scholarly journals Consensus statement on tumour bed localization for radiation after oncoplastic breast surgery

2020 ◽  
Vol 27 (3) ◽  
Author(s):  
T. Tse ◽  
S. Knowles ◽  
J. Bélec ◽  
J.M. Caudrelier ◽  
M. Lock ◽  
...  
Keyword(s):  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Careful Consideration ◽  
Adjuvant Radiation ◽  
Oncoplastic Breast Surgery ◽  
Modified Delphi ◽  
Radiation Oncologists ◽  
Boost Radiation

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery.  OPS has led to some challenges with adjuvant radiation, particularly when accurate tumour bed (TB) delineation is needed for focused radiation (i.e. accelerated partial breast radiation or boost radiation).  Currently, there on no guidelines on tumour bed localization for adjuvant targeted radiation after OPS. Methods: A modified-Delphi method was used to establish consensus amongst a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus (LABCNC) Group and in subsequent online surveys. Results: The main recommendations are as follows: 1) Surgical clips are necessary and should, at a minimum, be placed along the four side walls of the cavity plus one to four clips at the posterior margin if necessary; 2) Operative reports should include pertinent information to help guide the radiation oncologists; 3) Breast surgeons and radiation oncologists should have a basic understanding of OPS techniques and work on “speaking a common language”; and 4) Careful consideration is needed when determining the value of targeted radiation, like boost, in higher level OPS procedures with extensive tissue rearrangement. Conclusion: The panel developed a total of six recommendations on TB delineation for more focused radiation therapy after OPS, with over 80% agreement on each statement.  These are summarized along with the corresponding evidence and/or expert opinion.

Feasibility of breast conservation after neoadjuvant taxae-based chemotherapy in locally advanced breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11627-e11627
Author(s):  
M. A. Aboziada ◽  
M. I. El-Sayed ◽  
D. W. Maximous ◽  
M. E. Abdel-Wanis ◽  
M. M. Bakr
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Metastatic Cancer ◽  
Locally Advanced Breast Cancer ◽  
Tumour Size ◽  
Locally Advanced ◽  
Breast Conservation ◽  
Hormonal Treatment ◽  
Standard Of Care ◽  
Cancer Breast ◽  
Response To Chemotherapy

e11627 Background: Neoadjuvant chemotherapy is the standard of care of locally advanced cancer breast. Our study was aiming to evaluate the feasibility of breast conversation (BC) after neoadjuvant chemotherapy. Methods: Forty five patients had stage IIB and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤ 5cm underwent BC while patients who had tumour size >5cm underwent radical surgery. Negative margin is essential for BC. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients. Results: Thirty four patients had BC. Response to chemotherapy was the only statistically significant factor which influences the BC. Incidence of local recurrence was 5.9% for patients who had BC at a median follow up 24 months. Conclusions: Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤ 4cm after chemotherapy are the best candidates for BC. No significant financial relationships to disclose.

International Expert Panel on the Use of Primary (Preoperative) Systemic Treatment of Operable Breast Cancer: Review and Recommendations

2003 ◽  
Vol 21 (13) ◽  
pp. 2600-2608 ◽  
Author(s):  
Manfred Kaufmann ◽  
Gunter von Minckwitz ◽  
Roy Smith ◽  
Vicente Valero ◽  
Luca Gianni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Breast Disease ◽  
The United States ◽  
Postoperative Treatment ◽  
Routine Practice ◽  
Primary Systemic Therapy ◽  
Pathologic Evaluation

Primary systemic therapy (PST) represents the standard of care in patients with locally advanced breast cancer. In addition, there is increasing information on PST in operable breast disease that supports the use of PST in routine practice. However, current regimens and techniques vary. To address this concern, a group of representatives from breast cancer clinical research groups in France, Germany, Italy, the United Kingdom, and the United States reviewed all available data on prospective randomized trials in this setting. Recommendations are made regarding terminology, indications, regimen, diagnosis before treatment, monitoring of efficacy, tumor localization, surgery, pathologic evaluation, and postoperative treatment.

scholarly journals Locally advanced breast cancer in younger women

2003 ◽  
Vol 11 (3) ◽  
pp. 149-149
Author(s):  
Jadranka Lakicevic ◽  
Dinka Lakic ◽  
Milan Sorat
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Adjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Breast Conserving Surgery ◽  
Advanced Breast ◽  
Neo Adjuvant Chemotherapy

Background: Standard treatment of locally advanced breast cancer is not yet established. In most institutions treatment is multimodal and consists of primary chemotherapy, surgical treatment with or without radiotherapy (RT) and hormonal therapy. To find out whether the age influences the kind of surgical treatment in a group of locally advanced breast cancer patients (LABC patients) responding to neo-adjuvant chemotherapy. Methods: Analysis included 39 LABC patients treated from January 2000 till January 2003 with neo-adjuvant chemotherapy and surgical treatment in Clinical Center of Montenegro, Podgorica. All patients had locally advanced disease (T2, T3 or T4b and/or N1-2 M1 sc). Patients with T4d tumors were excluded. The treatment consisted of neo-adjuvant chemotherapy, mostly anthracycline based, and surgical treatment - radical mastectomy or breast conserving surgery. Additional procedures after surgical treatment included 3-4 cycles of the same chemotherapy, hormonal treatment and/or RT. Results: Median age of patients was 47 years (range: 24-67 years). Thirty patients were initially in stage IIIA (14 post- and 16 premenopausal patients respectively), 6 patients in stage IIIB (2 post- and 4 premenopausal respectively), and 3 patients in stage IV, with supraclavicular node involvement (M1+sc, 2 post- and 1 premenopausal, respectively). Applied preoperative chemotherapy was anthracycline-based regimen (FAC, 3-6 cycles) except in one patient in premenopausal group and 2 patients in postmenopausal group, who had been treated with CMF chemotherapy due to anthracycline contraindications. All analyzed patients responded to neo-adjuvant chemotherapy, mostly with partial or minimal remission of their tumors. In a whole group 15/39 (38%) patients had breast conserving surgery (8 pre-, 7 postmenopausal, respectively), 24/39 (61%) patients radical mastectomy (13 pre-, 11 postmenopausal, respectively). In a group of patients old 40 years and younger only 2 partial resections were performed (2/9, 22%), and 7 radical mastectomies. Conclusion: Although in a small group of patients, our results confirmed that effective neo-adjuvant chemotherapy enabled breast surgery of LABC, even breast conservative procedure in some patients. However, breast conservation was not possible in majority of young patients. This suggests the investigation of more aggressive neo-adjuvant treatments, especially in patients old 40 years or younger.

