Propensity-score matched pair comparison of accelerated partial breast irradiation (APBI) and whole breast irradiation (WBI) for ductal carcinoma in situ (DCIS).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1123-1123
Author(s):  
John Ben Wilkinson ◽  
Ashley Fowler ◽  
Ovidiu Marina ◽  
Michelle Wallace ◽  
Kimberly Marvin ◽  
...  

1123 Background: DCIS remains a cautionary criterion for APBI by the ASTRO APBI consensus statement. We performed a matched analysis to compare the efficacy of WBI and APBI for patients with DCIS. Methods: Women with DCIS treated with APBI or WBI were reviewed. APBI (n=102) patients with ≥2 y follow-up were matched 1:3 to WBI (n=546) patients with ≥5 y follow-up by age, tumor size, nuclear grade, ER status, margin status, and laterality. Ipsilateral breast tumor recurrence (IBTR), distant metastasis (DM), contralateral breast cancer (CLBC) and cause-specific survival (CSS) were compared by cumulative incidence (Gray’s) and competing risks regression (Fine and Gray’s), and overall survival (OS) and disease-free survival (DFS) by Kaplan-Meier (log-rank test). Results: Median follow-up was 4.6 y (2.0-14.7) for APBI and 9.0 y (5.4-27.0) for WBI. Median (range) or percentages are shown (Table). Patients did not differ by match criteria. There were 17 LR, 1 DM, 19 CLBC, 2 CSS, 22 OS, and 19 DFS events during follow-up. The patient groups had similar rates of cancer-related events including ipsilateral and contralateral breast recurrences at both five and eight years. Treatment type, age, tumor size, nuclear grade, ER status, and hormone therapy (HT) were not prognostic of LR or CLBC on uni- and multi-variate analyses. Conclusions: APBI provides equivalent and exemplary outcomes compared to WBI following breast-conserving surgery for DCIS. These findings support previous reports on the efficacy of APBI in the treatment of noninvasive breast carcinoma. Prospective randomized comparison of APBI to WBI for DCIS is needed. [Table: see text]

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 65-65
Author(s):  
Peter Y. Chen ◽  
John Ben Wilkinson ◽  
Chirag Shah ◽  
Jessica Wobb ◽  
Michelle Wallace ◽  
...  

65 Background: Given the initial report of the RAPID trial with greater morbidity for 3-D conformal external beam APBI [3D-APBI] vs. Canadian Hypofractionation [CHfx], a propensity-score matched-pair analysis of brachytherapy-based APBI [B-APBI] vs. CHfx was performed to assess efficacy, toxicities, and cosmesis. Methods: Early-stage breast cancer patients treated with B-APBI or CHfx were reviewed. With ≥ 1y follow-up [FU], B-APBI (n=108) pts were matched 1:1 to CHfx (n=108) by age, T-stage, nodal/ER status, endocrine or chemotherapy and laterality. Ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastasis (DM), contralateral breast cancer (CLBC), cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) were compared by Kaplan-Meier (log-rank test). Toxicities were graded per CTCAE v3 and comesis per Harvard criteria. Results: Median FU was 5.7 y (1.0-17.8) for B-APBI and 2.1 y (1.0-5.7) for CHfx [p < 0.001]. Patients did not differ by match criteria. In comparing B-APBI to CHfx, median age was 69.0 vs. 70.0 [p = 0.72]; for laterality, T-stage, nodal/ER status, endocrine or chemotherapy, no significance [NS] was noted between the 2 groups [p = 0.79, 1.0, 0.60, 0.09, 0.15, and 0.16 respectively]. Comparing B-APBI to CHfx, NS was seen in 5-y actuarial rates of IBTR [1% vs. 0% p = 0.35], RR [0% both], DM [3.4% vs. 0% p = 0.25], CLBC [2.3% vs. 2% p = 0.63], CSS [94.3% vs. 100% p = 0.47], OS [87.7% vs. 88.3% p = 0.71] & DFS [97.5% vs. 100% p = 0.52]. The majority of maximal late toxicities were Gr 1-2. Of toxicities analyzed, including pigmentary changes, edema, pain, induration, volume reduction, telangiectasia, fat necrosis and seroma, only Gr 2-3 hyperpigmentation was significantly higher in the CHfx [8% B-APBI vs. 22% CHfx p = 0.017]. Good/excellent cosmesis was seen in > 93% in both groups. Conclusions: With FU of >5 yrs, B-APBI has similar efficacy and cosmesis but less morbidity vs. CHfx; the lesser toxicity of B-APBI vs. CHfx is in contradistinction to the RAPID results comparing 3D-APBI vs. CHfx. Further FU and more patients are needed to substantiate these findings.


