scholarly journals Synchronous Bilateral Breast Cancer: Implications for Adjuvant Radiation

2019 ◽  
pp. 1-3
Author(s):  
Susanna Nguy ◽  
Naamit K. Gerber
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Bilateral Breast Cancer ◽  
Left Breast ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Excellent Teaching ◽  
Synchronous Bilateral Breast Cancer ◽  
Nodal Burden

We present the case of a 55-year old postmenopausal female with bilateral early stage clinically node negative breast cancer who was treated with bilateral lumpectomy with axillary lymph node dissection revealing N1a nodal disease in her right breast with extra-nodal extension and micrometastatic disease in her left breast. Given the controversy in management for low nodal burden for macroscopic and microscopic nodal disease, we review the key trials in regional nodal management that have included patients with low nodal burden to explain our reasoning for treatment decisions. Our patient was treated with both hypofractionation and conventional treatment. She is an excellent teaching case to demonstrate how much of an impact the decision regarding fractionation can have on long term breast cosmesis and toxicity.

scholarly journals Is It Contralateral Axillary Metastasis or Occult Breast Cancer: A Confusing Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 498-502 ◽  
Author(s):  
Yong Gi Son ◽  
Woon Won Kim ◽  
Ki Hoon Kim ◽  
Jin Soo Kim
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Growth Factor Receptor ◽  
Immunohistochemical Analysis ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Lymph Node Biopsy ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Axillary Metastasis

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

scholarly journals Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

2021 ◽  
Vol 27 (3) ◽  
pp. 201-206
Author(s):  
Özlem Mermut ◽  
Aysun Ozsoy Ata ◽  
Didem Can Trabulus
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Organs At Risk ◽  
Bilateral Breast Cancer ◽  
Radiotherapy Planning ◽  
Conformity Index ◽  
Treatment Unit ◽  
Significant Difference ◽  
Synchronous Bilateral Breast Cancer ◽  
The Right

Abstract Objective: We compared mono-isocenter and dual-isocenter plans in synchronous bilateral breast cancer (SBBC), which is defined as tumours occurring simultaneously in both breasts, and evaluated the effects of these differences in plans on organs-at-risk (OARs). Materials and methods: We evaluated 10 women with early stage, nod negative (Tis-2N0M0) SBBC. The treatment dose was determined to be 50 Gy. We used mean dose and VXGy to evaluate the OARs. To evaluate the effectiveness of treatment plans, Homogeneity index (HI), conformity index (CI) and sigma index (SI) and monitor units (MU) of monoisocenter (MIT) and dual-isocenter (DIT) plans were compared. During bilateral breast planning, for the single-centre plan, the isocenter was placed at the center of both breasts at a depth of 3-4 cm. For the two-center plan, dual-isocenters were placed on the right and left breasts. Results: No significant difference between the techniques in terms of the scope of the target volume was observed. Statistically significant results were not achieved in MIT and DIT plans for OARs. Upon comparing MIT and DIT, the right-side monitor unit (MU) value in DIT (p = 0.011) was statistically significantly lower than that in MIT. Upon comparing right-left side MIT and DIT, the MU value (p = 0.028) was significantly lower in DIT than MIT. Conclusion: SBBC irradiation is more complex than unilateral breast radiotherapy. No significant difference between both techniques and OARs was observed. However, we recommend MIT as a priority technique due to the ability to protect OARs, ease of administration during treatment, and the fact that the patient stays in the treatment unit for a shorter period of time.

scholarly journals Nodal micrometastases in early stage breast cancer: two case reports

2009 ◽  
Vol 12 (3) ◽  
Author(s):  
J. Reeder ◽  
S. Puhalla ◽  
V. Vogel
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Case Reports ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Micrometastatic Disease

AbstractThe most important predictor of outcome for women with early stage breast cancer is the presence or absence of metastases in the axillary lymph nodes. In the era of sentinel lymph node biopsies and improved pathology techniques, micrometastatic disease can be diagnosed. The question of whether or not to treat these women as if they have nodal disease remains in doubt. In order to further explore this topic, we identified two cases of women with nodal micrometastases at our institution. A literature review of PUBMED and SABCS abstracts was then performed. In this article, we discuss our results and the emerging clinical debate about the management of nodal micrometastases.

