scholarly journals Patterns and Correlates of Adjuvant Radiotherapy Receipt After Lumpectomy and After Mastectomy for Breast Cancer

2010 ◽  
Vol 28 (14) ◽  
pp. 2396-2403 ◽  
Author(s):  
Reshma Jagsi ◽  
Paul Abrahamse ◽  
Monica Morrow ◽  
Sarah T. Hawley ◽  
Jennifer J. Griggs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Adjuvant Radiotherapy ◽  
Strong Influence ◽  
Response Rate ◽  
Breast Conserving Surgery ◽  
Self Report ◽  
Seer Data ◽  
Survey Responses ◽  
Positive Lymph Nodes

Purpose To use patient self-report to provide more valid estimates of whether radiotherapy (RT) is underutilized than possible with registry data, as well as to evaluate for disparities and the influence of preferences and provider interactions. Methods We considered 2,260 survey respondents who had nonmetastatic breast cancer, were age 20 to 79 years, were diagnosed between July 2005 and February 2007 in Detroit and Los Angeles, and reported to Surveillance, Epidemiology and End Results (SEER) registries (72% response rate). Survey responses were merged with SEER data. We assessed rates and correlates of RT receipt among all patients with invasive cancer receiving breast-conserving surgery (BCS) and among patients undergoing mastectomy with indications for RT (ie, positive lymph nodes or T3-4 tumors). Results Among 904 patients undergoing BCS with strong indications for RT, 95.4% received RT, and 77.6% received RT among the 135 patients undergoing mastectomy with strong indications (P < .001). Among 114 patients undergoing BCS with weaker indications (ie, elderly) for RT, 80.0% received treatment, and 47.5% received RT among the 164 patients undergoing mastectomy with weaker indications (T1N1, T2N1, or T3N0 disease; P < .001). On multivariate analysis, surgery type (P < .001), indication strength (P < .001), age (P = .005), comorbidity (P < .001), income (P = .03), patient desire to avoid RT (P < .001), level of surgeon involvement in decision to have radiation (P < .001), and SEER site (P < .001) were significantly associated with likelihood of RT receipt. Conclusion RT receipt was consistently high across sociodemographic subgroups after BCS but was lower after mastectomy, even among patients with strong indications for treatment, in whom clinical benefit is similar. Surgeon involvement had a strong influence on RT receipt.

Mammography Adherence among High-Risk Women with Breast Cancer and Either a Non-Pathogenic Mutation Identified or Untested BRCA1/2 Genetic Status

2020 ◽  
Vol 1 (1) ◽  
pp. 29-42
Author(s):  
Alison Flehr ◽  
Fiona Judd ◽  
Geoffrey J. Lindeman ◽  
Maira Kentwell ◽  
Penny Gibson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Illness Perceptions ◽  
Response Rate ◽  
Familial Cancer ◽  
Pathogenic Mutation ◽  
Self Report ◽  
Middle Income ◽  
Income Status ◽  
Emotional Representations ◽  
The Impact

Background: Little is known about the illness perceptions of women with a previous breast cancer diagnosis and either no access to a personal BRCA1/2 test or tested and a no pathogenic mutation identified result and how this might impact their mammography adherence. Objective: The aim of this study was to assess the impact of illness beliefs, specifically those relating to emotional representations and cure and control beliefs about breast cancer, and socio-economic status (SES) on mammography adherence of these women. The traditional health belief model (HBM) was compared to a modified model which allowed for the contribution of emotions in health surveillance decision-making. Method: Mailed self-report questionnaires were completed by 193 women recruited from an Australian Familial Cancer Centre. Step-wise logistic regression analyses were conducted on n=150 [aged 27-89 years (M=56.9)] for whom complete data were available. Results: The questionnaire response rate was 36%. Higher levels of emotional representations of breast cancer were associated with greater mammography adherence (OR = 1.18, 95% CI = 1.03-1.36, p =.019). Middle income was six times more likely to predict mammography adherence than lower income (OR = 6.39, 95% CI = 1.03 – 39.63, p =.047). The modified HBM was superior to the traditional HBM in predicting mammography adherence (X2 [15, N = 118] = 26.03, p =.038). Conclusions: Despite a modest response rate, our data show that emotional illness representations about breast cancer and middle income status were found to significantly predict mammography adherence. Therefore, providing surveillance services and delivering information considerate of financial status and constructed around emotional motivators may facilitate mammography adherence among women like those described in this study.

scholarly journals Breast Cancer Care in South India: Is Practice Concordant With National Guidelines?