2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 55-55
Author(s):  
Jessica Wobb ◽  
Michelle Wallace ◽  
Chirag Shah ◽  
Hong Ye ◽  
Maha Saada Jawad ◽  
...  

55 Background: Breast conserving therapy (BCT) represents a standard of care in the management of early stage breast cancer; while adjuvant radiation therapy was traditionally delivered using whole breast irradiation (WBI), accelerated partial breast irradiation (APBI) offers an alternative to WBI that shortens the duration of treatment and may improve toxicity profiles and quality of life. The purpose of this analysis is to compare clinical outcomes of patients treated with WBI versus APBI. Methods: A total of 3,009 patients were treated with BCT at single institution between 1980 and 2012 with 2,528 patients receiving WBI and 481 patients receiving APBI (interstitial or balloon-based). A matched-pair analysis was performed with patients matched according to age (+/- 3 years), T stage (Tis vs T1 vs T2), and estrogen receptor (ER) status (+/-). All patients had a minimum of 12 months of follow up. A total of 247 matches were made with clinical outcomes compared using the Kaplan-Meier method. Results: Mean follow-up was 8.1 years for WBI vs. 7.8 years for APBI (p<0.001), a difference of less than 4 months. There were no differences with respect to age (p=0.88), tumor stage (p=1.0), or ER status (p=1.0). Long-term cosmesis was good to excellent in 94% vs. 95% of patients (p=0.78). WBI patients demonstrated a trend for slightly larger tumors (13.0 vs. 11.4 mm, p=0.06). At 10 years, no difference in ipsilateral breast tumor recurrence (4% vs. 4%, p=0.11), regional recurrence (1% vs. 1%, p=0.20), distant metastases (3% vs. 6%, p=0.47), disease free survival (93% vs. 91%, p=0.10), or contralateral breast failure (9% v. 3%, p=0.06) was noted when comparing WBI and APBI. In addition, 10 year cause-specific survival (94% v. 93%, p=0.72) and overall survival (83% vs. 75%, p=0.34) were similar. Conclusions: At 10 years, no differences in locoregional recurrence, distant metastasis or survival were found between patients undergoing whole breast irradiation or accelerated partial breast irradiation using interstitial catheter or balloon-based brachytherapy. These data represent one of the only APBI series with prolonged follow-up and show similar outcomes in a matched group of patients undergoing WBI or APBI.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18196-e18196
Author(s):  
Temidayo Fadelu ◽  
Ruth Damuse ◽  
Liz Pecan ◽  
Cyrille Dubuisson ◽  
Lauren Greenberg ◽  
...  

