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.

scholarly journals Solitary late spinal metastasis from apocrine salivary duct carcinoma: Case report

2021 ◽  
Vol 12 ◽  
pp. 122
Author(s):  
Bianca Maria Baldassarre ◽  
Federica Penner ◽  
Luca Bertero ◽  
Giuseppe Di Perna ◽  
Marco Ajello ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Spinal Metastasis ◽  
Osteolytic Lesion ◽  
Treatment Algorithm ◽  
Tumor Control ◽  
Salivary Duct ◽  
Elderly Male ◽  
Recurrence Rates ◽  
Surgical Biopsy ◽  
Duct Carcinoma

Background: The salivary duct carcinomas (SDCs) are rare, high-grade neoplasms involving major salivary glands. Parotid is the most frequently involved gland (85%). Apocrine phenotype (histological presence of decapitation secretions) and androgen reception expression define SDC. The clinical course of these tumors is characterized by aggressive local behavior with extraglandular extension, high recurrence rates, early metastases, and poor prognoses. Despite aggressive surgical/radiation therapy management, the rates of locoregional and metastatic relapses are high, and the mortality rates over 48 months approach 65%. Notably, there is no treatment algorithm available for managing vertebral metastases from apocrine SDC. Case Description: An elderly male presented with MR/CT findings of an isolated T11 vertebral metastasis attributed to a previously treated parotid SDC. On both CT/MR, it was an osteolytic lesion and demonstrated spinal canal infiltration. The patient underwent surgical biopsy/decompression/resection, following which the lesion histopathologically proved to be a SDC. The patient was subsequently treated with 30 Gy in 10 fractions within 2 weeks of discharge. One-month later, the MRI confirmed adequate epidural decompression without recurrence, and 9 months post-operatively, patient remained disease free. Conclusion: Isolated metastasis attributed to parotid SDC followed by radiation therapy may result in tumor control.

Value of adjuvant radiation therapy in breast cancer patients with one to three positive lymph nodes undergoing a modified radical mastectomy and systemic therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 507-507 ◽  
Author(s):  
S. Dawood ◽  
A. M. Gonzalez-Angulo ◽  
W. Woodward ◽  
F. Meric-Bernstam ◽  
K. Hunt ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Lymph Nodes ◽  
Systemic Therapy ◽  
Distant Recurrence ◽  
Axillary Lymph Nodes ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Adjuvant Radiation Therapy ◽  
Increased Risk ◽  
Segmental Mastectomy

507 Background: Whether adjuvant radiation therapy should be utilized for patients (pts) with early stage breast cancer with up to 3 positive axillary lymph nodes treated with mastectomy and systemic therapy is controversial. This retrospective study was performed to determine if adjuvant radiation therapy had an impact on survival for this cohort of pts. Methods: 4240 pts with T1–2N0–1 breast cancers, diagnosed between 1980–2007, who underwent either mastectomy without adjuvant radiation therapy or segmental mastectomy with adjuvant radiation therapy were identified. All pts received systemic treatment. Women with >3 positive axillary lymph nodes were excluded. Overall (OS) and distant disease free survival (DDFS) were estimated using the Kaplan-Meir product method. Cox proportional hazards were used to determine associations between OS/DDFS and type of surgery after controlling for pt and disease characteristics. Results: 1336 (18.8%) had T1N0 disease, 1114 (26.27%) had T2N0 disease, 989 (23.33%) had T1N1 disease and 801 (18.89%) had T2N1 disease. Median follow-up was 54 months.5- year DDFS among women who underwent mastectomy and segmental mastectomy was 81% (95% 78%-83%) and 86% (95% CI 84%-87%), respectively (p < 0.0001). In the Cox analysis, pts who had mastectomy without radiation had a significantly increased risk of distant recurrence (HR= 1.39, 95% CI 1.14–1.70, p= 0.0013) than pts treated with segmental mastectomy and radiation. When looking at subgroups, no significant difference in DDFS was observed between the two groups in pts with lymph node negative disease. However, for pts with 1–3 positive lymph nodes, pts treated with mastectomy without radiation had significantly increased risk of distant recurrence compared to pts treated with segmental mastectomy with radiation (HR=1.614, 95% CI 1.198–2.177, p= 0.002). This difference was most pronounce in the subset of patients with T2N1 disease (HR= 1.794, 95% CI 1.220–2.637, p=0.003). Similar trends were observed for OS. Conclusions: This study provides provocative evidence for benefit of radiation therapy among pts with 1–3 positive axillary lymph nodes who are treated with surgery and systemic therapy. No significant financial relationships to disclose.

scholarly journals Surgical considerations for breast-conserving therapy in patients undergoing neoadjuvant chemotherapy for early-stage breast cancer

2005 ◽  
Vol 8 (2) ◽  
Author(s):  
G. V. Babiera
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Systemic Therapy ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Optimal Outcomes ◽  
Adjuvant Surgery

