Radiation therapy after breast-conserving surgery: When are we missing the mark?

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 43-43
Author(s):  
Mohammed Nassif ◽  
Nora Trabulsi ◽  
Kristen Reidel ◽  
Sarkis H. Meterissian ◽  
Robyn Tamblyn ◽  
...  
Keyword(s):  
Advanced Disease ◽  
Postoperative Radiotherapy ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Administrative Claims ◽  
Cancer Registry Data ◽  
Chemotherapy Administration ◽  
Patient Diagnosis ◽  
Physician Characteristics ◽  
Wide Dissemination

43 Background: Postoperative radiotherapy (RT) after breast conserving surgery (BCS) represents the standard of care for local control of breast cancer (BC). Despite wide dissemination of clinical guidelines, variations in practice persist. Our objective was to identify patient, disease, and physician characteristics that predict lack of consideration for RT after BCS. Methods: Cancer registry data and administrative claims for all BCs diagnosed in Quebec from 1998 to 2005 were collected. Receipt of a consultation for RT in women with non-metastatic BC treated with BCS was measured. Multivariate logistic regression was used to assess the association between patient, disease, and physician characteristics and having an RT consult. Results: 27,483 women were included. Mean age was 59 years, 76.5% had no comorbidities, and 27.6% had stage III BC. Overall, 90.1% of women were considered for RT within 1 year of diagnosis. Patients at age extremes were less likely to be considered as compared to women 50-69: those 30-49, 70-79 and 80+ had odds ratios (OR) of 0.82 (CI 0.73-0.93), 0.54 (CI 0.48-0.61) & 0.11 (CI 0.09-0.12), respectively. Women with any ER visit and women with a hospitalization (unrelated to BC) had 15% and 17% lower odds of having an RT consult, respectively. In patients with advanced disease, receiving a consultation for chemotherapy within 4 months of BCS increased the likelihood of also being considered for RT within 1 year (OR 1.54, CI 1.19-2.00). Increases in physician BCS volume in the year prior to patient diagnosis increased the chance of their patient receiving an RT consult by 7% for every additional 10 BCS performed. Conclusions: Patient age, use of non- BC-related health services and physician volume of BCS predicts use of RT. Guideline deviations in chemotherapy administration also predicts variation in RT use.

scholarly journals Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

2021 ◽  
Vol 186 (3) ◽  
pp. 617-624
Author(s):  
Kate R. Pawloski ◽  
Audree B. Tadros ◽  
Varadan Sevilimedu ◽  
Ashley Newman ◽  
Lori Gentile ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Advanced Disease ◽  
Breast Conserving Surgery ◽  
Risk Profile ◽  
High Grade ◽  
Group A ◽  
First Recurrence

Abstract Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

scholarly journals Breast Conserving Treatment for Breast Cancer: Dosimetric Comparison of Sequential versus Simultaneous Integrated Photon Boost

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hilde Van Parijs ◽  
Truus Reynders ◽  
Karina Heuninckx ◽  
Dirk Verellen ◽  
Guy Storme ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Helical Tomotherapy ◽  
Organs At Risk ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Conventional Technique ◽  
Breast Conserving Treatment ◽  
Safe Alternative ◽  
Dosimetric Comparison ◽  
Sequential Boost

Background. Breast conserving surgery followed by whole breast irradiation is widely accepted as standard of care for early breast cancer. Addition of a boost dose to the initial tumor area further reduces local recurrences. We investigated the dosimetric benefits of a simultaneously integrated boost (SIB) compared to a sequential boost to hypofractionate the boost volume, while maintaining normofractionation on the breast.Methods. For 10 patients 4 treatment plans were deployed, 1 with a sequential photon boost, and 3 with different SIB techniques: on a conventional linear accelerator, helical TomoTherapy, and static TomoDirect. Dosimetric comparison was performed.Results. PTV-coverage was good in all techniques. Conformity was better with all SIB techniques compared to sequential boost (P= 0.0001). There was less dose spilling to the ipsilateral breast outside the PTVboost (P= 0.04). The dose to the organs at risk (OAR) was not influenced by SIB compared to sequential boost. Helical TomoTherapy showed a higher mean dose to the contralateral breast, but less than 5 Gy for each patient.Conclusions. SIB showed less dose spilling within the breast and equal dose to OAR compared to sequential boost. Both helical TomoTherapy and the conventional technique delivered acceptable dosimetry. SIB seems a safe alternative and can be implemented in clinical routine.