e18196 Background: Few studies have reported outcomes of breast cancer (BC) patients in Haiti. Since 2013, University Hospital Mirebalais, a tertiary government hospital, has offered treatment for BC, in partnership with Dana-Farber Cancer Institute and Zanmi Lasante, a Haitian non-profit. Standard chemotherapy and hormone therapy are available, but HER2 therapies and radiation are not. Here, we comprehensively describe patient characteristics, treatments delivered and outcomes of non-metastatic BC patients in this program. Methods: We conducted a retrospective observational study including 339 patients with non-metastatic BC, who presented between January 1, 2013 and June 30, 2016. We conducted detailed chart abstraction of patient characteristics, clinical diagnostic and treatment data, and outcomes. Our endpoint was disease-free survival (DFS) defined as time from presentation to cancer recurrence, progression or death. We used Kaplan-Meier estimation to plot survival curves, censoring at the time of last follow-up. Log-rank test was used to examine subgroup differences. Results: The median age in the cohort was 49, inter-quartile range of 42 to 58; 35.7% were post-menopausal. Invasive ductal carcinoma was the most common histology (65.5%). At presentation, 52.8% had T3/T4 disease, while 54.6% had locally advanced disease, and 37.5% were poorly differentiated. There was incomplete documentation of stage (18.3%), ER status (44.2%) and histologic grade (39.5%). 156 patients received neoadjuvant therapy with hormonal therapy (26.2%), chemotherapy (67.9%), or both (5.8%), while 227 received adjuvant therapy (25.5%, 26.5% and 48.0% respectively). 275 patients (81%) completed surgical resection. Median follow up time for the cohort was 24.8 months. 23 patients died; 75 had recurrences; and 9 had progression. Median DFS was 50.8 months (95% CI, 40.6 to 57.0). There was no DFS difference by ER status. Median DFS for early-stage patients was not reached compared to locally advanced patients of 40.4 months (95% CI, 34.0 to 49.7), P-value < 0.0001. Conclusions: Non-metastatic BC patients in Haiti present with more advanced disease and have poorer prognostic factors compared to high-income countries. Although these patients have comparatively worse outcome, curative treatment is feasible in Haiti.


Author(s):  
Debanjali Sinha ◽  
Sumantro Mondal ◽  
Arijit Nag ◽  
Debasish Lahiri ◽  
Alakendu Ghosh

Background: The objective of the present study was to monitor the disease activity of Takayasu arteritis clinically by the Indian Takayasu Activity Score 2010 (ITAS) and ultra sonographically by Colour Doppler Ultrasound-Kolkata (CDUS-K) Score after 12months of treatment with methotrexate and steroid, and to find the correlation between these two scores.Methods: Around 25 Angiographically proven Takayasu arteritis patients were treated with Methotrexate (15mg weekly) and Steroids (1mg/kg/day for 6weeks and then tapered) for 12months. Wilcoxon matched pair signed rank test was done to assess the change in ITAS 2010 with treatment. A correlation study was done between ITAS 2010 and change in CDUS-K scores at the end of 12months.Results: By Wilcoxon’s matched pair signed rank test, a non-significant change of ITAS 2010 (p=0.066) was observed at the end of 12months, which means that the treatment helps to control the disease progression by preventing a significant increase in ITAS 2010. Strong correlation (correlation coefficient of 0.878, 95% CI = 0.602 to 1.000) was found between the ITAS 2010 and change in CDUS-K scores at 12months follow up.Conclusions: The combination of Methotrexate and steroids helps to control the disease progression in Takayasu arteritis. Colour doppler ultrasonography may serve as a reliable and safe surrogate disease activity measure at follow up, as it avoids the radioactivity exposure and invasiveness of angiography.


2011 ◽  
Vol 29 (13) ◽  
pp. 1657-1663 ◽  
Author(s):  
Allan Hackshaw ◽  
Michael Roughton ◽  
Sharon Forsyth ◽  
Kathryn Monson ◽  
Krystyna Reczko ◽  
...  

