WorldWideScience

Sample records for breast-conserving therapy bct

  1. Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC)

    Energy Technology Data Exchange (ETDEWEB)

    Gollamudi, Smitha V; Gelman, Rebecca S; Peiro, Gloria; Schneider, Lindsey; Connolly, James L; Schnitt, Stuart; Silver, Barbara; Harris, Jay R

    1995-07-01

    PURPOSE: To determine whether patients with early-stage SBBC can be safely and effectively treated with bilateral BCT. MATERIALS and METHODS: We retrospectively reviewed records of 26 patients with clinical Stage I-II SBBC treated between 1968-1989 with bilateral BCT. SBBC was defined as tumors diagnosed no more than one month apart, with both sides demonstrating invasive cancer. Maximum (max) clinical stage was based on the more advanced breast tumor. Median age at diagnosis was 56 years (range, 32-85 years); menopausal status was 6 pre-, 16 post-, 3 peri-, and 1 unknown at diagnosis. Median follow-up for surviving pts is 95 months (range, 68-157). Outcome was compared to 1325 pts with unilateral Stage I or II breast cancer, within the same age range, treated during the same time period. There were no significant differences in median age, median total dose, tumor size, estrogen receptor (ER) status, pathologic nodal status, and use of systemic therapy between the study population and the comparison group. Local recurrence (LR) was evaluated as true recurrence (TR, i.e., in the original tumor bed), marginal miss (MM, at the edge of the boost field), or elsewhere (E). Median total dose to the primary was 6100 cGy (range, 5000-7000). Pathology was available for review in 19 cases. Cytology (nuclear and cytoplasmic features) was similar in (7(19)) evaluable cases, and architecture (growth pattern, ie, papillary, solid) was similar in (5(19)) cases. The presence of either cytologic or architectural similarity was noted in(9(19)) cases. 7 of 19 pts who had axillary lymph node evaluation on at least one side had pathological confirmation of lymph node metastasis. Stage was the same in both breasts in 13 cases (10 Stage I, 3 Stage II); ER status data was complete in 11 pts, and the same in both primaries in 9 cases. Cosmetic results and complications after BCT were scored. Statistical significance was evaluated by use of the Fisher exact test. RESULTS: The 5-yr actuarial

  2. Psychological aspects of breast conserving therapy (BCT) in early breast cancer

    International Nuclear Information System (INIS)

    Jeziorski, A.

    1994-01-01

    Psychological and social status of 40 women who underwent BCT in early cancer was compared with 40 women after radical mastectomy. Women in BCT group showed significantly less anxiety about overall body image. The majority of them reported adjustment to work or ability to carry out household tasks. Almost all returned to normal social activities and interpersonal relationships. The majority of patients treated with BCT were fully satisfied in spite of unsatisfactory cosmetic results achieved in some of them and in spite of long duration of combined modality treatment. (author)

  3. How effective is mammography in detecting breast cancer recurrence in women after Breast Conservation Therapy (BCT) – A systematic literature review

    International Nuclear Information System (INIS)

    Curran, J.

    2016-01-01

    Breast Conservation Therapy (BCT) is now seen as the treatment of choice for early-stage breast cancer, leading to a rising demand for post-operative surveillance. Ongoing mammographic surveillance of the post-operative breast is necessary to minimise the morbidity risk from recurrence. This review evaluates the diagnostic value of mammography following BCT, and identifies the possible challenges with mammography regarding imaging, interpretation and test performance when investigating the treated breast. Relevant literature was reviewed and critically analysed. Three studies reported that surveillance mammography provided a significant survival advantage through early detection of recurrence. Five studies recognised the diagnostic challenges of surveillance mammography following BCT, reporting reduced sensitivity after breast surgery. The need for a more tailored screening strategy after treatment for breast cancer was highlighted in four studies. Although overall mammographic sensitivity is reduced after BCT, it is still proven to be effective in detecting recurrences, therefore remains an important surveillance tool. - Highlights: • Mammographic surveillance – survival advantage. • Sensitivity reduced post-surgery. • Tailored strategy needed.

  4. Psychological aspects of breast conserving therapy (BCT) in early breast cancer; Psychologiczne aspekty leczenia oszczedzajacego chorych na raka sutka

    Energy Technology Data Exchange (ETDEWEB)

    Jeziorski, A. [Klinika Chirurgii Onkologicznej, Akademia Medyczna, Lodz (Poland)

    1994-12-31

    Psychological and social status of 40 women who underwent BCT in early cancer was compared with 40 women after radical mastectomy. Women in BCT group showed significantly less anxiety about overall body image. The majority of them reported adjustment to work or ability to carry out household tasks. Almost all returned to normal social activities and interpersonal relationships. The majority of patients treated with BCT were fully satisfied in spite of unsatisfactory cosmetic results achieved in some of them and in spite of long duration of combined modality treatment. (author). 11 refs, 1 fig.

  5. Is Ki-67 Expression Prognostic for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast Conservation Therapy (BCT)?

    Energy Technology Data Exchange (ETDEWEB)

    Hafeez, Farhaan [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Neboori, Hanmanth J. [Drexel Medical College, Philadelphia, Pennsylvania (United States); Harigopal, Malini [Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (United States); Wu, Hao; Haffty, Bruce G. [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Yang, Qifeng [Department of Breast Surgery, Shandong University School of Medicine, Shanghai (China); Schiff, Devora [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2013-10-01

    Purpose: Ki-67 is a human nuclear protein whose expression is strongly up-regulated in proliferating cells and can be used to determine the growth fraction in clonal cell populations. Although there are some data to suggest that Ki-67 overexpression may be prognostic for endpoints such as survival or postmastectomy recurrence, further elucidation of its prognostic significance is warranted. Specifically after breast conservation therapy (BCT) (defined in this setting as breast-conserving surgery and adjuvant radiation therapy), whether Ki-67 predicts for locoregional recurrence has not been investigated. The purpose of this study was to assess Ki-67 expression in a cohort of early-stage breast cancer patients to determine whether a significant independent association between Ki-67 and locoregional relapse exists. Methods and Materials: Ki-67 staining was conducted on a tissue microarray of 438 patients previously treated with BCT, and expression was analyzed with clinicopathologic features and outcomes from our database. Results: Ki-67 expression was more prevalent in black patients (37% of black patients vs 17% of white patients, P<.01), younger patients (27% of patients aged ≤50 years vs 15% of patients aged >50 years, P<.01), estrogen receptor (ER)–negative tumors (25% of ER-negative tumors vs 17% of ER-positive tumors, P=.04), human epidermal growth factor receptor 2 (HER2)/neu–positive tumors (35% of HER2-positive tumors vs 18% of HER2-negative tumors, P=.01), and larger tumors (26% of T2 tumors vs 16% of T1 tumors, P=.03). On univariate/multivariate analysis, Ki-67 did not predict for overall survival (74.4% vs 72.6%), cause-specific survival (82.9% vs 82.1%), local relapse-free survival (83.6% vs 88.5%), distant metastasis-free survival (76.1% vs 81.4%), recurrence-free survival (65.5% vs 74.6%), and locoregional recurrence-free survival (81.6% vs 84.7%): P>.05 for all. Conclusions: Ki-67 appears to be a surrogate marker for aggressive disease and

  6. Psychological effects of breast conserving therapy in comparison with radical mastectomy

    International Nuclear Information System (INIS)

    Bartelink, H.; van Dam, F.; van Dongen, J.

    1985-01-01

    Psychosocial sequelae of breast conserving therapy (BCT) and radical mastectomy (RM) have been compared. Also, in the BCT group, the cosmetic results were judged by the patients themselves and two plastic surgeons. Body image in the BCT group (n = 114) was significantly more positive than in the RM group (n = 58). Patients treated with BCT had even less fear of recurrence of the cancer and would, if necessary, choose the same treatment again. Cosmetic results were good to excellent in 75% of the cases as judged by the two plastic surgeons. Most of the patients with a bad grading by the surgeons were happy with the results

  7. Breast conserving therapy: the role of surgery

    International Nuclear Information System (INIS)

    Dongen, J.A. van

    1994-01-01

    Breast conserving therapy generally is considered to be a safe alternative to mastectomy in a large proportion of operable breast cancer patients. Small tumor size, wide excisions, absence of vascular invasion and of extensive intraductal component are prognosticators for therapy success. Good results depend on technique and on patient selection. For some tumor situations specific therapy modifications are under investigation. (author)

  8. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    International Nuclear Information System (INIS)

    Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

    2012-01-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985–2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18–89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  9. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    Energy Technology Data Exchange (ETDEWEB)

    Demirci, Senem, E-mail: senem.demirci@ege.edu.tr [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir (Turkey); Broadwater, Gloria [Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC (United States); Cancer and Leukemia Group B Statistical Center, Duke Cancer Institute, Durham, NC (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Clough, Robert; Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2012-07-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  10. Non-Surgical Breast-Conserving Treatment (KORTUC-BCT Using a New Radiosensitization Method (KORTUC II for Patients with Stage I or II Breast Cancer

    Directory of Open Access Journals (Sweden)

    Yasuhiro Ogawa

    2015-11-01

    Full Text Available The purpose of the present study was to establish a non-surgical breast-conserving treatment (BCT using KORTUC II radiosensitization treatment. A new radiosensitizing agent containing 0.5% hydrogen peroxide and 0.83% sodium hyaluronate (a CD44 ligand has been developed for intra-tumoral injection into various tumors. This new method, named KORTUC II, was approved by our local ethics committee for the treatment of breast cancer and metastatic lymph nodes. A total of 72 early-stage breast cancer patients (stage 0, 1 patient; stage I, 23; stage II, 48 were enrolled in the KORTUC II trial after providing fully informed consent. The mean age of the patients was 59.7 years. A maximum of 6 mL (usually 3 mL for tumors of less than approximately 3 cm in diameter of the agent was injected into breast tumor tissue twice a week under ultrasonographic guidance. For radiotherapy, hypofraction radiotherapy was administered using a tangential fields approach including an ipsilateral axillary region and field-in-field method; the energy level was 4 MV, and the total radiation dose was 44 Gy administered as 2.75 Gy/fraction. An electron boost of 3 Gy was added three times. Treatment was well tolerated with minimal adverse effects in all 72 patients. No patients showed any significant complications other than mild dermatitis. A total of 24 patients under 75 years old with stage II breast cancer underwent induction chemotherapy (EC and/or taxane prior to KORTUC II treatment, and 58 patients with estrogen receptor-positive tumors also received hormonal therapy following KORTUC II. The mean duration of follow-up as of the end of September 2014 was 51.1 months, at which time 68 patients were alive without any distant metastases. Only one patient had local recurrence and died of cardiac failure at 6.5 years. Another one patient had bone metastases. For two of the 72 patients, follow-up ended after several months following KORTUC II treatment. In conclusion, non

  11. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Nesvold, Inger-Lise (Dept. of Cancer Rehabilitation-Physiotherapy, Rikshospitalet, Univ. of Oslo, Div. The Norwegian Radium Hospital, Montebello, Oslo (Norway)); Dahl, Alv A.; Fossaa, Sophie D. (Dept. of Clinical Cancer Research, Rikshospitalet, Univ. of Oslo: Division The Norwegian Radiumhospital, Montebello, Oslo (Norway)); Loekkevik, Erik (Dept. of Oncology, Rikshospitalet, Montebello, Oslo (Norway)); Marit Mengshoel, Anne (Inst. of Nursing and Health Sciences, Univ. of Oslo: Medical Faculty, Oslo (Norway))

    2008-06-15

    Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

  12. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

    International Nuclear Information System (INIS)

    Nesvold, Inger-Lise; Dahl, Alv A.; Fossaa, Sophie D.; Loekkevik, Erik; Marit Mengshoel, Anne

    2008-01-01

    Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

  13. Reactive intramammary lymph node mimicking recurrence on MRI study in a patient with prior breast conservation therapy

    Directory of Open Access Journals (Sweden)

    Seema A Kembhavi

    2013-01-01

    Full Text Available Breast conservative therapy (BCT is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.

  14. Angiosarcoma after breast-conserving therapy: long-term outcomes with hyperfractionated radiotherapy.

    Science.gov (United States)

    Palta, Manisha; Morris, Christopher G; Grobmyer, Stephen R; Copeland, Edward M; Mendenhall, Nancy P

    2010-04-15

    With breast-conserving therapy (BCT) as the standard of care for patients with noninvasive and early stage invasive breast cancer, a small incidence of post-BCT angiosarcoma has emerged. The majority of therapeutic interventions have been unsuccessful. To the authors' knowledge, there is no consensus in the medical literature to date regarding the treatment of this malignancy. The current study was conducted to report the long-term outcomes of a novel approach using hyperfractionated and accelerated radiotherapy (HART) for angiosarcoma developing after BCT. The authors retrospectively reviewed the outcomes of 14 patients treated with HART with or without surgery at the University of Florida between November 1997 and March 2006 for angiosarcoma that developed after BCT. At the time of last follow-up, 9 patients had remained continuously without evidence of disease for a median of 61 months after HART (range, 36-127 months). Five patients had further manifestations of angiosarcoma after HART at a median of 1 month (range, 1-28 months): 3 with progressive pulmonary and/or mediastinal disease that was likely present before HART and 2 with local or regional disease extension. Progression-free survival rates for the 14 patients at 2 years and 5 years were 71% and 64%, respectively. The overall and cause-specific survival rates were both 86% at 2 years and 5 years. To the best of the authors' knowledge, HART with or without subsequent surgery, as documented in the current series, is the first approach to provide a high rate of local control, disease-free survival, and overall survival after the development of post-BCT angiosarcoma. The authors believe the success noted with this approach is related to both the hyperfractionation and acceleration of the RT. (c) 2010 American Cancer Society.

  15. Mammographic compression after breast conserving therapy: Controlling pressure instead of force

    International Nuclear Information System (INIS)

    Groot, J. E. de; Branderhorst, W.; Grimbergen, C. A.; Broeders, M. J. M.; Heeten, G. J. den

    2014-01-01

    Purpose: X-ray mammography is the primary tool for early detection of breast cancer and for follow-up after breast conserving therapy (BCT). BCT-treated breasts are smaller, less elastic, and more sensitive to pain. Instead of the current force-controlled approach of applying the same force to each breast, pressure-controlled protocols aim to improve standardization in terms of physiology by taking breast contact area and inelasticity into account. The purpose of this study is to estimate the potential for pressure protocols to reduce discomfort and pain, particularly the number of severe pain complaints for BCT-treated breasts. Methods: A prospective observational study including 58 women having one BCT-treated breast and one untreated nonsymptomatic breast, following our hospital's 18 decanewton (daN) compression protocol was performed. Breast thickness, applied force, contact area, mean pressure, breast volume, and inelasticity (mean E-modulus) were statistically compared between the within-women breast pairs, and data were used as predictors for severe pain, i.e., scores 7 and higher on an 11-point Numerical Rating Scale. Curve-fitting models were used to estimate how pressure-controlled protocols affect breast thickness, compression force, and pain experience. Results: BCT-treated breasts had on average 27% smaller contact areas, 30% lower elasticity, and 30% higher pain scores than untreated breasts (allp 2 decrease in contact area, as well as increased pain sensitivity, BCT-breasts had on average 5.3 times higher odds for severe pain than untreated breasts. Model estimations for a pressure-controlled protocol with a 10 kPa target pressure, which is below normal arterial pressure, suggest an average 26% (range 10%–36%) reduction in pain score, and an average 77% (range 46%–95%) reduction of the odds for severe pain. The estimated increase in thickness is +6.4% for BCT breasts. Conclusions: After BCT, women have hardly any choice in avoiding an annual

  16. Breast-conserving therapy in patients with bilateral breast cancer: Do today's treatment choices burn bridges for tomorrow?

    International Nuclear Information System (INIS)

    Gilroy, Jeffrey S.; Morris, Christopher G.; Mendenhall, Nancy Price

    2005-01-01

    Purpose: To determine how often initial treatment choices limit treatment options for subsequent breast cancer management in patients undergoing breast-conserving therapy (BCT), in particular with treatment of internal mammary nodes. Methods and Materials: Between January 1985 and June 2001, 464 women with pathologic Stage 0, I, and II (T0-2, N0-1) breast cancer underwent BCT at our institution. All 464 patients had computed tomography-based treatment planning. In patients with bilateral breast cancer, the planning computed tomography scans were used to determine the impact initial radiation therapy fields had on treatment options for subsequent contralateral breast cancer. Results: There were 500 breast cancers diagnosed in 464 patients. Thirty-six patients (8%) had bilateral breast cancer with 9 (2%) synchronous and 27 (6%) metachronous primaries. In 80 patients, the ipsilateral internal mammary nodes were explicitly treated. Initial breast cancer treatment choices impacted subsequent treatment decisions for the contralateral breast in only 2 of 464 patients (0.4%) in the study: 2 of 80 patients (2.5%) whose internal mammary nodes were treated, and 2 of 27 patients (7.4%) who developed metachronous bilateral breast cancer. Conclusions: Initial BCT, including internal mammary node irradiation, rarely compromised future contralateral breast-conserving therapy

  17. Prognosis for Mammographically Occult, Early-Stage Breast Cancer Patients Treated With Breast-Conservation Therapy

    International Nuclear Information System (INIS)

    Yang, Tzu-I. J.; Yang Qifeng; Haffty, Bruce G.; Moran, Meena S.

    2010-01-01

    Purpose: To compare mammographically occult (MamOcc) and mammographically positive (MamPos) early-stage breast cancer patients treated with breast-conservation therapy (BCT), to analyze differences between the two cohorts. Methods and Materials: Our two cohorts consisted of 214 MamOcc and 2168 MamPos patients treated with BCT. Chart reviews were conducted to assess mammogram reports and method of detection. All clinical-pathologic and outcome parameters were analyzed to detect differences between the two cohorts. Results: Median follow-up was 7 years. There were no differences in final margins, T stage, nodal status, estrogen/progesterone receptor status, or 'triple-negative' status. Significant differences included younger age at diagnosis (p o histology (p < 0.0001). At 10 years, the differences in overall survival, cause-specific survival, and distant relapse between the two groups did not differ significantly. The MamOcc cohort had more breast relapses (15% vs. 8%; p = 0.0357), but on multivariate analysis this difference was not significant (hazard ratio 1.0, 95% confidence interval 0.993-1.007, p = 0.9296). Breast relapses were mammographically occult in 32% of the MamOcc and 12% of the MamPos cohorts (p = 0.0136). Conclusions: Although our study suggests that there are clinical-pathologic variations for the MamOcc cohort vs. MamPos patients that may ultimately affect management, breast relapse after BCT was not significantly different. Breast recurrences were more often mammographically occult in the MamOcc cohort; consideration should be given to closer follow-up and alternative imaging strategies (ultrasound, breast MRI) for routine posttreatment examination. To our knowledge, this represents the largest series addressing the prognostic significance of MamOcc cancers treated with BCT.

  18. The patterns of care study for breast-conserving therapy in Japan: Analysis of process survey from 1995 to 1997

    International Nuclear Information System (INIS)

    Mitsumori, Michihide; Hiraoka, Masahiro; Negoro, Yoshiharu; Yamauchi, Chikako; Shikama, Naoto; Sasaki, Shigeru; Yamamoto, Tokihiro; Teshima, Teruki; Inoue, Toshihiko

    2005-01-01

    Purpose: To present the results of a process survey on breast-conserving therapy (BCT) in Japan from 1995 to 1997. Methods and Materials: From September 1998 to December 1999, data on the treatment process of 865 randomly selected BCT patients were collected by extramural audits. Results: For primary surgery, wide excision or tumorectomy was performed in 372 patients (43.0%), and quadrantectomy or segmental mastectomy was performed in 493 patients (57%). The extent of axillary dissection was equal or beyond Level II in 590 patients (68.2%). Systemic chemotherapy was administered to 103 of 160 node-positive patients (64.4%) and 180 of 569 node-negative patients (31.6%). Tamoxifen was administered to 234 of 323 hormone receptor-positive patients (72.5%) and 68 of 130 hormone receptor-negative patients (52.3%). Photon energy of 10 MV was administered for whole breast irradiation in 38 patients (4.4%) without bolus. Conclusions: The extent of surgical resection for BCT was large in Japan. Pathologic assessment and the technique of radiation therapy were apparently suboptimal in some cases. Information on prognostic/predictive factors was not fully utilized to individualize systemic adjuvant therapy. Establishment and widespread use of guidelines for BCT for in Japan are desirable. Repeated surveys will demonstrate how such guidelines affect clinical practices

  19. Locoregional control and survival after breast conserving therapy

    International Nuclear Information System (INIS)

    Rajer, M.; Majdic, E.

    2006-01-01

    Background. The purpose of our study was to present a 5-year survival and locoregional control rates in breast cancer patients and to establish eventual impact of the treatment and patient characteristics on locoregional control and survival. Methods. From January 1998 to December 1999 564 stage 1 and 2 breast cancer patients were treated with breast conserving therapy. We evaluated the following characteristics: age, histological diagnosis, grade, size, number of metastatic lymph nodes, hormonal receptor status, extensive intraductal component (EIDC), vascular invasion, pathologic tumour margins, type of surgery and use of adjuvant therapy. Results. The mean age of our patients was 54.2 years. Invasive ductal carcinoma was the most common diagnosis (82.4%), followed by invasive lobular carcinoma (10.6%). Most of the tumours were grade 2. Seventy-two % of patients had T1 tumours, 24% T2 and 3% T is tumours. Metastatic lymph nodes were present in 44% of patients. All patients were treated with breast conserving surgery followed by radiotherapy (RT). Fifty % of patients received adjuvant chemotherapy and/ or hormonal therapy. The 5-year survival rate was 88.5%. Tumour size, number of metastatic lymph nodes, grade, hormonal receptors and vascular invasion proved to be statistically significant prognostic factors for the survival, while age and histological diagnosis were not. Local recurrence developed in 4.3% of our patients, while in 3.4% regional recurrence developed. Conclusions. Breast conserving surgery followed by RT was associated with good rates of locoregional control and survival, comparable to those reported in the literature. (author)

  20. Breast abscesses after breast conserving therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Kazuhisa [National Kyoto Hospital (Japan)

    2001-09-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  1. Breast abscesses after breast conserving therapy for breast cancer

    International Nuclear Information System (INIS)

    Fujiwara, Kazuhisa

    2001-01-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  2. Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy

    International Nuclear Information System (INIS)

    Feigenberg, Steven J.; Price Mendenhall, Nancy; Reith, John D.; Ward, Jon R.; Copeland, Edward M.

    2002-01-01

    Purpose: To report our promising results of hyperfractionated radiotherapy (RT) in conjunction with surgery for angiosarcoma occurring after breast-conserving therapy for early-stage breast cancer. Methods and Materials: Since 1997, 3 cases of angiosarcoma after breast-conserving therapy have been managed at the University of Florida. The histologic specimens in each case were reviewed and graded by one of us (J.D.R.). Results: Explosive growth of discolored skin lesions coincident with histologic evidence of angiosarcoma characterized all 3 cases but was preceded by a fairly indolent period (almost 2 years) of atypical vascular hyperplasia in 2 patients. All 3 patients were treated initially with radical surgery for the angiosarcoma, but extensive recurrences were noted within 1 to 2 months of surgery. Because of the extremely rapid growth noted before and after surgery, hyperfractionated RT was used. Two of the patients underwent planned resection after RT, and neither specimen demonstrated any evidence of high-grade angiosarcoma. All 3 patients were alive without any recurrent disease 22, 38, and 39 months after treatment. Conclusions: Hyperfractionated irradiation appears to be effective treatment for rapidly proliferating angiosarcoma. For previously untreated angiosarcoma, we now recommend hyperfractionated RT followed by surgery to enhance disease control and remove as much reirradiated tissue as possible

  3. Non-surgical breast-conservation treatment (KORTUC-BCT) using a new image-guided, enzyme-targeted, and breast cancer stem cell targeted radiosensitization treatment (KORTUC II) for patients with stage I or II breast cancer

    International Nuclear Information System (INIS)

    Ogawa, Yasuhiro; Kubota, Kei; Tadokoro, Michiko

    2012-01-01

    Tumor tissue can be re-oxygenated by inactivating peroxidase/catalase in the tumor tissue through application of hydrogen peroxide. The hydrogen peroxide in turn is then degraded to produce oxygen. In this way, low-LET (linear energy transfer) radioresistant tumors can be transformed into radiosensitive ones (Ogawa Y, et al: Int J Mol Med 12: 453-458, 845-850, 2003, Ogawa Y, et al: Int J Mol Med 14: 397-403, 2004, Kariya S, et al: Int J Radiat Oncol Biol Phys 75: 449-454, 2009). The purpose of the present study was to establish a non-surgical breast-conservation treatment (KORTUC-BCT) by utilizing a novel Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, Type II (KORTUC II) radiosensitization treatment. KORTUC I was shown to remarkably enhance radiotherapeutic effects in various types of superficially exposed and locally advanced neoplasms (Ogawa Y, et al: Oncol Rep 19: 1389-1394, 2008). Based on clinical experiences using KORTUC I, a new radiosensitizing agent containing hydrogen peroxide and sodium hyaluronate has been developed for intra-tumoral injection in various tumors which are not superficially exposed. The agent is composed of 0.5% hydrogen peroxide and 0.83% sodium hyaluronate (CD44 molecule). Sodium hyaluronate mixed with hydrogen peroxide attaches to CD44-positive tumor cells, which are generally reported to be breast cancer stem cells. This new method, named KORTUC II, was approved by our local ethics committee for treatment of advanced skin cancer (including malignant melanoma), bone/soft tissue malignant neoplasm, breast cancer and metastatic lymph node. A total of 39 early stage breast cancer patients (stage I: 12 patients and stage II: 27) were enrolled in the KORTUC II trial upon fully informed consent. Mean age of the patients was 61.1 years old. All 39 patients were unable or unwilling to undergo surgery and therefore undertook non-surgical breast-conservation treatment (KORTUC-BCT) by KORTUC II. A maximum of 6 ml of the agent was

  4. Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    International Nuclear Information System (INIS)

    Jobsen, Jan; Palen, Job van der; Riemersma, Sietske; Heijmans, Harald; Ong, Francisca; Struikmans, Henk

    2014-01-01

    Purpose: To analyze the incidence and prognostic factors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) in a large, population-based, single-center study with long-term follow-up. Methods and Materials: We analyzed 3595 cases in which BCT was performed in 3824 women with stage I or II breast cancer. The incidence of IBTR was analyzed over time and was based on IBTR as first event. Results: The 15-year local relapse-free survival was 90.9%. The hazard estimates for IBTR showed a time course with 2 peaks, the first at approximately 5 years and the second, twice as high, at 12 years. Stratifying subjects by age and margin status showed that, for women ≤40 years old with negative margins, adjuvant systemic therapy led to a 5-fold reduced risk of recurrence compared to none, and the presence of lymph vascular space invasion (LVSI) had a 3-fold increased risk compared to its absence. For women >40 years old, the presence of LVSI (hazard ratio [HR] 2.5) and the presence of lobular carcinoma in situ in the lumpectomy specimen (HR 2.3) were the only 2 risk factors. Conclusions: We demonstrated a pattern in risk of IBTR over time, with 2 peaks, first at approximately 5 years and a second, much higher peak at approximately 12 years, especially for women ≤40 years old. For women ≤40 years old with tumor-free resection margins, we noted that the absence of adjuvant systemic therapy and the presence of LVSI were independent prognostic factors of IBTR. For women >40 years old, the presence of LVSI and the presence of lobular carcinoma in situ were independent risk factors

  5. Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jobsen, Jan, E-mail: j.jobsen@mst.nl [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Palen, Job van der [Department of Epidemiology, Medisch Spectrum Twente, Enschede (Netherlands); Department of Research Methodology, Measurement, and Data Analysis, Faculty of Behavioral Science, University of Twente, Enschede (Netherlands); Riemersma, Sietske [Laboratory for Pathology Oost Nederland, Hengelo (Netherlands); Heijmans, Harald [Department of Surgery, Ziekenhuis Groep Twente, Hengelo (Netherlands); Ong, Francisca [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Struikmans, Henk [Department of Radiation Oncology, Leiden University Medical Centre, Leiden (Netherlands); Radiotherapy Centre West, Medical Centre Haaglanden, The Hague (Netherlands)

    2014-08-01

    Purpose: To analyze the incidence and prognostic factors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) in a large, population-based, single-center study with long-term follow-up. Methods and Materials: We analyzed 3595 cases in which BCT was performed in 3824 women with stage I or II breast cancer. The incidence of IBTR was analyzed over time and was based on IBTR as first event. Results: The 15-year local relapse-free survival was 90.9%. The hazard estimates for IBTR showed a time course with 2 peaks, the first at approximately 5 years and the second, twice as high, at 12 years. Stratifying subjects by age and margin status showed that, for women ≤40 years old with negative margins, adjuvant systemic therapy led to a 5-fold reduced risk of recurrence compared to none, and the presence of lymph vascular space invasion (LVSI) had a 3-fold increased risk compared to its absence. For women >40 years old, the presence of LVSI (hazard ratio [HR] 2.5) and the presence of lobular carcinoma in situ in the lumpectomy specimen (HR 2.3) were the only 2 risk factors. Conclusions: We demonstrated a pattern in risk of IBTR over time, with 2 peaks, first at approximately 5 years and a second, much higher peak at approximately 12 years, especially for women ≤40 years old. For women ≤40 years old with tumor-free resection margins, we noted that the absence of adjuvant systemic therapy and the presence of LVSI were independent prognostic factors of IBTR. For women >40 years old, the presence of LVSI and the presence of lobular carcinoma in situ were independent risk factors.

