RT was associated with lower mortality in the propensity matched model (overall HR for BCS=0.28, p-value<0.001; overall HR for MS=0.62,p-value=0.001) and is shown in the table. Conclusions: This study demonstrates there may be an association between decreased mortality and Adj-RT in MBC undergoing BCS. Although this implies that Adj-RT should be routinely delivered, it appears to be omitted frequently and its use requires further investigation. The study also suggests a benefit to Adj-Rt after MS for stage-III MBC. [Table: see text]

Surgery of early stage breast cancer in older women – multicenter study and review of 143 cases

2017 ◽  
Vol 86 (1) ◽  
pp. 13
Author(s):  
Abdalla Saad Abdalla ◽  
Beata Adamczyk
Keyword(s):  
Breast Cancer ◽  
Assessment Tool ◽  
Ductal Carcinoma ◽  
Radical Surgery ◽  
Screening Program ◽  
Early Stage ◽  
Breast Conservation ◽  
Breast Conservation Surgery ◽  
Management Decision ◽  
Co Morbidity

Most of breast cancers are diagnosed in females over 50 years of age, however it is found that about 30% of the disease diagnosed with women above 70 years. Generally speaking, those patients is treated with a smaller range of treatment which usually offered to the younger group of patients. Despite the presence of many comorbidities, however the patient may still have a good physiological reserve, which make offering a radical surgery of the cancer very possible. Age should not be a determinant for quality of care in breast cancer. In this paper, we looked to 143 breast cancer patients with age >70 years had been operated. The oldest was 86. ASA assessment tool used Pre‑operatively. Mastectomy done in 70% where 30% underwent Breast Conservation Surgery. Axillary surgery done in 94% of cases (52% Sentinel lymph node biopsy and 42% axillary clearance). The histology of the removed cancers showed invasive ductal carcinoma in 76% of cases, invasive lobular carcinoma in 11%, with DCIS in 06%. After surgery, every patient has been offered the individual suitable adjuvant treatment as chemotherapy, radiotherapy, Herceptin or hormonal manipulation. As those patients can stand the radical surgery and live with a good life quality after treatment, we advise to extend the screening program beyond the current recommended age. Also we recommend further research to understand more about the biology of the breast cancer in the older age group and disseminate geriatric assessment tool as Adult Co‑morbidity Evaluation (ACE-27) to provide a proper evaluation of the patient status prior to final management decision.

The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer

2009 ◽  
Vol 197 (6) ◽  
pp. 740-746 ◽  
Author(s):  
Peter J. Lovrics ◽  
Sylvie D. Cornacchi ◽  
Forough Farrokhyar ◽  
Anna Garnett ◽  
Vicky Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conservation ◽  
Margin Status ◽  
Early Stage Breast Cancer ◽  
Breast Conservation Surgery ◽  
Conservation Surgery ◽  
The Relationship
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