Purpose The Cancer Research UK “Over 50s” trial compared 5 and 2 years of tamoxifen in women with early breast cancer. Results are reported after median follow-up of 10 years. Patients and Methods Between 1987 and 1997, 3,449 patients age 50 to 81 years with operable breast cancer who had been taking 20 mg of tamoxifen for 2 years were randomly assigned to either stop or continue for an additional 3 years, if they were alive and recurrence free. Data on recurrences, new tumors, deaths, and cardiovascular events were obtained (April 2010). Results There were 1,103 recurrences, 755 deaths as a result of breast cancer, 621 cardiovascular (CV) events, and 236 deaths as a result of CV events. Fifteen years after starting treatment, for every 100 women who received tamoxifen for 5 years, 5.8 fewer experienced recurrence, compared with those who received tamoxifen for 2 years. The risk of contralateral breast cancer was significantly reduced (hazard ratio, 0.70; 95% CI, 0.48 to 1.00). Among women age 50 to 59 years, there was a 35% reduction in CV events (P = .005) and 59% reduction in death as a result of a CV event (P = .02); in older women, the effect was much smaller and not statistically significant. Conclusion Taking tamoxifen for the recommended 5 years reduces the risk of recurrence or contralateral breast cancer 15 years after starting treatment. It also lowers the risk of CV disease and death as a result of a CV event, particularly among those age 50 to 59 years. Women should therefore be encouraged to complete the full course. Although aromatase inhibitors improve disease-free survival, tamoxifen remains a cheap and highly effective alternative, particularly in developing countries.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2062-2062
Author(s):  
Nathalie T. Nguyen ◽  
Liisa L Lyon ◽  
Gregory S Moes ◽  
Kamran Sahrakar ◽  
John L. Villano

2062 Background: Meningioma is the most common primary brain tumor in the United States, but there is limited data on clinical outcomes. Methods: We performed descriptive and survival analysis of meningioma cases diagnosed 2001-2010 from the Kaiser Permanente Northern California Cancer Registry, which began inclusion of benign brain tumors in 2001. Datasets provided variables on gender, age at diagnosis, race, and vital status. Chart review extracted additional information on mortality, histology, imaging, tumor size, tumor site, and treatment. We used Kaplan Meier method to calculate overall survival (OS) and disease-free survival (DFS) and log-rank test to compare survival rates by variables. Cox proportional hazard models were used to analyze variables relative to endpoints. Results: 1968 cases in 1792 patients with meningioma were analyzed. 55% of cases had histological confirmation. 5- and 10-year OS and DFS for all groups were 76% & 61% and 89% & 82%. Disease progression and recurrence presented in 10% of cases at 10 years, resulting in 4% disease-specific mortality (DSM). Statistically significant prognostic factors of worse DFS were age >= 80, WHO grade 2-3, tumor size >= 18 mm, peritumoral edema on imaging, Simpson grades (SG) 4 or 5, and no surgery. Factors associated with significantly worse OS included age >= 60, male gender, tumor size >= 42 mm, peritumoral edema, SG 4 or 5, no histology and no treatment (NT). SG 1-3 groups provided statistically the highest OS and DFS. There was no significant difference in DFS or OS for definitive RT versus surgery and adjuvant RT groups. Definitive RT showed significantly better OS than NT (HR=0.46, 95% CI: 0.21-0.98). Cases with progression or recurrence had 51% DSM with 65% of deaths associated with lack of salvage therapy. Salvage RT provided better OS benefit compared to other salvage groups (HR=0.35, 95% CI: 0.14-0.91). Conclusions: We demonstrated favorable long-term outcome for meningiomas and confirmed the prognostic benefit of Simpson grading. We have identified additional adverse factors affecting outcome. While surgery remains standard, definitive RT demonstrates comparable outcome to cases not amenable to gross total resection. Salvage RT is effective, providing a survival benefit.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16081-e16081
Author(s):  
Temidayo Fadelu ◽  
Fidel Sebahungu ◽  
Kevin Diasti ◽  
Cam Nguyen ◽  
Tiffany Yeh ◽  
...  