  6. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

    International Nuclear Information System (INIS)

    DiBiase, Steven J.; Komarnicky, Lydia T.; Heron, Dwight E.; Schwartz, Gordon F.; Mansfield, Carl M.

    2002-01-01

    Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT. Methods and Materials: Between 1978 and 1994, 733 women with pathologic Stage I-II breast cancer and known surgical margin status were treated at Thomas Jefferson University Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor bed dose of 60 Gy and had documentation of their margin status; 509 had negative surgical margins, and 132 had positive surgical margins before definitive radiotherapy. Complete gross excision of the tumor and axillary lymph node sampling was obtained in all patients. The median radiation dose to the primary site was 65.0 Gy (range 60-76). Of the women with positive margins (n=132), the influence of higher doses of radiotherapy was evaluated. The median follow-up time was 52 months. Results: The local tumor control rate for patients with negative margins at 5 and 10 years was 94% and 88%, respectively, compared with 85% and 67%, respectively, for those women with positive margins (p=0.001). The disease-free survival rate for the negative margin group at 5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%, respectively, for the positive margin group (p = 0.001). The overall survival rate of women with negative margins at 5 and 10 years was 95% and 90%, respectively. By comparison, for women with positive surgical margins, the overall survival rate at 5 and 10 years was 86% and 79%, respectively (p=0.008). A comparison of the positive and negative margin groups revealed that an increased radiation dose (whether entered as a dichotomous or a continuous variable) >65.0 Gy did not improve local tumor control (p=0.776). On Cox

  7. Smoking and Breast Cancer Recurrence after Breast Conservation Therapy

    Directory of Open Access Journals (Sweden)

    Jennifer D. Bishop

    2014-01-01

    Full Text Available Background. Prior studies have shown earlier recurrence and decreased survival in patients with head and neck cancer who smoked while undergoing radiation therapy. The purpose of the current study was to determine whether smoking status at the time of partial mastectomy and radiation therapy for breast cancer affected recurrence or survival. Method. A single institution retrospective chart review was performed to correlate smoking status with patient demographics, tumor characteristics, and outcomes for patients undergoing partial mastectomy and radiation therapy. Results. There were 624 patients who underwent breast conservation surgery between 2002 and 2010 for whom smoking history and follow-up data were available. Smoking status was associated with race, patient age, and tumor stage, but not with grade, histology, or receptor status. African American women were more likely to be current smokers (22% versus 7%, P<0.001. With a mean follow-up of 45 months, recurrence was significantly higher in current smokers compared to former or never smokers (P=0.039. In a multivariate model adjusted for race and tumor stage, recurrence among current smokers was 6.7 times that of never smokers (CI 2.0–22.4. Conclusions. Although the numbers are small, this study suggests that smoking may negatively influence recurrence rates after partial mastectomy and radiation therapy. A larger study is needed to confirm these observations.

  8. Dosimetric Inhomogeneity Predicts for Long-Term Breast Pain After Breast-Conserving Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mak, Kimberley S. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen, Yu-Hui; Catalano, Paul J. [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S.; Truong, Linh [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@LROC.harvard.edu [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States)

    2015-12-01

    Purpose: The objective of this cross-sectional study was to characterize long-term breast pain in patients undergoing breast-conserving surgery and radiation (BCT) and to identify predictors of this pain. Methods and Materials: We identified 355 eligible patients with Tis-T2N0M0 breast cancer who underwent BCT in 2007 to 2011, without recurrent disease. A questionnaire derived from the Late Effects Normal Tissue Task Force (LENT) Subjective, Objective, Management, Analytic (SOMA) scale was mailed with 7 items detailing the severity, frequency, duration, and impact of ipsilateral breast pain over the previous 2 weeks. A logistic regression model identified predictors of long-term breast pain based on questionnaire responses and patient, disease, and treatment characteristics. Results: The questionnaire response rate was 80% (n=285). One hundred thirty-five patients (47%) reported pain in the treated breast, with 19 (14%) having pain constantly or at least daily; 15 (11%) had intense pain. The pain interfered with daily activities in 11 patients (8%). Six patients (4%) took analgesics for breast pain. Fourteen (10%) thought that the pain affected their quality of life. On univariable analysis, volume of breast tissue treated to ≥105% of the prescribed dose (odds ratio [OR] 1.001 per cc, 95% confidence interval [CI] 1.000-1.002; P=.045), volume treated to ≥110% (OR 1.009 per cc, 95% CI 1.002-1.016; P=.012), hormone therapy use (OR 1.95, 95% CI 1.12-3.39; P=.02), and other sites of pain (OR 1.79, 95% CI 1.05-3.07; P=.03) predicted for long-term breast pain. On multivariable analysis, volume ≥110% (OR 1.01 per cc, 95% CI 1.003-1.017; P=.007), shorter time since treatment (OR 0.98 per month, 95% CI 0.96-0.998; P=.03), and hormone therapy (OR 1.84, 95% CI 1.05-3.25; P=.03) were independent predictors of pain. Conclusion: Long-term breast pain was common after BCT. Although nearly half of patients had pain, most considered it tolerable. Dosimetric inhomogeneity

  9. Radiation dermatitis and pneumonitis following breast conserving therapy

    International Nuclear Information System (INIS)

    Yoden, Eisaku; Hiratsuka, Junichi; Imajo, Yoshinari

    2000-01-01

    We investigated the frequency, degree and risk factors of radiation-induced dermatitis and pneumonitis in 255 patients receiving breast conserving therapy between April 1987 and April 1998. The majority of the patients underwent a wide excision or quadrantectomy with a level I, II axillary dissection, followed by radiotherapy consisting of 50 Gy/25 Fr/5 weeks to the preserved breast with a 4 MV beam by tangentially opposed portals using the half-field technique. Eleven patients received an additional 10 Gy/5 Fr of electron therapy to the tumor bed. Most of the patients developed radiation dermatitis which was limited to reddening or dry desquamation, with the exception of 14 patients with a localized moist reaction. The skin reaction was transient in all patients and improved with conservative treatments. Radiation pneumonitis appeared on chest X-rays in 30 patients, with a slight appearance in 21 and patchy appearance in 9. Three patients presented with persistent symptoms requiring medication. They were treated with steroids, resulting in complete resolution of the symptoms. A large volume of the chest wall within the irradiation field and a large area of irradiated skin were the risk factors of radiation dermatitis. The volume of irradiated lung significantly correlated with the frequency and degree of radiation pneumonitis. It was preferable that the maximum thickness of the involved lung should not exceed 3 cm. Complicated disease, adjuvant therapy and boost irradiation had no impact on the radiation dermatitis or pneumonitis. (author)

  10. Quality of life in patients with recurrent breast cancer after second breast-conserving therapy in comparison with mastectomy: the German experience.

    Science.gov (United States)

    Jendrian, Svenja; Steffens, Katharina; Schmalfeldt, Barbara; Laakmann, Elena; Bergelt, Corinna; Witzel, Isabell

    2017-06-01

    Although some studies suggest that breast-conserving therapy (BCT) shows better psychosocial outcomes than mastectomy in patients with primary breast cancer, little is known about the outcomes of these surgical options in recurrent breast cancer. We investigated differences in overall survival and re-recurrence rates as well as psychosocial outcomes among patients who underwent BCT or mastectomy after the diagnosis of recurrent breast cancer in a single-center setting. 124 of 186 eligible patients who underwent surgical treatment for breast cancer recurrence completed the questionnaires on quality of life (EORTC QLQ-C30 and -BR23), fear of progression (PA-F-KF), anxiety and depression (HADS), and body image (BIS). Women after breast-conserving surgery (n = 46) showed significantly better outcomes than women after mastectomy (n = 61) with respect to body image (P quality of life were partnership (OR 2.46), higher monthly family income (OR 3.54), and higher professional qualification (OR 4.3) in our group of patients. Our results indicate that patients treated with breast-conserving therapy after recurrent breast cancer perceive lower impairments in body image and several aspects of quality of life than patients treated with mastectomy.

  11. Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q™.

    Science.gov (United States)

    Dahlbäck, Cecilia; Ullmark, Jenny Heiman; Rehn, Martin; Ringberg, Anita; Manjer, Jonas

    2017-08-01

    A gold standard for evaluation of aesthetic outcome after breast-conserving therapy (BCT) is still lacking. The BCCT.core software has been developed to assess aesthetic result in a standardised way. We aimed to study how the result of BCCT.core after BCT is associated with quality of life, measured with the BREAST-Q™, a validated questionnaire. Women eligible for BCT were consecutively recruited between February 1st 2008 and January 31st 2012 (n = 653). Photographs of 310 women, taken one year after BCT, were evaluated using the BCCT.core software. The postoperative BCT module of the BREAST-Q™ questionnaire was administered by mail and 348 questionnaires were returned (median 5.5 years after BCT). In all, 216 women had both BCCT.core results and completed BREAST-Q™ questionnaires available. The results from the BCCT.core evaluation were: excellent n = 49 (15.8%); good n = 178 (57.4%); fair n = 73 (23.5%); poor n = 10 (3.2%). The median BREAST-Q™ score for satisfaction with breasts was 66 [interquartile range (IQR) 57-80] and for psychosocial well-being 82 (IQR 61-100). Poor/fair results on BCCT.core were associated with Q-scores below median for both satisfaction with breasts [odds ratio (OR) 3.4 (confidence interval (CI) 1.7-6.8)] as well as for psychosocial well-being [OR 2.2 (CI 1.1-4.2)]. A statistically significant association between BCCT.core results one year after BCT and quality of life ratings using BREAST-Q™ several years later is shown in this study. This implies that the BCCT.core may be valuable in BCT follow-up and used as a standardised instrument in the evaluation of aesthetic results.

  12. Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review.

    Science.gov (United States)

    Gu, Jeffrey; Groot, Gary; Boden, Catherine; Busch, Angela; Holtslander, Lorraine; Lim, Hyun

    2018-01-03

    We have performed a narrative synthesis. A literature search was conducted between January 2000 and June 2014 in 7 databases. The initial search identified 2717 articles; 319 underwent abstract screening, 67 underwent full-text screening, and 25 final articles were included. This review looked at early stage breast cancer in women only, excluding ductal carcinoma in situ and advanced breast cancer. A conceptual framework was created to organize the central constructs underlying women's choices: clinicopathologic factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and personal beliefs and preferences. This framework guided our review's synthesis and analysis. We found that larger tumor size and increasing stage was associated with increased rates of mastectomy. The results for age varied, but suggested that old and young extremes of diagnostic age were associated with an increased likelihood of mastectomy. Higher socioeconomic status was associated with higher breast conservation therapy (BCT) rates. Resident rural location and increasing distance from radiation treatment facilities were associated with lower rates of BCT. Individual belief factors influencing women's choice of mastectomy (mastectomy being reassuring, avoiding radiation, an expedient treatment) differed from factors influencing choice of BCT (body image and femininity, physician recommendation, survival equivalence, less surgery). Surgeon factors, including female gender, higher case numbers, and individual surgeon practice, were associated with increased BCT rates. The decision-making process for women with early stage breast cancer is complicated and affected by multiple factors. Organizing these factors into central constructs of clinicopathologic, individual, and physician factors may aid health-care professionals to better understand this process. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Breast conservation therapy for breast cancer. Radiation oncologist's point of view

    International Nuclear Information System (INIS)

    Hiraoka, Masahiro; Mitsumori, Michihide; Kokubo, Masaki; Fujishiro, Satsuki

    1998-01-01

    The roles and problems of radiation therapy in breast conserving therapy for breast cancer were presented. The roles of radiation therapy include decrease in breast recurrence, an alternative to axillary dissection for N0 cases, and neo-adjuvant radiation therapy. On the other hand, problems associated with radiation therapy are question of using radiation therapy for all cases, complications and worsening of cosmetics, and relatively high breast recurrence rates for margin-positive cases. The concept of breast conserving therapy is to improve QOL without decreasing treatment outcomes. It is considered that we should be more concentrated on the aspects of QOL because treatment outcomes of breast conserving therapy in Japan demonstrated sofar appear excellent. (author)

  14. Breast-conserving therapy in breast cancer patients - a 12-year ...

    African Journals Online (AJOL)

    conserving therapy (BCT). However, local recurrence of cancer ... Adjuvant therapy (hormones, chemotherapy) was undertaken, and the incidence and times of local recurrence and distant metastases were recorded. Results: Ninety-four per cent of ...

  15. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    International Nuclear Information System (INIS)

    Sedlmayer, F.

    2013-01-01

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast

  16. Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pengel, Kenneth E., E-mail: k.pengel@nki.nl [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Loo, Claudette E. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Wesseling, Jelle [Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Pijnappel, Ruud M. [Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Rutgers, Emiel J.Th. [Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    2014-02-15

    Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.

  17. Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

    International Nuclear Information System (INIS)

    Pengel, Kenneth E.; Loo, Claudette E.; Wesseling, Jelle; Pijnappel, Ruud M.; Rutgers, Emiel J.Th.; Gilhuijs, Kenneth G.A.

    2014-01-01

    Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted

  18. Influence of race on outcome in patients treated with breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, T; Heimann, R; Powers, C; Vijayakumar, S; Ewing, C; Halpern, H; Michel, A; Rubin, S; Weichselbaum, R

    1995-07-01

    PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown (<1%). One hundred eighty six (21%) patients were pathologically node positive. There were 354 AA (40%) and 538 white (60%) patients. The chi-square test was used to compare distribution of prognostic factors between races. Outcome was evaluated by Kaplan-Meier actuarial method and logrank test. Sub-groups analyzed for outcome differences by race included T stage, tumor size, nodal status, grade, receptor status, age, menopausal status and family history. Multivariate analysis was performed by Cox proportional hazard model. RESULTS: No significant differences between AA and whites were seen in age, menopausal status, family history, T stage, N stage, number of nodes involved, histologic grade, total RT dose or chemotherapy. However, a larger percentage of whites received tamoxifen (43 vs 27%)(p<0.001), had low nuclear grade (19 vs 9

  19. Influence of race on outcome in patients treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Campbell, T.; Heimann, R.; Powers, C.; Vijayakumar, S.; Ewing, C.; Halpern, H.; Michel, A.; Rubin, S.; Weichselbaum, R.

    1995-01-01

    PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown ( 4cm (5 vs 1%)(p=0.001) or were unknown size (10 vs 6%)(p=.001). Comparing AA and whites yielded 5 yr actuarial LC (94 vs 94%)(p=0.380), DFS (83 vs 85%)(p=0.120), CSS (84 vs 85%)(p=0.201) and OS (77 vs 80%)(p=0.112). Multivariate analysis demonstrated that the number of positive nodes was the strongest predictor of OS (p<.001) and although race did not reach statistical significance as an independent prognostic factor, a trend was demonstrated (p=.106). Sub-group analysis of 186 patients with ER/PR negative tumors showed significantly worse DFS (75 vs 93%)(p=0.005), CSS (79 vs 91%)(p=0.021) and OS (76 vs 89%)(p=0.011) for AA patients. Race was demonstrated to be an independent prognostic factor by multivariate analysis in this sub-group (p=.024). No significant differences by race were apparent in patients grouped by tumor size

  20. The impact of young age on locoregional recurrence after doxorubicin-based breast conservation therapy in patients 40 years old or younger: How young is 'young'?

    International Nuclear Information System (INIS)

    Oh, Julia L.; Bonnen, Mark; Outlaw, Elesyia D.; Schechter, Naomi R.; Perkins, George H.; Strom, Eric A.; Babiera, Gildy; Oswald, Mary Jane; Allen, Pamela K.; Thames, Howard D.; Buchholz, Thomas A.

    2006-01-01

    Purpose: The aim of this study was to investigate whether patients <35 years old have similar risk of locoregional recurrence after breast conservation therapy compared with patients 35 to 40 years old. Methods and materials: We retrospectively reviewed records of 196 consecutive patients ≤40 years old who received breast conservation therapy (BCT) from 1987 to 2000 for breast cancer and compared outcomes between patients <35 years old with patients 35 to 40 years old. The majority of patients received neoadjuvant chemotherapy as part of their treatment. Multivariate analysis was performed to assess risk factors for locoregional recurrence. Results: After a median follow-up of 64 months, 22 locoregional recurrences (LRR) were observed. Twenty patients developed locoregional recurrence as their first site of relapse. Two patients had bone-only metastases before their locoregional recurrence. On multivariate analysis, age <35 years was associated with a statistically significant increased risk of locoregional recurrence. The 5-year rate of locoregional control was 87.9% in patients <35 years old compared with 91.7% in patients 35 to 40 years old (p = 0.042). Conclusions: Our finding supports an increased risk of locoregional recurrence as a function of younger age after breast conservation therapy, even among young patients 40 years old and younger

  1. Monomorphic Epithelial Proliferations of the Breast: A Possible Precursor Lesion Associated With Ipsilateral Breast Failure After Breast Conserving Therapy in Patients With Negative Lumpectomy Margins

    International Nuclear Information System (INIS)

    Goldstein, Neal S.; Kestin, Larry L.; Vicini, Frank A.

    2011-01-01

    Background: It is generally believed that ipsilateral breast failures (IBFs) after breast-conserving therapy (BCT) develop from incompletely eradicated carcinoma. We previously suggested that monomorphic epithelial proliferations (MEPs) in the breast may be a pool of partially transformed clones from which breast carcinomas can arise and that radiation therapy (RT) may also reduce the risk of IBF by eradicating MEPs. We examined salvage mastectomy specimens in patients experiencing an IBF to define the relationship between MEPs and IBFs and an additional potential mechanism for IBF risk reduction by RT. Methods and Materials: The location, number, and distribution of radiation changes and MEPs relative to 51 IBFs were mapped in salvage mastectomy specimens from BCT patients with adequately excised, initial carcinomas (negative lumpectomy margins). Results: All 51 salvage mastectomies had diffuse, late radiation changes. None had active fibrocystic lesions. MEPs were predominantly located in the immediate vicinity of the IBFs. A mean of 39% of MEP cases were located within the IBF, 46% were located within 2 cm of the IBF, and 14% were 2-3 cm from the IBF. Conclusions: MEPs appear to be a pool of partially transformed precursor lesions that can give rise to ductal carcinoma in situ and invasive carcinomas (CAs). Many IBFs may arise from MEPs that reemerge after RT. Radiation may also reduce IBF risk after BCT (including in patients with negative margins) by primarily eradicating MEPs.

  2. Bilateral breast carcinoma: results with breast conservation therapy and a comparison with bilateral mastectomy

    International Nuclear Information System (INIS)

    Kim, David H.; Haffty, Bruce G.

    1996-01-01

    Purpose: To assess outcome of patients with bilateral breast carcinoma treated with bilateral breast conserving surgery with radiation therapy (CS+RT) and to compare their outcome to (1) patients with unilateral disease treated with CS+RT and (2) patients of comparable stage treated with bilateral mastectomy. Methods and Materials: The charts of all patients with the diagnosis of breast cancer treated with CS+RT at our facilities prior to 1993 were reviewed to identify patients with bilateral disease. A total of 50 patients identified as having bilateral breast cancer conservatively treated(BCT) served as the index population. Out of the 50 patients, 23 presented with synchronous bilateral breast cancer and 27 presented with metachronous bilateral breast cancer. A group of 984 patients with unilateral breast cancer (UCT) treated with CS+RT during the same time interval served as the first control group. A second control group was comprised of 42 patients with early stage bilateral breast cancer presenting during the same time interval treated with bilateral mastectomy (BMAST). Patients who had locally advanced disease in either breast or those patients treated exclusively for lobular carcinoma in situ in either breast were excluded from the analysis. Of the 42 BMAST patients, 33 presented with synchronous disease and nine presented with metachronous disease. Local-regional relapse rates were calculated from the date of treatment of each breast. Overall survival and distant relapse rates were calculated from the date of treatment of the second breast cancer diagnosed. Survival curves were calculated via the life table method and statistical comparisons between curves were performed using the log rank statistic. Chi square analysis was used to detect differences between categorical variables. Results: As of December 1995, the median follow-up of the bilateral conservatively treated patient population was 9.4 years. No statistically significant differences were noted

  3. The role of magnetic resonance imaging (MRI) and MRI-guided surgery in the evaluation of patients with early stage breast cancer for breast conserving therapy

    International Nuclear Information System (INIS)

    Tan, Jacqueline E.; Orel, Susan G.; Schnall, Mitchell D.; Solin, Lawrence J.

    1997-01-01

    Purpose: Mammography is the primary imaging modality for the detection of breast cancer and the evaluation of patients with early stage breast cancer for breast conserving therapy (BCT). MRI may be more sensitive than mammography for detecting breast cancer and may have an adjunctive role in assessing patients with early stage disease for BCT. Our experience with 83 patients undergoing breast MRI during consideration for breast conserving therapy is analyzed. Materials and Methods: We reviewed 83 consecutive cases of patients undergoing breast MRI during standard work-up and evaluation for BCT from 1993 to 1996. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, or II and who received definitive therapy at our institution. All patients signed informed consent. MRI of the breast was performed at 1.5 Tesla. Sagittal T1 and T2 and 3-D gradient pre- and post-contrast images were obtained. All MRI studies were reviewed by two radiologists. All patients were evaluated by one radiation oncologist. The records of these 83 patients were reviewed for patient age, tumor size, AJCC stage, histology, physical examination findings, mammographic findings, ultrasound findings, MRI findings, timing of first MRI study with respect to excisional surgery, findings from MRI-guided surgery (when done), and whether the patient underwent BCT. Results: The median age at the time of presentation was 51.5 years (range 26-77 years). Of the 83 patients, 16% were AJCC clinical stage 0, 65% were stage I, and 19% were stage II. No patient presented with synchronous bilateral carcinoma. Two patients had a history of prior contralateral breast carcinoma; both received BCT for their initial disease. Sixteen percent of patients had intraductal carcinoma, 39% had intraductal and infiltrating carcinoma, 28% had infiltrating ductal carcinoma, 7% had infiltrating lobular carcinoma, 4% had tubular carcinoma, 2% had adenoid cystic carcinoma, 2% had medullary carcinoma, 1% had colloid

  4. Long-Term Outcome in Patients With Ductal Carcinoma In Situ Treated With Breast-Conserving Therapy: Implications for Optimal Follow-up Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shaitelman, Simona F. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wilkinson, J. Ben [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Kestin, Larry L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ye Hong [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Goldstein, Neal S. [Advanced Diagnostics Laboratory, Redford, Michigan (United States); Martinez, Alvaro A. [Michigan HealthCare Professionals, Pontiac, Michigan (United States); Vicini, Frank A., E-mail: fvicini@pol.net [Michigan HealthCare Professionals, Pontiac, Michigan (United States)

    2012-07-01

    Purpose: To determine 20-year rates of local control and outcome-associated factors for ductal carcinoma in situ (DCIS) after breast-conserving therapy (BCT). Methods and Materials: All DCIS cases receiving BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival. Results: One hundred forty-five cases were evaluated; the median follow-up time was 19.3 years. IBTR developed in 25 patients, for 5-, 10-, 15-, and 20-year actuarial rates of 9.9%, 12.2%, 13.7%, and 17.5%, respectively. One third of IBTRs were elsewhere failures, and 68% of IBTRs occurred <10 years after diagnosis. Young age and cancerization of lobules predicted for IBTR at <10 years, and increased slide involvement and atypical ductal hyperplasia were associated with IBTR at later time points. Conclusions: Patients with DCIS treated with BCT have excellent long-term rates of local control. Predictors of IBTR vary over time, and the risk of recurrence seems highest within 10 to 12 years after diagnosis.

  5. Long-Term Outcome in Patients With Ductal Carcinoma In Situ Treated With Breast-Conserving Therapy: Implications for Optimal Follow-up Strategies

    International Nuclear Information System (INIS)

    Shaitelman, Simona F.; Wilkinson, J. Ben; Kestin, Larry L.; Ye Hong; Goldstein, Neal S.; Martinez, Alvaro A.; Vicini, Frank A.

    2012-01-01

    Purpose: To determine 20-year rates of local control and outcome-associated factors for ductal carcinoma in situ (DCIS) after breast-conserving therapy (BCT). Methods and Materials: All DCIS cases receiving BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival. Results: One hundred forty-five cases were evaluated; the median follow-up time was 19.3 years. IBTR developed in 25 patients, for 5-, 10-, 15-, and 20-year actuarial rates of 9.9%, 12.2%, 13.7%, and 17.5%, respectively. One third of IBTRs were elsewhere failures, and 68% of IBTRs occurred <10 years after diagnosis. Young age and cancerization of lobules predicted for IBTR at <10 years, and increased slide involvement and atypical ductal hyperplasia were associated with IBTR at later time points. Conclusions: Patients with DCIS treated with BCT have excellent long-term rates of local control. Predictors of IBTR vary over time, and the risk of recurrence seems highest within 10 to 12 years after diagnosis.

  6. Supraclavicular failure after breast-conserving therapy in patients with four or more positive axillary lymph nodes when prophylactic supraclavicular irradiation is omitted

    International Nuclear Information System (INIS)

    Hamamoto, Yasushi; Kataoka, Masaaki; Semba, Takatoshi

    2009-01-01

    The incidence of supraclavicular metastasis as the initial failure and the failure patterns in patients with four or more positive axillary lymph nodes (PALNs) after breast-conserving therapy (BCT) without prophylactic supraclavicular irradiation were investigated. Between 1991 and 2002, a total of 48 women with four or more PALNs underwent BCT without prophylactic supraclavicular irradiation (33 patients with 4-9 PALNs; 15 patients with ≥10 PALNs). The median follow-up time was 50 months. Among the patients with 4-9 PALNs, 3% had isolated supraclavicular metastasis as the initial failure, and 30% had distant metastasis as the initial failure. Among patients with ≥10 PALNs, 7% had isolated supraclavicular metastasis as the initial failure, and 40% had distant metastasis as the initial failure. The 4-year isolated supraclavicular failure rates were 5% for all patients, 3% for patients with 4-9 PALNs, and 8% for patients with ≥10 PALNs. In patients who had undergone BCT and had had four or more PALNs, the major failure pattern was distant failure with or without locoregional failure; isolated supraclavicular failure as the initial failure comprised a less common failure pattern. Omission of prophylactic supraclavicular irradiation may be acceptable for this subset of patients. (author)

  7. Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis

    NARCIS (Netherlands)

    Powers, M.B.; Vedel, E.; Emmelkamp, P.M.G.

    2008-01-01

    Narrative reviews conclude that behavioral couples therapy (BCT) produces better outcomes than individual-based treatment for alcoholism and drug abuse problems (e.g., [Epstein, E. E., & McCrady, B. S. (1998). Behavioral couples treatment of alcohol and drug use disorders: Current status and

  8. Patient-Reported Outcomes following Breast Conservation Therapy and Barriers to Referral for Partial Breast Reconstruction.

