Treatment of invasive lobular carcinoma with breast conserving therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11046-11046
Author(s):  
A. H. Tulusan ◽  
M. Bühner ◽  
M. Popovich
Keyword(s):  
Local Recurrence ◽  
Invasive Lobular Carcinoma ◽  
Breast Imaging ◽  
Lobular Carcinoma ◽  
Distant Metastases ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Breast Irradiation ◽  
Exact Size

11046 Background: Invasive lobular carcinoma (ILC) is the second most common histological type of breast carcinoma .There is still a persisting concern regarding the use of breast-conserving therapy(BCT) in patients with ILC.Difficulty to identify the exact size , location of ILC and multifocality and/or multicentricity are the reasons to suggest that patients with ILC might be poor candidates for BCT. The aim of our current study was to evaluate the possibilty of risk adapted BCT for patients with ILC with or without breast irradiation. Methods: 277 patients with ILC pure or mixed type between 1994 and 2006 were accrued for pospective risk adapted therapy. Contraindications for BCT are multicentricity , inability to obtain negative margins or poor cosmesis. Palpation, mammograpy,ultrasound were routinely done and preoperative MRI in cases with no sharp tumor image. Breast conserving surgery was standardised by performing a radial segmental resection. Inking margins,histological semiserial step sections and specimen radiography was done. Sharp dileneated ILC with a free margins of >/= 1cm and no lymphvesel invasion(LVI) were treated by BCT without breast irradiation(Rx). Patients with ER + were treated with endocrine therapy.Mean follow-up time was 74 months. Results: Of the 277 ILC cases , 55(19,8%) were treated by mastectomy and five patients palliatively because of distant metastases. 217 ILC (79%) were treated with BCT (T1:108/48%;T2:45(21%);T3:67/31% ; NO:135/62%; ER+: 295/94%). 6 patients(2,8%) had local recurrence(LR). 161 ILC (T1 38%; T2 22%; T3 39%; N0 55%) were treated with BCT with Rx. Patients mean age was 57 years. 6(3,7%) of the patients had local recurrence (4 LR only, 2 LR and distant metastases). 56 ILC (T1 69%; T2 15% T3 22% ; NO 81%) were treated with BCT without Rx. Mean age 66 years. There were no LR , 2 patients had distant metastases. Conclusions: Using strict selecting criteria with a standardized breast conserving surgical procedure, thorough histological examination and using all breast imaging possibilities risk adapted BCT for ILC are not more likely to fail than BCT of other types of breast cancer. These results support the use of BCT for ILC patients. No significant financial relationships to disclose.

Breast Cancer Subtype Approximated by Estrogen Receptor, Progesterone Receptor, and HER-2 Is Associated With Local and Distant Recurrence After Breast-Conserving Therapy

2008 ◽  
Vol 26 (14) ◽  
pp. 2373-2378 ◽  
Author(s):  
Paul L. Nguyen ◽  
Alphonse G. Taghian ◽  
Matthew S. Katz ◽  
Andrzej Niemierko ◽  
Rita F. Abi Raad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Breast Cancer Subtype ◽  
Distant Metastases ◽  
Breast Conserving Therapy ◽  
Luminal A ◽  
Luminal B ◽  
Cancer Subtype ◽  
Her 2

Purpose To determine whether breast cancer subtype is associated with outcome after breast-conserving therapy (BCT) consisting of lumpectomy and radiation therapy. Patients and Methods We studied 793 consecutive patients with invasive breast cancer who received BCT from July 1998 to December 2001. Among them, 97% had pathologically negative margins of resection, and 90% received adjuvant systemic therapy. No patient received adjuvant trastuzumab. Receptor status was used to approximate subtype: estrogen receptor (ER) or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 negative = luminal A; ER+ or PR+ and HER-2+ = luminal B; ER–and PR –and HER-2+ = HER-2; and ER–and PR –and HER-2–= basal. Competing risks methodology was used to analyze time to local recurrence and distant metastases. Results Median follow-up was 70 months. The overall 5-year cumulative incidence of local recurrence was 1.8% (95% CI, 1.0 to 3.1); 0.8% (0.3, 2.2) for luminal A, 1.5% (0.2, 10) for luminal B, 8.4% (2.2, 30) for HER-2, and 7.1% (3.0, 16) for basal. On multivariable analysis (MVA) with luminal A as baseline, HER-2 (adjusted hazard ratio [AHR] = 9.2; 95% CI, 1.6 to 51; P = .012) and basal (AHR = 7.1; 95% CI, 1.6 to 31; P = .009) subtypes were associated with increased local recurrence. On MVA, luminal B (AHR = 2.9; 95% CI, 1.3 to 6.5; P = .007) and basal (AHR = 2.3; 95% CI, 1.1 to 5.2; P = .035) were associated with increased distant metastases. Conclusion Overall, the 5-year local recurrence rate after BCT was low, but varied by subtype as approximated using ER, PR, and HER-2 status. Local recurrence was particularly low for the luminal A subtype, but was less than 10% at 5 years for all subtypes. Although further follow-up is needed, these results may be useful in counseling patients about their anticipated outcome after BCT.