e16081 Background: There are few studies on CRC in sub-Saharan Africa. BCCOE in Rwanda provides patients with CRC access to chemotherapy, surgery and radiotherapy referrals. Here, we describe patient characteristics, treatments delivered and outcomes. Methods: This retrospective observational study included 136 patients with CRC who presented between July 2012 and June 2018. We abstracted patient characteristics, diagnostic and treatment data, and outcomes from electronic and paper records. We compared baseline and treatment characteristics for colon cancer (CC) versus (vs.) rectal cancer (RC) patients. For patients treated with curative intent, we plotted Kaplan Meier estimation of disease free survival (DFS), defined as time from presentation to cancer recurrence, progression or death. Log-rank test was used to examine subgroup differences. Results: The mean age was 52.5, and 71 (52.2%) were female. 101 (74.2%) patients had RC. Compared to CC, patients with RC were older 54.5 vs. 46.9 (p = 0.0084), and more likely female 59.4 vs. 31.4 (p = 0.0043). All provinces in Rwanda were represented including 14 (10.3%) from outside Rwanda; 79 (58.1%) patients lived in rural areas. Median duration of symptoms prior to presentation was 12 months, and 57 (41.9%) had used traditional medicine prior to presentation. 72 (52.9%) patients were non-metastatic, 46 (33.8%) de novo metastatic, 4 (2.9%) recurrent, and 14 (10.2%) had indeterminate stage. Of the patients treated with curative intent, 54 (65.1%) had neoadjuvant and/or adjuvant chemotherapy, while only 34 (41.0%) had curative surgery. 40 (48.2%) patients received a permanent colostomy. 18 (27.7%) patients with RC received concurrent chemoradiation. Over the follow up period, 49 (36%) patients died or were referred for end of life care, 13 (9.3%) remain in surveillance, while 65 (47.8%) were lost to follow up. Median DFS for patients with non-metastatic disease was 22.2 months. On exploratory analyses, there were no statistically significant differences in DFS by cancer type, gender, or performance status, though these analyses were underpowered and follow-up short. Conclusions: CRC treatment requires multidisciplinary care, which is a challenge in low-resource settings. Our results highlight gaps in CRC care delivery and suboptimal patient outcomes; most striking gaps were the low rates of surgery and radiation, and high loss to follow up rates. Rigorous research is needed to understand the underlying causes, and to develop interventions to address these gaps.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4554-4554
Author(s):  
Rebecca Carr ◽  
Meier Hsu ◽  
Kay See Tan ◽  
Manjit S. Bains ◽  
Matthew Bott ◽  
...  

4554 Background: Induction chemotherapy with PET-directed CRT and surgery is the standard treatment for locally advanced EA at our institution. Following results of the CALGB 80803 trial, FOLFOX has recently replaced CP as the preferred induction regimen. Methods: We retrospectively evaluated patients with locally advanced EA treated with induction CP vs FOLFOX, followed by trimodality therapy between January 2010 and June 2019. Patients treated with CP with RT followed by surgery without induction chemo were also included. We compared pathological complete response (pCR) and near pCR (ypN0 with ≥90% response) rates in the induction FOLFOX group to the induction CP and no-induction groups. Univariable and multivariable analyses were used to adjust for confounding factors. Disease-free survival (DFS) was estimated by the Kaplan-Meier method and compared between groups using max-combo weighted log rank test. Results: 445 patients were included. Patients in the induction FOLFOX group had significantly higher pCR and near pCR rates vs induction CP patients. Notably, pCR rate was 38% among FOLFOX PET responders vs 19% in non-responders. In multivariable analysis, compared to induction CP, induction FOLFOX administration was an independent predictor of near pCR (OR: 2.22, 95%CI: 1.20-4.20, p = 0.012). Compared to 24% pCR rate among no-induction patients, induction FOLFOX pCR rate was slightly higher at 32%. DFS by 2-years was higher in induction FOLFOX compared to no-induction-treated patients (62% vs. 42%, p = 0.05). Postoperative complication rates were similar among the three groups. Conclusions: PET-directed CRT with FOLFOX instead of CP improves pCR and near pCR rates. Improved DFS was observed in the FOLFOX vs no-induction patients. Longer follow-up is needed to confirm any survival benefits. [Table: see text]