scholarly journals Biliary Tract Cancers: Molecular Heterogeneity and New Treatment Options

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3370
Author(s):  
Nicola Personeni ◽  
Ana Lleo ◽  
Tiziana Pressiani ◽  
Francesca Colapietro ◽  
Mark Robert Openshaw ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Advanced Disease ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Resistance Mechanisms ◽  
Anatomical Location ◽  
Molecular Heterogeneity ◽  
Isocitrate Dehydrogenase 1 ◽  
Tract Cancer

Most patients with biliary tract cancer (BTC) are diagnosed with advanced disease, relapse rates are high in those undergoing surgery and prognosis remains poor, while the incidence is increasing. Treatment options are limited, and chemotherapy is still the standard of care in both adjuvant and advanced disease setting. In recent years, different subtypes of BTC have been defined depending on the anatomical location and genetic and/or epigenetic aberrations. Especially for intrahepatic cholangiocarcinoma (iCCA) novel therapeutic targets have been identified, including fibroblast growth factor receptor 2 gene fusions and isocitrate dehydrogenase 1 and 2 mutations, with molecularly targeted agents having shown evidence of activity in this subgroup of patients. Additionally, other pathways are being evaluated in both iCCA and other subtypes of BTC, alongside targeting of the immune microenvironment. The growing knowledge of BTC biology and molecular heterogeneity has paved the way for the development of new therapeutic approaches that will completely change the treatment paradigm for this disease in the near future. This review provides an overview of the molecular heterogeneity of BTC and summarizes new targets and emerging therapies in development. We also discuss resistance mechanisms, open issues, and future perspectives in the management of BTC.

Incidence of local recurrence in patients after breast-conserving surgery and postoperative radiotherapy with or without a supplementary radiation.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 159-159
Author(s):  
Danijela D. Scepanovic ◽  
Andrea Hurakova ◽  
Martina Lukacovicova ◽  
Zuzana Dolinska ◽  
Andrea Masarykova ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Significant Influence ◽  
Postoperative Radiotherapy ◽  
Local Treatment ◽  
Breast Conserving Surgery ◽  
Low Risk ◽  
Surgical Margins ◽  
Complete Excision ◽  
Incomplete Excision ◽  
Significant Difference

159 Background: We evaluated the incidence of local recurrence (LR) among patients (pts) who received radiotherapy with/without a supplementary dose of radiation (boost) to the tumor bed after breast-conserving surgery (BCS) for early breast cancer (BC). Methods: In our retrospective analysis (from 2000-2004) 449 pts with stage I/II BC received 50Gy of radiation to the whole breast in 2Gy fractions over a five-week period after BCS. There were 328 pts (73%) with microscopically complete excision (>5mm margins) and 121 pts (27%) with a microscopically incomplete excision (≤5mm margins). Patients with a microscopically complete or incomplete excision were randomly assigned to receive either no further local treatment (190) or an additional localized dose (309) of 10-16Gy, usually given in 5-8 fractions (fr) by electrons/15Gy in 3 fr by HDR interstitial brachytherapy. Results: During a median follow-up period of 79 months (min 20, max 120), the cumulative incidence of LR was 3% for all group of pts (449). The LR was observed in 1 of 190 pts in group without boost and 13 of 309 pts in group with boost. There was statistically significant difference between two groups of pts regarding local recurrence rate (LRR) (p= 0.0218).The 5 year actuarial rates of LR were 1% in group of pts with negative surgical margins versus 8% in group of pts with positive margins [95% CI, 6% (1%-26%)] (p<0.001). Multivariate analysis showed that pts with negative surgical margins had strongly statistically significant influence (p<0.001) and pts with negative lymph/angioinvasion had statistically significant influence on low risk of LR (p = 0.007). The 5 year DFS was 90% and OS was 98% in all group of pts (449). There was no statistical significant difference between two groups of pts regarding DFS and OS. Conclusions: In our analysis, the incidence of LR is low. However, there was better result in no boost group of pts regarding LRR. The cause was in more frequent selection among worse group of pts with positive surgical margins for application of boost (73% vs 52%, p<0.0001). The strong criteria for identifying low risk group of pts for LR were: negative surgical margins and absence of lymph/angioinvasion.

