scholarly journals Recurrence and mortality after breast-conserving surgery without radiation

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
K. Guidolin ◽  
M. Lock ◽  
K. Vogt ◽  
J. A. McClure ◽  
J. Winick-Ng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Protective Effect ◽  
Randomized Trials ◽  
Primary Outcome ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Cohort Size ◽  
Hazard Ratios ◽  
High Comorbidity ◽  
Cancer Studies

Background Breast-conserving surgery (bcs) and radiation therapy (rt) are the standard of care for early breast cancer; studies have demonstrated that adjuvant rt confers a protective effect with respect to recurrence, although no randomized trials have shown a survival benefit.Methods This retrospective cohort study used Ontario data linked through ices to examine patients treated for breast cancer between 1 April 2007 and 31 March 2014. The primary outcome was death or recurrence. Outcomes were compared between patients who did and did not receive rt.Results The total cohort size was 26,279. The hazard ratios (hrs) for various outcomes were significantly higher for patients who did not receive rt than for patients who did: recurrence or death combined [hr: 2.49; 95% confidence interval (ci): 2.25 to 2.75], recurrence (hr: 2.33; 95% ci: 1.91 to 2.84), and death (hr: 2.28; 95% ci: 2.03 to 2.56). The hr for death was 1.81 (95% ci: 1.65 to 1.99) for patients having stage ii cancer compared with those having stage I disease. The hr for death was 1.97 (95% ci: 1.74 to 2.22) for patients having high comorbidity compared with those having little comorbidity.Conclusions Adjuvant rt carries a protective effect with respect to recurrence and survival in patients with earlystage breast cancer. That survival benefit has not been appreciated in previous randomized trials and underscores the importance of rt as a component of breast cancer treatment.

scholarly journals Appropriate treatment receipt after breast-conserving surgery

2018 ◽  
Vol 25 (6) ◽  
Author(s):  
K. Guidolin ◽  
M. Lock ◽  
K. Vogt ◽  
J. A. McClure ◽  
J. Winick-Ng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Income Quintile ◽  
Appropriate Treatment ◽  
Increased Risk ◽  
Breast Care ◽  
High Comorbidity ◽  
Incomplete Treatment ◽  
Treat Breast Cancer

Background Breast-conserving surgery (bcs) and radiation therapy (rt) are the standard of care for early breastcancer, although some women receive ipsilateral mastectomy or adjuvant tamoxifen, both of which can be appropriate alternatives to rt. Objectives of the present study were to determine the proportion of women who are treated appropriately after bcs and to identify factors associated with non-receipt of rt.Methods This retrospective cohort study used Ontario data linked at the Institute for Clinical and Evaluative Sciences to examine 33,718 patients who received bcs during 2004–2010. Primary outcome was rt receipt. The ipsilateral mastectomy rate and patient, surgeon, and setting variables were measured.Results Of the study patients, 86.1% received either rt or completion mastectomy; in the cohort less than 70 years of age, 90.8% received rt or completion mastectomy. Among patients less than 70 years of age, 3 risk factors for nonreceipt of rt were identified: age less than 46 years, treatment in a non-academic institution, and earlier year of initial bcs. Additionally, in the overall cohort, rt non-receipt was associated with high comorbidity, more than 40 km to the cancer centre, income quintile, and breast care specialization.Conclusions In Ontario, 90.8% of patients less than 70 years of age are appropriately treated for early breast cancer; approximately 1 in 10 do not receive rt or completion mastectomy. Based on those findings, women less than 46 years of age might be at increased risk of recurrence and death because of incomplete treatment. It also appears that academic centres more effectively treat breast cancer; however, breast cancer care appears to be improving over time in Ontario.

scholarly journals Breast Conserving Treatment for Breast Cancer: Dosimetric Comparison of Sequential versus Simultaneous Integrated Photon Boost

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hilde Van Parijs ◽  
Truus Reynders ◽  
Karina Heuninckx ◽  
Dirk Verellen ◽  
Guy Storme ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Helical Tomotherapy ◽  
Organs At Risk ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Conventional Technique ◽  
Breast Conserving Treatment ◽  
Safe Alternative ◽  
Dosimetric Comparison ◽  
Sequential Boost