2019 ◽  
pp. 1-7 ◽  
Author(s):  
D.K. Vijaykumar ◽  
Sujana Arun ◽  
Aswin G. Abraham ◽  
Wilma Hopman ◽  
Andrew G. Robinson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Care ◽  
Adjuvant Radiotherapy ◽  
South India ◽  
Breast Cancer Care ◽  
Adjuvant Trastuzumab ◽  
Positive Lymph Nodes

PURPOSE The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines. METHODS All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab. RESULTS A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab. CONCLUSION Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.

scholarly journals Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer

Cancer ◽  
2010 ◽  
Vol 117 (12) ◽  
pp. 2590-2598 ◽  
Author(s):  
Anthony E. Dragun ◽  
Bin Huang ◽  
Thomas C. Tucker ◽  
William J. Spanos
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer

Primary systemic chemotherapy for operable breast cancer with docetaxel followed by cyclophosphamide, epirubicin, and fluorauracil (DOC-CEF)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11085-11085
Author(s):  
Y. Kikawa ◽  
Y. Masai ◽  
T. Hashimoto ◽  
Y. Nakamoto ◽  
H. Nishikawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Chemotherapy ◽  
Response Rate ◽  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
High Response Rate ◽  
High Response ◽  
Clinical Response Rate ◽  
Primary Systemic Chemotherapy ◽  
Sequential Administration

11085 Background: Primary systemic chemotherapy (PSC) for breast cancer has been considered to be useful controlling the micrometastasis and shown to increase the breast conserving surgery rate, result in similar survival rate as usual post-operative adjuvant chemotherapy. Recently, doxorubicin based regimen followed by taxan regimen in neoadjuvant chemotherapy has shown a high response rate and sequential administration is supposed to be important. However, taxan regimens sequentially followed by doxorubicin are not so common. The purpose of this study is to evaluate the efficacy of primary systemic chemotherapy with docetaxel followed by cyclophosphamide, epirubicin and fluoraouracil (DOC-CEF) in breast cancer. Methods: Since 2003, 80 women histologically proven as the primary breast cancer, measurable lesion >= 2cm or inflammatory breast cancer, age 20–75, PS 0–1 were enrolled. The patients received 4 cycles of DOC (75mg/m2) every 3 weeks followed by CEF (500mg/m2, 75mg/m2, 500mg/m2) every 3 weeks as the primary systemic chemotherapy. After administrations, clinical responses and tumor vascularities were recorded by ultrasonography and pathological responses were examined after surgery for all patients. Results: 57 out of 80 patients (T2: 45, T3 6, T4 6) were analyzed at this time. Clinical response rate recorded by ultrasonography and pathological response rate were 82.4% (47/57) and 91.2% (52/57) respectively. Pathological CR rate was 26.3% (15/57). 8 pCR cases showed ER/PR-negative tumors of which 3 cases showed ER/PR-negative/Her2-negative (triple negative pattern). Breast conservative surgery was underwent in 51 patients (89.5%). Among the response group, the tumor vascularities were almost remarkably decreased in the early phase (mostly until 2–3 cycles) of the chemotherapy. Grade 4 neutropenia was observed in 16% (9/57) and 4% (2/57) had febrile neutropenia. Conclusion: This regimen is well tolerated and has good feasibility because most patients have experienced the early reduction of tumor by high response rate of docetaxel. No significant financial relationships to disclose.

scholarly journals Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: results of a prospective trial

2020 ◽  
Author(s):  
David Krug ◽  
René Baumann ◽  
Katja Krockenberger ◽  
Reinhard Vonthein ◽  
Andreas Schreiber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Prospective Trial ◽  
Treatment Protocol ◽  
Breast Conserving Surgery ◽  
Simultaneous Integrated Boost ◽  
Hypofractionated Radiotherapy ◽  
Tumor Bed ◽  
Integrated Boost ◽  
3D Crt

Abstract Purpose We report results of a multicenter prospective single-arm phase II trial (ARO-2013-04, NCT01948726) of moderately accelerated hypofractionated radiotherapy with a simultaneous integrated boost (SIB) in patients with breast cancer receiving adjuvant radiotherapy after breast-conserving surgery. Methods The eligibility criteria included unifocal breast cancer with an indication for adjuvant radiotherapy to the whole breast and boost radiotherapy to the tumor bed. The whole breast received a dose of 40 Gy and the tumor bed a total dose of 48 Gy in 16 fractions of 2.5 and 3 Gy, respectively. Radiotherapy could be given either as 3D conformal RT (3D-CRT) or as intensity-modulated radiotherapy (IMRT). The study was designed as a prospective single-arm trial to evaluate the acute toxicity of the treatment regimen. The study hypothesis was that the frequency of acute skin reaction grade ≥2 would be 20% or less. Results From November 2013 through July 2014, 149 patients were recruited from 12 participating centers. Six patients were excluded, leaving 143 patients for analysis. Eighty-four patients (58.7%) were treated with 3D-CRT and 59 (41.3%) with IMRT. Adherence to the treatment protocol was high. The rate of grade ≥2 skin toxicity was 14.7% (95% confidence interval 9.8–21.4%). The most frequent grade 3 toxicity (11%) was hot flashes. Conclusion This study demonstrated low toxicity of and high treatment adherence to hypofractionated adjuvant radiotherapy with SIB in a multicenter prospective trial, although the primary hypothesis was not met.