    Science.gov (United States)

    Vrouwe, Sebastian Q; Somogyi, Ron B; Snell, Laura; McMillan, Catherine; Vesprini, Danny; Lipa, Joan E

    2018-01-01

    The purpose of this study was to evaluate the self-reported aesthetic outcome of breast conservation therapy in a generalized sample of patients, and to describe potential barriers to referral for partial breast reconstruction. Consecutive breast conservation therapy patients completing radiotherapy over a 1-year period at a regional cancer center were identified. Eligible patients were contacted by means of mail/e-mail and invited to participate. Participants completed the BREAST-Q breast conservation therapy module along with a questionnaire examining feelings about breast reconstruction. Multiple regression analysis was performed using the satisfaction with breasts scale as the dependent variable. Surveys were completed by 185 of 592 eligible participants (response rate, 31.3 percent; mean age, 61 years) an average of 38 months after lumpectomy. The mean score for the BREAST-Q satisfaction with breasts scale was 59 of 100. Younger age (p = 0.038), lumpectomy reexcision (p = 0.018), and lumpectomy at a nonacademic center (p = 0.026) were significantly associated with lower satisfaction. Bra size, months from lumpectomy, and tumor quadrant/size were not significantly associated with satisfaction (p > 0.05). The most common statements regarding reconstruction were "I don't feel the need for it" (60.0 percent), "I don't like the thought of having breast implants" (22.7 percent), and "I don't want any more surgeon/doctor visits" (22.2 percent). Before lumpectomy, only 1.6 percent had a consultation for reconstruction, and only 22.7 percent were aware of this option. If offered, 33.1 percent of patients would have attended this consultation. There is an unmet demand for partial breast reconstruction, with an opportunity to advocate and increase awareness on behalf of patients undergoing breast conservation therapy.

  9. Thermography in the follow-up of breast cancer patients after breast-conserving treatment by tumorectomy and radiation therapy

    International Nuclear Information System (INIS)

    Ulmer, H.U.; Brinkmann, M.; Frischbier, H.J.

    1990-01-01

    It is often suggested in the literature that thermography is able to diagnose a recurrence in the breast after breast-conserving therapy by a rise in breast temperature much earlier than other diagnostic tools, but no thermographic values are presented. The thermographic data of a prospective study of 309 women after breast-conserving therapy were evaluated. Seventeen of these women had an intramammary recurrence. A total of 2432 individual measured values were evaluated from 292 patients without evidence of a recurrence and 146 measured values from 17 patients with intramammary recurrence. The thermographic behavior of the breast after breast-conserving therapy is not uniform. However, the breast temperatures of the patients with intramammary recurrences were not significantly different from those without recurrences. This means that thermography is of no value in the care after breast-conserving therapy

  10. BREAST CONSERVING THERAPY IN STAGE T1 & T2 BREAST CANCER PATIENTS

    Institute of Scientific and Technical Information of China (English)

    FAN Jiang; LIU Bang-ling; SHEN Zhen-zhou; SHAO Zhi-ming; WU Jiong; LU Jin-song; WANG Lei; HOU Yi-feng; WANG Jie; DI Gen-hong; SHEN Kun-wei; HAN Qi-xia

    2005-01-01

    Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.

  11. Efficacy of breast conservation therapy in early stage bilateral breast cancer

    International Nuclear Information System (INIS)

    Lee, Misa M.; Chen, Luci M.; Heimann, Ruth; Powers, Claire; Weichselbaum, Ralph R.

    1996-01-01

    PURPOSE: To evaluate outcome of patients with bilateral breast cancer as compared to unilateral breast cancer treated with breast conservation therapy. This is a complex issue, however, we address this by comparing (1) synchronous bilateral breast cancer patients, (2) metachronous bilateral breast cancer patients from the time of diagnosis of the second breast primary, and (3) unilateral breast cancer patients. The authors recognize that there are inherent biases in these comparisons. MATERIALS AND METHODS: A total of 60 bilateral patients and 1080 unilateral patients treated with breast conservation therapy from 1977-1994 were analyzed for outcome. Of the 60 bilateral patients, 44 were metachronous bilateral breast cancer patients (MBBC) and 16 were synchronous breast cancer patients (SBBC). Patients with bilateral breast cancer had local-regional disease with the following tumor stages: DCIS=8%, T1=80%, T2=12%, pathologic N0=90%, pathologic N+=10%. Unilateral patients had the following tumor stages: DCIS=10%, T1=66%, T2=20%, T3=1.2%, Tx=2%, pathological N0=80%, pathological N+=19%, and NX=1%. The majority of patients received lumpectomy and axillary node dissection followed by radiation therapy. The median size of the lesions were 1.4cm and 1.5cm for bilateral and unilateral patients, respectively. Median total dose to the primary tumor was 60Gy for both unilateral and bilateral patients. Of the 44 metachronous bilateral breast cancer patients, 14 patients received breast conservation for both the first and second lesions while 30 patients had breast conservation for only the second metachronous breast lesion. Thus 58 lesions in the 44 patients were treated with breast conservation therapy in the patients with metachronous bilateral breast cancer. Of the synchronous bilateral breast cancer patients, 13 out of 16 patients had breast conserving therapy for both breasts, and 3 patients received mastectomy for the second synchronous breast tumor. The median follow

  12. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    1999-01-01

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  13. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] [and others

    1999-03-01

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  14. Deformities of contour after breast conserving therapy and the possibilities of correction

    International Nuclear Information System (INIS)

    Deutinger, M.; Tairych, G.

    1999-01-01

    Background: Breast conserving treatment is increasing for primary treatment of breast carcinoma because of the importance of the cosmetic outcome. Patients and method: We examined 195 patients after breast conserving therapy which was performed between 1983 and 1992. For evaluation of the cosmetic result symmetry, contour of the breast and location of the areola were examined. Radiation effect on breast tissue was evaluated by the Lent score. 72% of the patients had been treated with quadrantectomy and 28% with lumpectomy. Results: Deformities of the contour were visible in 59% of the patients depending on the primary location of the tumor. Lumpectomy from medial quadrants caused poor results. Dislocation of the areola of more than 2 cm was detected in 32% of the patients. The dislocation depended on the primary kind of incision and resulted in 89% of the patients after a radial incision and only in 11% after curvilinear incisions. Telangiectasies were absent in 84% of the patients, the others showed telangiectasies Grade 1 to 3. In 48% of the patients no signs of fibrosis could be detected, in 49% fibrosis Grade 1 to 2 was found. 68% of the patients estimated the cosmetic result as very good or good. Only 10% of the patients estimated the result as fair or bad. The examiner estimated the results as good or very good in 28%. Examples of operative procedures for primary and secondary correction are demonstrated. Conclusions: Our results showed an adverse effect of long radial incisions. For lumpectomy and axillary node dissection separate incisions should be used. Correction of contour deformities should be done primarily in breast conserving procedures. This is possible by using modified reduction mammaplasties, local flaps of the breast tissue or switching a latissimus dorsi muscle flap. For secondary correction of defects after breast conserving treatment a latissimus dorsi muscle can be used as well as z-plasty for scar contracture. (orig.) [de

  15. Profile of prognostic factors in 1022 Indian women with early-stage breast cancer treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Dinshaw, Ketayun A.; Budrukkar, Ashwini N.; Chinoy, Roshan F.; Sarin, Rajiv; Badwe, Rajendra M.S.; Hawaldar, Rohini; Shrivastava, Shyam Kishore

    2005-01-01

    Purpose: The outcome of breast cancer treatment can vary in different geographic and ethnic groups. A multivariate analysis was performed for various prognostic factors in 1022 Indian women with pathologic Stage I-II breast cancer treated between 1980 and 2000 with standard breast-conserving therapy with or without systemic adjuvant therapy. Methods and Materials: At a mean follow-up of 53 months, the outcomes studied were local failure, locoregional failure, and distant failure, overall survival (OS), and disease-free survival (DFS). Results: The median pathologic tumor size was 3 cm (range, 1-5 cm), and axillary lymph node metastasis was present in 39% of women. The actuarial 5- and 10-year OS and DFS rate was 87% and 77% and 76% and 68%, respectively. Lymphovascular emboli or invasion (LVI) was the strongest independent adverse factor for all failure and survival (local failure, hazard ratio 2.85; 95% confidence interval, 1.68-4.83; OS; hazard ratio, 2.01, 95% confidence interval, 1.35-2.99). Lymph node metastasis was also an independent adverse factor for local failure, locoregional failure, distant failure, DFS, and OS (hazard ratio, 1.55, 95% confidence interval, 1.04-2.30). Age ≤40 years increased the incidence of local recurrence, and patients with inner quadrant tumors had inferior DFS. The incidence of LVI was significantly greater in women with lymph node metastases than in node-negative women (p < 0.001) and in women with Grade 3 tumors than in those with Grade 1 or 2 tumors (p = 0.001). Conclusion: In Indian women, LVI was the strongest independent prognostic factor for OS, DFS, and local recurrence, irrespective of nodal status and systemic adjuvant treatment. Although LVI may not be a contraindication for BCT, as has been proposed by certain groups, it is necessary to define its role in prospective studies in determining local and systemic treatment

  16. Optimization of Adjuvant Radiation in Breast Conservation Therapy: Can We Minimize without Compromise?

    International Nuclear Information System (INIS)

    Edwards-Bennett, S.M.; Correa, C.R.; Harris, E.E.

    2011-01-01

    Adjuvant breast radiation therapy after breast conservation surgery is recommended as it yields significant reduction in the risk of local recurrence, and confers a potential overall survival benefit. Although the standard breast radiation regimen has historically been delivered over 57 weeks; more novel, shorter courses of breast radiation are currently being employed, offering the advantage of more convenience and less time-commitment. Herein, we review the recent literature substantiating these abbreviated radiation treatment approaches and the methods of delivery thereof. In addition, we discuss imaged guided techniques currently being utilized to further refine the delivery of adjuvant breast radiation therapy

  17. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score

    International Nuclear Information System (INIS)

    Huang, Eugene H.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Sahin, Aysegul A.; Hortobagyi, Gabriel N.; Buchholz, Thomas A.

    2006-01-01

    Purpose: We previously developed a prognostic index that stratified patients treated with breast conservation therapy (BCT) after neoadjuvant chemotherapy into groups with different risks for local-regional recurrence (LRR). The purpose of this study was to compare the rates of LRR as a function of prognostic index score for patients treated with BCT or mastectomy plus radiation after neoadjuvant chemotherapy. Methods and Materials: We retrospectively analyzed 815 patients treated with neoadjuvant chemotherapy, surgery, and radiation. Patients were assigned an index score from 0 to 4 and given 1 point for the presence of each factor: clinical N2 to N3 disease, lymphovascular invasion, pathologic size >2 cm, and multifocal residual disease. Results: The 10-year LRR rates were very low and similar between the mastectomy and BCT groups for patients with an index score of 0 or 1. For patients with a score of 2, LRR trended lower for those treated with mastectomy vs. BCT (12% vs. 28%, p = 0.28). For patients with a score of 3 to 4, LRR was significantly lower for those treated with mastectomy vs. BCT (19% vs. 61%, p = 0.009). Conclusions: This analysis suggests that BCT can provide excellent local-regional treatment for the vast majority of patients after neoadjuvant chemotherapy. For the few patients with a score of 3 to 4, LRR was >60% after BCT and was <20% with mastectomy. If these findings are confirmed in larger randomized studies, the prognostic index may be useful in helping to select the type of surgical treatment for patients treated with neoadjuvant chemotherapy, surgery, and radiation

  18. Evaluation of Resection Margins in Breast Conservation Therapy: The Pathology Perspective—Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Rajyasree Emmadi

    2012-01-01

    Full Text Available Tumor surgical resection margin status is important for any malignant lesion. When this occurs in conjunction with efforts to preserve or conserve the afflicted organ, these margins become extremely important. With the demonstration of no difference in overall survival between mastectomy versus lumpectomy and radiation for breast carcinoma, there is a definite trend toward smaller resections combined with radiation, constituting “breast-conserving therapy.” Tumor-free margins are therefore key to the success of this treatment protocol. We discuss the various aspects of margin status in this setting, from a pathology perspective, incorporating the past and current practices with a brief glimpse of emerging future techniques.

  19. Mammographic, pathologic, and treatment-related factors associated with local recurrence in patients with early-stage breast cancer treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Kini, Vijay R.; Vicini, Frank A.; Frazier, Robert; Victor, Sandra J.; Wimbish, Kathryn; Martinez, Alvaro A.

    1999-01-01

    Background: We retrospectively reviewed our institution's experience treating early-stage breast cancer patients with breast conserving therapy (BCT) to determine clinical, pathologic, mammographic, and treatment-related factors associated with outcome. Methods: Between January 1980 and December 1987, 400 cases of Stage I and II breast cancer were managed with BCT at William Beaumont Hospital, Royal Oak, Michigan. All patients underwent at least an excisional biopsy. Radiation treatment consisted of delivering 45-50 Gy to the whole breast, followed by a boost to the tumor bed to at least 60 Gy in all patients. The median follow-up in the 292 surviving patients is 118 months. Multiple clinical, pathologic, mammographic, and treatment-related factors were analyzed for an association with local recurrence and survival. Results: A total of 37 local recurrences developed in the treated breast, for a 5- and 10-year actuarial rate of 4% and 10%, respectively. On univariate analysis, patient age ≤ 35 years (25% vs. 7%, p = 0.004), and positive surgical margins (17% vs. 6%, p = 0.018) were associated with an increased risk of local recurrence at 10 years. On multivariate analysis, only age ≤ 35 years remained significant. A subset analysis of 214 patients with evaluable mammographic findings was performed. On univariate analysis, age ≤ 35 years (38% vs. 8%, p = 0.0029) and the presence of calcifications on preoperative mammography (22% vs. 6%, p = 0.0016) were associated with an increased risk of local recurrence. On multivariate analysis, both of these factors remained significant. The presence of calcifications on preoperative mammography did not affect the rates of overall survival, disease-free survival, and cause-specific survival. Conclusion: In patients with early-stage breast cancer treated with BCT, age ≤ 35 years and calcifications on preoperative mammography appear to be associated with an increased risk of local recurrence

  20. Does adjuvant systemic therapy contribute to decrease of breast recurrence after breast-conserving surgery?

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Matsuda, Masakazu; Okazaki, Shinji; Kai, K.; Hiyoshi, Y.

    2005-01-01

    Preventing breast recurrence after breast-conserving surgery is an important issue. The main factors contributing to breast recurrences are positive margins and absence of radiotherapy. In late years a standard adjuvant treatment is widely used in Japan. We examined whether these standard treatments contributed to reduction of a breast recurrence. By March 2003, 845 patients were treated by breast-conserving surgery, and the cases were divided into two groups by operation period; 426 cases until 1998 (the first half group) and 202 patients with follow-up periods more than 2 years (the latter group). There were much positive margins and patients with radiotherapy in a latter group in background factor. An endocrine therapy for estrogen receptor (ER) positive was performed in 68.1% in first half period, and in contrast 94.2% in the latter period, and chemotherapy was performed in 87% (mainly Epirubicin) for ER negative in the latter period, and 77% (mainly oral agent) in the first half period. There was a significant difference of breast recurrence-free survival between 2 groups; an early recurrence was seen in 19 cases (4.5%) in the first half period and 2 cases (1.0%) in the latter group. In particular the difference was significant in patients with absence of radiotherapy or negative ER. Multivariate analysis revealed that the operation time was a significant factor for breast recurrence. In conclusion, an apparent reduction of breast recurrence may be brought by a standard adjuvant therapy. (authors)

  1. Analysis of radiation pneumonitis outside the radiation field in breast conserving therapy for early breast cancer

    International Nuclear Information System (INIS)

    Ogo, Etsuyo; Fujimoto, Kiminori; Hayabuchi, Naofumi

    2002-01-01

    In a retrospective study of radiation-induced pulmonary changes for patients with breast conserving therapy for early breast cancer, we sent questionnaires to the main hospitals in Japan. In this study, we analyzed pulmonary changes after tangential whole-breast irradiation. The purpose of this study was to determine the incidence and risk factors for radiation pneumonitis outside the radiation field. The questionnaires included patients data, therapy data, and lung injury information between August 1999 and May 2000. On the first questionnaires, answer letters were received from 107 institutions out of 158 (67.7%). On the second questionnaires, response rate (hospitals which had radiation pneumonitis outside the radiation field) was 21.7% (23/106). We could find no risk factors of this type of pneumonitis. We suggested that lung irradiation might trigger this type of pneumonitis which is clinically similar to BOOP (bronchiolitis obliterans organizing pneumonia). It developed in 1.5-2.1% among the patients with breast conserving surgery and tangential whole-breast irradiation. And it is likely appeared within 6 months after radiotherapy. (author)

  2. Role of specimen US for predicting resection margin status in breast conserving therapy.

    Science.gov (United States)

    Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

    2015-01-01

    To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

  3. Breast-conserving therapy as a model for creating new knowledge in clinical oncology

    International Nuclear Information System (INIS)

    Harris, Jay R.

    1995-01-01

    New knowledge can be derived from various kinds of studies. Studies of innovative approaches are the basis for progress. Some advances in treatment are so obvious that they do not need formal testing; e.g., penicillin for pneumococcal infection. For comparing interventions with small differences in efficacy or in groups without predictable outcome, prospective randomized trials are the 'gold standard'. However, randomized trials are cumbersome, expensive, and potentially difficult for both patients and physicians. Retrospective studies are less valid scientifically because they are more likely to suffer from bias, misclassification, confounding variables, and the use of multiple comparisons. Retrospective studies can be made more valid by first specifying the study design and analysis, but are generally most useful to generate hypotheses to be tested more formally. Retrospective studies can be particularly useful in improving outcome by identifying 'problems' and their causes. An important issue for radiation oncologists in doing retrospective studies is the difficulty of assessing an effect on local tumor control in diseases in which there are competing risks of local and distant failure. Many of these points will be illustrated in studies from the Joint Center for Radiation Therapy. Studies of innovative approaches, retrospective reviews and prospective randomized clinical trials have all been useful in establishing breast-conserving therapy as a safe and effective treatment for patients with early-stage breast cancer. Several studies of innovative breast-conserving therapy beginning in the 1960's showed favorable results. Based on this experience, a series of randomized clinical trials were initiated, beginning in the early 1970's, formally comparing mastectomy and breast-conserving therapy. These trials firmly established that the two forms of local treatment provide equivalent survival. Additional retrospective studies have also been useful in establishing

  4. Late sequelae and cosmetic outcome after radiotherapy in breast conserving therapy

    International Nuclear Information System (INIS)

    Dore, M.; Hennequin, C.

    2012-01-01

    Radiotherapy after breast-conserving therapy for early breast cancer is reported to adversely affect the cosmetic outcome. The incidence of radiation-induced fibro-atrophy is around 10% at 5 years. A better knowledge of its pathophysiology has revealed the essential role of activated fibroblasts and reactive oxygen species, mediated by TGF beta 1, allowing the development of antioxidant in the management of the established radiation-induced fibro-atrophy. Cosmetic sequelae are evaluated with standardized scales, such as the LENT-SOMA and must be monitored during at least 5 years. The main factors determining the occurrence of sequelae are a large breast volume, dose heterogeneity and the use of tumour bed boost after whole-breast radiation therapy. Intensity modulated radiotherapy and partial breast irradiation position themselves as a good alternatives to reduce the incidence of late skin side effects. The use of predictive tests of intrinsic radiosensitivity might fit into the therapeutic strategy. (authors)

  5. Locoregional recurrence after breast-conserving therapy remains an independent prognostic factor even after an event free interval of 10 years in early stage breast cancer

    NARCIS (Netherlands)

    Tanis, E.; van de Velde, C. J. H.; Bartelink, H.; van de Vijver, M. J.; Putter, H.; van der Hage, J. A.

    2012-01-01

    Locoregional recurrence (LRR) after breast-conserving therapy is a well-known independent risk factor associated with unfavourable long-term outcome. Controversy exists concerning the prognostic impact of a LRR after a very long event-free interval. Patients who underwent breast-conserving therapy

  6. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Gage, Irene; Nixon, Asa J.; Schnitt, Stuart J.; Recht, Abram; Gelman, Rebecca; Silver, Barbara; Connolly, James L.; Harris, Jay R.

    1995-01-01

    PURPOSE: To assess the relationship between microscopic margin status and recurrence after breast-conserving therapy for tumors with or without an extensive intraductal component (EIC). MATERIALS AND METHODS: During the years 1968 to 1986, 1865 women with unilateral clinical stage I or II breast cancer were treated with radiation therapy for breast conservation. Of these, 340 received ≥60 Gy to the tumor bed and had margins that were evaluable on review of their pathologic slides; these constitute the study population. The median follow-up was 109 months. All available slides were reviewed by one of the study pathologists (SS, JC). Final radial margins of excision were classified as negative >1 mm (no invasive or ductal carcinoma in-situ within 1 mm of the inked margin), negative ≤1 mm (any carcinoma ≤1 mm of the inked margin but not at ink) or positive (any carcinoma at the inked margin). A focally positive margin was defined as any invasive or in-situ carcinoma at the margin in ≤3 LPF. The extent of positivity was not evaluable in 2 patients and the distance of the tumor from the margin was not evaluable in 48 patients with a negative margin. Thirty-nine percent of EIC-negative and 46% of EIC-positive patients underwent a re-excision and, for these, the final margin analyzed was from the re-excised specimen. The median dose to the tumor bed was 63 Gy for patients with positive margins and 62 Gy for patients with negative margins. Recurrent disease was classified as ipsilateral breast recurrence (IBR) or distant metastasis/regional nodal failure (DM/RNF). RESULTS: Five year crude rates for the first site of recurrence were calculated for 340 patients evaluable at 5 years. Results were tabulated separately for all patients, EIC-negative and EIC-positive. All p-values tested for differences in the distribution of sites of first failure. CONCLUSIONS: The risk of ipsilateral breast recurrence is equally low for patients with close (≤1 mm) or negative (>1 mm

  7. Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation

    International Nuclear Information System (INIS)

    Alpert, Tracy E.; Kuerer, Henry M.; Arthur, Douglas W.; Lannin, Donald R.; Haffty, Bruce G.

    2005-01-01

    Purpose: To compare outcomes of salvage mastectomy (SM) and salvage breast-conserving surgery (SBCS) and study the feasibility of SBCS. Methods and Materials: Of 2,038 patients treated with breast-conserving therapy at Yale-New Haven Hospital before 1999, 166 sustained an ipsilateral breast tumor recurrence (IBTR). Outcomes and prognostic factors of patients treated with SM or SBCS were compared. Patients were considered amenable to SBCS if the recurrence was localized on mammogram and physical examination, and had pathologic size <3 cm, confined to the biopsy site, without skin or lymphovascular invasion, and with ≤3 positive nodes. Results: Of the 146 patients definitively managed at IBTR, surgery was SM (n = 116) or SBCS (n 30). The median length of follow-up after IBTR was 13.8 years. The SM and SBCS cohorts had no significant differences, except at IBTR the SM cohort had a greater tumor size (p = 0.049). Of the SM cohort, 65.5% were considered appropriate for SBCS, and a localized relapse was predicted by estrogen-receptor positive, diploid, and detection of recurrence by mammogram. Multicentric disease correlated with BRCA1/2 mutation, estrogen-receptor negative, lymph node positive at relapse, and detection of recurrence by physical examination. Survival after IBTR was 64.5% at 10 years, with no significant difference between SM (65.7%) and SBCS (58.0%). Only 2 patients in the SBCS cohort subsequently had a second IBTR, and were salvaged with mastectomy. Conclusions: While mastectomy is considered the standard surgical salvage of IBTR, SBCS is feasible and prognostic factors are related to favorable tumor biology and early detection. Patients with BRCA1/2 germline mutations may be less appropriate for SBCS, as multicentric disease was more prevalent. Patients who underwent SBCS had comparable outcomes as those who underwent SM, but remain at continued risk for IBTR. A prospective trial evaluating repeat lumpectomy and partial breast reirradiation is

  8. The effect of age in breast conserving therapy : A retrospective analysis on pathology and clinical outcome data

    NARCIS (Netherlands)

    Chen, Wei; Sonke, Jan-Jakob; Stroom, Joep; Bartelink, Harry; Verheij, Marcel; Gilhuijs, Kenneth

    Background and propose: Age is an important prognostic marker of patient outcome after breast conserving therapy; however, it is not clear how age affects the outcome. This study aimed to explore the relationship between age with the cell quantity and the radiosensitivity of microscopic disease

  9. The impact of lobular carcinoma in situ in association with invasive breast cancer on the rate of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Jolly, Shruti; Kestin, Larry L.; Goldstein, Neal S.; Vicini, Frank A.

    2006-01-01

    Purpose: The significance of lobular carcinoma in situ (LCIS) associated with invasive breast cancer in patients undergoing breast-conserving therapy (BCT) remains controversial. We examined the impact of the presence and extent of LCIS associated with invasive breast cancer on clinical outcome in BCT patients. Methods and Materials: From 1980 to 1996, 607 cases of invasive breast cancer were treated with BCT. All slides were reviewed by a single pathologist. Positive margin was defined as presence of invasive carcinoma/ductal carcinoma in situ at the inked margin. Multiple clinical, pathologic, and treatment-related variables were analyzed for their association with ipsilateral breast tumor recurrence (IBTR) and true recurrence/marginal miss (TR/MM). Median follow-up was 8.7 years. Results: Fifty-six patients (9%) had LCIS in association with invasive cancer. On univariate analysis, positive final margin, positive/no reexcision, smaller maximum specimen dimension, and the presence of LCIS predicted for IBTR. The 10-year IBTR rate was 14% for cases with LCIS vs. 7% without LCIS (p = 0.04). On multivariate analysis, positive margin (p < 0.01), positive/no reexcision (p = 0.04), and presence of LCIS (p = 0.02) remained independently associated with IBTR; positive margin (p < 0.01) and LCIS (p = 0.04) were also associated with TR/MM failure. When examining only cases with negative final margins, the presence of LCIS remained associated with higher IBTR and TR/MM rates (p < 0.01). Conclusion: The presence of LCIS was independently associated with higher rate of IBTR and TR/MM after BCT for invasive breast cancer. LCIS may have significant premalignant potential and progress to an invasive IBTR at the site of index lesion. The adequacy of excision of LCIS associated with invasive carcinoma should be considered in patients undergoing BCT

  10. Validation of the methods of cosmetic assessment after breast-conserving therapy in the EORTC 'boost versus no boost' trial

    International Nuclear Information System (INIS)

    Vrieling, Conny; Collette, Laurence; Bartelink, Ellen; Borger, Jacques H.; Brenninkmeyer, Stefan J.; Horiot, Jean-Claude; Pierart, Marianne; Poortmans, Philip M.; Struikmans, Henk; Schueren, Emmanuel van der; Dongen, Joop A. van; Limbergen, Erik van; Bartelink, Harry

    1999-01-01

    Purpose: To evaluate both qualitative and quantitative scoring methods for the cosmetic result after breast-conserving therapy (BCT), and to compare the usefulness and reliability of these methods. Methods and Materials: In EORTC trial 22881/10882, stage I and II breast cancer patients were treated with tumorectomy and axillary dissection. A total of 5318 patients were randomized between no boost and a boost of 16 Gy following whole-breast irradiation of 50 Gy. The cosmetic result was assessed for 731 patients in two ways. A panel scored the qualitative appearance of the breast using photographs taken after surgery and 3 years later. Digitizer measurements of the displacement of the nipple were also made using these photographs in order to calculate the breast retraction assessment (BRA). The cosmetic results after 3-year follow-up were used to analyze the correlation between the panel evaluation and digitizer measurements. Results: For the panel evaluation the intraobserver agreement for the global cosmetic score as measured by the simple Kappa statistic was 0.42, considered moderate agreement. The multiple Kappa statistic for interobserver agreement for the global cosmetic score was 0.28, considered fair agreement. The specific cosmetic items scored by the panel were all significantly related to the global cosmetic score; breast size and shape influenced the global score most. For the digitizer measurements, the standard deviation from the average value of 30.0 mm was 2.3 mm (7.7%) for the intraobserver variability and 2.6 mm (8.7%) for the interobserver variability. The two methods were significantly, though moderately, correlated; some items scored by the panel were only correlated to the digitizer measurements if the tumor was not located in the inferior quadrant of the breast. Conclusions: The intra- and interobserver variability of the digitizer evaluation of cosmesis was smaller than that of the panel evaluation. However, there are some treatment sequelae

  11. Basal Subtype of Invasive Breast Cancer Is Associated With a Higher Risk of True Recurrence After Conventional Breast-Conserving Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hattangadi-Gluth, Jona A. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Wo, Jennifer Y. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Nguyen, Paul L. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, Massachusetts (United States); Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Sreedhara, Meera [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Freer, Phoebe E. [Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States); Georgian-Smith, Dianne [Department of Radiology, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Bellon, Jennifer R.; Wong, Julia S. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, Massachusetts (United States); Smith, Barbara L. [Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Harris, Jay R. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2012-03-01

    Purpose: To determine whether breast cancer subtype is associated with patterns of ipsilateral breast tumor recurrence (IBTR), either true recurrence (TR) or elsewhere local recurrence (ELR), among women with pT1-T2 invasive breast cancer (IBC) who receive breast-conserving therapy (BCT). Methods and Materials: From Jan 1998 to Dec 2003, 1,223 women with pT1-T2N0-3 IBC were treated with BCT (lumpectomy plus whole-breast radiation). Ninety percent of patients received adjuvant systemic therapy, but none received trastuzumab. Biologic cancer subtypes were approximated by determining estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and human epidermal growth factor receptor-2-positive (HER-2+) expression, classified as luminal A (ER+ or PR+ and HER-2 negative [HER-2-]), luminal B (ER+ or PR+ and HER-2+), HER-2 (ER- and PR- and HER-2+), and basal (ER- and PR- and HER-2- ) subtypes. Imaging, pathology, and operative reports were reviewed by two physicians independently, including an attending breast radiologist. Readers were blinded to subtype and outcome. TR was defined as IBTR within the same quadrant and within 3 cm of the primary tumor. All others were defined as ELR. Results: At a median follow-up of 70 months, 24 patients developed IBTR (5-year cumulative incidence of 1.6%), including 15 TR and 9 ELR patients. At 5 years, basal (4.4%) and HER-2 (9%) subtypes had a significantly higher incidence of TR than luminal B (1.2%) and luminal A (0.2%) subtypes (p < 0.0001). On multivariate analysis, basal subtype (hazard ratio [HR], 4.8, p = 0.01), younger age at diagnosis (HR, 0.97; p = 0.05), and increasing tumor size (HR, 2.1; p = 0.04) were independent predictors of TR. Only younger age (HR, 0.95; p = 0.01) significantly predicted for ELR. Conclusions: Basal and HER-2 subtypes are significantly associated with higher rates of TR among women with pT1-T2 IBC after BCT. Younger age predicts for both TR and ELR. Strategies to reduce TR in basal

  12. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  13. Results of salvage surgery for mammary recurrence following breast-conserving therapy

    International Nuclear Information System (INIS)

    Kurtz, J.M.; Amalric, R.; Brandone, H.; Ayme, Y.; Spitalier, J.M.

