scholarly journals Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost

2021 ◽  
Vol 28 (5) ◽  
pp. 3474-3487
Author(s):  
Ioannis M. Koukourakis ◽  
Marianthi Panteliadou ◽  
Axiotis G. Giakzidis ◽  
Christos Nanos ◽  
Ioannis Abatzoglou ◽  
...  
Keyword(s):  
Triple Negative ◽  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
Long Term Results ◽  
Radiation Dermatitis ◽  
Radiation Toxicity ◽  
Accelerated Radiotherapy ◽  
Early Radiation ◽  
Breast Quadrant

We report long-term results (median follow-up 12 years) of hypofractionated accelerated radiotherapy (HypoAR) in patients treated with breast-conserving surgery. In total, 367 women were treated with HypoAR. Axillary and supraclavicular area (ASA) were treated in patients with involved nodes. In total, 290 patients (scheme A) received 3.5 Gy/day ×10 fractions (breast/ASA) followed by two 4 Gy fractions with electrons to the affected breast quadrant within 16 days. In total, 77 patients (Scheme B) received 2.7 Gy/day for 16 consecutive fractions (breast/ASA) within 22 days, while concurrently, the affected breast quadrant received an electron booster dose of 0.8 Gy for the first 13 fractions. Amifostine was offered to 252/367 patients. Early radiation toxicity was minimal. Regarding late toxicities, symptomatic breast edema was noted in 2.2%, asymptomatic breast fibrosis in 1.9%, and arm lymphedema in 3.7% of patients. Amifostine reduced early radiation dermatitis (p = 0.001). In total, 2.2% of patients developed contralateral breast and 1.6% other carcinomas. Locoregional recurrence (LR) occurred in 3.1% of patients (0% for in situ carcinomas). Positive margins after surgery, extracapsular node invasion, and HER2-enriched/triple-negative tumors were linked with significantly worse LR-free survival. The involvement of more than three nodes and luminal type other than A were independent prognostic variables of metastasis and death events. HypoAR delivering a biological dose of 50–52 Gy to the breast/ASA is a safe and effective therapy for patients treated with conservative surgery. The risk of carcinogenesis is low. Positive surgical margins, extracapsular node invasion, and HER2-enriched/triple-negative phenotypes appear as a cluster of features linked with a higher risk for locoregional relapse.

Infiltrating ependymomas of the cauda equina

1974 ◽  
Vol 41 (4) ◽  
pp. 446-448 ◽  
Author(s):  
Michael Scott
Keyword(s):  
Cauda Equina ◽  
Conservative Surgery ◽  
Long Term Results ◽  
Content Type ◽  
Radical Removal ◽  
Benign Course ◽  
Fine Print

✓ The author reports the long-term results of combined conservative surgery and radiotherapy in the treatment of three patients with infiltrating papillary ependymomas Of the cauda equina. Seventeen to 20 years later they have relatively minimal complaints and dysfunction. This long benign course emphasizes the folly of attempting radical removal with its potential for serious mutilation of the cauda equina.

Sixteen years follow-up results of a randomized phase II trial of neoadjuvant FAC compared with CMF in stage III breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1073-1073
Author(s):  
Ariel Osvaldo Zwenger ◽  
Julieta Leone ◽  
Carlos Teodoro Vallejo ◽  
Juan Eduardo Perez ◽  
Alberto Omar Romero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Breast Conserving Surgery ◽  
Stage Iii ◽  
Long Term Results ◽  
Significant Difference ◽  
Stage Iii Breast Cancer

