scholarly journals Outcomes After Accelerated Partial Breast Irradiation in Women With Triple Negative Subtype and Other “High Risk” Variables Categorized as Cautionary in The ASTRO Guidelines

2021 ◽  
Vol 11 ◽  
Author(s):  
Anabel Goulding ◽  
Lina Asmar ◽  
Yunfei Wang ◽  
Shannon Tole ◽  
Lora Barke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Triple Negative ◽  
Axillary Recurrence ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Ipsilateral Breast ◽  
Risk Patients

PurposeTo report a primary objective clinical outcome of ipsilateral breast recurrence following accelerated partial breast irradiation (APBI) in women with triple negative and other high risk breast cancer (as described in 2017 ASTRO guidelines) (i.e., age 40–49, size 2.1–3.0 cm, estrogen receptor negative and invasive lobular breast cancer). Secondary objectives of axillary and regional failure as well as overall survival are also reported.Methods and MaterialPatients from two clinical trials (NCT01185145, NCT01185132) were treated with 38.5 Gy IMRT or 3D-CRT APBI w/3.85 Gy fraction/BID fractionation for 10 fractions. Triple negative and other high risk patients (n=269) were compared to a total of 478 low risk patients which ASTRO defined as “suitable” for APBI. High risk patients, for the purpose of this study, were defined as those who possess one or more high risk criteria: triple negative (n=30), tumor size >2 cm <3 cm (n=50), HER 2+ (n=54), age range 40–50 years (n=120), ER- (n=43), and ILC histology (n=52).ResultsMedian follow up was 4.0 years for all patients. No significant difference was found for this high-risk cohort at 5 years for ipsilateral breast, or regional recurrences. Axillary recurrence was significantly adversely impacted by triple negative and ER- statuses (p=0.01, p=0.04). There were significant correlations between triple negative type and axillary recurrence on multivariate analysis (p=0.03). Overall survival for all patients was unaffected by any of the high-risk categories.ConclusionThe data from this study suggests that women possessing high risk features are at no more meaningful risk for recurrence than other patients considered to be acceptable for APBI treatment. However, the finding of axillary recurrence in patients with triple negative breast cancer does warrant a degree of caution in proceeding with accelerated partial breast irradiation technique in this patient group.

scholarly journals Accelerated Partial Breast Irradiation: Macrophage Polarisation Shift Classification Identifies High-Risk Tumours in Early Hormone Receptor-Positive Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 446
Author(s):  
Sören Schnellhardt ◽  
Ramona Erber ◽  
Maike Büttner-Herold ◽  
Marie-Charlotte Rosahl ◽  
Oliver J. Ott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Hormone Receptor ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
M2 Macrophage ◽  
Breast Irradiation ◽  
Hormone Receptor Positive

Studies have demonstrated correlations between accumulations of tumour-associated macrophages (TAMs), especially of M2-like phenotype, and increased mortality in advanced breast cancer. We investigated the prognostic potential of both main macrophage phenotypes in early hormone receptor-positive (HR+) breast cancer. The studied cohort of 136 patients participated in an institutional APBI phase II trial. Patient selection was characterized by HR+, small tumour size and no metastasis. Tissue microarrays from pre-RT resection samples were double stained for CD68/CD163 using immunohistochemistry. CD68+/CD163− cells were considered M1-like macrophages and CD68+/CD163+ was representative of M2-like macrophages. M1 and M2 macrophage densities were analysed semi-automatically in the stromal and intraepithelial tumour compartment. Low M1 and high M2 densities were strongly associated with decreased disease-free survival (DFS). Combined TAM phenotype densities were studied after defining a macrophage shift classification: M1-shifted (M1 high, M2 low) and non-shifted (M1 low, M2 low; M1 high, M2 high) tumours entailed a favourable outcome. In contrast, M2-shifted (M1 low, M2 high) TAM populations were associated with extremely reduced DFS. Thus, the full predictive potential of TAMs was revealed in a combined analysis of both phenotypes. The M2-shifted subgroup of tumours is classified as high-risk and probably not suitable for partial breast irradiation.

Preliminary results with accelerated partial breast irradiation in high-risk breast cancer patients

Brachytherapy ◽  
2010 ◽  
Vol 9 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Richard B. Wilder ◽  
Lisa D. Curcio ◽  
Rajesh K. Khanijou ◽  
Martin E. Eisner ◽  
Jane L. Kakkis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Breast Cancer Patients ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer

Efficacy analysis of high-risk breast cancer patients treated with accelerated partial breast irradiation from a single institution.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 111-111
Author(s):  
P. Y. Chen ◽  
F. A. Vicini ◽  
C. Mitchell ◽  
M. Wallace ◽  
P. Benitez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Breast Cancer Patients ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer

111 Background: We present the results of an analysis of high-risk breast cancer patients as defined by the NSABP B-39/RTOG 0413 phase III trial, all treated with accelerated partial breast irradiation (APBI) from a single institution. Methods: Between July 1993 and August 2010, 130 patients with any combination of at least one of the high-risk features of estrogen receptor (ER) negativity, age < 50, and/or axillary nodal positivity were treated with 1 of 3 forms of APBI. Sixty-seven patients were treated with interstitial needle-catheter brachytherapy, 44 balloon-based brachytherapy and 19 with 3D conformal external beam radiation therapy. Aside from the high-risk features, general eligibility criteria included infiltrating ductal carcinoma, with inclusion of invasive lobular and DCIS since 2003, margins > 2 mm, and surgically staged axilla. One-hundred eighteen patients had one high-risk factor, 11 had two, and 1 had all three factors. The median tumor size was 12.0 mm with margins > 2 mm in 80% of patients. Greater than 75% had T1 tumors and 50% were ER negative. Thirty-one percent of patients were node positive. Based upon the ASTRO Consensus Guidelines for use of APBI (2009) none of these patients were suitable, 38% cautionary and 62% were unsuitable. Results: Median age was 56.5 yrs (range 40-90). With a median follow-up of 5.3 yrs (0.02-16.9) the 5-yr actuarial local recurrence rate (LR) was 4.2%; regional recurrence (RR) was 2.1%. Median time to LR and RR were 1.2 and 2.8 yrs, respectively. On univariate analysis, the only factor significant for LR was a close/positive margin (p=0.031), as ER/PR, age, nodal status, tumor size, histology, grade, hormonal or chemotherapy were all NS. The 5-yr actuarial cause specific, disease-free, and overall survivals as well as distant metastasis were 94%, 91%, 90%, and 6.4%, respectively. Conclusions: This cohort of NSABP B-39/RTOG 0413 identified high-risk patients who have undergone APBI has yielded local-regional control rates and survival outcomes comparable to standard risk patients undergoing partial breast irradiation. Continued follow-up will be needed to assess the long-term efficacy of such high-risk breast cancer patients treated with APBI.

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