Phase II study of capecitabine (X) + docetaxel (T) as neoadjuvant treatment in patients (pts) with locally advanced breast cancer (LABC) including biological correlates

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 664-664
Author(s):  
M. Bellet ◽  
M. Muñoz ◽  
B. Bellosillo ◽  
J. Corominas ◽  
T. Pena ◽  
...  
Keyword(s):  
Locally Advanced Breast Cancer ◽  
Dihydropyrimidine Dehydrogenase ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Residual Tumor ◽  
Breast Conserving Surgery ◽  
Small Sample ◽  
Pathological Response ◽  
Exact Test ◽  
Highly Active

664 Background: X and T have demonstrated synergy in preclinical studies and survival benefits in metastatic BC. We aimed to determine whether the high efficacy of XT could translate into the neoadjuvant setting. Methods: Expression levels (mRNA) of 3 enzymes involved in X intratumoral activation and metabolism (thymidylate synthase [TS], thymidine phosphorylase [TP] and dihydropyrimidine dehydrogenase [DPD]), were determined in tumor biopsies before treatment and their relationship with clinical and pathological response analyzed using Fisher’s Exact Test. Pts with stage IIIA/IIIB LABC, adequate organ function and KPS ≥80 received 4 cycles of X 1250mg/m2 (1000mg/m2 for age >60) bid d1–14 and T 75mg/m2 d1 q3w followed by surgery, adjuvant AC q3w × 4 ± tamoxifen according to ER and PR status. The primary endpoint was pCR. Results: We enrolled 34 pts with LABC IIIA (44%)/IIIB (56%): median age 52y (30–72); KPS ≥90 (76%); median tumor size 6.8cm (2–20); N0 (20%), N1 (41%), N2/3 (35%); ER+PR-/p53+/HER2+ (23/24/28%). 128 cycles of X and T were administered (median 4, range 1–5). Main G3/G4 toxicities were: HFS 32%, diarrhea 15%, asthenia 9%, stomatitis 6% and neutropenia 71%. There were no treatment-related deaths. 2 pts were withdrawn prematurely due to adverse events. The overall response in 32 evaluable pts was 78%, including 5 CRs and 20 PRs. 6/29 pts evaluable for pathological response had pCR (20%), and 10 (33%) had ≤10mm residual tumor (3 microscopic RD) in breast. Nodal involvement after chemotherapy was N0 (33%), N1 (33%), N2 (27%), N3 (7%), and the rate of breast-conserving surgery was 17%. High TP/DPD ratio was associated with CR (p=0.037) and both high TP/DPD and low TS/DPD ratio appeared to correlate with residual tumor ≤10 mm (p=0.028). Conclusions: Neoadjuvant XT appears to be highly active. Safety was similar to that reported in anthracycline-pretreated pts but with less stomatitis. In this small sample, a high TP/DPD ratio appears to correlate with clinical response and a favorable enzymatic profile (high TP/DPD and low TS/DPD ratio) may predict for high pCR. A further prospective study is required to validate this hypothesis. No significant financial relationships to disclose.

Impact of trastuzumab on the pathological complete response (pCR) rates in primary systemic therapy for breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11000-11000
Author(s):  
N. Mizuta ◽  
H. Nakajima ◽  
K. Sakaguchi ◽  
Y. Hachimine ◽  
I. Fujiwara
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Pathological Complete Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Primary Systemic Therapy ◽  
Group A ◽  
Group B

11000 Background: Various regimens of primary systemic therapy (PST) have been performed to patients with locally advanced breast cancer to decrease the size of the primary tumor and allow for effective local and distant control. In terms of pathological complete response (pCR) rate, however, satisfactory results were not obtained. Therefore, in this study, we have tried to determine whether the addition of trastuzumab on PST could increase pCR rate. Methods: Two prospective nonrandomized studies were performed that used different regimens as PST, followed by breast conserving surgery. Group-A ; Eighty-fore HER2-negative patients with operable breast cancer were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel. GroupB; Eighteen HER2-positive patients were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel and trastuzumab. Results: A total of 102 assessable patients were enrolled, and all the patients have completed the above 2 regimens of PST. Pathological complete response (pCR) rates were 12% in Group-A and 61.1% in Group-B, respectively. Following the PST, 75% of Group-A and all of Group-B patients were able to be subjected to breast conserving surgery. All the toxicities happened in both groups were well controlled in grade 1 or 2. Conclusion: These results indicate that both the PST regimens were safely performed in women with locally advanced breast cancer and allow breast conserving surgery in a high fraction of patients (90%). In addition, significantly high rates of pCR were obtained in patients with use of trastuzumab (p<0.01). No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document