1073 Background: Neoadjuvant chemotherapy allows direct evaluation of the tumor’s sensitivity to therapy, eradication of micrometastatic disease and the possibility of performing breast conserving surgery. The aim of this study was to describe long-term results of neoadjuvant chemotherapy in stage III breast cancer patients (pts). Methods: We evaluated 126 pts with stage III breast cancer that participated in a phase-II randomized trial of neoadjuvant 5-fluorouracil, doxorubicin and cyclophosphamide (FAC every 21 days) compared with cyclophosphamide, methotrexate and 5-fluorouracil (CMF days 1 and 8 every 28). Chemotherapy was administered for three cycles prior to definitive surgery and radiotherapy, and then for six cycles as adjuvant. Response was assessed by WHO criteria. Results: Pts characteristics were well balanced in both groups (FAC: 64pts, CMF: 62pts). Median follow-up was 4.5 years (range 0.2-16.4). No significant difference was found regarding acute and long-term toxicity; however, alopecia was more frequent in FAC group. Breast conserving surgery was performed in 13.5% of pts with no difference between groups. Objective response rate (OR) was similar in both groups but pathological complete response was achieved by 4 pts who received FAC. Although both groups had similar locoregional and distant recurrences, contralateral breast cancer was higher in the CMF group (6.5% vs 1.6%, P=NS). Disease free survival (DFS) and overall survival (OS) data are shown in the table. After 16 years of follow-up, 42.1% (n=53) of pts are still alive. Disease progression was the principal cause of death in both groups (78.9% vs 84.2%). Conclusions: To the best of our knowledge, this is the first study to report long-term outcomes of FAC and CMF in the neoadjuvant setting. Within the sensitivity of our study, both regimens showed similar OR, long-term toxicity, DFS and OS rate at 16 years. Around 40% of pts are currently alive. Clinical trial information: NCT00002696. [Table: see text]

Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

2011 ◽  
Vol 81 (4) ◽  
pp. 1091-1097 ◽  
Author(s):  
Jayant S. Vaidya ◽  
Michael Baum ◽  
Jeffrey S. Tobias ◽  
Frederik Wenz ◽  
Samuele Massarut ◽  
...  
Keyword(s):  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Long Term Results

scholarly journals Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

Breast Cancer ◽  
2020 ◽  
Vol 27 (6) ◽  
pp. 1107-1113 ◽  
Author(s):  
Constanze Elfgen ◽  
U. Güth ◽  
G. Gruber ◽  
S. Birrer ◽  
V. Bjelic-Radisic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Complication Rate ◽  
Local Treatment ◽  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Long Term Results ◽  
Patient Reported

Abstract Purpose When ipsilateral breast-tumor recurrence (IBTR) following breast-conserving surgery (BCS) occurs, the cure of a potentially life-threatening disease is the main goal. If, however, this is diagnosed early, prognosis is still good and patient-reported outcomes become more important. Despite the fact that many patients would prefer a further BCS, international breast cancer guidelines still recommend mastectomy, mainly because previous radiation implies limited options. Our comparative study evaluates the long-term quality-of-life and outcome in patients with IBTR who received BCS plus intraoperative radiotherapy (IORT) versus mastectomy. Methods Patients with IBTR were retrospectively divided into three groups according to the local treatment: group 1 (n = 26) was treated with BCS + IORT; group 2 (n = 35) received a standard mastectomy; group 3 (n = 52) had a mastectomy with subsequent reconstruction. Outcomes were analyzed after a mean follow-up of 5 years after IBTR. Quality-of-life was evaluated by the validated questionnaire BREAST-Q in 50 patients who fulfilled the inclusion criteria. Results Quality-of-life scores varied within the groups, ranging from 51.4 to 91.3 (out of 100 points). We observed satisfactory scores in all items, with no statistical difference within the groups. Disease-free survival of all groups did not statistically differ, and overall mortality was very low (0.9%). The postinterventional complication rate was lower after BCS (19.2% versus 34.3% after mastectomy and 30.8% after mastectomy with reconstruction). Conclusion For patients with previous surgery and radiation who demand a second BCS in the recurrent situation, this surgical technique can be offered in combination with IORT. Our long-term results imply oncological safety, lower complication rate, and good patient satisfaction.

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