Long-term survival update of the Scandinavian Prostate Cancer Group 6 study: Bicalutamide 150 mg daily versus placebo in hormone-naïve, non-metastatic prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 2-2 ◽  
Author(s):  
Frederik Birkebæk Thomsen ◽  
Klaus Brasso ◽  
Ib Jarle Christensen ◽  
Jan-Erik Johansson ◽  
Anders Angelsen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Survival Benefit ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Baseline Psa

2 Background: The optimal timing of endocrine therapy in non-metastatic prostate cancer (PCa) is not clear. There is a need for more data from randomized trials. Methods: A randomized, double-blind, parallel-group trial comparing bicalutamide 150 mg once daily with placebo in addition to standard of care in patients with hormone-naïve, non-metastatic PCa. Kaplain-Meier analysis was used to estimate overall survival (OS) and multivariate Cox proportional hazard model was performed to analyse time-to-event (death). Results: 1,218 patients were included into the SPCG-6 study, 607 patients were randomised to bicalutamide and 611 patients to placebo. The majority (81.4%) were managed on watchful waiting. After median 14.6 years follow-up, 866 (71.1%) patients died, 428 (70.5%) in the bicalutamide arm and 438 (71.7%) in the placebo arm, p=0.87. In patients with localised disease (cT1-2, N0/Nx) survival favoured randomisation to the placebo arm (HR=1.19 (95% CI: 1.00-1.43), p=0.056). Bicalutamide significantly improved OS and reduced the risk of death by 23% relative to the placebo arm in patient with locally advanced disease (cT3-4, any N; or any cT, N+) with a median survival difference of 1.8 years (HR=0.77 (95% CI: 0.63-0.94, p=0.01). The survival benefit of bicalutamide in patients with locally advanced PCa was present throughout the study period. In multivariate Cox proportional hazard model OS was dependent on age (HR 1.55 (95% CI:1.20-1.85)), baseline PSA (localised PCa HR for 2 x increase in PSA 1.09 (95% CI:1.02-1.16), locally advanced PCa HR 1.23 (95% CI:1.14-1.33)), WHO histological grade (moderate vs. well HR 1.27 (95% CI:1.08-1.49), poor vs. well HR 1.92 (95% CI:1.51-2.45)), and randomisation to placebo in locally advanced disease (HR=0.76 (95% CI: 0.61-0.95)). Conclusions: The addition of early bicalutamide to standard of care resulted in a significant OS benefit in patients with locally advanced PCa, whereas patients with localised PCa derived no survival benefit from early bicalutamide. The survival benefit of bicalutamide therapy increased with higher baseline PSA. Clinical trial information: NCT00672282.

Targets, Trials, and Travails in Pancreas Cancer

2007 ◽  
Vol 5 (10) ◽  
pp. 1042-1053 ◽  
Author(s):  
Kamel Izeradjene ◽  
Sunil R. Hingorani
Keyword(s):  
Pancreas Cancer ◽  
Advanced Disease ◽  
Standard Of Care ◽  
Therapeutic Strategies ◽  
Current Standard ◽  
Fatal Disease ◽  
New Therapies

Pancreas cancer is a highly aggressive and rapidly fatal disease. The current standard of care for advanced disease improves survival modestly at best and provides palliation for a minority of patients. The need for new therapies is undisputed. This article describes new therapeutic strategies currently under investigation and discusses possible reasons that others have failed. New potential targets in the treatment of this formidable disease are suggested based on recent findings.

scholarly journals Current Challenges in Access to Melanoma Care: A Multidisciplinary Perspective

2021 ◽  
pp. e295-e303
Author(s):  
Nikhil I. Khushalani ◽  
Thach-Giao Truong ◽  
John F. Thompson
Keyword(s):  
Advanced Disease ◽  
Standard Of Care ◽  
Optimal Care ◽  
Improve Treatment ◽  
Therapeutic Landscape ◽  
The World ◽  
Specialized Care ◽  
Multidisciplinary Perspective ◽  
The Many ◽  
Complex Drug

A diagnosis of melanoma requires multidisciplinary specialized care across all stages of disease. Although many important advances have been made for the treatment of melanoma for local and advanced disease, barriers to optimal care remain for many patients who live in areas without ready access to the expertise of a specialized melanoma center. In this article, we review some of the recent advances in the treatment of melanoma and the persistent challenges around the world that prevent the delivery of the best standard of care to patients living in the community. With the therapeutic landscape continuing to evolve and newer more complex drug therapies soon to be approved, it is important to recognize the many challenges that patients face and attempt to identify tools and policies that will help to improve treatment outcomes for their melanoma.

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

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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