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 Real-world data: evaluation of sentinel lymph node biopsy after complete pathological response of breast cancer to neoadjuvant chemotherapy in patients with triple-negative and her2 positive breast cancer in a cohort from rio grande do sul, brazil

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Alessandra Borba Anton de Souza ◽  
Nathalia da Cunha Rossato ◽  
Felipe Pereira Zerwes ◽  
Tomas Reinert ◽  
Antonio Luiz Frasson
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Triple Negative ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Her2 Positive ◽  
Node Disease ◽  
Positive Lymph Nodes

Introduction: International publications show a high correlation of axillary response and complete pathological response (CPR) of breast cancer to neoadjuvant chemotherapy (NACT) in patients with triple-negative (TN) and HER2 positive (HER2+) tumors. The need for surgery is being questioned when percutaneous breast biopsy after NACT indicates CPR, despite recent presentations demonstrating high rates of false-negative (FN), ranging from 17–39%. The proper axillary management in patients with CPR of breast cancer is still discussed: is it possible to avoid the axillary evaluation? What is the axillary downstaging rate? Identifying any residual disease to adjust the adjuvant treatment is also a concern. Retrospective studies reveal a rate of positive lymph nodes lower than 2% in this population when CPR of breast cancer is reached. Objective: To identify the rate of complete axillary response in patients with CPR of breast cancer to NACT in TN and HER2+ tumors. Methods: This is a retrospective cohort study conducted in two health facilities in Southern Brazil. The sample consists of 130 patients who underwent NACT, followed by surgery between January 2016 and December 2018. The patients included were treated in the public health system (Sistema Único de Saúde – SUS) and private health system. Results: Among the 130 patients submitted to NACT, 76 (58%) had HER2+ and TN immunohistochemical subtypes – luminal HER2+: 23 patients, HER2+ pure: 15, TN: 38. Among these patients, 33 (43%) reached CPR of breast cancer, of which 9 corresponded to luminal HER2+, 10 to HER2+, and 14 to TN. In patients with CPR of breast cancer, 29 (87.8%) had no lymph node disease. Out of the 10 HER2+ pure with CPR of breast cancer, 100% had no lymph node disease, and 8 were positive pre-NACT. Among the 14 TN, only 1 patient had 2 positive lymph nodes (2+/10), and she was cN0 prior to NACT (with negative axillary ultrasound). Among the 5 pre-NACT clinically positive lymph nodes in TN patients (including 1 patient with cN2), all had CPR to NACT (3 axillary dissections and 2 sentinel lymph node biopsies – SLNB). Out of the 9 patients with luminal HER and CPR of breast cancer, 4 had clinically positive lymph nodes before NACT, and 3 remained positive (15% of conversion). Conclusion: In this study, CPR of breast cancer was highly correlated with negative axillary evaluation after NACT (87.8%), mainly in the TN and HER2+ pure subtypes (98%), even if the lymph node was clinically positive before NACT, with 100% of conversion of HER 2+ pure cases. SUS patients used trastuzumab as the single drug targeting anti HER2. These data agree with those found in the literature, despite the small sample. Larger studies are necessary, as around 70% of our population depend on SUS. With more published data, considering the performance of SLNB in HER2+ pure and TN patients submitted to NACT could become a common practice, reducing morbidity. The safety of this practice in the luminal HER+ subtype remains unclear.

scholarly journals Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer

2019 ◽  
Vol 15 (2) ◽  
pp. 76-84 ◽  
Author(s):  
Fabiana Tonellotto ◽  
◽  
Anke Bergmann ◽  
Karen de Souza Abrahao ◽  
Suzana Sales de Aguiar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Node Positive ◽  
Node Ratio ◽  
Positive Lymph Nodes ◽  
Positive Breast Cancer

Intermittent adjuvant chemotherapy as an alternative to improve survival in breast cancer patients with ten or more positive lymph nodes

2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 906-906
Author(s):  
F. U. Lara medina ◽  
T. Ramirez-Ugalde ◽  
D. Flores-Estrada ◽  
A. Alvarado-Miranda ◽  
N. Castaneda soto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Positive Lymph Nodes

Assessing the impact of CMF/FEC/FEC-DOC/ETC (dose-dense) adjuvant chemotherapy in dependency of positive axillary lymph nodes on survival: A retrospective multicenter cohort study of 4,526 breast cancer patients receiving adjuvant chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1074-1074
Author(s):  
Lukas Schwentner ◽  
Reyn Van Ewijk ◽  
Isabell Hoffmann ◽  
Rolf Kreienberg ◽  
Maria Blettner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Significant Benefit ◽  
Axillary Lymph ◽  
Dose Dense ◽  
The Impact ◽  
Positive Lymph Nodes ◽  
Positive Breast Cancer

1074 Background: Adjuvant chemotherapy has changed dramatically in the last decades. Anthracycline-/taxane-based and dose-dense chemotherapy regimens improved survival in node positive breast cancer. This study tries to answer the following questions: (1) Are there differences in survival dependent on chemotherapy regimens in 0/0-3/4-10/<10 positive lymph nodes? (2) Is it possible to define a cut-off of positive lymph nodes for the use of Taxane-based and dose dense chemotherapy? Methods: This German is a multi-center [17 participating hospitals all are certified as breast cancer centers] retrospective cohort study. We included CMF (1.385), FEC (1.170), FEC-DOC (1.723), and dose-dense ETC (248) into the analysis. Results: In case of 0 LN CMF/FEC/FEC-DOC did not show significant differences in DFS, but OAS was significantly impaired by the use of FEC-DOC in 0 LN [p=0.024; HR=2.02 (95% CI: 1.10-3.73)] (no ETC use in 0 LN). In case of 1-3 positive LN CMF/FEC/FEC-DOC/ETC did not differ significantly in survival parameters. But in 4-10 LN FEC-DOC [p=0.049; HR=0.67 (95% CI: 0.44-0.99)] and ETC [p=0.024; HR=0.56 (95% CI: 0.34-0.93)] demonstrated a significant benefit in DFS and a strong trend in OAS. Dose-dense ETC showed a significant improvement in DFS [p=0.003; HR=0.35 (95% CI: 0.17-0.69)] and OAS [p=0.009; HR=0.35 (95% CI: 0.16-0.77)] in patients with >10 positive LN. Conclusions: Our data confirms that Taxane-based chemotherapy does not improve DFS in LN negative breast cancer, but rather demonstrated an inferior OAS. But in LN positive breast cancer we can demonstrate a benefit by the use of Taxane-based chemotherapy regimens. Furthermore, dose-dense ETC demonstrated a significant benefit in survival in >10 positive LN.

69 Intensified adjuvant chemotherapy for patients with breast cancer and > 10 positive lymph nodes. A phase II study

1995 ◽  
Vol 31 ◽  
pp. S16
Author(s):  
G. Fountzilas ◽  
D. Skarlos ◽  
A. Athanassiadis ◽  
C. Nikolaides ◽  
T. Giannakakis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Positive Lymph Nodes
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