Background. Breast conserving surgery followed by whole breast irradiation is widely accepted as standard of care for early breast cancer. Addition of a boost dose to the initial tumor area further reduces local recurrences. We investigated the dosimetric benefits of a simultaneously integrated boost (SIB) compared to a sequential boost to hypofractionate the boost volume, while maintaining normofractionation on the breast.Methods. For 10 patients 4 treatment plans were deployed, 1 with a sequential photon boost, and 3 with different SIB techniques: on a conventional linear accelerator, helical TomoTherapy, and static TomoDirect. Dosimetric comparison was performed.Results. PTV-coverage was good in all techniques. Conformity was better with all SIB techniques compared to sequential boost (P= 0.0001). There was less dose spilling to the ipsilateral breast outside the PTVboost (P= 0.04). The dose to the organs at risk (OAR) was not influenced by SIB compared to sequential boost. Helical TomoTherapy showed a higher mean dose to the contralateral breast, but less than 5 Gy for each patient.Conclusions. SIB showed less dose spilling within the breast and equal dose to OAR compared to sequential boost. Both helical TomoTherapy and the conventional technique delivered acceptable dosimetry. SIB seems a safe alternative and can be implemented in clinical routine.

Statistical Interaction in the Survival Analysis of Early Breast Cancer using Registry Data: Role of Breast Conserving Surgery and Radiotherapy

2005 ◽  
Vol 91 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Vincent Vinh-Hung ◽  
Tomasz Burzykowski ◽  
Jan Van de Steene ◽  
Mia Voordeckers ◽  
Jan Lamote ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Postoperative Radiotherapy ◽  
Wald Test ◽  
Breast Conserving Surgery ◽  
Axillary Lymph ◽  
Hazard Ratios ◽  
Significant Survival ◽  
Advanced Stages ◽  
Subgroup Effects

Purpose To identify subgroup effects that might influence the survival results of postoperative radiotherapy. Patients and methods Women selected from the Surveillance, Epidemiology, and End Results database, aged 40-69 years, with non-metastasized T1-T2 breast carcinoma, in whom axillary lymph node dissection was performed. Subgroup analyses were performed using proportional hazards models with interactions. Joint significance of subgroups was evaluated with the Wald test. Event was death from any cause. Results Statistically significant interactions were found between type of surgery (breast-conserving [BCS] or mastectomy [ME]), radiotherapy [RT], T stage, and extent of nodal involvement, but not between treatments and nodal examination. For each treatment combination, ME-no RT, ME+RT, BCS-no RT, BCS+RT, the mortality hazard ratios were respectively: 1, 1.12, 1.11, 0.78 in T1, 0-3 positive nodes; 2.45, 2.77, 2.71, 1.92 in T2, 4+ nodes; 1.31, 1.38, 1.33, 1.19 in T2, 0-3+ nodes; and 3.41, 2.79, 3.44, 2.40 in T2, 4+ nodes. The corresponding joint tests showed: in the absence of radiotherapy, no significant survival disadvantage for breast-conserving surgery vs mastectomy; with radiotherapy, significant survival advantage for breast-conserving surgery irrespective of stage and for mastectomy in T2, 4+ nodes. For mastectomy in less advanced stages receiving radiotherapy, excess breast cancer deaths suggested undocumented adverse selection. The corresponding result was considered inconclusive. Conclusions The analyses found subgroup effects that should be taken into account to interpret treatment results in breast cancer.

scholarly journals Minimally invasive approaches: cryoablation

2005 ◽  
Vol 8 (8) ◽  
Author(s):  
T. L. Huston ◽  
R. M. Simmons
Keyword(s):  
Breast Cancer ◽  
Minimally Invasive ◽  
Randomized Trials ◽  
Ultrasound Guidance ◽  
Breast Conserving Surgery ◽  
Skin Incision ◽  
Ablative Therapies ◽  
Multiple Cycles ◽  
Treat Breast Cancer

As widespread screening for breast cancer detects more women at younger ages and earlier stages, the need for minimally invasive, cosmetically preferable approaches to its treatment grows. The combination of a superficial location on the thorax and lack of intervening organs makes the breast ideal for ablative therapies, one of which is cryoablation. Cryoablation destroys tissue through multiple cycles of localized freezing. Major advantages to cryoablation are: the ability to perform the procedure in the office under real-time ultrasound guidance, improved post-procedure cosmesis when compared to breast conserving surgery since only a 2 mm skin incision is necessary, and the avoidance of anesthesia since freezing numbs the breast. Numerous studies, reviewed here, have demonstrated success in eradication of invasive breast cancer using this modality. However, before cryoablation can be added to the armamentarium of those who treat breast cancer, prospective randomized trials are needed to determine its long-term effectiveness.

scholarly journals Intensification of radiation therapy for localized breast cancer in the settings of the COVID-19 pandemic: A literature review