scholarly journals Association between waiting time for radiotherapy after surgery for early-stage breast cancer and survival outcomes in Ontario: a population-based outcomes study

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
M. J. Raphael ◽  
R. Saskin ◽  
S. Singh
Keyword(s):  
Breast Cancer ◽  
Waiting Time ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Survival Outcomes ◽  
Event Free Survival ◽  
Free Survival

Background: Following surgery for early stage breast cancer, adjuvant radiotherapy decreases the risk of locoregional recurrence and death from breast cancer. It is unclear if delays to the initiation of adjuvant radiotherapy are associated with inferior survival outcomes. Methods: This population-based, prospective cohort study included a random sample of 25% of all women with stage I and II breast cancer treated with adjuvant radiotherapy in Ontario, Canada between September 1, 2001 and August 31, 2002, when due to capacity issues, wait times for radiation were abnormally long. Pathology reports were manually abstracted and deterministically-linked to population-level administrative databases to obtain information on recurrence and survival outcomes. Cox proportional hazard modeling was used to evaluate the association between waiting time and survival outcomes. A composite survival outcome was used to ensure that all possible measurable harms of delay would be captured. The composite outcome, event-free survival, included locoregional recurrence, development of metastatic disease or breast cancer-specific mortality. Results: We identified 1,028 women with Stage I and II breast cancer who were treated with breast-conserving surgery and adjuvant radiotherapy. Among 599 women who were treated with adjuvant radiation without intervening chemotherapy, waiting time ≥12 weeks from surgery to start of radiation appears to be associated with worse event-free survival after a median follow-up of 7.2 years (HR, composite outcome = 1.44, 95% CI: 0.98-2.11; p= 0.07). Among 429 women who received intervening adjuvant chemotherapy, waiting time ≥6 weeks from completion of chemotherapy to start of radiation was associated with worse event-free survival after a median follow-up of 7.4 years (HR 1.50, 95% CI: 1.00-2.22; p= 0.047). Conclusion: Delay to the initiation of adjuvant radiotherapy following breast-conserving surgery is associated with inferior breast cancer survival outcomes. The good prognosis for patients with early stage breast cancer limits the statistical power to detect an effect of delay to radiotherapy. Given that there is no plausible advantage to delay, we agree with Mackillop et al, that time to initiation of radiotherapy should be kept “as short as reasonably achievable.”

scholarly journals Clinicogenomic Radiotherapy Classifier Predicting the Need for Intensified Locoregional Treatment After Breast-Conserving Surgery for Early-Stage Breast Cancer

2019 ◽  
Vol 37 (35) ◽  
pp. 3340-3349 ◽  
Author(s):  
Martin Sjöström ◽  
S. Laura Chang ◽  
Nick Fishbane ◽  
Elai Davicioni ◽  
Shuang G. Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cumulative Incidence ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Treatment Strategies ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Phase Iii ◽  
Primary Tumors ◽  
Tumor Bed

PURPOSE Most patients with early-stage breast cancer are treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) to prevent locoregional recurrence (LRR). However, no genomic tools are used currently to select the optimal RT strategy. METHODS We profiled the transcriptome of primary tumors on a clinical grade assay from the SweBCG91-RT trial, in which patients with node-negative breast cancer were randomly assigned to either whole-breast RT after BCS or no RT. We derived a new classifier, Adjuvant Radiotherapy Intensification Classifier (ARTIC), comprising 27 genes and patient age, in three publicly available cohorts, then independently validated ARTIC for LRR in 748 patients in SweBCG91-RT. We also compared previously published genomic signatures for ability to predict benefit from RT in SweBCG91-RT. RESULTS ARTIC was highly prognostic for LRR in patients treated with RT (hazard ratio [HR], 3.4; 95% CI, 2.0 to 5.9; P < .001) and predictive of RT benefit ( Pinteraction = .005). Patients with low ARTIC scores had a large benefit from RT (HR, 0.33 [95% CI, 0.21 to 0.52], P < .001; 10-year cumulative incidence of LRR, 6% v 21%), whereas those with high ARTIC scores benefited less from RT (HR, 0.73 [95% CI, 0.44 to 1.2], P = .23; 10-year cumulative incidence of LRR, 25% v 32%). In contrast, none of the eight previously published signatures were predictive of benefit from RT in SweBCG91-RT. CONCLUSION ARTIC identified women with a substantial benefit from RT as well as women with a particularly elevated LRR risk in whom whole-breast RT was not sufficiently effective and, thus, in whom intensified treatment strategies such as tumor-bed boost, and possibly regional nodal RT, should be considered. To our knowledge, ARTIC is the first classifier validated as predictive of benefit from RT in a phase III clinical trial with patients randomly assigned to receive or not receive RT.

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