    1988-01-01

    A retrospective analysis was performed of 118 surgically treated mammary recurrences, occurring following primary conservative excision and radiation therapy for clinical Stages I and II breast cancer. Actuarial cancer-specific survival following salvage surgery was 72% at 5 years and 58% at 10 years. With a median followup of 7 years, further local-regional recurrences were observed in 20 of the 118 patients, many of whom could be treated by further surgery. Actuarial survival after recurrence was significantly influenced by initial clinical stage, as well as by the disease-free interval following primary therapy, but was similar for both premenopausal and postmenopausal patients and for patients treated by radical or breast-conserving salvage operations. For recurrences after the fifth year, actuarial survival following salvage surgery was 83% and 68% at 5 and 10 years, respectively. Survival for Stage I patients was favorable regardless of disease-free interval. It is concluded that recurrences in the breast following primary treatment with limited surgery and irradiation have a considerably more favorable prognosis than that of local failures after primary radical surgery. Suggestions for the management of these recurrences are presented

  14. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conservation therapy

    International Nuclear Information System (INIS)

    Markiewicz, Deborah A.; Schultz, Delray J.; Haas, Jonathan A.; Harris, Eleanor E. R.; Fox, Kevin R.; Glick, John H.; Solin, Lawrence J.

    1996-01-01

    Purpose: Chemotherapy plays an increasingly important role in the treatment of both node-negative and node-positive breast cancer patients, but the optimal sequencing of chemotherapy and radiation therapy is not well established. The purpose of this study is to evaluate the interaction of sequence and type of chemotherapy and hormonal therapy given with radiation therapy on the cosmetic outcome and the incidence of complications of Stage I and II breast cancer patients treated with breast-conserving therapy. Methods and Materials: The records of 1053 Stage I and II breast cancer patients treated with curative intent with breast-conserving surgery, axillary dissection, and radiation therapy between 1977-1991 were reviewed. Median follow-up after treatment was 6.7 years. Two hundred fourteen patients received chemotherapy alone, 141 patients received hormonal therapy alone, 86 patients received both, and 612 patients received no adjuvant therapy. Patients who received chemotherapy ± hormonal therapy were grouped according to sequence of chemotherapy: (a) concurrent = concurrent chemotherapy with radiation therapy followed by chemotherapy; (b) sequential = radiation followed by chemotherapy or chemotherapy followed by radiation; and (c) sandwich = chemotherapy followed by concurrent chemotherapy and radiation followed by chemotherapy. Compared to node negative patients, node-positive patients more commonly received chemotherapy (77 vs. 9%, p < 0.0001) and/or hormonal therapy (40 vs. 14%, p < 0.0001). Among patients who received chemotherapy, the majority (243 patients) received concurrent chemotherapy and radiation therapy with two cycles of cytoxan and 5-fluorouracil (5-FU) administered during radiation followed by six cycles of chemotherapy with cytoxan, 5-fluorouracil and either methotrexate(CMF) or doxorubicin(CAF). For analysis of cosmesis, patients included were relapse free with 3 years minimum follow-up. Results: The use of chemotherapy had an adverse effect

  15. Clinical investigation of predictors of radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

    International Nuclear Information System (INIS)

    Matsuyama, Tomohiko; Furusawa, Mitsuhiro; Yasunaga, Tadamasa; Nishimura, Reiki; Ohya, Natsuo

    2011-01-01

    We investigated 710 patients with breast cancer who received radiotherapy after breast-conserving surgery at our institution to evaluate the incidence of radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome focusing on the interval from irradiation to onset and the clinical presentation. The predictive value of age (≤50 or >50), chemotherapy and hormone therapy was statistically analyzed to determine whether these are risk factors for BOOP syndrome. Radiation-induced BOOP syndrome was seen in 1.3% (9/710). In most cases, the symptoms were mild and none of the patients required hospitalization. Eight patients (88.9%) responded well to steroid administration, but 5 of these patients relapsed after or during tapering of steroids. Although we could not detect significant risk factors for BOOP syndrome, a higher patient age was associated with a higher incidence of radiation-induced BOOP syndrome after breast-conserving therapy. (author)

  16. Attitudes and treatment outcome of breast conservation therapy for stage I and II breast cancer using peroperative iridium-192 implant boost to the tumour bed

    International Nuclear Information System (INIS)

    Deo, S.V.S.; Shukla, N.K.; Mohanti, B.K.; Chawla, S.; Julka, P.K.; Rath, G.K.; Raina, V.

    2001-01-01

    Breast conservation therapy for early breast cancer is an established but grossly under-utilized treatment option in India for various reasons. Breast conservation therapy was offered to 200 suitable breast cancer patients between June 1993 and June 1998. Fifty-one patients (25%) opted for breast conservation and the remaining preferred mastectomy. In patients agreeing to conservation therapy, surgery was performed first along with peroperative implantation of iridium-192 to deliver a boost. Whole breast irradiation of 45 Gy was delivered 3-4 weeks after the boost. Cosmesis was assessed at the end of 6 months from completion of therapy. The main reason for refusal of breast conservation therapy was fear of recurrence in the remaining breast (60%). There were no loco-regional failures in our study at a median follow up of 42 months; one patient experienced a systemic relapse. Cosmesis was good to excellent in 80% of patients. Breast conservation therapy using peroperative iridium-192 implant provides excellent loco-regional disease control and cosmesis. The results of our study indicate that patient preference for mastectomy is an important reason for the under-utilization of breast conservation therapy in India. Copyright (2001) Blackwell Science Pty Ltd

  17. Evaluation of Vascular Endothelial Growth Factor as a Prognostic Marker for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast-Conserving Therapy

    International Nuclear Information System (INIS)

    Moran, Meena S.; Yang Qifeng; Goyal, Sharad; Harris, Lyndsay; Chung, Gina; Haffty, Bruce G.

    2011-01-01

    Purpose: Vascular endothelial growth factor (VEGF) is an important protein involved in the process of angiogenesis that has been found to correlate with relapse-free and overall survival in breast cancer, predominantly in locally advanced and metastatic disease. A paucity of data is available on the prognostic implications of VEGF in early-stage breast cancer; specifically, its prognostic value for local relapse after breast-conserving therapy (BCT) is largely unknown. The purpose of our study was to assess VEGF expression in a cohort of early-stage breast cancer patients treated with BCT and to correlate the clinical and pathologic features and outcomes with overexpression of VEGF. Methods and Materials: After obtaining institutional review board approval, the paraffin specimens of 368 patients with early-stage breast cancer treated with BCT between 1975 and 2005 were constructed into tissue microarrays with twofold redundancy. The tissue microarrays were stained for VEGF and read by a trained pathologist, who was unaware of the clinical details, as positive or negative according the standard guidelines. The clinical and pathologic data, long-term outcomes, and results of VEGF staining were analyzed. Results: The median follow-up for the entire cohort was 6.5 years. VEGF expression was positive in 56 (15%) of the 368 patients. Although VEGF expression did not correlate with age at diagnosis, tumor size, nodal status, histologic type, family history, estrogen receptor/progesterone receptor status, or HER-2 status, a trend was seen toward increased VEGF expression in the black cohort (26% black vs. 13% white, p = .068). Within the margin-negative cohort, VEGF did not predict for local relapse-free survival (RFS) (96% vs. 95%), nodal RFS (100% vs. 100%), distant metastasis-free survival (91% vs. 92%), overall survival (92% vs. 97%), respectively (all p >.05). Subset analysis revealed that VEGF was highly predictive of local RFS in node-positive, margin

  18. IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis

    International Nuclear Information System (INIS)

    Sedlmayer, F.; Fastner, G.; Merz, F.; Deutschmann, H.; Reitsamer, R.; Menzel, C.; Ciabattoni, A.; Petrucci, A.; Hager, E.; Willich, N.; Orecchia, R.; Valentini, V.

    2007-01-01

    There is common consensus that postoperative whole-breast irradiation with doses around 50 Gy remains the gold standard for local treatment after breast conserving surgery (BCS). A substantial benefit of an additional boost with 16 Gy to the tumor bed was recently confirmed by a re-analysis of the EORTC trial data: local recurrence rates were reduced by 50% in all age groups. The idea of a Linac-based IORT with electrons (IOERT) during breast conserving surgery is the delivery of a single boost dose to the tumor bed with utmost precision, due to direct visualization. However, the published data about boost-IOERT for breast cancer are scarce and rarely updated with only few centers participating. Therefore, we initiated a collaborative analysis within the European Group of the International Society of Intraoperative Radiotherapy (ISIORT). A pooled analysis has been performed by 6 institutions of the ISIORT-Europe using comparable methods, sequencing and dosage in intra- and postoperative radiotherapy during BCT. Between 10/98 and 05/05, 1131 patients were treated. Patients' characteristics, histologic workup and tumor staging are summarized in Table 1. Sixty percent of all patients (671 pat.) presented with at least one risk factor for local recurrence in terms of tumor size > 2 cm, high grading, young age < 45 years and/or positive axillary nodes. Breast tumor resection was primarily performed by circular incision. Surgical margins were assessed by frozen section after tumorectomy. Prior to IOERT, the tissue surrounding the excision cavity was temporarily approximated by sutures to bring it in reach of the electron beam. In most cases, intraoperative sonography was performed for depth measurement allowing dose prescription, alternatively mobile CT or direct ruler measurement was used. During IOERT, median single fractional doses of 9,7 Gy (range 5-17) were applied to the 90% reference isodose, using round perspex tubes with 5-8 cm diameter and electron energies of

  19. Breast conserving therapy in breast cancer patients presenting with nipple discharge

    International Nuclear Information System (INIS)

    Obedian, Edward; Haffty, Bruce G.

    2000-01-01

    may be suitable candidates for radiation therapy, local relapse rates were higher than those presenting without nipple discharge. The limitations of the study and implications regarding breast conserving management in patients presenting with nipple discharge are discussed

  20. Irradiation of the tumor bed alone after lumpectomy in selected patients with early stage breast cancer treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Vicini, F.; Chen, P; Benitez, P.; Johnson, P.; Gustafson, G.; Horwitz, E.; McCarthy, K.; Lacerna, M.; Goldstein, Neil; Martinez, A.

    1997-01-01

    Purpose: We present the initial findings of our in-house protocol treating the tumor bed alone after lumpectomy with low dose rate (LDR) interstitial brachytherapy in selected patients with early stage breast cancer treated with breast conserving therapy (BCT). Materials and Methods: Since 1/1/93, 50 women with early stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma ≤ 3 cm in maximum diameter, pathologic margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with ≤ 3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hours to the lumpectomy bed plus a 1-2 cm margin. Local control, cosmetic outcome, and complications were assessed. Results: Patients ranged in age from 40 to 84 years (median 65). The median tumor size was 10 mm (range, 1-25). Seventeen patients (34%) had well differentiated tumors, 22 (4%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node negative while 5 (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up is 40 months (range 29-50). No patient has experienced a local, regional, or distant failure. One patient died from colorectal carcinoma with no evidence of recurrent breast cancer. Good-to-excellent cosmetic results have been observed in all 50 patients (median cosmetic follow-up 36 months). No patient has experienced significant sequelae related to their implant. Conclusions: Early results with treatment of the tumor bed alone with a LDR interstitial implant appear promising. Long-term follow-up of these patients will be

  1. The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC 'boost versus no boost' trial

    International Nuclear Information System (INIS)

    Vrieling, Conny; Collette, Laurence; Fourquet, Alain; Hoogenraad, Willem J.; Horiot, Jean-Claude; Jager, Jos J.; Pierart, Marianne; Poortmans, Philip M.; Struikmans, Henk; Hulst, Marleen van der; Schueren, Emmanuel van der; Bartelink, Harry

    1999-01-01

    Purpose: To evaluate the influence of a radiotherapy boost on the cosmetic outcome after 3 years of follow-up in patients treated with breast-conserving therapy (BCT). Methods and Materials: In EORTC trial 22881/10882, 5569 Stage I and II breast cancer patients were treated with tumorectomy and axillary dissection, followed by tangential irradiation of the breast to a dose of 50 Gy in 5 weeks, at 2 Gy per fraction. Patients having a microscopically complete tumor excision were randomized between no boost and a boost of 16 Gy. The cosmetic outcome was evaluated by a panel, scoring photographs of 731 patients taken soon after surgery and 3 years later, and by digitizer measurements, measuring the displacement of the nipple of 3000 patients postoperatively and of 1141 patients 3 years later. Results: There was no difference in the cosmetic outcome between the two treatment arms after surgery, before the start of radiotherapy. At 3-year follow-up, both the panel evaluation and the digitizer measurements showed that the boost had a significant adverse effect on the cosmetic result. The panel evaluation at 3 years showed that 86% of patients in the no-boost group had an excellent or good global result, compared to 71% of patients in the boost group (p = 0.0001). The digitizer measurements at 3 years showed a relative breast retraction assessment (pBRA) of 7.6 pBRA in the no-boost group, compared to 8.3 pBRA in the boost group, indicating a worse cosmetic result in the boost group at follow-up (p = 0.04). Conclusions: These results showed that a boost dose of 16 Gy had a negative, but limited, impact on the cosmetic outcome after 3 years

  2. Improved Outcomes of Breast-Conserving Therapy for Patients With Ductal Carcinoma in Situ

    Energy Technology Data Exchange (ETDEWEB)

    Halasz, Lia M. [Harvard Radiation Oncology Program, Boston, MA (United States); Sreedhara, Meera [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States); Chen, Yu-Hui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (United States); Bellon, Jennifer R.; Punglia, Rinaa S.; Wong, Julia S.; Harris, Jay R. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, MA (United States); Brock, Jane E., E-mail: jebrock@partners.org [Department of Pathology, Brigham and Women' s Hospital, Boston, MA (United States)

    2012-03-15

    Purpose: Patients treated for ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) and radiation therapy (RT) at our center from 1976 to 1990 had a 15% actuarial 10-year local recurrence (LR) rate. Since then, improved mammographic and pathologic evaluation and greater attention to achieving negative margins may have resulted in a lower risk of LR. In addition, clinical implications of hormone receptor and HER-2 status in DCIS remain unclear. We sought to determine the following: LR rates with this more modern approach; the relation between LR and HER-2 status; and clinical and pathologic factors associated with HER-2{sup +} DCIS. Methods and Materials: We studied 246 consecutive patients who underwent BCS and RT for DCIS from 2001 to 2007. Of the patients, 96 (39%) were Grade III and the median number of involved tissue blocks was 3. Half underwent re-excision and 222 (90%) had negative margins (>2 mm). All received whole-breast RT (40-52 Gy) and 99% (244) received a tumor bed boost (8-18 Gy). Routine estrogen receptor (ER), progesterone receptor (PR), and HER-2 immunohistochemistry was instituted in 2003. Results: With median follow-up of 58 months, there were no LRs. Seven patients (3%) developed contralateral breast cancer (4 invasive and 3 in situ). Among 163 patients with immunohistochemistry, 124 were ER/PR{sup +}HER-2{sup -}, 27 were ER/PR{sup +}HER-2{sup +}, 6 were ER{sup -}/PR{sup -}HER-2{sup +}, and 6 were ER{sup -}/PR{sup -}HER-2{sup -}. On univariable analysis, HER-2{sup +}was significantly associated with Grade III, ER{sup -}/PR{sup -}, central necrosis, comedo subtype, more extensive DCIS, and postmenopausal status. On multivariable analysis, Grade III and postmenopausal status remained significantly associated with HER-2{sup +}. Conclusions: In an era of mammographically identified DCIS, larger excisions, widely negative margins and the use of a tumor bed boost, we observed no LR regardless of ER/PR/HER-2 status. Factors associated

  3. A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy

    Directory of Open Access Journals (Sweden)

    Elliot M. Hirsch, MD

    2014-01-01

    Conclusions: Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.

  4. DEGRO practical guidelines for radiotherapy of breast cancer I. Breast-conserving therapy

    International Nuclear Information System (INIS)

    Sautter-Bihl, M.L.; Budach, W.; Dunst, J.; Feyer, P.; Haase, W.; Harms, W.; Sedlmayer, F.; Souchon, R.; Wenz, F.; Sauer, R.

    2007-01-01

    Background: The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel. Methods: The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence-based medicine. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail. Results: Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions. Conclusion: After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women ≤ 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled

  5. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Fujishiro, Satsuki; Mitsumori, Michihide; Kokubo, Masaki; Nagata, Yasushi; Sasai, Keisuke; Hiraoka, Masahiro; Kodama, Hiroshi

    1999-01-01

    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 γ-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  6. The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Park, Seho; Park, Hyung-Seok; Kim, Seung-ll; Koo, Ja-Seung; Park, Byeong-Woo; Lee, Kyong-Sik

    2011-01-01

    The aim of the study was to investigate the parameters affecting positive margin and the impact of positive margin on outcomes after breast-conserving therapy in patients with breast cancer. Characteristics and survival of 705 patients attempted breast-conserving therapy between January 1994 and December 2004 were retrospectively analyzed using χ 2 tests, the Kaplan-Meier methods and multivariate analyses. Ninety-five (13.5%) showed positive margins at initial resection. Among them, 28 (4.0%) had negative margin on the initial frozen section; however, they finally turned out a focally positive margin with intraductal carcinoma on the permanent pathology. Positive margin at initial resection was significantly associated with lobular histology (P=0.001), four or more involved lymph nodes (P=0.015) and the presence of extensive intraductal component (P<0.001). A focally positive margin did not influence local (P=0.250; 95% confidence interval, 0.612-6.592) or regional failure (P=0.756; 95% confidence interval, 0.297-5.311). Patients with a focally positive margin showed an advanced nodal stage and received a higher dose of irradiation and more systemic therapy. Nodal involvements were the most significant factor for locoregional failure. Although the achievement of negative margins is the best way to reduce local failure, patients with a focally positive margin and favorable risk factors such as node negativity and older age could have an option of close follow-up with adequate boost irradiation and adjuvant therapy instead of conversion to total mastectomy. (author)

  7. Four cases of radiation pneumonia after breast conservative therapy for breast cancer

    International Nuclear Information System (INIS)

    Horii, Rie; Fukuuchi, Atushi; Nishi, Tsunehiro

    1997-01-01

    Between 1983 and 1996, a series of 240 patients with early stage breast cancer were treated with breast conservative treatment, and 201 patients of them all received irradiation at a dose of 46-60 Gy to the affected breast. Among the 201 patients who received breast irradiation, four (2.0%) patients experienced radiation pneumonia. These four patients with radiation pneumonia presented with coughing from 7 to 20 weeks after irradiation. Chest X-ray film revealed interstitial pneumonia in a lung field where coincided with the irradiated field in them. Three out of four patients demanded steroids, but all patients got well within 4 months. Radiation pneumonia following conservative surgery and radiotherapy for breast cancer is an infrequent complication, but attention should be paid to radiation pneumonia if the patient suffers from persistent coughing after radiotherapy. (author)

  8. Treatment morbidity associated with the management of the axilla in breast-conserving therapy

    International Nuclear Information System (INIS)

    Johansen, J.; Overgaard, J.; Blichert-Toft, M.; Overgaard, M.

    2000-01-01

    The purpose of this study was to determine the impact of surgery and radiotherapy on late morbidity associated with the management of the axilla in breast cancer patients. Two hundred and sixty-six patients from a randomized breast conservation trial (DBCG-82TM protocol) were called in for a single follow-up interview and clinical examination of several functional outcome measures after a median of 6.6 years (3.5-10.5). All the patients were treated with lumpectomy and axillary dissection, followed by external beam radiotherapy to the residual breast. High-risk patients were given additional radiation to the regional lymph nodes plus adjuvant systemic treatment. Twenty-eight patients (11%) had arm edema (> or 2 cm), which was associated with the extent of axillary node dissection as well as with age and radiotherapy (relative risk, RR 4.5 (1.8-11.2, p = 0.001)). Impaired shoulder movement of any degree (7%) was associated with radiotherapy (RR 4.0 (1.5-13.8, p = 0.007)) and advanced age (p = 0.002), while the extent of axillary dissection as described by the number of nodes retrieved was the only factor that predicted pain on logistic regression analysis (p = 0.02). A moderate to severe change in arm/shoulder strength and working ability was observed in 7% and 5% of patients, respectively, but no independent predisposing factor was discerned for these endpoints. It is concluded that the level of late functional morbidity several years after breast-conserving treatment is relatively low and clearly relates to age, extension of surgery, irradiation of the axilla or a combination of these factors, depending on the specific clinical outcome measure

  9. Results of breast conserving therapy for early breast cancer and the role of mammographic follow-up

    International Nuclear Information System (INIS)

    Grosse, Antje; Schreer, Ingrid; Frischbier, Hans-Joachim; Maass, Heinrich; Loening, Thomas; Bahnsen, Jens

    1997-01-01

    Purpose: The following article is a review of 23 years of breast-conserving therapy in our hospital. This study was performed to assess and improve the follow-up care of women with early breast cancer and to evaluate whether or not biannual mammogram is useful. Methods and Materials: Between 1972 and December 1995, 3072 women with pathological size pT1 and pT2 breast cancer were treated with conservative surgery and radiation therapy. Eighty-five patients developed a recurrence in the treated breast as the first site of failure, 12 of which had positive axillary nodes. In the following patient study, those with an noninvasive recurrence were excluded. A retrospective assessment of the entire mammographic course was made, starting with the mammogram at the time of original diagnosis to the mammogram of the recurrence. Results: In our study group the probability for local failure ranged from 1 to 2% per year. At 5 and 10 years the actuarial rates were 5 and 10%. The median time to recurrence was 41 months (range 8-161). Twenty-six (31%) recurrences were detected by mammography alone, 10 (12%) by clinical examination only, and 35 (41%) by both methods. For the patients with an ipsilateral recurrence, the overall actuarial 5- and 10-year survival after treatment was 87 and 70%, respectively. The 5-year actuarial rate of survival from salvage mastectomy was 61%. Conclusion: Considering the high percentage of recurrences detectable by mammography and the possibility of detection within a short-term interval, we think biannual mammographic follow-up is appropriate for the first years following breast-conserving therapy

  10. Relationship of family history and outcome after breast conservation therapy in women with ductal carcinoma in situ of the breast

    International Nuclear Information System (INIS)

    Harris, Eleanor E.R.; Schultz, Delray J.; Peters, Christopher A.; Solin, Lawrence J.

    2000-01-01

    Purpose: The purpose of this study was to evaluate the relationship between a family history of breast or ovarian cancer and outcome after breast-conserving surgery and radiation in women presenting with an initial diagnosis of ductal carcinoma in situ (DCIS) of the breast. Methods and Materials: A total of 146 consecutive women with a pathologic diagnosis of ductal carcinoma in situ as their first diagnosis of any breast cancer were identified; 28 (19%) had a positive family history of breast or ovarian cancer in a first-degree relative, 27 (19%) had a positive family history in a second-degree relative, and 91 (62%) had no family history. Pathologic, clinical, and treatment factors, and clinical outcomes for each family history group were compared. Cosmesis and complications were recorded at each follow-up. Patients were treated between 1978 and 1995, and the median follow-up was 7.1 years. Results: Patients with a positive family history in a first- or second-degree relative each had an 8% incidence of local failure at 10 years, while the negative family history group demonstrated a 16% local failure rate (p = 0.33). Overall survival at 10 years for patients with a positive family history in a first- or second-degree relative was 100% and for those with a negative family history was 91% (p = 0.08). The negative family history group had a higher median age that may account for the difference in overall survival. Cause-specific survival (CSS) was 97%, 100%, and 99%, respectively, at 10 years (p = 0.25). There were no differences in the cosmetic results or complication rates between women with a positive or negative family history. Conclusion: We have shown that a family history of breast and/or ovarian cancer is not associated with an adverse outcome for women treated with breast conservation therapy for DCIS. Local recurrence, cause-specific survival, overall survival, cosmesis, and complication rates were comparable to that of similarly treated women with

  11. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis.

    Science.gov (United States)

    Valachis, Antonios; Mamounas, Eleftherios P; Mittendorf, Elizabeth A; Hayashi, Naoki; Ishitobi, Makoto; Natoli, Clara; Fitzal, Florian; Rubio, Isabel T; Tiezzi, Daniel G; Shin, Hee-Chul; Anderson, Stewart J; Hunt, Kelly K; Matsuda, Naoko; Ohsumi, Shozo; Totomi, Athina; Nilsson, Cecilia

    2018-05-03

    Several studies have reported a high risk of local disease recurrence (LR) and locoregional disease recurrence (LRR) in patients with breast cancer after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). The objective of the current study was to identify potential risk factors for LR and LRR after NCT and BCT. Individual patient data sets from 9 studies were pooled. The outcomes of interest were the occurrence of LR and/or LRR. A 1-stage meta-analytic approach was used. Cox proportional hazards regression models were applied to identify factors that were predictive of LR and LRR, respectively. A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN + disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively. BCT after NCT appears to be an oncologically safe procedure for a large percentage of patients with breast cancer. Two easy-to-use clinical scores were developed that can help clinicians to identify patients at higher risk of LR and LRR after NCT and BCT and individualize the postoperative treatment plan and follow-up. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  12. Effect of External Boost Volume in Breast-Conserving Therapy on Local Control With Long-Term Follow-Up

    International Nuclear Information System (INIS)

    Jobsen, Jan J.; Palen, Job van der; Ong, Francisca

    2008-01-01

    Purpose: To determine the effects of boost volume (BV) in relation to margin status and tumor size on the development of local recurrence with breast-conserving therapy. Methods and Materials: Between 1983 and 1995, 1,073 patients with invasive breast cancer underwent 1,101 breast-conserving therapies. Of these 1,101 BCTs, 967 were eligible for analysis. The BV was categorized into tertiles: 3 (n = 330), 66-98 cm 3 (n = 326), and >98 cm 3 (n = 311). The median follow-up was 141 months. Separate analyses were done for women ≤40 years and >40 years. Results: No significant difference in local recurrence was shown between the tertiles and the recurrence site. The 15-year local recurrence-free survival rate was 87.9% for the first tertile, 88.7% for the second, and 89% for the third. For women ≤40 years old, the corresponding 15-year local recurrence-free survival rate was 80%, 74.5%, and 69.2%. For women >40 years old, the corresponding rate was 88.7%, 89.5%, and 90.9%. At 5 years, women >40 years old had significantly more local failures in the first tertile; this difference disappeared with time. A test for trend showed significance at 5 years (p = 0.0105) for positive margins for ductal carcinoma in situ in women >40 years of age. Conclusion: The results of this study have shown that the size of the external BV has no major impact on local control. For women >40 years old, positive margins for ductal carcinoma in situ showed a trend with respect to BV at 5 years. The BV had no influence on local control in the case of positive margins for invasive carcinoma

  13. Evaluation of anxiety and salivary chromogranin a secretion in women receiving breast conserving surgery followed by radiation therapy

    International Nuclear Information System (INIS)

    Seki-Nakamura, Kaori; Maebayashi, Katsuya; Nasu-Izumi, Sachiko; Akimoto, Tetsuo; Mitsuhashi, Norio

    2011-01-01

    We conducted a prospective study to assess the anxiety and salivary Chromogranin A (CgA), which is considered to be a biomarker of the stress response, in outpatients receiving breast conserving surgery followed by radiation therapy (RT) to the whole breast. Fifty consecutive patients who received whole-breast RT were enrolled in this study. The anxiety levels were measured by the State-Trait Anxiety Inventory (STAI) at the beginning of RT (baseline), 30 Gy, completion of RT, and 1 and 3 months after RT. Salivary CgA levels were also measured at the same time. The mean state anxiety score for all patients was 46.16 with a standard error (SE) of 1.57 at the beginning of RT (baseline) which continued to decline during and after RT. It reached its lowest score with 36.34±1.56 at 3 months after RT (p<0.0001). The mean trait anxiety score for all patients was 43.10±1.54 at baseline and remained constant during RT but began to decline after completion of RT and reached a low level at 3 months after RT (p=0.0021). The mean salivary CgA concentration for all patients demonstrated no consistent trends over time, but at 30 Gy the concentration showed a significant decreasing pattern (p=0.0473). Salivary CgA concentrations and state anxiety and trait anxiety scores at all time points showed no correlation. The mean anxiety scores measured by State Trait Anxiety Inventory (STAI) showed no positive correlation with salivary CgA concentration for breast cancer patients undergoing radiation therapy following breast conserving surgery. (author)

  14. Quality control in breast conservation

    International Nuclear Information System (INIS)

    Schwartz, G.F.