According to the National Cancer Comprehensive Network guidelines patients with breast tumours ≤1 cm should be offered systemic therapy. Multiple studies, however, have demonstrated no survival advantage between giving chemotherapy before (neoadjuvant) or after (adjuvant) surgery. There are, however, certain benefits that can be derived from patients who undergo neoadjuvant chemotherapy. Such benefits include better stratification of the patient's prognosis based on tumour and nodal response, and converting patients from mastectomy-only candidates to breast-conserving surgery candidates. Due to these advantages, many patients with early-stage breast cancer will undergo neoadjuvant chemotherapy and the surgical issues must be considered for patients who are treated in such a manner to guarantee optimal outcomes. Issues that will be discussed are the surgical preoperative evaluation, extent and timing of local resection of both the breast and regional nodes and finally, the potential future effects of this multi-modality therapy.

scholarly journals Prognosis After Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Patients Treated by Breast-Conserving Therapy in Five National Surgical Adjuvant Breast and Bowel Project Protocols of Node-Negative Breast Cancer

2009 ◽  
Vol 27 (15) ◽  
pp. 2466-2473 ◽  
Author(s):  
Stewart J. Anderson ◽  
Irene Wapnir ◽  
James J. Dignam ◽  
Bernard Fisher ◽  
Eleftherios P. Mamounas ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Breast Tumor ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Breast Conserving Therapy ◽  
Adjuvant Systemic Therapy ◽  
Ipsilateral Breast ◽  
Distant Disease ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
Bowel Project

Purpose Locoregional failure (LRF) after breast-conserving therapy (BCT) is associated with increased risk of distant disease and death. The magnitude of this risk has not been adequately characterized in patients with lymph node-negative disease. Patients and Methods Our study population included 3,799 women randomly assigned to five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative disease (ie, B-13, B-14, B-19, B-20, and B-23) who underwent lumpectomy and whole breast irradiation with or without adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated, along with distant-disease–free interval (DDFI) and overall survival (OS) after these events. Cox models were employed to model mortality by using clinical and pathologic factors jointly with these events. Results Four hundred nineteen patients (11.0%) experienced LRF: 342 (9.0%) experienced IBTR, and 77 (2.0%) experienced oLRR. The 12-year cumulative incidences of IBTR and oLRR in patients treated with adjuvant systemic therapy were 6.6% and 1.8%, respectively. Overall, 37.1% of IBTRs and 72.7% of oLRRs occurred within 5 years of diagnosis. Older age, black race, higher body mass index (BMI), larger tumors, and occurrence of IBTR or oLRR were significantly associated with increased mortality. The 5-year OS after IBTR and oLRR were 76.6% and 34.9%, respectively. Adjusted hazard ratios for mortality associated with IBTR and oLRR were significantly higher in estrogen receptor (ER)–negative patients than in ER-positive patients (P = .002 and P < .0001, respectively). Patients with early LRF had worse OS and DDFI than those with later-occurring LRF. Conclusion Although LRF is uncommon in patients with node-negative breast cancer who are treated with lumpectomy, radiation, and adjuvant systemic therapy, those who do develop LRF have substantially worse OS and DDFI.

scholarly journals High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

2015 ◽  
Vol 23 (6) ◽  
pp. 788-797 ◽  
Author(s):  
Ronny L. Rotondo ◽  
Wendy Folkert ◽  
Norbert J. Liebsch ◽  
Yen-Lin E. Chen ◽  
Frank X. Pedlow ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Control ◽  
High Dose ◽  
Recurrence Rates ◽  
En Bloc ◽  
Primary Tumors ◽  
Entire Cohort

OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

Outcome at 8 Years After Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence

2000 ◽  
Vol 18 (8) ◽  
pp. 1668-1675 ◽  
Author(s):  
Catherine C. Park ◽  
Michihide Mitsumori ◽  
Asa Nixon ◽  
Abram Recht ◽  
James Connolly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Systemic Therapy ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Positive Margins

PURPOSE: To examine the relationship between pathologic margin status and outcome at 8 years after breast-conserving surgery and radiation therapy. PATIENTS AND METHODS: The study population comprised 533 patients with International Union Against Cancer/American Joint Committee on Cancer clinical stage I or II breast cancer who had assessable margins, who received at least 60 Gy to the primary tumor bed, and who had more than 8 years of potential follow-up. Each margin was scored (according to the presence of invasive or in situ disease that touched the inked surgical margin) as one of the following: negative, close, focally positive, or extensively positive. Outcome at 8 years was calculated using crude rates of first site of failure. A polychotomous logistic regression analysis was performed. Median follow-up time was 127 months. RESULTS: At 8 years, patients with close margins and those with negative margins both had a rate of local recurrence (LR) of 7%. Patients with extensively positive margins had an LR rate of 27%, whereas patients with focally positive margins had an intermediate rate of LR of 14%. In the polychotomous logistic regression model, margin status and the use of systemic therapy were the only two variables that had significant effects on the risk ratio of LR to remaining alive and free of disease. Among the 45 patients with focally positive margins who received systemic therapy, the crude LR rate was 7% at 8 years (95% confidence interval, 1% to 20%). CONCLUSION: Pathologic margin status and the use of adjuvant systemic therapy are the most important factors associated with LR among patients treated with breast-conserving surgery and radiation therapy.

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