2013 ◽  
Vol 2 (3) ◽  
pp. 151
Author(s):  
Oktahermoniza Oktahermoniza ◽  
Wirsma Arif Harahap ◽  
Tofriza Tofriza ◽  
Rosfita Rasyid

AbstrakKanker tiroid merupakan kanker yang jarang terjadi, namun kanker tersering pada organ endokrin. Tujuan penelitian ini untuk mengetahui ketahanan hidup lima tahun kanker tiroid yang di tatalaksana di RS Dr. M. Djamil Padang dari Januari 2007 sampai dengan Desember 2011. Metode: Subjek penelitian adalah 117 penderita kanker tiroid yang ditatalaksana di RS Dr. M. Djamil Padang dari Januari 2007 sampai dengan Desember 2011. Data dianalisis dengan pendekatan survival time menggunakan Kaplan-Meier survival curve dan Log rank test. Hasil: Median umur 39 tahun (range, 11 sampai 77 tahun), median waktu follow up 32 bulan (range, 1 sampai 70 bulan), median ukuran tumor 6 cm (range, 1 sampai 16 cm). Didapatkan 100 (85,5%) %) penderita sehat bebas tumor, 7 (6%) penderita kambuh lokal, 1 (0,9%) metastasis jauh serta 9 (7,7%) penderita meninggal. Overall five survival rate pada penelitian ini 92,3%. Faktor umur, ukuran tumor, dan jenis histopatologi berhubungan secara bermakna dengan survival (p 0,000), (p= 0,046) dan (p= 0,000). Sedangkan faktor-faktor jenis kelamin, jenis operasi, dan terapi adjuvan tidak mempunyai hubungan bermakna dengan survival. Pembahasan: Umur, ukuran tumor, dan jenis histopatologi memiliki hubungan bermakna dengan survival. Jenis kelamin, jenis operasi, dan terapi adjuvan tidak tidak berhubungan bermakna dengan survival.Kata kunci: Umur, Ukuran Tumor, Jenis Histopatologi, Survival, Kanker TiroidAbstractThyroid cancer is a rare cancer, but most common in endocrine organ. The purpose of this research is to determine about at five year survival of thyroid cancer which recorded at RS M. Djamil Padang Hospital from January 2007 until December 2011. Methods: Subjects were 117 patients with thyroid cancer be recorded in hospital Dr. M. Djamil Padang from January 2007 to December 2011. Data were analyzed with the survival time using Kaplan-Meier survival curve and log rank test. Result: Median age 39 years (range, 11 to 77 years), median follow-up time of 32 months (range, 1 to 70 months), median tumor size was 6 cm (range, 1 to 16 cm). Obtained 100 (85.5%)%) patients with tumor-free healthy, 7 (6%) patients with local recurrence, 1 (0.9%) distant metastases, and 9 (7.7%) patients died. Five overall survival rate in this study was 92.3%. Factors of age, tumor size and histopathological type was significantly associated with survival (p 0.000), (p = 0.046) and (p = 0.000). While the factors gender, type of surgery, and adjuvant therapy had no significant association with survival. Discussion: Discussion: Age, tumor size and histopathological type has a significant relationship with survival. Gender, type of surgery, and adjuvant therapy did not significantly associated with survival.Keywords: Age, Tumor Size, Type of Histopathology, Survival, Thyroid Cancer


2020 ◽  
pp. 1639-1646
Author(s):  
Muhammad Atif Mansha ◽  
Tabinda Sadaf ◽  
Asmara Waheed ◽  
Amna Munawar ◽  
Asma Rashid ◽  
...  

PURPOSE To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. METHODS AND MATERIALS Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated. RESULTS A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery ( P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates ( P < .05). CONCLUSION IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.


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