    1992-01-01

    Over the past 15 years, breast conservation has become an accepted option for treatment of Stages I and II carcinoma of the breast; in this practice in 1991, more than 80% of these patients were treated in this manner. A surgical procedure to excise the primary lesion and to dissect the axilla is generally required to prepare patients for breast conservation, concurrently maximizing esthetic appearance of the breast, minimizing the risk of local recurrence and providing appropriate information for recommendations concerning adjuvant therapy. The volume of breast tissue to be removed, significance of findings at surgical margins, and extent of the axillary dissection are all somewhat controversial subjects. Based upon a personal series of almost 800 patients undergoing breast conservation, observations that reflect the findings from this experience may be shared. (author)

  15. Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009.

    Science.gov (United States)

    Hartmann-Johnsen, Olaf Johan; Kåresen, Rolf; Schlichting, Ellen; Nygård, Jan F

    2017-07-03

    Recent registry studies on early-stage breast cancer have shown better survival rates when women underwent breast-conserving therapy (BCT) compared with mastectomy (MTX). The aim of this study is to investigate women participating in screening, in all four stages of early breast cancer (T1N0M0, T2N0M0, T1N1M0, and T2N1M0), as to whether there is a survival benefit when women undergo BCT compared to MTX. A cohort of 6387 women aged 50-69, with primary-operated breast cancer from January 1998 to December 2009, participating in screening and followed-up until the end of 2010. Life tables were calculated by stages (pT1N0M0, pT2N0M0, pT1N1M0, and pT2N1M0), surgery groups (BCT and MTX), and screening detection (first screening, later screening, or interval cancer). Cox regression was used to calculate hazard ratios (HR) between BCT and MTX in crude and adjusted analyses. In stage T1N1M0, women who underwent MTX had an HR of 2.91 (95% CI 1.30-6.48) for breast cancer death compared to women who underwent BCT, after adjusting for screening detection, years of diagnosis, age at diagnosis, histology, grade, and hormone receptor status. For all other TNM categories of early breast cancer, there was no difference in survival. 10-year breast cancer-specific survival (BCSS) in T1N0M0 was 98% for women undergoing BCT and 96% for women undergoing MTX. 10-year BCSS in T1N1M0 was 97% for women undergoing BCT and 89% for women undergoing MTX. For women participating in screening, there is a benefit of BCT over MTX in stage T1N1M0. No such effects were observed in the other early stages of breast cancer.

  16. Single dose IOERT versus whole breast irradiation. Cosmetic results in breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Struikmans, Henk [Medical Centre Haaglanden, Radiotherapy Centre West, The Hague (Netherlands); Leiden University Medical Centre, Department of Radiotherapy, Leiden (Netherlands); Snijders, Malou; Mast, Mirjam E.; Fisscher, Ursula; Petoukhova, Anna; Koper, Peter [Medical Centre Haaglanden, Radiotherapy Centre West, The Hague (Netherlands); Franssen, Jan-Huib; Speijer, Gabrielle [HAGA Medical Centre, Department of Radiotherapy, The Hague (Netherlands); Immink, Marcelle J. [Reinier de Graaf Medical Centre, Department of Radiotherapy, Delft (Netherlands); Leiden University Medical Centre, Department of Radiotherapy, Leiden (Netherlands); Marinelli, Andreas [Medical Centre Haaglanden, Department of Surgery, The Hague (Netherlands); Merkus, Jos [HAGA Medical Centre, Department of Surgery, The Hague (Netherlands)

    2016-10-15

    Scarce data are available about the cosmetic result of single dose intraoperative electron radiotherapy (IOERT) in breast-conserving radiotherapy. We included 71 breast cancer patients. Breast-conserving surgery and sentinel node procedure had started almost 3 years earlier. Subsequently, 26 patients were treated with IOERT and 45 patients received postoperative whole breast irradiation (WBI). For both groups we determined seven dimensionless asymmetry features. We compared the subjectively and the objectively derived cosmetic scores with each other. For four asymmetry features we noted significantly smaller differences for patients treated with IOERT when compared to those treated with WBI: relative breast contour difference, relative breast area difference and relative breast overlap difference. After correcting for excision volume a significant difference was noticed also for relative lower breast contour. For the IOERT group the cosmetic scores ''excellent or good'' as determined by each patient and one physician were 88 and 96 %, respectively. When the overall cosmetic scores for patients treated with IOERT and WBI were compared to those of the objectively derived scores, there was a fair level of agreement. For patients treated with IOERT we noted less asymmetry and high rates of ''good or excellent'' subjectively derived cosmetic scores. The level of agreement between the subjectively and the objectively derived cosmetic scores was limited. Due to the small sample size and the design of the study no definitive conclusions can be drawn. (orig.) [German] Es sind nur wenige Daten zum kosmetischen Ergebnis nach alleiniger intraoperativer Radiotherapie mittels Elektronen (IOERT) in der brusterhaltenden Behandlung verfuegbar. In einer komparativen Kohortenanalyse wurden 71 Brustkrebspatientinnen eingeschlossen. Ihre brusterhaltende Operation mit Sentinel-Lymphknotenverfahren begann 3 Jahre vorher. Im Anschluss erhielten 26

  17. The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy

    International Nuclear Information System (INIS)

    Bornstein, Bruce A.; Peiro, Gloria; Connolly, James L.; Gelman, Rebecca; Schnitt, Stuart J.; Hetelekidis, Stella; Nixon, Asa J.; Recht, Abram; Silver, Barbara; Harris, Jay R.

    1996-01-01

    PURPOSE: To examine the clinical characteristics of patients with lobular or mixed lobular-ductal histology in relation to those with pure ductal histology and to compare treatment outcome in patients in these histologic groups treated with breast-conserving surgery and radiation therapy. MATERIALS AND METHODS: Between 1970 and 1986, 1863 patients were treated for clinical Stage I or II invasive breast cancer with breast-conserving surgery and radiation therapy. The original slides were reviewed in 1536 cases (82%). Of these, 1089 patients had pure invasive ductal carcinoma, 93 had invasive lobular carcinoma, and 59 had mixed histology; these constitute the study population. The median follow-up time was 133 months. RESULTS: The distribution of clinical stage I or II, tumor stage T1 or T2, and clinical nodal stage N0 or N1 was similar in all three groups. Positive lymph nodes were found in 31% of patients with lobular cancer compared to 38% of those with ductal cancer and 48% of patients with mixed lobular-ductal histology (p=0.05). The use of adjuvant chemo/hormonal therapy followed the same pattern (20%, 29%, 37%, respectively [p=0.07]). Lymphatic vessel invasion was more common in patients with ductal cancer (38%) than in those with mixed histology (27%) or pure lobular cancer (15%, p<0.0001). Patients with ductal carcinoma tended to be younger, with a median age of 50 years compared to 51 years for patients with mixed lobular-ductal histology and 58 years for patients with lobular histology (p=0.0001). Among 410 patients with evaluable margins, margins were less likely to be positive in patients with ductal histology (39% versus 66% for pure lobular and 67% for mixed lobular-ductal histology [p=0.0004]). The 5- and 10-year crude results by site of first failure for patients evaluable at those times were similar for patients with lobular, mixed and ductal carcinomas. In a multivariate analysis for survival including established prognostic factors, neither

  18. Assessment of complications in a randomized controlled study on multimodality therapy for patients following breast-conserving surgery

    International Nuclear Information System (INIS)

    Hiraoka, Masahiro; Inoue, Toshihiko; Kodama, Hiroshi; Sako, Masao

    2002-01-01

    We conducted a randomized controlled study to evaluate the safety and usefulness of a combined treatment of radiotherapy and chemotherapy with doxifluridine (5'-DFUR) plus tamoxifen (TAM) as an adjuvant therapy for breast cancer patients after conservative surgery. The complications observed in this trial are reported herein. A total of 550 patients were registered and randomized (based on factors such as T, N, with/without radiotherapy) to groups A and B. Drug regimens were: group A, 5'-DFUR 600 mg/body/day for 6 months and TAM 20 mg/body/day for 2 years; group B, 5'-DFUR 600 mg/body/day for 2 years and TAM 20 mg/body/day for 2 years. Radiotherapy (2 Gy x 5 times/week, for 5 weeks) was administered to 88.6% of evaluable patients (481/543). Radiation-related acute adverse reactions occurred in 28.5% of the 481 patients and moderate to severe reactions occurred in 1.5% of the patients. Delayed radiation-related adverse reactions occurred in 17.9% of group A patients and 25.6% of group B patients. Grade 3 reactions occurred in 6 of the group A patients (2.4%) and in 5 of the group B patients (1.9%); all adverse reactions subsided after dose reduction or discontinuation. These findings suggest that the combination therapy of irradiation and 5'-DFUR with TAM is safe for patients after breast conserving surgery. (author)

  19. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    International Nuclear Information System (INIS)

    Senthi, Sashendra; Link, Emma; Chua, Boon H.

    2012-01-01

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  20. Results of breast conservation therapy from a single-institution community hospital in Hawaii with a predominantly Japanese population

    International Nuclear Information System (INIS)

    Kanemori, Mark; Prygrocki, Maria C.T.R.

    2005-01-01

    Purpose: To evaluate the outcome data from breast conservation therapy performed at the Kuakini Medical Center in Honolulu, Hawaii. The remarkably low rates of recurrence found in this study prompted a review of the literature and evaluation of the prognostic factors that may explain these results. Methods and materials: The data from patients with Tis, T1 or T2 breast tumors, treated with lumpectomy and radiotherapy during the 12-year period between January 1990 and December 2001 were retrospectively reviewed and compared to results found in national publications. Results: Current follow-up data was available in 97.1% of patients who met these criteria, identifying a total of 896 patients who were analyzed in this study. With a median follow-up exceeding 6 years, the local in-breast failure rate was 0.67%. Survival data was superior to the National Cancer Data Base for each stage of disease. Conclusion: This low rate of local relapse is extraordinary and unmatched by the published results generally cited in the literature. The findings are consistent with other studies reporting unusually low rates of breast cancer recurrence in patients of Japanese ancestry

  1. The effect of age in breast conserving therapy: A retrospective analysis on pathology and clinical outcome data

    International Nuclear Information System (INIS)

    Chen, Wei; Sonke, Jan-Jakob; Stroom, Joep; Bartelink, Harry; Verheij, Marcel; Gilhuijs, Kenneth

    2015-01-01

    Background and propose: Age is an important prognostic marker of patient outcome after breast conserving therapy; however, it is not clear how age affects the outcome. This study aimed to explore the relationship between age with the cell quantity and the radiosensitivity of microscopic disease (MSD) in relation to treatment outcome. Materials and methods: We employed a treatment simulation framework which contains mathematic models for describing the load and spread of MSD based on a retrospective cohort of breast pathology specimens, a surgery simulation model for estimating the remaining MSD quantity and a tumor control probability model for predicting the risk of local recurrence following radiotherapy. Results: The average MSD cell quantities around the primary tumor in younger (age ⩽ 50 years) and older patients were estimated at 1.9 ∗ 10 8 cells and 8.4 ∗ 10 7 cells, respectively (P < 0.01). Following surgical simulation, these numbers decreased to 2.0 ∗ 10 7 cells and 1.3 ∗ 10 7 cells (P < 0.01). Younger patients had smaller average surgical resection volume (118.9 cm 3 ) than older patients (162.9 cm 3 , P < 0.01) but larger estimated radiosensitivity of MSD cells (0.111 Gy −1 versus 0.071 Gy −1 , P < 0.01). Conclusion: The higher local recurrence rate in younger patients could be explained by larger clonogenic microscopic disease cell quantity, even though the microscopic disease cells were found to be more radiosensitive

  2. Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery.

    Science.gov (United States)

    Zhang, Huai-Wen; Hu, Bo; Xie, Chen; Wang, Yun-Lai

    2018-05-01

    This study aimed to evaluate dosimetric differences of intensity-modulated radiation therapy (IMRT) in target and normal tissues after breast-conserving surgery. IMRT five-field plan I, IMRT six-field plan II, and field-in-field-direct machine parameter optimization-IMRT plan III were designed for each of the 50 patients. One-way analysis of variance was performed to compare differences, and P mean dose (D mean ) for the heart (P optimization-IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  3. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Fuh Yong, E-mail: fuhyong@yahoo.com [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Wang, Fuqiang [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Chen, John Ju [Department of Cancer Informatics, National Cancer Centre Singapore (Singapore); Tan, Chiew Har [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Tan, Puay Hoon [Department of Pathology, Singapore General Hospital (Singapore)

    2014-04-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation.

  4. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    International Nuclear Information System (INIS)

    Wong, Fuh Yong; Wang, Fuqiang; Chen, John Ju; Tan, Chiew Har; Tan, Puay Hoon

    2014-01-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation

  5. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Nelson, Carl; Bai, Harrison; Neboori, Hanmanth; Takita, Cristiane; Motwani, Sabin; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, Tiffanie; Goyal, Sharad; Moran, Meena S.

    2012-01-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  6. A case of fat necrosis with ulceration after breast-conserving surgery and postoperative radiation therapy

    International Nuclear Information System (INIS)

    Nomoto, Yuki; Kijima, Yuko; Hirata, Munetsugu; Shinden, Yoshiaki; Arima, Hideo; Nakajo, Akihiro; Hiraki, Tsubasa; Natsugoe, Shoji

    2017-01-01

    An 82 year-old woman was diagnosed with right breast cancer, and partial mastectomy with sentinel lymph node biopsy was performed in another hospital. Lateral subcutaneous fat was mobilized and used to fill mammary gland defect. Two months after surgery, she received postoperative radiation therapy and endocrine therapy. Two years and six months after surgery, induration of the left breast was marked and skin redness appeared. It then became exposed, and the lesion was diagnosed as fat necrosis and abscess the core needle biopsy. Conservative observation was then conducted. Pain developed and pus exudatation continued from the necrotic tissue. Two years and nine months after surgery, she was admitted to our hospital for treatment. Deformity, induration with a fistula, and skin redness were found in the surgically treated and irradiated right breast. The lesion was diagnosed as fat necrosis based on several imaging examinations. Simple mastectomy was performed for pain reduction and to treat the continuous fistula leakage. Since the mass showed firm adhesion with the major pectoral muscle, a part of the muscle was excised. Histology revealed necrotic fat and an abscess with a skin fistula, but not malignancy. The endocrine therapy has been continued, and she has survived without recurrent disease for a year and eight months since surgery. (author)

  7. Contralateral breast cancer and other second malignancies in patients treated by breast-conserving therapy with radiation

    International Nuclear Information System (INIS)

    Kurtz, J.M.; Amalric, R.; Brandone, H.; Ayme, Y.; Spitalier, J.M.

    1988-01-01

    Metachronous contralateral breast cancers and other second malignancies were evaluated in 2,850 patients treated between 1960 and 1981 primarily with radiotherapy (RT) either alone or following breast-conserving surgery. One hundred eighty-four contralateral cancers were observed in 22,491 patient-years of observation (818 per 10(5) patient-years), with a cumulative probability of 4.5% at 5, 7.9% at 10, and 11% at 15 and 20 years. Compared to patients with unilateral tumors, those destined to develop contralateral cancers were younger (mean age 51.9 vs 56.6) and more often gave a family history of breast cancer. Contralateral breast cancers were more frequent for more extensive tumors (T3 10% vs T1-26%; with inflammatory signs 10.6% without 6%), and in patients with ipsilateral local recurrence (with 9.1%, without 5.6%). Patients with contralateral cancers had a significantly less favorable survival experience (15-year actuarial survival after primary therapy 42%) than patients without contralateral cancer (15-year survival 65.5%). In early stage patients treated with conservative surgery and RT, contralateral cancer was not prognostically more favorable than ipsilateral breast recurrence. Among 72 other second malignancies (320 per 10(5) patient-years) were 2 soft tissue sarcomas in the irradiated area. This corresponds to an incidence of 21 cases per 10(5) patient-years for survivors beyond the fifth year. The possible influence of RT on contralateral cancers and other second malignancies is discussed

  8. Cancer of the breast: Conservation surgery and curative radiation therapy - Technique

    International Nuclear Information System (INIS)

    Brady, L.W.; Bedwinek, J.M.; Markoe, A.M.; Micaily, B.; Damsker, J.I.; Karlsson, U.L.

    1987-01-01

    Current evidence strongly suggests that radiation therapy following conservation surgery in the primary local management of stage I and stage II breast cancer can achieve survival and local-regional control rates that are comparable to those obtained by radical and modified radical mastectomy. Since primary radiation therapy has the benefit of leaving the patient with intact and cosmetically acceptable breasts, it should be considered as a viable and reasonable alternative to radical mastectomy. An analysis of current series of primary radiation data suggests that total excision of the tumor should be carried out. An axillary node sampling or dissection including level 1 and level 2 axillary nodes (those lying beneath and lateral to the pectoralis minor muscle) should be carried out in addition to tumor excision since knowledge of the axillary nodal status serves as a prognostic indicator and facilitates the intelligent selection of those patients for adjuvant hormonal or chemotherapy. Technique then becomes a critical and important part of the management of the patient. No effort should be spared to insure that the volumes irradiated are properly chosen, receive the appropriate dose to maximize the potential for local-regional control and done within the context of minimization of complication from the treatment program. It is only under these circumstances that the best in terms of long-term survival and cosmetic can be achieved

  9. Breast conservation therapy based on liberal selection criteria and less extensive surgery. Analysis of cases with positive margins

    International Nuclear Information System (INIS)

    Amemiya, Atsushi; Kondo, Makoto

    1999-01-01

    The relationship between the margin status and the risk of in-breast recurrence (IBR) is an important consideration in patients treated with breast conservation therapy but has not been defined adequately. To address this issue, 1533 clinical stage I and II patients who completed irradiation therapy between 1983 and 1998 were evaluated. Only selection criterion was whether she could be satisfied with cosmesis after lumpectomy. Size and location of the tumor, nodal status, histology and age were not primary consideration. The tumor was excised in such a way to obtain macroscopically clear margins. The breast was treated with 50 Gy of external irradiation but without boost. Margins were evaluated by serially sectioning of the specimen and the margin was judged positive only when cancer cells were present on the inked surface. Margins were also evaluated by scratch cytology. Seventy two IBR were experienced within 5 years. Only age and margin status were found to be independent risk factors. Five-year IBR rate with negative and positive margins was 3.7% and 10.0%, respectively. In patients with positive margins, number of positive site and positive cytology were independent risk factor for IBR. IBR rate among patients with focally involved margins by non-comedo, comedo and invasive ca, was 0.0%, 3.5%, and 8.7%, respectively. IBR rate in more than focal involvement by non-comedo, comedo, and invasive ca, was 4.0%, 33.0% and 30.0%, respectively. If histologically positive margin was also positive cytologically, IBR was 14.8%, whereas only 3.6% if negative cytologically. Even with liberal patient selection and less extensive local treatment, adequate local control can be obtained, provided that margins are histologically and/or cytologically negative. Focal margin involvement by DCIS or more than focal involvement by non-comedo type DCIS does not jeopardize local control. More than focal involvement by comedo DCIS or involvement by invasive ca results in high IBR rate

  10. Adjuvant radiotherapy after breast conserving surgery - a comparative effectiveness research study.

    Science.gov (United States)

    Corradini, Stefanie; Niyazi, Maximilian; Niemoeller, Olivier M; Li, Minglun; Roeder, Falk; Eckel, Renate; Schubert-Fritschle, Gabriele; Scheithauer, Heike R; Harbeck, Nadia; Engel, Jutta; Belka, Claus

    2015-01-01

    The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population. Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan-Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression. Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (pstudy shows a decrease in local control and a survival disadvantage if postoperative radiotherapy after breast conserving surgery is omitted in an unselected cohort of primary breast cancer patients. Due to its epidemiological nature, it cannot answer the question in whom postoperative radiotherapy can be safely omitted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Clinicopathologic Significance of Excision Repair Cross-Complementation 1 Expression in Patients Treated With Breast-Conserving Surgery and Radiation Therapy

    International Nuclear Information System (INIS)

    Goyal, Sharad; Parikh, Rahul R.; Green, Camille; Schiff, Devora B.S.; Moran, Meena S.; Yang Qifeng; Haffty, Bruce G.

    2010-01-01

    Purpose: The excision repair cross-complementation 1 (ERCC1) enzyme plays a rate-limiting role in the nucleotide excision repair pathway and is associated with resistance to platinum-based chemotherapy in cancers of the head and neck and the lung. The purpose of this study was to evaluate the clinicopathologic and prognostic significance of ERCC1 expression in a cohort of early-stage breast cancer patients treated with breast conservation therapy. Methods and Materials: Paraffin specimens from 504 women with early-stage breast cancer treated with breast conservation therapy were constructed into tissue microarrays. The array was stained for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and ERCC1. This was then correlated with clinicopathologic factors and outcomes data. Results: ERCC-1 expression was evaluable in 366 cases (72%). In this group, 32% and 38% of patients received adjuvant chemotherapy and hormonal therapy, respectively. Increased ERCC-1 expression was found to be correlated with ER positivity (p 50 (p 50. To our knowledge, this is the first study investigating ERCC1 expression in patients receiving adjuvant radiation therapy for breast cancer.

  12. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Koyama, Hiroki

    1998-01-01

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ''occult'' inflammatory breast cancer. (author)

  13. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki [Kumamoto City Hospital (Japan); Koyama, Hiroki

    1998-09-01

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ``occult`` inflammatory breast cancer. (author)

  14. In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women Younger Than 40 Years of Age? A Multi-Institution Study

    Energy Technology Data Exchange (ETDEWEB)

    Frandsen, Jonathan; Ly, David [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Cannon, George [Department of Radiation Oncology, Intermountain Medical Center, Murray, Utah (United States); Suneja, Gita [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Matsen, Cindy [Department of General Surgery, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Gaffney, David K. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Wright, Melissa [Oncology Clinical Program, Intermountain Healthcare, Salt Lake City, Utah (United States); Kokeny, Kristine E. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States); Poppe, Matthew M., E-mail: matthew.poppe@hci.utah.edu [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, Utah (United States)

    2015-12-01

    Purpose: Mastectomy is often recommended for women ≤40 years of age with breast cancer, as young women were under-represented in the landmark trials comparing breast conservation therapy (BCT) to mastectomy. We hypothesized that, in the modern treatment era, BCT and mastectomy result in equivalent local control rates in young women. Methods and Materials: Breast cancer cases arising between 1975 and 2013 in women ≤40 years old were collected from the tumor registries of 2 large healthcare systems in Utah. Kaplan-Meier estimates and Cox proportional hazards models were used to analyze freedom from locoregional recurrence (FFLR), overall survival (OS), and relapse-free survival (RFS). Results: This analysis identified 853 BCT candidates. A comparison of BCT to mastectomy after 2000 showed FFLR, RFS, and OS were all similar. Rate for FFLR at 10 years was 94.9% versus 92.1% for BCT and mastectomy, respectively (P=.57). For women whose cancer was diagnosed after 2000, who received BCT, FFLR and RFS rates were improved compared to those whose cancer was diagnosed prior to 2000 (P<.05), whereas OS (P=.46) rates were similar. Among those who underwent mastectomy, FFLR, OS, and RFS were significantly improved (P<.05) with diagnosis after 2000. Conclusions: FFLR rates for young women, ≤40 years of age, have significantly improved for BCT and mastectomy over time. If patients were treated after 2000, BCT appears to be safe and equivalent to mastectomy at 10 years in terms of FFLR, OS, and RFS.