scholarly journals Optimizing Adjuvant Radiation Planning Outcomes in Patients with Synchronous Bilateral Breast Cancer

2021 ◽  
Vol 10 (03) ◽  
pp. 110-119
Author(s):  
Mohamed M. Alhefny ◽  
Hany S. Attallah ◽  
Mahmoud Abdallah ◽  
Adel Yassin ◽  
Khaled M. El-Shahat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bilateral Breast Cancer ◽  
Adjuvant Radiation ◽  
Synchronous Bilateral Breast Cancer ◽  
Radiation Planning

An IMRT technique to increase therapeutic ratio of breast irradiation in patients with early stage left breast cancer: Limiting second malignancies

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10791-10791 ◽  
Author(s):  
R. S. Ahmed ◽  
J. B. Fiveash ◽  
R. A. Popple ◽  
S. A. Spencer ◽  
J. F. De Los Santos
Keyword(s):  
Breast Cancer ◽  
Low Dose ◽  
Early Stage ◽  
Breast Conservation ◽  
Left Breast ◽  
Breast Conservation Surgery ◽  
Adjuvant Radiation ◽  
Target Coverage ◽  
Second Malignancy ◽  
Dose Levels

10791 Background: The clinical application of IMRT for adjuvant treatment of breast cancer has been the subject of increasing study in recent years. IMRT plans have improved target coverage and reduced dose inhomogeneities observed within the breast in standard plans. IMRT was able to reduce doses delivered to the heart, lungs, and right breast at clinically significant doses, but this has been at the cost of larger volumes of low dose radiation to these structures and thus, increasing the risk for second malignancy. Our goal was to develop an IMRT beam arrangement that did not result in additional low dose spill to risk organs while maintaining equal or better target coverage. Methods: Five patients with early stage left-sided breast cancer, who underwent breast conservation surgery, and adjuvant radiation using standard wedged tangential fields, were chosen for this comparative study. An IMRT plan consisting of 6 tangential beams (3 medial and 3 lateral) was generated by using the gantry, collimator and table angles of the standard plan used for the conventional radiation (CRT), and moving the table +10 and −10 degrees on each side. The prescription dose for both CRT and IMRT plans was 45 Gy, 1.8 Gy/fraction, prescribed to the isocenter which was placed near the center of the breast. Results: IMRT plans provided significantly better coverage of the left breast than CRT plans, (p=0.03). Although dose heterogeneity was greater with the IMRT plans, the difference was not significant (p = 0.68). The mean volumes of the heart, lung, and right breast were lower in patients planned with IMRT at all dose levels from 5% to 100% dose (5% increments). This difference was significant for volumes receiving 2.25 Gy for the heart (p = 0.003), volumes receiving 2.25 Gy, 4.5 Gy, 6.75 Gy, 33.75 Gy, 36 Gy, 38.25 Gy, and 42.75 Gy for the lung (p = 0.014, 0.04, 0.044, 0.05, 0.049, 0.045, 0.05, respectively). Surprisingly, breast IMRT resulted in significantly lower right breast volumes irradiated at all dose levels compared to CRT. Conclusions: A six-tangential field IMRT technique achieved significantly better left breast coverage while maintaining lower doses to risk organs at all dose levels and therefore, reducing the potential for induction of a second malignancy. No significant financial relationships to disclose.

B-cell lymphoma as well as breast cancer contributes to the development of hemophagocytic lymphohistiocytosis: A rare case report

2021 ◽  
Author(s):  
Neng Zhou ◽  
Zongxiu Yanbiao Yin ◽  
Yali Chang ◽  
Chunyan Xing ◽  
Yanbiao Chu
Keyword(s):  
Breast Cancer ◽  
B Cell ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Cell Lymphoma ◽  
Early Stage ◽  
Blood Platelets ◽  
B Cell Lymphoma ◽  
Left Breast ◽  
Axillary Lymph ◽  
Delayed Treatment