scholarly journals Molecular breast imaging detected invasive lobular carcinoma in dense breasts: A case report

2019 ◽  
Vol 7 (3) ◽  
pp. 442-444 ◽  
Author(s):  
Naziya Samreen ◽  
Katie N. Hunt ◽  
Carrie B. Hruska ◽  
Deborah J. Rhodes
Keyword(s):  
Case Report ◽  
Invasive Lobular Carcinoma ◽  
Breast Imaging ◽  
Lobular Carcinoma ◽  
Molecular Breast Imaging ◽  
Dense Breasts

Correlations Between Ultrasonographic Findings of Invasive Lobular Carcinoma of the Breast and Intrinsic Subtypes

2018 ◽  
Vol 40 (06) ◽  
pp. 764-770
Author(s):  
Xin Wen ◽  
Yingjiao Yu ◽  
Xiwen Yu ◽  
Wen Cheng ◽  
Zhuozhong Wang ◽  
...  
Keyword(s):  
Invasive Lobular Carcinoma ◽  
Breast Imaging ◽  
Lobular Carcinoma ◽  
Her2 Overexpression ◽  
Intrinsic Subtypes ◽  
Luminal A ◽  
Luminal B ◽  
The Masses ◽  
Accurate Imaging ◽  
Acoustic Shadowing

Abstract Purpose To analyze the ultrasonographic findings of invasive lobular carcinoma (ILC) of the breast in 360 women and the correlations between the characteristics and the intrinsic subtypes. Materials and Methods We evaluated the imaging findings according to the lexicon of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). The included ultrasonographic features were shape, orientation, margin, echo pattern, posterior features, calcifications, the vascularity of the masses and the presence of architectural distortions. The associations between those features and the intrinsic ILC subtypes were investigated. Results The most common manifestations of ILC on ultrasound (US) were hypoechoic masses with irregular shape, parallel orientation, spiculated margin, posterior acoustic shadowing, no calcification and blood vessels in the rim. The patients in the luminal A subtype were the youngest, and the patients in the HER2 overexpression subtype were the oldest (p = 0.01). On US, the HER2 overexpression subtype was characterized by microlobulated margins (p = 0.002), while the luminal A subtype and the luminal B subtype mostly had spiculated margins. The basal-like subtype was distinctive in that it had no posterior features (p = 0.041), rather than acoustic shadowing, and the masses in the HER2 and basal-like subtypes were larger than in the other two groups (p = 0.03). Conclusion There were significant differences and several trends in the ultrasonographic characteristics of different intrinsic subtypes, which may supply accurate imaging diagnostic criteria to assist in the management of individuals with ILC.

scholarly journals Accelerated Partial Breast Irradiation as an Alternative to Whole-Breast Irradiation in Breast-Conserving Therapy for Early-Stage Breast Cancer

2005 ◽  
Vol 1 (1) ◽  
pp. 59-71
Author(s):  
Timothy M Pawlik ◽  
Henry M Kuerer
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Therapy ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

scholarly journals Fifty Years of Progress in Radiation Therapy for Breast Cancer

2014 ◽  
pp. 21-25 ◽  
Author(s):  
Jay R. Harris
Keyword(s):  
Radiation Therapy ◽  
Systemic Therapy ◽  
Distant Metastases ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Adjuvant Systemic Therapy ◽  
Tumor Control ◽  
Axillary Lymph ◽  
Recurrence Rates ◽  
Term Survival

Fifty years ago, radiation therapy (RT) was only used after mastectomy in patients with high-risk disease. The equipment, treatment planning, and treatment delivery were rudimentary compared to what is available today. In retrospect, the deleterious effects of the RT back then negated its benefits. The strategy of combining lesser surgery with RT (and adjuvant systemic therapy) has been successfully employed in breast-conserving therapy (BCT) and in avoiding axillary lymph node dissection in patients with 1 or 2 involved sentinel nodes. Local recurrence rates at 10 years following BCT are now similar to those following mastectomy. RT after breast-conserving surgery and after mastectomy has been demonstrated to not only decrease local-regional recurrence but also decrease distant metastases and improve long-term survival. The development of effective adjuvant systemic therapy has made RT not only more effective but also arguably more important. If systemic therapy is effective at addressing micro-metastatic disease, then obtaining local tumor control becomes even more important. Moderately hypofractionated RT (2.66 Gy per day) is just as safe and effective as conventional fractionation shortening BCT from 6 weeks to 3–4 weeks. Treatment is now given with multiple-energy linear accelerators, CT-based simulation, 3-dimensional beam modulation for much greater dose homogeneity, on-board imaging for greater daily accuracy, and various techniques to reduce cardiac dose.

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