  15. Dosimetric comparison of volumetric modulated arc therapy (VMAT), DMlC (Dynamic IMRT), and 3DCRT in left breast cancer after breast conserving surgery receiving left breast irradiation

    International Nuclear Information System (INIS)

    Pratibha, Bauskar; Vibhay, Pareek; Rajendra, Bhalavat; Chandra, Manish

    2016-01-01

    Previous studies have demonstrated that the risk of ischemic heart disease is increased as a result of exposure to ionizing radiation in women treated for breast cancer. Alternative radiation techniques, such as dynamic intensity-modulated radiation therapy (DMLC), volumetric-modulated arc therapy (VMAT), have been shown to improve dosimetric parameters of the heart and substructures. However, these techniques have not been compared with each other to potentially guide treatment decisions. Volumetric modulated arc therapy (VMAT) is a novel extension of conventional intensity-modulated radiotherapy (c-IMRT), in which an optimized three dimensional dose distribution may be delivered in a single gantry rotation. VMAT is the predecessor to Rapid-Arc (Varian Medical System). This study uses VMAT, DMLC and 3DCRT to compare target volume coverage and doses to organs at risk (OARs), especially lung and heart doses, using these three techniques in whole breast irradiation after breast conserving surgery in left breast cancer cases

  16. Validation of the Web-Based IBTR! 2.0 Nomogram to Predict for Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kindts, Isabelle, E-mail: Isabelle.kindts@uzleuven.be [Department of Oncology, KU Leuven - University of Leuven, Leuven (Belgium); Department of Radiation Oncology, University Hospitals Leuven, Leuven (Belgium); Laenen, Annouschka [Leuven Biostatistics and Statistical Bioinformatics Center (L-Biostat), KU Leuven - University of Leuven, Leuven (Belgium); Peeters, Stephanie; Janssen, Hilde; Depuydt, Tom [Department of Oncology, KU Leuven - University of Leuven, Leuven (Belgium); Department of Radiation Oncology, University Hospitals Leuven, Leuven (Belgium); Nevelsteen, Ines [Department of Oncology, KU Leuven - University of Leuven, Leuven (Belgium); Department of Surgical Oncology, University Hospitals Leuven, Leuven (Belgium); Van Limbergen, Erik; Weltens, Caroline [Department of Oncology, KU Leuven - University of Leuven, Leuven (Belgium); Department of Radiation Oncology, University Hospitals Leuven, Leuven (Belgium)

    2016-08-01

    Purpose: To evaluate the IBTR! 2.0 nomogram, which predicts 10-year ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy with and without radiation therapy for breast cancer, by using a large, external, and independent cancer center database. Methods and Materials: We retrospectively identified 1898 breast cancer cases, treated with breast-conserving therapy and radiation therapy at the University Hospital Leuven from 2000 to 2007, with requisite data for the nomogram variables. Clinicopathologic factors were assessed. Two definitions of IBTR were considered where simultaneous regional or distant recurrence were either censored (conform IBTR! 2.0) or included as event. Validity of the prediction algorithm was tested in terms of discrimination and calibration. Discrimination was assessed by the concordance probability estimate and Harrell's concordance index. The mean predicted and observed 10-year estimates were compared for the entire cohort and for 4 risk groups predefined by nomogram-predicted IBTR risks, and a calibration plot was drawn. Results: Median follow-up was 10.9 years. The 10-year IBTR rates were 1.3% and 2.1%, according to the 2 definitions of IBTR. The validation cohort differed from the development cohort with respect to the administration of hormonal therapy, surgical section margins, lymphovascular invasion, and tumor size. In univariable analysis, younger age (P=.002) and a positive nodal status (P=.048) were significantly associated with IBTR, with a trend for the omission of hormonal therapy (P=.061). The concordance probability estimate and concordance index varied between 0.57 and 0.67 for the 2 definitions of IBTR. In all 4 risk groups the model overestimated the IBTR risk. In particular, between the lowest-risk groups a limited differentiation was suggested by the calibration plot. Conclusions: The IBTR! 2.0 predictive model for IBTR in breast cancer patients shows substandard discriminative ability, with an

  17. Validation of the Web-Based IBTR! 2.0 Nomogram to Predict for Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy.

    Science.gov (United States)

    Kindts, Isabelle; Laenen, Annouschka; Peeters, Stephanie; Janssen, Hilde; Depuydt, Tom; Nevelsteen, Ines; Van Limbergen, Erik; Weltens, Caroline

    2016-08-01

    To evaluate the IBTR! 2.0 nomogram, which predicts 10-year ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy with and without radiation therapy for breast cancer, by using a large, external, and independent cancer center database. We retrospectively identified 1898 breast cancer cases, treated with breast-conserving therapy and radiation therapy at the University Hospital Leuven from 2000 to 2007, with requisite data for the nomogram variables. Clinicopathologic factors were assessed. Two definitions of IBTR were considered where simultaneous regional or distant recurrence were either censored (conform IBTR! 2.0) or included as event. Validity of the prediction algorithm was tested in terms of discrimination and calibration. Discrimination was assessed by the concordance probability estimate and Harrell's concordance index. The mean predicted and observed 10-year estimates were compared for the entire cohort and for 4 risk groups predefined by nomogram-predicted IBTR risks, and a calibration plot was drawn. Median follow-up was 10.9 years. The 10-year IBTR rates were 1.3% and 2.1%, according to the 2 definitions of IBTR. The validation cohort differed from the development cohort with respect to the administration of hormonal therapy, surgical section margins, lymphovascular invasion, and tumor size. In univariable analysis, younger age (P=.002) and a positive nodal status (P=.048) were significantly associated with IBTR, with a trend for the omission of hormonal therapy (P=.061). The concordance probability estimate and concordance index varied between 0.57 and 0.67 for the 2 definitions of IBTR. In all 4 risk groups the model overestimated the IBTR risk. In particular, between the lowest-risk groups a limited differentiation was suggested by the calibration plot. The IBTR! 2.0 predictive model for IBTR in breast cancer patients shows substandard discriminative ability, with an overestimation of the risk in all subgroups. Copyright

  18. Validation of the Web-Based IBTR! 2.0 Nomogram to Predict for Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    International Nuclear Information System (INIS)

    Kindts, Isabelle; Laenen, Annouschka; Peeters, Stephanie; Janssen, Hilde; Depuydt, Tom; Nevelsteen, Ines; Van Limbergen, Erik; Weltens, Caroline

    2016-01-01

    Purpose: To evaluate the IBTR! 2.0 nomogram, which predicts 10-year ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy with and without radiation therapy for breast cancer, by using a large, external, and independent cancer center database. Methods and Materials: We retrospectively identified 1898 breast cancer cases, treated with breast-conserving therapy and radiation therapy at the University Hospital Leuven from 2000 to 2007, with requisite data for the nomogram variables. Clinicopathologic factors were assessed. Two definitions of IBTR were considered where simultaneous regional or distant recurrence were either censored (conform IBTR! 2.0) or included as event. Validity of the prediction algorithm was tested in terms of discrimination and calibration. Discrimination was assessed by the concordance probability estimate and Harrell's concordance index. The mean predicted and observed 10-year estimates were compared for the entire cohort and for 4 risk groups predefined by nomogram-predicted IBTR risks, and a calibration plot was drawn. Results: Median follow-up was 10.9 years. The 10-year IBTR rates were 1.3% and 2.1%, according to the 2 definitions of IBTR. The validation cohort differed from the development cohort with respect to the administration of hormonal therapy, surgical section margins, lymphovascular invasion, and tumor size. In univariable analysis, younger age (P=.002) and a positive nodal status (P=.048) were significantly associated with IBTR, with a trend for the omission of hormonal therapy (P=.061). The concordance probability estimate and concordance index varied between 0.57 and 0.67 for the 2 definitions of IBTR. In all 4 risk groups the model overestimated the IBTR risk. In particular, between the lowest-risk groups a limited differentiation was suggested by the calibration plot. Conclusions: The IBTR! 2.0 predictive model for IBTR in breast cancer patients shows substandard discriminative ability, with an

  19. Is Short-Interval Mammography Necessary After Breast Conservation Surgery and Radiation Treatment in Breast Cancer Patients?

    International Nuclear Information System (INIS)

    Hymas, Richard V.; Gaffney, David K.; Parkinson, Brett T.; Belnap, Thomas W.; Sause, William T.

    2012-01-01

    Purpose: The optimum timing and frequency of mammography in breast cancer patients after breast-conserving therapy (BCT) are controversial. The American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis but no earlier than 6 months after completion of radiotherapy. The National Comprehensive Cancer Network recommends annual mammography. Intermountain Healthcare currently follows a more frequent mammography schedule during the first 2 years in BCT patients. This retrospective study was undertaken to determine the cancer yield mammography during the first 2 years after BCT. Methods and Materials: 1,435 patients received BCT at Intermountain Healthcare between 2003 and 2007, inclusive. Twenty-three patients had bilateral breast cancer (1,458 total breasts). Patients were followed up for 24 months after diagnosis. The 1- and 2-year mammography yields were determined and compared with those of the general screening population. Results: 1,079 breasts had mammography at less than 1 year, and two ipsilateral recurrences (both noninvasive) were identified; 1,219 breasts had mammography during the second year, and nine recurrences (three invasive, six noninvasive) were identified. Of the 11 ipsilateral recurrences during the study, three presented with symptoms and eight were identified by mammography alone. The mammography yield was 1.9 cancers per 1,000 breasts the first year and 4.9 per 1,000 the second year. Conclusions: These data demonstrate that the mammography yield during the first 2 years after BCT is not greater than that in the general population, and they support the policy for initiating followup mammography at 1 year after BCT.

  20. Assessment of radiation dermatitis using objective analysis for patients with breast cancer treated with breast-conserving therapy. Influence of body weight

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Kobayashi, Kana; Tsubokura, Takuji; Kodani, Naohiro; Aibe, Norihiro; Ikeno, Hiroyasu; Nishimura, Takuya; Yoshida, Ken

    2012-01-01

    The purpose of this study was to evaluate the effect of patient factors on radiation dermatitis for patients with breast cancer who underwent postoperative radiotherapy after breast-conserving surgery. The study population comprised 87 patients who underwent breast-conserving surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost radiation (10 Gy/5 fractions). We examined their treated and contralateral breast skin color by use of an objective analyzer, and expressed findings as L*, a*, b* ratios by dividing by pre-radiotherapy (RT) values. Next, we examined correlation between patient factors (age, height, body weight, and body mass index, BMI) and change of L* and a* values by use of correlation coefficients. Radiation therapy caused changes in a* and L* ratios (p<0.0001) but not in b* ratio. The a* ratio (reddish) increased 1.4-fold and peaked after radiotherapy. The L* ratio (darkening) decreased by 10% and reached a minimum value between completion of radiotherapy and 1 month after treatment. Although, age and height did not affect Δ value, body weight and BMI correlated significantly with Δa* value (p=0.0012 and 0.0017) not with ΔL* value. Body weight and BMI predict degree of radiation dermatitis, and more reddish dermatitis was observed for heavier patients than for their lighter counterparts. (author)

  1. Photobiomodulation therapy for the management of radiation-induced dermatitis. A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

    International Nuclear Information System (INIS)

    Strouthos, Iosif; Chatzikonstantinou, Georgios; Tselis, Nikolaos; Bon, Dimitra; Karagiannis, Efstratios; Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos

    2017-01-01

    Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a ''matched'' group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery. (orig.) [de

  2. A multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy

    International Nuclear Information System (INIS)

    Nozaki, Miwako; Kagami, Yoshikazu; Mitsumori, Michihide; Hiraoka, Masahiro

    2012-01-01

    The objective of this study was to investigate late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated radiation therapy in 24 hospitals. This is a prospective investigation into patients who have been followed for 3 years or more after the completion of radiation therapy. The women visited hospitals for routine medical follow-up between 1 March and 31 May 2008. All patients underwent interviews and visual/palpating examinations. Their clinical chart, past chest X-rays and laboratory findings were reviewed. Evaluation criteria for late adverse events and breast cosmetic outcome were based on the Common Terminology Criteria for Adverse Events v.3 and the European Organization for Research and Treatment of Cancer Global Cosmetic Rating System. Seven hundred and three women, including 448 treated with whole-breast irradiation and 255 treated with whole-breast and boost irradiation, were examined by radiation oncologists in 24 hospitals. The frequent adverse events were breast pain (Grade 1, 115; Grade 2, 2), breast fibrosis (Grade 1, 72; Grade 2, 8), chest wall pain (Grade 1, 67; Grade 2, 3), telangiectasia (Grade 1, 29; Grade 2, 5) and pneumonitis (Grade 1, 20; Grade 2, 6; Grade 3, 3). Adverse events of Grade 2 or 3 were found in 27 patients (3.8%); 3 presented with radiation pneumonitis of Grade 3. The percentage of patients with an excellent or good cosmetic outcome was 69.1%. In the first multicenter investigation for Japanese women after breast-conserving therapy, the evaluation of late adverse events and breast cosmetic outcome was similar to several other reports from clinical trials in North America and Europe. (author)

  3. Comparison between intensity modulated radiotherapy (IMRT) and 3D tangential beams technique used in patients with early-stage breast cancer who received breast-conserving therapy

    International Nuclear Information System (INIS)

    Sas-Korczynska, B.; Kokoszka, A.; Korzeniowski, S.; Sladowska, A.; Rozwadowska-Bogusz, B.; Lesiak, J.; Dyczek, S.

    2010-01-01

    Background: The most often found complications in patients with breast cancer who received radiotherapy are cardiac and pulmonary function disorders and development of second malignancies. Aim: To compare the intensity modulated radiotherapy with the 3D tangential beams technique in respect of dose distribution in target volume and critical organs they generate in patients with early-stage breast cancer who received breast-conserving therapy. Materials and methods: A dosimetric analysis was performed to assess the three radiotherapy techniques used in each of 10 consecutive patients with early-stage breast cancer treated with breast-conserving therapy. Radiotherapy was planned with the use of all the three techniques: 3D tangential beams with electron boost, IMRT with electron boost, and intensity modulated radiotherapy with simultaneous integrated boost. Results: The use of the IMRT techniques enables more homogenous dose distribution in target volume. The range of mean and median dose to the heart and lung was lower with the IMRT techniques in comparison to the 3D tangential beams technique. The range of mean dose to the heart amounted to 0.3 - 3.5 Gy for the IMRT techniques and 0.4 - 4.3 for the tangential beams technique. The median dose to the lung on the irradiated side amounted to 4.9 - 5 Gy for the IMRT techniques and 5.6 Gy for the 3D tangential beams technique. Conclusion: The application of the IMRT techniques in radiotherapy patients with early-stage breast cancer allows to obtain more homogenous dose distribution in target volume, while permitting to reduce the dose to critical organs. (authors)

  4. Validation of a Web-Based Tool to Predict the Ipsilateral Breast Tumor Recurrence (IBTR! 2.0) after Breast-Conserving Therapy for Korean Patients.

    Science.gov (United States)

    Jung, Seung Pil; Hur, Sung Mo; Lee, Se Kyung; Kim, Sangmin; Choi, Min-Young; Bae, Soo Youn; Kim, Jiyoung; Kim, Min Kuk; Kil, Won Ho; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo; Nam, Seok Jin; Bae, Jeoung Won; Lee, Jeong Eon

    2013-03-01

    IBTR! 2.0 is a web-based nomogram that predicts the 10-year ipsilateral breast tumor recurrence (IBTR) rate after breast-conserving therapy. We validated this nomogram in Korean patients. The nomogram was tested for 520 Korean patients, who underwent breast-conserving surgery followed by radiation therapy. Predicted and observed 10-year outcomes were compared for the entire cohort and for each group, predefined by nomogram-predicted risks: group 1, 10%. In overall patients, the overall 10 year predicted and observed estimates of IBTR were 5.22% and 5.70% (p=0.68). In group 1, (n=124), the predicted and observed estimates were 2.25% and 1.80% (p=0.73), in group 2 (n=177), 3.95% and 3.90% (p=0.97), in group 3 (n=181), 7.14% and 8.80% (p=0.42), and in group 4 (n=38), 11.66% and 14.90% (p=0.73), respectively. In a previous validation of this nomogram based on American patients, nomogram-predicted IBTR rates were overestimated in the high-risk subgroup. However, our results based on Korean patients showed that the observed IBTR was higher than the predicted estimates in groups 3 and 4. This difference may arise from ethnic differences, as well as from the methods used to detect IBTR and the healthcare environment. IBTR! 2.0 may be considered as an acceptable nomogram in Korean patients with low- to moderate-risk of in-breast recurrence. Before widespread use of this nomogram, the IBTR! 2.0 needs a larger validation study and continuous modification.

  5. Long-term radiation sequelae after breast-conserving therapy in women with early-stage breast cancer: an observational study using the LENT-SOMA scoring system

    International Nuclear Information System (INIS)

    Fehlauer, Fabian; Tribius, Silke; Hoeller, Ulrike; Rades, Dirk; Kuhlmey, Antje; Bajrovic, Amira; Alberti, Winfried

    2003-01-01

    Purpose: To evaluate the long-term toxicity after breast-conserving therapy in women with early-stage breast cancer. Methods and Materials: Late toxicity according to the late effects of normal tissue-subjective, objective, management, and analytic (LENT-SOMA) criteria and cosmetic outcome (graded by physicians) were evaluated in 590 of 2943 women with early-stage breast cancer who were irradiated between 1983 and 1995 using the following fractionation schedules: group A, 1983-1987, 2.5 Gy 4x/wk to 60 Gy; group B, 1988-1993, 2.5 Gy 4x/wk to 55 Gy, group C, 1994-1995, 2.0 Gy 5x/wk to 55 Gy. Results: LENT-SOMA Grade 3-4 toxicity was observed as follows: group A (median follow-up 171 months; range 154-222 months), fibrosis 16% (7 of 45), telangiectasia 18% (8 of 45), and atrophy 4% (2 of 45); group B (median follow-up 113 months; range 78-164 months), pain 2% (8 of 345), fibrosis 10% (34 of 345), telangiectasia 10% (33 of 345), arm edema 1% (2 of 345), and atrophy 8% (27 of 345); and group C (median follow-up 75 months, range 51-96 months, n = 200), occurrence of Grade 3-4 late morbidity ≤2%. The cosmetic outcome was very good to acceptable in 78% (35 of 45) of patients in group A, 83% (286 of 345) in group B, and 94% (187 of 200) in group C. Conclusion: In our population, the long-term side effects after breast-conserving therapy were not rare, but were mainly asymptomatic. The LENT-SOMA breast module is a practical tool to assess radiation-induced long-term toxicity

  6. Impact of neoadjuvant chemotherapy and pathological complete response on eligibility for breast-conserving surgery in patients with early breast cancer: A meta-analysis.

    Science.gov (United States)

    Criscitiello, Carmen; Golshan, Mehra; Barry, William T; Viale, Giulia; Wong, Stephanie; Santangelo, Michele; Curigliano, Giuseppe

    2018-05-04

    We conducted a meta-analysis of randomised trials evaluating pathological complete response (pCR) and surgical outcomes after neoadjuvant systemic therapy (NST) in patients with early breast cancer (EBC). The primary outcome was breast-conserving surgery (BCT) rate. Secondary outcomes were pCR rate and association to BCT. Meta-analyses were performed using random effects models that use inverse-variance weighting for each treatment arm based on evaluable patients. Point estimates are reported with 95% confidence interval (CI), and p < 0.05 was considered statistically significant. Thirty-six studies were identified (N = 12,311 patients). We selected for the analysis 16 of 36 studies reporting both pCR and BCT for at least one treatment arm. Arms per study ranged from one to six; 42 independent units were available to evaluate the association between pCR and BCT. BCT rate ranged 5-76% across arms with an average BCT of 57% (95% CI 52-62%). Significant heterogeneity was observed among the trials (Cochrane Q = 787, p < 0.001, I 2  = 97%). In the meta-regression model, BCT rates were not significantly associated with year of first patient-in (p = 0.89), grade (p = 0.93) and hormone-receptor status (p = 0.39). Clinical N-stage (p = 0.01) and human epidermal growth factor receptor (HER2) status (p = 0.03) were significantly associated with BCT. pCR rate ranged 3-60% across studies. The average pCR across all study arms was 24% (95% CI 19-29%). No association was observed between pCR rate in a study arm and the resulting BCT rate in a univariate model (p = 0.34) nor after adjusting for HER2 and clinical nodal status (p = 0.82). In the subset of 14 multi-arm studies, no significant association was seen between the differences in pCR and BCT between treatment arms (p = 0.27). pCR does not increase BCT in patients receiving NST for EBC. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Association between skin phototype and radiation dermatitis in patients with breast cancer treated with breast-conserving therapy. Suntan reaction could be a good predictor for radiation pigmentation

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Nishimura, Takuya; Kobayashi, Kana; Tsubokura, Takuji; Kodani, Naohiro; Aibe, Norihiro; Nishimura, Tsunehiko; Yoshida, Ken

    2011-01-01

    The purpose of this study was to evaluate the significance of skin phototype (suntan or sunburn type) in association with radiation dermatitis in patients with breast cancer who underwent postoperative radiotherapy after breast-conserving surgery because phototype could predict sunlight reaction. We divided patients into two phototypes (58 suntan/darkening and 28 sunburn/reddening types) according to self-reports before radiotherapy. We examined skin color changes in 86 patients who underwent breast-conserving surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost radiation (10 Gy/5 fractions). Color change was assessed according to CIE L*a*b* space, which is defined by the Commission Internationale de l'Eclairage (CIE) in 1976 for quantitative color assessment. The patients were also assessed by individual typology angle (ITA deg; indicator of skin color calculated by L*a*b* space) and Common Terminology Criteria for Adverse Event v3.0 (CTCAE v3). Radiation therapy changed all values except the b* value, and the suntan type showed a greater darkening response associated with radiation dermatitis than did the sunburn type in terms of ITA deg value change (p=0.04), whereas the sunburn type did not show higher a* value (reddening). By CTCAE v3 classifications, a Grade 2 reaction appeared in 14% sunburn patients and in 31% of the suntan group, respectively (p=0.16). Suntan type predicted higher pigmentation associated with radiation dermatitis. Self-reported phototype has the potential to be a good predictor of skin sensitivity to radiation exposure for clinical screening. (author)

  8. Original Article Surgical Margin Status after Breast Conservation ...

    African Journals Online (AJOL)

    KIGZ

    analysis of breast surgery for breast cancer patients was done from 2008 to 2011 at Aga Khan. University ... early breast cancer, thus breast conservation therapy is becoming more available. Excision of the ... palpable nodes. Histology was ...

  9. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial.

    Science.gov (United States)

    Polgár, Csaba; Fodor, János; Major, Tibor; Sulyok, Zoltán; Kásler, Miklós

    2013-08-01

    To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1-2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI (n=130) or PBI (n=128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n=88) or 50 Gy electron beam (EB) irradiation (n=40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results. After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively (p=0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group (p<0.01). Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Breast-conserving therapy with partial or whole breast irradiation: Ten-year results of the Budapest randomized trial

    International Nuclear Information System (INIS)

    Polgár, Csaba; Fodor, János; Major, Tibor; Sulyok, Zoltán; Kásler, Miklós

    2013-01-01

    Background and purpose: To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Patients and methods: Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1–2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n = 88) or 50 Gy electron beam (EB) irradiation (n = 40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results. Results: After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively (p = 0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group (p < 0.01). Conclusions: Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI

  11. Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy.

    Science.gov (United States)

    Thangarajah, F; Heilmann, J; Malter, W; Kunze, S; Marnitz, S; Mallmann, P; Wenz, F; Sperk, E

    2018-04-01

    Mastectomy is the standard procedure in patients with in-breast tumor recurrence (IBTR) or breast cancer after irradiation of the chest due to Hodgkin's disease. In certain cases a second breast conserving surgery (BCS) in combination with intraoperative radiotherapy (IORT) is possible. To date, data concerning BCS in combination with IORT in pre-irradiated patients are limited. This is the first pooled analysis of this special indication with a mature follow-up of 5 years. Patients with IBTR after external beam radiotherapy (EBRT; treated in two centers) for breast cancer were included. Patients with previous EBRT including the breast tissue due to other diseases were also included. IORT was performed with the Intrabeam™-device using low kV X-rays. Clinical data including outcome for all patients and toxicity for a representative cohort (LENT-SOMA scales) were obtained. Statistical analyses were done including Kaplan-Meier estimates for local recurrence, distant metastasis and overall survival. A total of 41 patients were identified (39 patients with IBTR, 2 with Hodgkin`s disease in previous medical history). Median follow-up was 58 months (range 4-170). No grade 3/4 acute toxicity occurred within 9 weeks. Local recurrence-free survival rate was 89.9% and overall survival was 82.7% at 5 years. Seven patients developed metastasis within the whole follow-up. BCS in combination with IORT in IBTR in pre-irradiated patients is a feasible method to avoid mastectomy with a low risk of side effects and an excellent local control and good overall survival.

  12. Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study

    International Nuclear Information System (INIS)

    Munshi, Anusheel; Dutta, Debnarayan; Kakkar, Sajal; Budrukkar, Ashwini; Jalali, Rakesh; Sarin, Rajiv; Gupta, Sudeep; Parmar, Vani; Badwe, Rajendra

    2010-01-01

    Introduction: To compare quality of life (QOL) in breast cancer patients from a developing country after breast conservation surgery (BCS) or mastectomy and adjuvant radiotherapy (RT). Materials and methods: In a 6-month period, all consecutive early and locally advanced breast cancer patients treated with either BCS or mastectomy and treated with RT were analyzed. All patients who underwent mastectomy were treated with 45 Gray/20/4 weeks. Patients with BCS were treated with a dose of 45-50 Gray/25/5 weeks to whole breast followed by tumor bed boost (15 Gray/6/6 days with suitable energy electrons). Prospective evaluation of QOL using EORTC QLQ C30 and breast cancer specific QLQ BR23 was done before starting RT (baseline), at mid-RT and at RT conclusion for all patients. Results: One hundred and thirteen patients had mastectomy and 142 patients underwent BCS. Reliability test (Cronbach alpha) for questionnaire filling was 0.669-0.886. At pre-RT assessment, global QOL scores in mastectomy and BCS groups were 71.1 and 71.3, respectively. There was no significant difference in pre-RT EORTC QLQ C30 functional and symptom domains between mastectomy and BCS patients. However, social function domain score was higher in patients who underwent mastectomy (83 versus 73.9; p = 0.018). In QLQ BR23 domains, body image and sexual functioning domains were similar between the two groups. However, sexual enjoyment (10.9 versus 47.6; p = 0.006) and future perspective (7.4 versus 37.1; p = 0.036) domains were significantly better in BCS arm. There was no difference between systemic side effect (BRSSE), breast symptom (BRBS) and arm symptom (BRAS) domain scores between the groups. There was no significant difference in change of QOL scores between mastectomy and BCS patients at RT completion as compared to baseline. Conclusions: There was no significant difference in quality of life in patients with BCS versus those with mastectomy. However, patients who underwent BCS had better

  13. Association of Locoregional Control With High Body Mass Index in Women Undergoing Breast Conservation Therapy for Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Bergom, Carmen; Kelly, Tracy; Bedi, Meena; Saeed, Hina; Prior, Phillip; Rein, Lisa E.; Szabo, Aniko; Wilson, J. Frank; Currey, Adam D.; White, Julia

    2016-01-01

    Purpose: Obesity, as measured by the body mass index (BMI), is a risk factor for distant recurrence and decreased survival in breast cancer. We sought to determine whether the BMI correlated with local recurrence and reduced survival in a cohort of predominantly obese women treated with breast conservation therapy. Methods and Materials: From 1998 to 2010, 154 women with early-stage invasive breast cancer and 39 patients with ductal carcinoma in situ underwent prone whole breast irradiation. Cox proportional hazards regression, Kaplan-Meier methods with the log-rank test, and multivariate analysis were used to explore the association of the outcomes with the BMI. Results: The median patient age was 60 years, and the median follow-up duration was 73 months. The median BMI was 33.2 kg/m 2 ; 91% of the patients were overweight (BMI ≥25 kg/m 2 ) and 69% of the patients were clinically obese (BMI ≥30 kg/m 2 ). The BMI was significantly associated with the locoregional recurrence-free interval for patients with invasive cancer and ductal carcinoma in situ (hazard ratio [HR], 1.09; P=.047). Also, a trend was seen for increased locoregional recurrence with a higher BMI (P=.09) for patients with invasive disease, which was significant when examining the outcomes with a BMI stratified by the median value of 33.2 kg/m 2 (P=.008). A greater BMI was also significantly associated with decreased distant recurrence-free interval (HR, 1.09; P=.011) and overall survival (HR, 1.09; P=.004); this association remained on multivariate analysis (distant recurrence-free interval, P=.034; overall survival, P=.0007). Conclusions: These data suggest that the BMI might affect the rate of locoregional recurrence in breast cancer patients. A higher BMI predicted a worse distant recurrence-free interval and overall survival. The present investigation adds to the increasing evidence that BMI is an important prognostic factor in early-stage breast cancer treated with breast conservation

  14. Association of Locoregional Control With High Body Mass Index in Women Undergoing Breast Conservation Therapy for Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bergom, Carmen; Kelly, Tracy; Bedi, Meena; Saeed, Hina; Prior, Phillip [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Rein, Lisa E.; Szabo, Aniko [Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Wilson, J. Frank; Currey, Adam D. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); White, Julia, E-mail: Julia.White@osumc.edu [Department of Radiation Oncology, James Cancer Hospital, Ohio State University Comprehensive Cancer Center, Columbus, Ohio (United States)

    2016-09-01

    Purpose: Obesity, as measured by the body mass index (BMI), is a risk factor for distant recurrence and decreased survival in breast cancer. We sought to determine whether the BMI correlated with local recurrence and reduced survival in a cohort of predominantly obese women treated with breast conservation therapy. Methods and Materials: From 1998 to 2010, 154 women with early-stage invasive breast cancer and 39 patients with ductal carcinoma in situ underwent prone whole breast irradiation. Cox proportional hazards regression, Kaplan-Meier methods with the log-rank test, and multivariate analysis were used to explore the association of the outcomes with the BMI. Results: The median patient age was 60 years, and the median follow-up duration was 73 months. The median BMI was 33.2 kg/m{sup 2}; 91% of the patients were overweight (BMI ≥25 kg/m{sup 2}) and 69% of the patients were clinically obese (BMI ≥30 kg/m{sup 2}). The BMI was significantly associated with the locoregional recurrence-free interval for patients with invasive cancer and ductal carcinoma in situ (hazard ratio [HR], 1.09; P=.047). Also, a trend was seen for increased locoregional recurrence with a higher BMI (P=.09) for patients with invasive disease, which was significant when examining the outcomes with a BMI stratified by the median value of 33.2 kg/m{sup 2} (P=.008). A greater BMI was also significantly associated with decreased distant recurrence-free interval (HR, 1.09; P=.011) and overall survival (HR, 1.09; P=.004); this association remained on multivariate analysis (distant recurrence-free interval, P=.034; overall survival, P=.0007). Conclusions: These data suggest that the BMI might affect the rate of locoregional recurrence in breast cancer patients. A higher BMI predicted a worse distant recurrence-free interval and overall survival. The present investigation adds to the increasing evidence that BMI is an important prognostic factor in early-stage breast cancer treated with

  15. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Gillespie, Erin F.; Matsuno, Rayna K.; Xu, Beibei; Triplett, Daniel P.; Hwang, Lindsay; Boero, Isabel J.; Einck, John P.; Yashar, Catheryn; Murphy, James D.