Abstract BackgroundHemophagocytic lymphohistiocytosis (HLH), which is also known as hemophagocytic syndrome (HPS), can be caused by various factors leading to the reactive proliferation of lymphocytes as well as tissues and cells and the release of inflammatory cytokines, which then impair vital organs. Hemophagocytic lymphohistiocytosis, especially malignancy-associated HLH, which is difficult to differentiate from other diseases in the early stage because of its nonspecific and overlapping manifestations, has a high mortality rate once it occurs. Cases of hemophagocytic lymphohistiocytosis triggered by both solid tumors and lymphomas have rarely been reported before. There is still no consensus regarding the first-line treatment for HLH in adults. More attention should be paid to its early diagnosis and treatments.Case presentationA 55-year-old woman who had undergone thyroidectomy in 2014, left mastectomy for left breast cancer in 2013 and twelve rounds of chemotherapy had continuous fever approximately twenty days prior to admission. Tumor cells were found in her right axillary lymph node aspiration smear in the hospital on January 23. The patient was first diagnosed with pneumonia and treated with antibiotics, with little effectiveness. The etiology of fever remained unclear after a series of examinations, which excluded infection and rheumatic diseases and led us to consider noninfectious fever. Continuous hyperpyrexia, pancytopenia and continuous decreases in blood platelets and plasma albumin were suggestive of HLH. Then, bone marrow puncture confirmed this finding and indicated B-cell lymphoma invading the bone. Unexpectedly, during this time, the disease progressed rapidly, culminating in the patient’s death, and no examinations or treatments were performed in time.ConclusionsSecondary hemophagocytic lymphohistiocytosis can be caused by various factors. Malignancy-associated HLH (M-HLH), as a kind of secondary HLH, is difficult to distinguish from primary cancer due to its nonprominent clinical manifestation, thus leading to misdiagnosis and delayed treatment.

Management of Breast Cancer After Hodgkin’s Disease

2000 ◽  
Vol 18 (4) ◽  
pp. 765-765 ◽  
Author(s):  
Suzanne L. Wolden ◽  
Steven L. Hancock ◽  
Robert W. Carlson ◽  
Don R. Goffinet ◽  
Stefanie S. Jeffrey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
General Population ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Bilateral Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Tissue Necrosis ◽  
Pathologic Features

PURPOSE: To evaluate the incidence, detection, pathology, management, and prognosis of breast cancer occurring after Hodgkin’s disease. PATIENTS AND METHODS: Seventy-one cases of breast cancer in 65 survivors of Hodgkin’s disease were analyzed. RESULTS: The median age at diagnosis was 24.6 years for Hodgkin’s disease and 42.6 years for breast cancer. The relative risk for invasive breast cancer after Hodgkin’s disease was 4.7 (95% confidence interval, 3.4 to 6.0) compared with an age-matched cohort. Cancers were detected by self-examination (63%), mammography (30%), and physician exam (7%). The histologic distribution paralleled that reported in the general population (85% ductal histology) as did other features (27% positive axillary lymph nodes, 63% positive estrogen receptors, and 25% family history). Although 87% of tumors were less than 4 cm, 95% were managed with mastectomy because of prior radiation. Two women underwent lumpectomy with breast irradiation. One of these patients developed tissue necrosis in the region of overlap with the prior mantle field. The incidence of bilateral breast cancer was 10%. Adjuvant systemic therapy was well tolerated; doxorubicin was used infrequently. Ten-year disease-specific survival was as follows: in-situ disease, 100%; stage I, 88%; stage II, 55%; stage III, 60%; and stage IV, zero. CONCLUSION: The risk of breast cancer is increased after Hodgkin’s disease. Screening has been successful in detecting early-stage cancers. Pathologic features and prognosis are similar to that reported in the general population. Repeat irradiation of the breast can lead to tissue necrosis, and thus, mastectomy remains the standard of care in most cases.

scholarly journals De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jose G. Bazan ◽  
Sachin R. Jhawar ◽  
Daniel Stover ◽  
Ko Un Park ◽  
Sasha Beyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Therapy ◽  
Adjuvant Radiation ◽  
Her2 Positive ◽  
Node Negative ◽  
Risk Of Death ◽  
Her2 Breast Cancer ◽  
Neoadjuvant Systemic Therapy ◽  
Increased Risk

AbstractIn the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.

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