2021 ◽  
Vol 62 (4) ◽  
pp. 48-56
Author(s):  
S. A. Kopochkina ◽  
A. Savkhatova ◽  
M. Zekebaev ◽  
D. Chen ◽  
E. Davletgildeyev
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Randomized Trials ◽  
Radiation Treatment ◽  
Breast Conserving Surgery ◽  
Malignant Neoplasms ◽  
Radiation Toxicity ◽  
Standard Regimen ◽  
Healthcare Facilities ◽  
Pubmed Database

Relevance: Since 2004, breast cancer steadily ranks first in the structure of the incidence of malignant neoplasms in the Republic of Kazakhstan in both sexes. In 2020, its share was 14.5% (vs. 15.2% in 2019). Breast cancer also constantly ranks first in the structure of female cancer incidence, with 44.3‰ in 2020 (vs. 51.6‰in 2019). In the early 1980s, radiation therapy was a standard specialized treatment for breast cancer. The current realities of the COVID-19 pandemic require a reorganization of healthcare facilities to determine the priorities. It is also important to balance the economic and clinical efficacy of radiotherapy methods applied. The study aimed to analyze the results of large randomized trials and compare breast cancer outcomes after hypofractionated and standard fractionation radiation treatment. Methods: We reviewed the results of large randomized trials of hypofractionated radiation therapy, emphasizing adequate patient selection according to the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. Radiobiological aspects of hypofractionation were considered due to its implementation in clinical practice. The research materials were obtained from the “PubMed” database of evidence-based medicine by the keywords “radiotherapy,” “breast cancer,” “hypofractionation dose” for the period 2000-2021. Large randomized trials involving patients of any age diagnosed with stages T1-3, N0-1 breast cancer, who underwent beam therapy in standard or hypofractionated mode, met the criteria for inclusion in this study. Results: According to the results of large randomized trials, the hypofractionated regimen is similar to the standard regimen in terms of late effects on normal tissues and ensures good control over the oncological process. Conclusions: Hypofractionation has proven effectiveness and safety and has lower late and/or acute radiation toxicity when treating early breast cancer. Hypofractionation can become a new standard of radiation therapy at early stages after breast-conserving surgery.

scholarly journals Moderate hypofractionation remains the standard of care for whole-breast radiotherapy in breast cancer: Considerations regarding FAST and FAST-Forward

2021 ◽  
Author(s):  
David Krug ◽  
◽  
René Baumann ◽  
Stephanie E. Combs ◽  
Marciana Nona Duma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Late Effects ◽  
Late Toxicity ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Breast Radiotherapy ◽  
Recurrence Rates ◽  
Whole Breast Radiotherapy ◽  
The Difference ◽  
Moderate Hypofractionation

AbstractModerate hypofractionation is the standard of care for adjuvant whole-breast radiotherapy after breast-conserving surgery for breast cancer. Recently, 10-year results from the FAST and 5‑year results from the FAST-Forward trial evaluating adjuvant whole-breast radiotherapy in 5 fractions over 5 weeks or 1 week have been published. This article summarizes recent data for moderate hypofractionation and results from the FAST and FAST-Forward trial on ultra-hypofractionation. While the FAST trial was not powered for comparison of local recurrence rates, FAST-Forward demonstrated non-inferiority for two ultra-hypofractionated regimens in terms of local control. In both trials, the higher-dose experimental arms resulted in elevated rates of late toxicity. For the lower dose experimental arms of 28.5 Gy over 5 weeks and 26 Gy over 1 week, moderate or marked late effects were similar in the majority of documented items compared to the respective standard arms, but significantly worse in some subdomains. The difference between the standard arm and the 26 Gy of the FAST-Forward trial concerning moderate or marked late effects increased with longer follow-up in disadvantage of the experimental arm for most items. For now, moderate hypofractionation with 40–42.5 Gy over 15–16 fractions remains the standard of care for the majority of patients with breast cancer who undergo whole-breast radiotherapy without regional nodal irradiation after breast-conserving surgery.

scholarly journals The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jacopo Nori ◽  
Maninderpal Kaur Gill ◽  
Icro Meattini ◽  
Camilla Delli Paoli ◽  
Dalmar Abdulcadir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Laser Ablation ◽  
Residual Disease ◽  
Performance Status ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Small Breast

Background and Objectives. Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods. Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results. At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions. Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.

scholarly journals Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Concetta Blundo ◽  
Massimo Giroda ◽  
Nicola Fusco ◽  
Elham Sajjadi ◽  
Konstantinos Venetis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Standard Of Care ◽  
First Trimester ◽  
Breast Conserving Surgery ◽  
Breast Cancers ◽  
First Trimester Of Pregnancy ◽  
Isolated Local Recurrence ◽  
Age Range

Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

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