    2016-01-01

    Purpose: To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. Methods and Materials: We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. Results: Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. Conclusions: This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.

  16. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, Erin F.; Matsuno, Rayna K.; Xu, Beibei; Triplett, Daniel P.; Hwang, Lindsay; Boero, Isabel J.; Einck, John P.; Yashar, Catheryn; Murphy, James D., E-mail: j2murphy@ucsd.edu

    2016-10-01

    Purpose: To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. Methods and Materials: We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. Results: Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. Conclusions: This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.

  17. Managing a small recurrence in the previously irradiated breast. Is there a second chance for breast conservation?

    Science.gov (United States)

    Chadha, Manjeet; Trombetta, Mark; Boolbol, Susan; Osborne, Michael P

    2009-10-01

    Over the past 30 years, lumpectomy and radiation therapy (breast-conservation therapy, or BCT) has been the preferred treatment for early-stage breast cancer. With accumulating follow-up, we have an ever-expanding pool of patients with history of an irradiated intact breast. Routine use of every-6-month or annual screening in this population has identified an emerging clinical dilemma with respect to managing a small recurrence or a second primary tumor in the treated breast. Most women diagnosed with a second cancer in a previously irradiated breast are advised to undergo mastectomy. More recently, with an improved understanding of the patterns of in-breast failure, and with advances in the delivery of conformal radiation dose there is an opportunity to reevaluate treatment alternatives for managing a small in-breast recurrence. A limited number of publications have reported on patient outcomes after a second lumpectomy and radiation therapy for this clinical scenario. In this report, we review the controversial subject of a second chance at breast conservation for women with a prior history of breast irradiation.

  18. Photobiomodulation therapy for the management of radiation-induced dermatitis. A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Strouthos, Iosif [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); Medical Center - Albert Ludwigs University of Freiburg, Department of Radiotherapy and Oncology, Freiburg (Germany); Chatzikonstantinou, Georgios; Tselis, Nikolaos [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); J.W. Goethe University, Department of Radiotherapy and Oncology, Frankfurt am Main (Germany); Bon, Dimitra [J.W. Goethe University, Institute of Biostatistics and Mathematical Modelling, Frankfurt am Main (Germany); Karagiannis, Efstratios [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); Otto von Guericke University, Department of Radiation Oncology, Magdeburg (Germany); Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany)

    2017-06-15

    Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a ''matched'' group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery. (orig.) [German] Radiotherapie (RT) ist integrativer Bestandteil der multimodalen Therapie beim Mammakarzinom. Strahlentherapieinduzierte Hauttoxizitaet ist dabei das haeufigste unerwuenschte Ereignis; dennoch sind Praevention und Management der

  19. Is Mastectomy Superior to Breast-Conserving Treatment for Young Women?

    International Nuclear Information System (INIS)

    Coulombe, Genevieve; Tyldesley, Scott; Speers, Caroline B.A.; Paltiel, Chuck M.Sc.; Aquino-Parsons, Christina; Bernstein, Vanessa; Truong, Pauline T.; Keyes, Mira; Olivotto, Ivo A.

    2007-01-01

    Purpose: To examine whether modified radical mastectomy (MRM) improves outcomes compared with breast-conserving treatment (BCT) in young women. Methods and Materials: Women aged 20-49 years, diagnosed with early breast cancer between 1989 and 1998, were identified. Management with BCT or MRM was compared for local (L), locoregional (LR), and distant relapse-free survival (DRFS) and breast cancer-specific survival (BCSS) by age group (20-39 years, 40-49 years). The analysis was repeated for patients considered 'ideal' candidates for BCT: tumor size ≤2 cm, pathologically negative axillary nodes, negative margins, and no reported ductal carcinoma in situ. Results: A total of 1,597 women received BCT, and 801 had MRM. After a median follow-up of 9.0 years, the outcomes (L, LR, BCSS) were worse for the younger age group; however, the outcomes were not statistically different by type of local treatment. For women aged 20-39 years considered 'ideal' for BCT, those treated with BCT had slightly lower LRFS compared with those treated with MRM (p = 0.3), but DRFS and BCSS were similar. Conclusions: A difference in LRFS at 10 years potentially favored MRM among women aged 20-39 years considered 'ideal' BCT candidates but was not statistically significant and did not translate into a noticeable difference in DRFS or BCSS. Our data suggest that young age alone is not a contraindication to BCT

  20. Oncoplastic Approaches to Breast Conservation

    Directory of Open Access Journals (Sweden)

    Dennis R. Holmes

    2011-01-01

    Full Text Available When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemibatwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, inframammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate.

  1. Oncoplastic Approaches to Breast Conservation

    International Nuclear Information System (INIS)

    Holmes, D.R.; Schooler, W.; Smith, R.

    2011-01-01

    When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemi batwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, infra mammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate

  2. Bronchiolitis obliterans organising pneumonia syndrome presenting with neutrophilia in bronchoalveolar lavage fluid after breast-conserving therapy

    Science.gov (United States)

    Chiba, Sahoko; Jinta, Torahiko; Chohnabayashi, Naohiko; Fujie, Toshihide; Sumi, Yuki; Inase, Naohiko

    2012-01-01

    A 61-year-old female presented with a dry cough and fever 4 months after tangential radiation therapy (RT) following conserving surgery for breast cancer. Chest radiography and CT demonstrated consolidation with air bronchogram outside the irradiated area. Neutrophil granulocytes were abundant in bronchoalveolar lavage fluid (BALF) (39.6% of total cells), and transbronchial lung biopsy revealed organising pneumonia (OP) histologically. Antibiotic therapy had no effect, but corticosteroid therapy brought about clinical improvement. Her condition was diagnosed as bronchiolitis obliterans OP (BOOP) syndrome. Lymphocytic BALF has been identified as a characteristic of BOOP syndrome induced after RT for breast cancer. The BALF in this case, however, was neutrophilic. In our analysis of differential cell counts in the BALF of 24 patients with BOOP syndrome, the BALF was neutrophilic (>5%) in 16 (76%) cases, and the neutrophilia was severe in some of those patients. PMID:22605699

  3. Family history suggestive of an inherited susceptibility to breast cancer and treatment outcome in young women after breast-conserving therapy

    International Nuclear Information System (INIS)

    Chabner, E.; Nixon, A.J.; Garber, J.; Gelman, R.; Bornstein, B.; Connolly, J.; Hetelekidis, S.; Recht, A.; Schnitt, S.; Silver, B.; Harris, J.R.

    1997-01-01

    PURPOSE: To determine whether outcome after conservative surgery and radiation therapy for young women is affected by having a family history (FH) suggestive of an inherited susceptibility to breast cancer. MATERIALS AND METHODS: Between 1968 and 1986, 205 patients 36 years of age or younger at diagnosis were treated with breast-conserving surgery and radiation therapy for clinical stage I or II invasive breast cancer. Three patients were not evaluable for FH; the remainder constitute the study population. At the time of diagnosis, 34 patients (17%; 95% CI 12-29%) had a mother or sister who had breast cancer diagnosed before age 50 years or who had ovarian cancer (2 cases) and were recorded as having a positive FH. This definition was chosen for clinical utility and to maximize the probability of inherited breast cancer within this sub-group (average 40-50%). Without genetic testing, the possibility of misclassification exists in both groups. The median age at diagnosis of the 34 patients with a positive FH was 33 years and was the same as the median age of the 168 patients in whom the FH was negative. All but 2 patients (99%) had a potential follow-up time of at least 5 years; 173 patients (86%) had a potential follow-up time of at least 10 years. RESULTS: Distributions of tumor size, pathologic nodal involvement, histologic type, histologic grade, the presence of an extensive intraductal component or lymphatic vascular invasion, volume of tissue excised, and use of adjuvant chemotherapy did not differ significantly by FH. The distribution of the sites of first failure within the first 5 years of follow-up is shown. The overall pattern of failure was significantly different (p=0.03) between patients with a positive FH and those with a negative FH; however, there was no statistically significant difference (Fisher Exact Test) in percentage of patients with no evidence of disease or local failure. At 5 years follow-up, the development of an opposite breast cancer

  4. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    International Nuclear Information System (INIS)

    Lalani, Nafisha; Paszat, Lawrence; Sutradhar, Rinku; Thiruchelvam, Deva; Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta; Done, Susan J.; Miller, Naomi; Youngson, Bruce; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Chang, Martin C.; Jani, Prashant A.; Bonin, Michel

    2014-01-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  5. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lalani, Nafisha; Paszat, Lawrence [University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Sutradhar, Rinku; Thiruchelvam, Deva [Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta [University of Toronto, Toronto, Ontario (Canada); Department of Anatomic Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Done, Susan J. [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Campbell Family Institute for Breast Cancer Research, Toronto, Ontario (Canada); Miller, Naomi; Youngson, Bruce [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Tuck, Alan [Pathology and Laboratory Medicine, London Health Sciences Centre and Saint Joseph' s Health Care, London, Ontario (Canada); Sengupta, Sandip [Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, Ontario (Canada); Elavathil, Leela [Department of Anatomical Pathology, Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Chang, Martin C. [Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Jani, Prashant A. [Department of Anatomical Pathology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario (Canada); Bonin, Michel [Pathology and Laboratory Medicine, Sudbury Regional Hospital, Sudbury, Ontario (Canada); and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  6. Customized Computed Tomography-Based Boost Volumes in Breast-Conserving Therapy: Use of Three-Dimensional Histologic Information for Clinical Target Volume Margins

    International Nuclear Information System (INIS)

    Hanbeukers, Bianca; Borger, Jacques; Ende, Piet van den; Ent, Fred van der; Houben, Ruud; Jager, Jos; Keymeulen, Kristien; Murrer, Lars; Sastrowijoto, Suprapto; Vijver, Koen van de; Boersma, Liesbeth

    2009-01-01

    Purpose: To determine the difference in size between computed tomography (CT)-based irradiated boost volumes and simulator-based irradiated volumes in patients treated with breast-conserving therapy and to analyze whether the use of anisotropic three-dimensional clinical target volume (CTV) margins using the histologically determined free resection margins allows for a significant reduction of the CT-based boost volumes. Patients and Methods: The CT data from 49 patients were used to delineate a planning target volume (PTV) with isotropic CTV margins and to delineate a PTV sim that mimicked the PTV as delineated in the era of conventional simulation. For 17 patients, a PTV with anisotropic CTV margins was defined by applying customized three-dimensional CTV margins, according to the free excision margins in six directions. Boost treatment plans consisted of conformal portals for the CT-based PTVs and rectangular fields for the PTV sim . Results: The irradiated volume (volume receiving ≥95% of the prescribed dose [V 95 ]) for the PTV with isotropic CTV margins was 1.6 times greater than that for the PTV sim : 228 cm 3 vs. 147 cm 3 (p 95 was similar to the V 95 for the PTV sim (190 cm 3 vs. 162 cm 3 ; p = NS). The main determinant for the irradiated volume was the size of the excision cavity (p < .001), which was mainly related to the interval between surgery and the planning CT scan (p = .029). Conclusion: CT-based PTVs with isotropic margins for the CTV yield much greater irradiated volumes than fluoroscopically based PTVs. Applying individualized anisotropic CTV margins allowed for a significant reduction of the irradiated boost volume.

  7. Relationship of tumor grade to other pathologic features and to treatment outcome for patients with early-stage breast cancer treated with breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Nixon, Asa J; Gage, Irene; Connolly, James L; Schnitt, Stuart; Silver, Barbara; Hetelekidis, Stella; Recht, Abram; Harris, Jay R

    1995-07-01

    Purpose: To study the relationship of tumor grade to the distribution of pathologic features and to the risk of local and distant recurrence following breast-conserving therapy in patients with pure infiltrating ductal carcinoma, and to explore the differences between this type and tubular carcinoma. Materials and Methods: Between 1968 and 1986, 1624 patients were treated for clinical Stage I or II invasive breast cancer with a complete gross excision and {>=}60 Gy to the tumor bed. The original slides were reviewed in 1337 cases (82%). Of these, 1081 were pure infiltrating ductal carcinoma and 28 were tubular carcinoma and these constitute the study population. Fifty-five patients (5%) have been lost to followup after 7-181 months. Median followup for 742 survivors is 134 months (7-278 mos.). We evaluated the following features: histologic grade (modified Bloom-Richardson system), the presence of nodal metastases (in 891 pts. (80%) undergoing axillary dissection [pLN+]), an extensive intraductal component (EIC), lymphatic vessel invasion (LVI), mononuclear cellular response (MCR), and necrosis. We analyzed the incidence of clinical and pathologic characteristics as a function of histology and histologic grade (Table 1). We also examined the 10-year crude rates of first failure for evaluable patients (Table 2) and calculated actuarial curves for regional nodal failure or distant metastasis (RNF/DM) at any time during followup (Figure 1). Results: Conclusions: 1) The proportion of tumors with LVI, EIC, or lymph node involvement did not vary significantly by histologic grade. Low grade tumors tended to be smaller and exhibit less MCR and necrosis; 2) Grade did not predict for local recurrence. Distant recurrence rates were significantly higher in patients with grade II or III as compared with grade I tumors, although recurrence rates continued to rise for grade I tumors through 10 years of followup; 3) Although patient numbers are small, tubular breast carcinomas

  8. Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry–Health Insurance Linkage Database Study

    Directory of Open Access Journals (Sweden)

    William W. Chance

    2017-05-01

    Full Text Available Purpose: To identify rates of postoperative radiation therapy (RT after breast conservation surgery (BCS in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods: The Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results: Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01 and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02 and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03 were found to be significantly less likely to receive RT. Conclusion: Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

  9. Efficacy of single-stage breast-conserving treatment using multicatheter partial breast brachytherapy evaluated by GEC-ESTRO phase 3 trial.

    Science.gov (United States)

    Sato, Kazuhiko; Fuchikami, Hiromi; Kato, Masahiro; Shimo, Takahiro; Kubota, Jun; Takeda, Naoko; Inoue, Yuko; Seto, Hiroshi; Okawa, Tomohiko

    2017-10-01

    The GEC-ESTRO has reported the equivalent outcomes of partial breast irradiation (PBI) using multicatheter interstitial brachytherapy (MCB) to whole breast irradiation (WBI) in breast-conserving therapy (BCT). We performed single-stage BCT with partial breast brachytherapy by intraoperative catheter placement. After the categorization of patients into inclusion and exclusion criteria on this trial, our databases were evaluated in order to translate it to Japanese patients. Patients undergoing BCT were retrospectively examined between November 2007 and December 2015. The technique is an open-cavity implant with a dose of 32 Gy in 8 fractions. The 4-year clinical outcomes of MCB-PBI were evaluated in the 2 distinct categories, and the comparison of the outcomes of MCB-PBI with WBI was performed in patients with unfavorable features. Of a total of 501 lesions undergoing BCT, 301 lesions were treated with MCB-PBI and 200 lesions with WBI. At the median follow-up time of 52 months, the 4-year rate of ipsilateral breast tumor recurrence (IBTR)-free, disease-free (DFS), and overall survival (OS) in patients with MCB-PBI and WBI were 98.9% vs. 98.0% ( p = 0.56), 97.0% vs. 95.3% ( p = 0.78), and 99.6% vs. 98.2% ( p = 0.38), respectively. Although in exclusion cohort treated with MCB-PBI, IBTR-free, and disease-free survival were significantly worse than in inclusion cohort, non-significantly worse outcomes was demonstrated than in exclusion cohort with WBI; IBTR-free survival (95.0% vs. 97.2%, p = 0.24), and disease-free survival (95.0% vs. 95.8%, p = 0.31). Single-stage BCT using MCB-PBI offered similar tumor control rates compering to WBI. However, further research is needed to define the benefit for patients with an exclusion criteria.

  10. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience

    International Nuclear Information System (INIS)

    Peterson, Michael E.; Schultz, Delray J.; Reynolds, Carol; Solin, Lawrence J.

    1999-01-01

    Purpose: To evaluate the significance of final microscopic resection margin status on treatment outcomes in women with early breast cancer who are treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 1021 consecutive women with clinical Stage I or II invasive carcinoma of the breast treated with breast-conserving surgery and definitive breast irradiation. Complete gross excision of tumor was performed in all cases, and an axillary staging procedure was performed to determine pathologic axillary lymph node status. The 1021 patients were divided into four groups based on the final microscopic margin from the tumor excision or from the re-excision if performed. These four groups were: (a) 518 patients with negative margins; (b) 124 patients with focally positive margins; (c) 96 patients with focally close margins (≤ 2 mm); and (d) 283 patients with unknown margins. Results: Local failure was not significantly different in patients with negative, focally positive, focally close or unknown final pathologic margins of resection at 8 years (8% vs. 10% vs. 17% vs. 16%, respectively, p = 0.21). The 8-year outcome also was not different among the four groups for overall survival (86% vs. 83% vs. 88% vs. 81%, respectively, p = 0.13), cause-specific survival (89% vs. 86% vs. 88% vs. 83%, respectively, p 0.14), no evidence of disease survival (81% vs. 73% vs. 86% vs. 77%, respectively, p = 0.09), and freedom from distant metastases (85% vs. 75% vs. 86% vs. 79%, respectively, p = 0.08). Conclusion: These results demonstrate that selected patients with focally positive or focally close microscopic resection margins can be treated with breast-conserving surgery and definitive breast irradiation with 8-year local control rates and survival rates that are similar to those seen in breast-conservation patients with negative or unknown final resection margins

  11. The national survey of breast cancer treatment pattern in Korea (1998): the use of breast-conserving treatment

    International Nuclear Information System (INIS)

    Shin, Hyun Soo; Chang, Sei Kyung; Lee, Hyung Sik

    2004-01-01

    In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast-conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted

  12. Eleven cases of breast conservation

    International Nuclear Information System (INIS)

    Matsuoka, Toshio; Sekine, Kenshi; Miyagawa, Akira; Sugimoto, Toichi

    1991-01-01

    Eleven patients with T1 and small T2 breast cancer were treated by a combination of quadrantectomy, axillary dissection and radiotherapy. The mean age of the patients was 44.6 years. Mean follow-up period was 7.1 months. Six patients had clinical stage I, and five patients had clinical stage II. Four patients had involvement of axillary content (36.3%) on histological examination. There were eight scirrhous carcinomas and three papillotubular carcinomas. The incidence of local and distant recurrence was none in our group. The multifocality of breast cancer based on pathologic studies had been shown. On the basis of these findings we concluded that the patients undergoing breast conservation should be subjected to postoperative radiotherapy. Psychological morbidity was compared in 10 patients treated by breast conservation and 23 patients treated by mastectomy. There were no statistically significant differences between two groups in the estimation of adjustment disorder, depression, anxiety and stress. The patients in breast conservation group had a significant excess or nervousness and the patients of the mastectomy group had an anger. (author)

  13. Hemangiosarcoma after breast-conserving therapy of breast cancer. Report of four cases with molecular genetic diagnosis and literature review; Haemangiosarkom nach brusterhaltender Therapie beim Mammakarzinom. Vier Fallbeispiele mit molekulargenetischer Diagnostik und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Nestle-Kraemling, Carolin [Universitaetsklinikum, Duesseldorf (Germany). Frauenklinik; Boelke, Edwin; Budach, Wilfried [Universitaetsklinikum Duesseldorf (DE). Klinik und Poliklinik fuer Strahlentherapie und radiologische Onkologie] (and others)

    2011-10-15

    Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor. In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature. Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients. Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.

  14. Change over time in the effect of grade and ER on risk of distant failure in patients treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Gelman, Rebecca; Nixon, Asa J.; O'Neill, Anne; Harris, Jay R.

    1996-01-01

    Purpose: Most analyses of the effect of patient and tumor characteristics on long-term outcome in breast cancer use the Cox proportional hazard (prohaz) model, which assumes that hazard rates for any two subsets are proportional (i.e., hazard ratios are constant) over time. We examined whether this assumption is correct for predicting time to distant failure in breast cancer patients treated with breast-conserving therapy and speculated on the biologic implications of these findings. Materials and Methods: Between 1968 and 1986, 1081 patients treated for clinical stage I or II invasive breast cancer with a complete gross excision and ≥60 Gy to the tumor bed had pure infiltrating ductal carcinoma on central pathologic review. 37 patients (3%) were lost to followup after 7-181 months. Median followup for 694 survivors was 12 years (8-23 yrs.). Time to distant failure was defined to be time to regional nodal failure or distant metastases and was not censored for local recurrence, contralateral breast cancer, or death from other causes. We evaluated the following characteristics: histologic grade (modified Bloom-Richardson, 219 grade I, 482 grade II, 380 grade III), estrogen receptor (252 ER neg, 386 ER pos, 443 ER unk), positive axillary nodes (0,1-3,≥4, no axillary dissection in 214), adjuvant chemotherapy (in 291 patients), T stage, lymphatic vessel invasion, mononuclear cell response, clinical size in mm, age at diagnosis, and necrosis. Results: A stepwise prohaz model found all the above characteristics except the last three to be significant (all p 0 (i.e., grade III has a larger risk) but for following years, the log hazard ratio is < 0 (i.e., grade II has a large risk; see Figure for estimated log hazard ratio and 95% CI). The test for non-proportionality of grade II vs. grade I (p=0.08) and ER positive vs negative (p=0.06) were suggestive but the log hazard ratios never cross 0 (i.e., no reversal of direction of risk). Conclusions: Tumor grade clearly

  15. Breast conserving surgery versus mastectomy

    DEFF Research Database (Denmark)

    Christiansen, Peer; Carstensen, Stina Lyck; Ejlertsen, Bent

    2018-01-01

    Background: Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. Methods: The cohort...... included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995–2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients...

  16. Perspectives of Cosmesis following Breast Conservation for Multifocal and Multicentric Breast Cancers

    Directory of Open Access Journals (Sweden)

    Mona P. Tan

    2015-01-01

    Full Text Available Background. Contemporary data suggest that breast conservation treatment (BCT for multifocal and multicentric breast cancer (MFMCBC may be appropriate with noninferior local control rates. However, there is a paucity of data to evaluate patient’s satisfaction with cosmetic outcomes after BCT for MFMCBC. This study was performed to bridge this information gap. Methods. All patients treated at the authors’ healthcare facility were included in the study. Patients with MFMCBC who were assessed to be eligible for BCT underwent tumour resection using standard surgical techniques with direct parenchymal closure through a single incision. After at least three years of follow-up, they were invited to participate in a survey regarding their cosmetic outcomes. Results. Of a total of 160 patients, 40 had MFMCBC, of whom 34 (85% underwent successful BCT. Five-year cancer-specific survival and disease-free survival were 95.7%. Twenty of the 34 patients responded to the survey. No patient rated her cosmetic outcome as “poor.” Analysis indicated low agreement between patients’ self-assessment and clinician-directed evaluation of aesthetic results. Conclusion. BCT for MFMCBC is feasible with acceptable survival and cosmetic outcomes. However, there appears to be a disparity between patient and clinician-directed evaluation of cosmetic results which warrant further research.

  17. Dosimetric study comparing volumetric arc modulation with RapidArc and fixed dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery

    International Nuclear Information System (INIS)

    Tie Jian; Sun Yan; Gong Jian; Han Shukui; Jiang Fan; Wu Hao

    2011-01-01

    Objective: To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery. Methods: Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery. After target definition, treatment planning was performed by RapidArc and two fixed fields dynamic IMRT respectively on the same CT scan. The target dose distribution, homogeneity of the breast, and the irradiation dose and volume for the lungs, heart, and contralateral breast were read in the dose-volume histogram (DVH) and compared between RapidArc and IMRT. The treatment delivery time and monitor units were also compared. Results: In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV), the volume proportion of 95% prescribed dose (V 95% ) was significantly higher by 0.65% in RapidArc (t=5.16, P=0.001), and the V 105% and V 110% were lower by 10.96% and 1.48 % respectively, however, without statistical significance (t=-2.05, P=0.055 and t=-1.33, P=0.197). The conformal index of planning target volume (PTV) by the RapidArc planning was (0.88±0.02), significantly higher than that by the IMRT planning [(0.74±0.03), t=18.54, P<0.001]. The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01, significantly lower than that by the IMRT planning (1.12±0.02, t=-2.44, P=0.02). There were no significant differences in the maximum dose (D max ) and V 20 for the ipsilateral lung between the RapidArc and IMRT planning, but the values of V 10 , V 5 , D min and D mean by RapidArc planning were all significantly higher than those by the IMRT planning (all P<0.01). The values of max dose and V 30 for the heart were similar by both techniques, but the values of V 10 and V 5 by the RapidArc planning were significantly higher (by 18% and 50%, respectively). The V 5 of the contralateral breast and lung by the RapidArc planning were

  18. Failure pattern and survival after breast conserving therapy. Long-term results of the Danish Breast Cancer Group (DBCG) 89 TM cohort

    DEFF Research Database (Denmark)

    Lyngholm, C D; Laurberg, T; Alsner, J

    2016-01-01

    -year overall survival (OS) and recurrence-free survival were 63.7% and 43.1%, respectively. Subdivided by age groups cumulative incidences at 20 years were LR: 18.9%, 10.5% and 12.4%, and DSM: 28.9%, 18.9% and 28.4% in young (≤45 years), middle-aged (46–55 years) and older (≥56 years) women, respectively....... Data from the DBCG database were completed via search through the Danish Pathology Data Bank and medical records. Results: Median follow-up time was 17 years. At 20 years the cumulative incidences of local recurrence (LR) and disease-specific mortality (DSM) were 15.3% and 25.8%, respectively. Twenty....... In an adjusted analysis age maintained a significant and independent effect on both LR and DSM. Conclusion: The DBCG 82 TM program was successfully implemented. The women treated with BCT in the DBCG 89 program displayed equal failure pattern and improved survival in comparison with women from the DBCG 82 TM...

  19. Cosmetic Outcomes and Complications Reported by Patients Having Undergone Breast-Conserving Treatment

    International Nuclear Information System (INIS)

    Hill-Kayser, Christine E.; Vachani, Carolyn; Hampshire, Margaret K.; Di Lullo, Gloria A.; Metz, James M.

    2012-01-01

    Purpose: Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate “excellent” or “good” cosmesis in >90% of patients treated with BCT. Methods and Materials: Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval. Results: Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. “Excellent” cosmesis was reported by 27% (n = 88), “Good” by 44% (n = 144), “Fair” by 24% (n = 81), and “Poor” by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%). Conclusions: This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be “excellent” or “good” than would be expected, with 30% of BCT survivors reporting “fair” or “poor” cosmesis. Patient reported incidence of

  20. Reduction mammaplasty and radiation therapy can allow breast conservation in patients with breast cancers not initially treatable by tumor-ectomy

    International Nuclear Information System (INIS)

    Otmezguine, Y.; Calitchi, E.; Cothier, I.; Feuilhade, F.; Le Bourgeois, J.P.; Baruch, J.

    1997-01-01

    A protocol combining reduction mammaplasty (RM) and radiation therapy was developed as an alternative of mastectomy in patients with breast cancers larger than 3 cm in diameter. This protocol was used in 51 patients between 1983 and 1990. Indications were extensive microcalcifications (n = 17; 33 %) ; residual tumor after neo-adjuvant therapy larger than 4 cm in diameter (n 18 ; 35 %); extensive DCIS (n = 4; 8 %) or tumor located within an area of fibrocystic disease (n = 6; 12 %); presence of a bifocal lesion (n = 12 %. area of fibrocystic disease (n = 6; 12 %); and presence of bifocal lesion (n 6; 12 %). Surgery consisted of tumor-ectomy removing a wide margin of skin and mammary gland, followed by immediate remodeling of the breast, same-side axillary node clearance, and symmetrization of the other breast. A radiation dose of 45 Gy was delivered to the entire mammary gland. Adjuvant therapy was given before and/or after therapy according to the institution's routine breast cancer protocol. During the mean follow-up of 8.1 years, four patients (8 %) developed a local recurrence, which has treated surgically. The five-year disease-free survival rate was 76 %. The cosmetic result was good or very good in 78% of cases. RM plus RT is a reasonable alternative to mastectomy in patients with large breast cancers, although further work is needed to refine its indications. (authors)

  1. Lobular carcinoma in situ as a component of breast cancer: the long-term outcome in patients treated with breast-conservation therapy

    International Nuclear Information System (INIS)

    Moran, Meena; Haffty, Bruce G.

    1998-01-01

    Purpose: The purpose of this study is to assess the long-term outcome of breast cancer patients with a component of lobular carcinoma in situ (LCIS) treated with conservative surgery and radiation therapy. Methods and Materials: The pathology reports of all patients treated with conservative surgery and radiation therapy at our institution prior to 1992 were reviewed to identify patients who had LCIS as a histologic component. A total of 51 patients were identified. Primary histology of the 51 patients was as follows: 53% infiltrating lobular, 20% invasive and intraductal, 18% invasive ductal, 10% intraductal. There were no patients treated who had LCIS only. One thousand forty-five patients treated conservatively during the same time interval without LCIS served as a control group. All patient characteristics, staging, treatment and outcome variables were entered into a computer database. Results: As of (3(96)), the median follow-up for the LCIS-containing group and control group was 10.6 and 11.4 years, respectively. There were no significant differences in age of presentation, clinical stage, nodal status, estrogen receptor status, or adjuvant therapy received between the two groups. Twenty-two patients (43%) in the LCIS group underwent reexcision. Of those, 69% had residual LCIS in the reexcision specimen. LCIS was characterized as focal in 29%, diffuse in 25%, and not specified in all other cases. The primary histology of the two populations differed significantly with a larger percentage of infiltrating lobular primaries in the LCIS group (53 vs. 5%, p < 0.001). The LCIS group also differed from the control group with respect to the percentage of patients with bilateral disease (17 vs. 8%, p = 0.05), and the percentage of patients with 'false negative' mammograms (20 vs. 10%, p = 0.02). There was no statistically significant difference between the LCIS group and control group in the 10-year overall survival (67 vs. 72%), distant disease-free survival (62 vs

  2. Lobular carcinoma in-situ as a component of breast cancer: the long term outcome in patients treated with breast conservation therapy

    International Nuclear Information System (INIS)

    Moran, Meena S.; Haffty, Bruce G.

    1996-01-01

    Purpose: There is a paucity of data regarding prognostic implications of having LCIS as a histologic component of invasive breast carcinomas or ductal carcinoma in situ. The purpose of this study is to assess the long term outcome of patients with breast carcinoma with a component of LCIS, treated with conservative surgery and radiation therapy. Materials and Methods: The pathology reports of all patients treated with conservative surgery and radiation therapy at our institution prior to 1993 were reviewed to identify patients who had LCIS as a histologic component. A total of 51 patients were identified. Primary histology of the 51 patients were as follows: 53% infiltrating lobular, 20% invasive and intraductal, 18% invasive ductal, 10% intraductal. There were no patients treated who had LCIS only. 1023 patients treated conservatively during the same time interval without LCIS served as a control group. All patient characteristics, staging, treatment and outcome variables were entered into a computer database. Overall survival, disease-free survival, local-regional relapse and distant metastasis rates were calculated from the date of diagnosis to the most recent follow-up. Results: As of (3(96)), the median follow-up for the LCIS containing group and control group was 10.6 and 11.4 years, respectively. There were no significant differences in age of presentation, clinical stage, nodal status, estrogen receptor status, or adjuvant therapy received between the two groups. Twenty-two patients (43%) in the LCIS group underwent re-excision. Of those, 68% had residual LCIS in the re-excision specimen. LCIS was characterized as focal in 29%, diffuse in 25%, and not specified in all other cases. Forty-one percent of patients with LCIS containing tumors had a positive family history. The primary histology of the two populations differed significantly with a larger percentage of infiltrating lobular primaries in the LCIS group (53% vs. 4%, p<.001). The LCIS group also

  3. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Baglan, Kathy L.; Martinez, Alvaro A.; Frazier, Robert C.; Kini, Vijay R.; Kestin, Larry L.; Chen, Peter Y.; Edmundson, Greg; Mele, Elizabeth; Jaffray, David; Vicini, Frank A.

    2001-01-01

    Purpose: We present the preliminary results of our in-house protocol using outpatient high-dose-rate (HDR) brachytherapy as the sole radiation modality following lumpectomy in patients with early-stage breast cancer. Methods and Materials: Thirty-seven patients with 38 Stage I-II breast cancers received radiation to the lumpectomy cavity alone using an HDR interstitial implant with 192 Ir. A minimum dose of 32 Gy was delivered on an outpatient basis in 8 fractions of 4 Gy to the lumpectomy cavity plus a 1- to 2-cm margin over consecutive 4 days. Results: Median follow-up is 31 months. There has been one ipsilateral breast recurrence for a crude failure rate of 2.6% and no regional or distant failures. Wound healing was not impaired in patients undergoing an open-cavity implant. Three minor breast infections occurred, and all resolved with oral antibiotics. The cosmetic outcome was good to excellent in all patients. Conclusion: In selected patients with early-stage breast cancer, treatment of the lumpectomy cavity alone with outpatient HDR brachytherapy is both technically feasible and well tolerated. Early results are encouraging, however, longer follow-up is necessary before equivalence to standard whole-breast irradiation can be established and to determine the most optimal radiation therapy technique to be employed

  4. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    International Nuclear Information System (INIS)

    Karlsson, Per; Cole, Bernard F.; Price, Karen N.; Gelber, Richard D.; Coates, Alan S.; Goldhirsch, Aron; Castiglione, Monica; Colleoni, Marco; Gruber, Günther

    2016-01-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  5. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Per, E-mail: per.karlsson@oncology.gu.se [Department of Oncology, Institute of Clinical Sciences, Sahgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg (Sweden); Cole, Bernard F. [Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont (United States); Price, Karen N. [International Breast Cancer Study Group Statistical Center, Frontier Science and Technology Research Foundation, Boston, Massachusetts (United States); Gelber, Richard D. [International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard T. F. Chan School of Public Health, Boston, Massachusetts (United States); Coates, Alan S. [International Breast Cancer Study Group and University of Sydney, Sydney (Australia); Goldhirsch, Aron [Senior Consultant Breast Cancer, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Castiglione, Monica [International Breast Cancer Study Group, Bern (Switzerland); Colleoni, Marco [Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Gruber, Günther [Institute of Radiotherapy, Klinik Hirslanden, Zürich (Switzerland)

    2016-10-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  6. Bell Canyon Test (BCT): cement development report

    International Nuclear Information System (INIS)

    Gulick, C.W.; Boa, J.A. Jr.; Buck, A.D.

    1980-05-01

    The Borehole Plugging (BHP) materials development program which has been underway at WES under Sandia sponsorship for about five years is reviewed. Development testing data for candidate grout mixtures for the BCT plug are presented. Field batching, mixing, and placement operations are discussed. Data from field samples molded during the two plug placements include strength, expansion, compressional wave velocity, dynamic modulus, density, and porosity. Microstructure and composition are compared for grout samples at ages of a few weeks and one year

  7. Breast-conserving treatment of early breast cancer

    International Nuclear Information System (INIS)

    Pirtoli, L.; Bellezza, A.; Pepi, F.; Tucci, E.; Crociani, M.; Crastolla, A.M.; Farzad, M.; Bindi, M.

    1993-01-01

    Results of large prospective trials, often based on selected series and optimal treatment techniques, indicate that breast conserving therapy is appropriate for most patients with early breast cancer. Questions remain regarding the therapeutic outcome in common practice. We report on a series of 206 consecutive, unselected patients treated with current radiotherapy procedures. The Kaplan-Meier evaluation showed 5- and 8-year survival rates (93%, 91%), distant disease-free survival rates (87%, 85%) and local relapse-free survival rates (90%, 88%) that were comparable to those of the conservative arms in reported randomised trials and to the data from retrospective studies reported by authoritative institutions. However, subanalysis according to prognostic factors such as menopausal status, age and axillary nodal status was of limited value, due to the small number of cases. (orig.)

  8. Outcomes After Breast Conservation Treatment With Radiation in Women With Prior Nonbreast Malignancy and Subsequent Invasive Breast Carcinoma

    International Nuclear Information System (INIS)

    Nemani, Deepika; Vapiwala, Neha; Hwang, W.-T.; Solin, Lawrence J.

    2009-01-01

    Purpose: Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy. Methods and Materials: The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years. Results: The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone. Conclusions: Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled

  9. Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study.

    Science.gov (United States)

    Hennigs, André; Biehl, Hannah; Rauch, Geraldine; Golatta, Michael; Tabatabai, Patrik; Domschke, Christoph; Schott, Sarah; Wallwiener, Markus; Schütz, Florian; Sohn, Christof; Heil, Jörg

    2016-05-01

    We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS). This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis. The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p procedures.

  10. A case of bullous pemphigoid exacerbated by irradiation after breast conservative radiotherapy

    International Nuclear Information System (INIS)

    Isohashi, Fumiaki; Konishi, Koji; Umegaki, Noriko; Tanei, Tomonori; Koizumi, Masahiko; Yoshioka, Yasuo

    2011-01-01

    We present a case, considered to be a form of the Koebner phenomenon, of bullous pemphigoid that was exacerbated mainly within the irradiated field after breast conservative radiotherapy. In May 2009, a 60-year-old woman was diagnosed with bullous pemphigoid, which was treated with steroid therapy. The following month, she was diagnosed with breast cancer (invasive ductal carcinoma, pT1cN0M0). After breast conservative surgery in December 2009, conservative radiotherapy to the right breast was performed (50 Gy in 25 fractions). Portal skin showed no serious change (up to grade 1 skin erythema) and no bullous neogenesis during conservative radiotherapy. However, 2 months after conservative radiotherapy, new blisters became exacerbated mainly within the irradiated field but also in the area outside the irradiated field. Increasing the dosage of oral steroid and minocycline resulted in relief of bullous pemphigoid, although patchy skin pigmentation remained especially in the irradiated skin. (author)

  11. Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

    International Nuclear Information System (INIS)

    Najafi, Massoome; Ebrahimi, Mandana; Kaviani, Ahmad; Hashemi, Esmat; Montazeri, Ali

    2005-01-01

    There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

  12. Objective and Longitudinal Assessment of Dermatitis After Postoperative Accelerated Partial Breast Irradiation Using High-Dose-Rate Interstitial Brachytherapy in Patients With Breast Cancer Treated With Breast Conserving Therapy: Reduction of Moisture Deterioration by APBI

    International Nuclear Information System (INIS)

    Tanaka, Eiichi; Yamazaki, Hideya; Yoshida, Ken; Takenaka, Tadashi; Masuda, Norikazu; Kotsuma, Tadayuki; Yoshioka, Yasuo; Inoue, Takehiro

    2011-01-01

    Purpose: To objectively evaluate the radiation dermatitis caused by accelerated partial breast irradiation (APBI) using high-dose-rate interstitial brachytherapy. Patients and Methods: The skin color and moisture changes were examined using a newly installed spectrophotometer and corneometer in 22 patients who had undergone APBI using open cavity implant high-dose-rate interstitial brachytherapy (36 Gy in six fractions) and compared with the corresponding values for 44 patients in an external beam radiotherapy (EBRT) control group (50–60 Gy in 25–30 fractions within 5–6 weeks) after breast conserving surgery. Results: All values changed significantly as a result of APBI. The extent of elevation in a∗ (reddish) and reduction in L∗ (black) values caused by APBI were similar to those for EBRT, with slightly delayed recovery for 6–12 months after treatment owing to the surgical procedure. In contrast, only APBI caused a change in the b∗ values, and EBRT did not, demonstrating that the reduction in b∗ values (yellowish) depends largely on the surgical procedure. The changes in moisture were less severe after APBI than after EBRT, and the recovery was more rapid. The toxicity assessment using the Common Toxicity Criteria, version 3, showed that all dermatitis caused by APBI was Grade 2 or less. Conclusion: An objective analysis can quantify the effects of APBI procedures on color and moisture cosmesis. The radiation dermatitis caused by APBI using the present schedule showed an equivalent effect on skin color and a less severe effect on moisture than the effects caused by standard EBRT.

  13. BCT phase formation in synthesis via microwave assisted hydrothermal method

    International Nuclear Information System (INIS)

    Barra, B.C.; Souza, A.E.; Teixeira, S.R.; Santos, G.T.A.; Lanzi, C.A.C.

    2012-01-01

    In previous work, samples of barium and calcium titanate (Ba1-xCaxTiO3 (BCT x = 0- 1) were prepared using the microwave assisted hydrothermal method in conditions of relatively short time and temperature. To the sample with 75wt% of Ca no BCT phase was formed but the photoluminescent emission was improved. In the present study, these titanates were synthesized by the same method with other concentrations of Ca, Ba1-xCaxTiO3 (x = 0, 0.20, 0.40, 0. 60, 0.80 and 1) to evaluate the limit of BCT phase formation. Results of X-ray diffraction showed that the phase BCT is formed between zero and 50wt%-Ca, in Ba substitution. Above this concentration, was observed only the formation of carbonates, and to x = 1 there was carbonate formation together with CaTiO3. These results were confirmed by micro Raman spectroscopy. (author)

  14. Delayed breast cellulitis: An evolving complication of breast conservation

    International Nuclear Information System (INIS)

    Indelicato, Daniel J.; Grobmyer, Stephen R.; Newlin, Heather; Morris, Christopher G.; Haigh, Linda S.; Copeland, Edward M.; Mendenhall, Nancy Price

    2006-01-01

    Purpose: Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC. Methods and Materials: From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome. Results: Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC. Conclusion: Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended

  15. Additional Surgery after Breast-Conserving Surgery Varies Widely

    Science.gov (United States)

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  16. Breast conservation in the setting of contemporary multimodality treatment provides excellent outcomes for patients with occult primary breast cancer.

    Science.gov (United States)

    Rueth, Natasha M; Black, Dalliah M; Limmer, Angela R; Gabriel, Emmanuel; Huo, Lei; Fornage, Bruno D; Dogan, Basak E; Chavez-MacGregor, Mariana; Yi, Min; Hunt, Kelly K; Strom, Eric A

    2015-01-01

    To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy. We performed a single-institution review of women with occult breast cancer presenting with axillary metastasis without identifiable breast tumor or distant metastasis. We excluded patients with tumors in the axillary tail or mastectomy specimen, patients with additional nonbreast cancer diagnoses, and patients with a history of breast cancer. Breast conservation was defined as axillary node dissection with radiation therapy, without breast surgery. We evaluated patient, tumor, treatment, and outcome variables. Patients were assessed for local, regional, and distant recurrences. Overall survival was calculated using the Kaplan-Meier method. Thirty-six patients met criteria for occult breast cancer. Most of these patients (77.8 %) had N1 disease. Fifty percent of cancers (n = 18) were estrogen receptor-positive; 12 (33.3 %) were triple-negative. All patients were evaluated with mammography. Thirty-five patients had breast ultrasound (97.2 %) and 33 (91.7 %) had an MRI. Thirty-four patients (94.4 %) were treated with chemotherapy and 33 (91.7 %) with radiotherapy. Twenty-seven patients (75.0 %) were treated with breast conservation. The median follow-up was 64 months. There were no local or regional failures. One distant recurrence occurred >5 years after diagnosis, resulting in a 5-years overall survival rate of 100 %. There were no significant survival differences between patients receiving breast conservation versus mastectomy (p = 0.7). Breast conservation-performed with contemporary imaging and multimodality treatment-provides excellent local control and survival for women with T0N+ breast cancer and can be safely offered instead of mastectomy.

  17. A case of postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery

    International Nuclear Information System (INIS)

    Nomura, Shinji; Okazaki, Yoshikazu; Fujii, Masakazu; Akiyama, Norio; Tomozawa, Naofumi; Morishige, Ichiro

    2008-01-01

    The patient was a 50-year-old woman who had undergone breast-conserving surgery for right breast cancer (C area, Bp+Ax, T2N0M0, Stage I, and scirrhous carcinoma), followed by irradiation at a total dose of 50 Gy in 1998. When 6 years 5 months had elapsed after the operation, redness and induration developed in the A area of the right breast. A biopsy via wedge resection was performed and the histopathological diagnosis was angiosarcoma. We could not rule out a possibility of positive surgical stump, and performed additional resection+skin grafting. No sarcoma remnant was demonstrated in the material resected additionally, but 2 years later, the patient experienced recurrence. Thus mastectomy+extended resection of the full thickness of the skin+skin grafting were performed. Postirradiation sarcoma involving the skin and vessels is a rare entity and occurs in 0.03-0.8% of all cases after radiation therapy. It metastasizes to the distant organs in an early stage and carries poor prognosis. No standard therapy for the disease has been established as yet. Early detection and extended resection are considered to contribute to an improvement of the prognosis. This paper deals with such a rare entity as postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery. (author)

  18. Beam self-trapping in a BCT crystal

    Science.gov (United States)

    Matusevich, V.; Kiessling, A.; Kowarschik, R.; Zagorskiy, A. E.; Shepelevich, V. V.

    2006-01-01

    We present some aspects of wave self-focusing and self-defocusing in a photorefractive Ba 0.77Ca 0.23TiO 3 (BCT) crystal without external electric field and without background illumination. The effects depend on the cross-section of the input beam. We show that by decreasing of the diameter of the input beam from 730 μm the fanning effect disappears at 150 μm. A symmetrical self-focusing is observed for input diameters from 150 um down to 40 μm and a symmetrical self-defocusing for input diameters from 40 μm down to 20 μm. The 1D self-trapping is detected at 65 μm in BCT. Light power and wavelength are correspondingly 3 mW and 633 nm. The experimental results are supplemented with numerical calculations based on both photovoltaic model and model of screening soliton.

  19. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    1999-01-01

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  20. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)

    1999-09-01

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  1. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Risk-modifying factors

    International Nuclear Information System (INIS)

    Hille-Betz, Ursula; Soergel, Philipp; Kundu, Sudip; Klapdor, Ruediger; Hillemanns, Peter; Vaske, Bernhard; Bremer, Michael; Henkenberens, Christoph

    2016-01-01

    The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis. LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5). Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters. (orig.) [de

  2. Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery.

    Science.gov (United States)

    Yu, Jennifer; Elmore, Leisha C; Cyr, Amy E; Aft, Rebecca L; Gillanders, William E; Margenthaler, Julie A

    2017-08-01

    The Society of Surgical Oncology and American Society of Radiation Oncology consensus statement was the first professional guideline in breast oncology to declare "no ink on tumor" as a negative margin in patients with stages I/II breast cancer undergoing breast-conservation therapy. We sought to analyze the financial impact of this guideline at our institution using a historic cohort. We identified women undergoing re-excision after breast-conserving surgery for invasive breast cancer from 2010 through 2013 using a prospectively maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with ductal carcinoma in situ. A subcohort of 83 patients (32.7%) who underwent breast-conservation therapy for stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure, per the Society of Surgical Oncology and American Society of Radiation Oncology guideline. The majority had invasive ductal carcinoma (n = 70 [84.3%]) and had invasive disease (n = 45 [54.2%]), and/or ductal carcinoma in situ (n = 49 [59.0%]) within 1 mm of the specimen margin. Seventy-nine patients underwent 1 re-excision and 4 patients underwent 2 re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. Implementation of the Society of Surgical Oncology and American Society of Radiation Oncology consensus guideline holds great potential to optimize resource use. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200

  3. The value of radiotherapy in breast-conserving treatment

    International Nuclear Information System (INIS)

    Kurtz, J.M.

    1994-01-01

    Breast conserving treatment owes its legitimacy to the ability of radiotherapy (RT), in conjunction with limited surgery, to provide local control equivalent to that associated with total mastectomy. This paper will be concerned exclusively with the treatment of the breast, since indications for RT of lymph node areas are independent of the type of breast surgery employed. Randomized trials have enabled quantitation of the effect of reduction in recurrence risk compared to surgery alone. Even though local recurrence is a predictor of metastatic disease, its prevention by breast RT has not yet been shown to improve survival. Thus the main benefits of breast RT relate to preventing the consequences of local failure, namely breast loss. With modern RT techniques, cosmetic results should be satisfactory in 90% of preserved breast. The main clinical research areas concern the optimal sequencing of surgery, RT and chemotherapy, the improvement of local control in high-risk patients, the extension of breast conservation to more advanced cases by the use of neo-adjuvant chemotherapy and RT, the identification of early-stage patients who could be treated with wide excision alone, and the value of RT in ductal in situ carcinomas. (author)

  4. Bilateral breast cancer treated with breast-conserving surgery and definitive irradiation

    International Nuclear Information System (INIS)

    Man, C. Fung; Schultz, Delray; Solin, Lawrence J.

    1996-01-01

    Objective: To assess whether patients with early stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complication rates, and cosmetic outcomes. Material and Methods: We reviewed 55 cases of patients with synchronous or sequential bilateral breast cancer treated with definitive irradiation following breast-conserving surgery at our institution from 1977 to 1992. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, and II. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, AJCC stage, pathologic axillary lymph nodes status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Analysis regarding matching technique, cosmetic outcome, and complication rate was also performed. The 5- and 10-year overall survival (OS), no evidence of disease (NED) survival, relapse-free survival (RFS), and local control rates were evaluated. Twelve women (22%) presented with synchronous bilateral carcinoma, and 43 women (78%) had sequential bilateral carcinoma. Of the 12 patients with synchronous cancer, 5 received adjuvant chemotherapy, 2 received Tamoxifen, and 1 received both adjuvant therapies. Of the 43 patients with sequential cancer, 6 received chemotherapy, 1 received Tamoxifen, and 1 received both adjuvant therapies for the first cancer treatment; seven received chemotherapy and 6 received Tamoxifen for the second cancer treatment. Results: The median age at the time of treatment of the first cancer was 56 years (range 26-86 years). For the 12 patients with synchronous cancer, the median follow-up was 48 months (range 9-164). For the 43 patients with sequential cancer, the median follow-up was 112 months (range 52-188 months) after the first cancer, and 59 months (range 11-153 months) after the second. The median dose delivered was 64 Gy (range 42-72 Gy) using a combination of

  5. Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation: the university of Pennsylvania experience

    International Nuclear Information System (INIS)

    Fung, Man C.; Schultz, Delray J.; Solin, Lawrence J.

    1997-01-01

    Purpose: To determine whether patients with early-stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complications, and cosmesis. Methods and Materials: During the period 1977-1992, 55 women with Stage 0, I, or II concurrent (n = 12) or sequential (n = 43) bilateral breast cancer were treated with definitive irradiation following breast-conserving surgery. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, pathologic axillary lymph node status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Curves for survival, local control, and regional control were determined. Cosmetic outcome, complication rates, and matching technique were analyzed. The median total radiation dose delivered was 64 Gy (range 42-72) using tangential whole-breast irradiation followed by an electron or iridium implant boost. The tangential fields were matched with no overlap in 40 patients (73%); there was overlap on skin of up to 4 cm in 14 patients (25%); and the matching technique was unknown in 1 patient (2%). The median follow-up for the 12 women with concurrent bilateral breast cancer was 4.0 years. The median follow-up for the other 43 women with sequential cancer was 9.3 and 4.9 years, respectively, after the first and second cancers. Results: For the overall group of 55 patients, the 5- and 10-year overall survival rates were 96% and 94%, respectively, after treatment of the first cancer, and 96% and 92%, respectively, after treatment of the second cancer. The 5- and 10-year actuarial relapse-free survival rates were 90% and 75%, respectively, after treatment of the first cancer, and 83% and 72%, respectively, after treatment of the second cancer. For the 110 treated breast cancers, the 5- and 10-year actuarial local failure rates were 5% and 15%, respectively. Complication rates were: 28% breast edema, 8

  6. Re-resection rates and risk characteristics following breast conserving surgery for breast cancer and carcinoma in situ

    DEFF Research Database (Denmark)

    Kryh, C G; Pietersen, C A; Rahr, Hans

    2014-01-01

    OBJECTIVES: To examine the frequency of re-resections and describe risk characteristics: invasive carcinoma or carcinoma in situ (CIS), palpability of the lesion, and neoadjuvant chemotherapy. RESULTS: 1703 breast conserving surgeries were performed: 1575 primary breast conserving surgeries (BCS...

  7. For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.

    Science.gov (United States)

    Sen, Sounok; Soulos, Pamela R; Herrin, Jeph; Roberts, Kenneth B; Yu, James B; Lesnikoski, Beth-Ann; Ross, Joseph S; Krumholz, Harlan M; Gross, Cary P

    2014-05-01

    Little is known about the relationship between operative care for breast cancer at for-profit hospitals and subsequent use of adjuvant radiation therapy (RT). Among Medicare beneficiaries, we examined whether hospital ownership status is associated with the use of breast brachytherapy--a newer and more expensive modality--as well as overall RT. We conducted a retrospective study of female Medicare beneficiaries who received breast-conserving surgery for invasive breast cancer in 2008 and 2009. We assessed the relationship between hospital ownership and receipt of brachytherapy or overall RT by using hierarchical generalized linear models. The sample consisted of 35,118 women, 8.0% of whom had breast-conserving operations at for-profit hospitals. Among patients who received RT, those who underwent operation at for-profit hospitals were more likely to receive brachytherapy (20.2%) than patients treated at not-for-profit hospitals (15.2%; odds ratio [OR] for for-profit versus not-for-profit: 1.50; 95% confidence interval [95% CI] 1.23-1.84; P profit hospital was associated with greater overall use of RT (OR 1.22; 95% CI 1.03-1.45, P = .03) and brachytherapy use (OR 1.66; 95% CI 1.18-2.34, P = .003). Operative care at for-profit hospitals was associated with increased use of the newer and more expensive RT modality, brachytherapy. Among the oldest women who are least likely to benefit from RT, operative care at a for-profit hospital was associated with greater overall use of RT, with this difference largely driven by the use of brachytherapy. Copyright © 2014 Mosby, Inc. All rights reserved.

  8. Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation

    International Nuclear Information System (INIS)

    Ohsumi, Shozo; Takashima, Shigemitsu; Sakamoto Goi

    2003-01-01

    Although many clinical data regarding breast-conserving treatment have already been reported from European and North American countries, few clinical data with long-term follow-up have been reported from Japan. We collected information on therapeutic and possible or developed prognostic factors and follow-up data for Japanese women who had received breast-conserving treatment consisting of wide excision of the primary tumor, axillary dissection and radiotherapy for unilateral breast cancer considered suitable for breast-conserving treatment from 18 Japanese major breast cancer treating hospitals; 1561 patients were registered. The median follow-up period was 77 months. Five-year disease-free and overall survival rates were 89.4 and 95.9%, respectively. The 5-year local recurrence-free rate was 96.3%. The patients with histologically positive margins (P<0.0001) or estrogen receptor negative tumor (P=0.0340) or younger than 40 years old (P<0.0001) developed statistically significantly more local recurrences. Adjuvant endocrine therapy was essential for the estrogen receptor positive patients to have a lower local recurrence rate. Endocrine therapy did not change the local recurrence rate among estrogen receptor negative patients at all. Multivariate analysis showed histological margin status and the combination of estrogen receptor status and endocrine therapy were independent prognostic factors for local recurrence. The 5-year local recurrence rate of Japanese breast cancer patients who were treated with breast-conserving treatment using radiotherapy was 3.7%. Independent prognostic factors for local recurrence were histological margin status and the combination of estrogen receptor status and adjuvant endocrine therapy. (author)

  9. Breast Conserving Treatment for Breast Cancer: Dosimetric Comparison of Sequential versus Simultaneous Integrated Photon Boost

    Directory of Open Access Journals (Sweden)

    Hilde Van Parijs

    2014-01-01

    Full Text Available 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.

  10. Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost.

    Science.gov (United States)

    Van Parijs, Hilde; Reynders, Truus; Heuninckx, Karina; Verellen, Dirk; Storme, Guy; De Ridder, Mark

    2014-01-01

    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. 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. 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. 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.

  11. Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI

    International Nuclear Information System (INIS)

    Kim, Mi Young; Cho, Nariya; Koo, Hye Ryoung; Yun, Bo La; Bae, Min Sun; Moon, Woo Kyung; Chie, Eui Kyu

    2013-01-01

    Background: The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR). Purpose: To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment. Material and Methods: Nineteen consecutive women (mean age, 44 years; range, 34-63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR. Results: In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR. Conclusion: In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment

  12. Diffusion of breast conserving surgery in medical communities.

    Science.gov (United States)

    Jerome-D'Emilia, Bonnie; Begun, James W

    2005-01-01

    Excluding skin cancers, breast cancer is the most common form of cancer in women. Due to an increased focus on early detection, many more cases of breast cancer are now diagnosed at an early stage, which makes the use of breast conserving surgery (BCS) an efficacious and often more desirable treatment choice than mastectomy. An analysis of the variation in the use of BCS in the United States was performed using data from the years 1988 and 1994, and stratifying hospitals on the basis of teaching status. In both 1988 and 1994, BCS was highest in academic teaching hospitals and lowest in community hospitals. This finding is interpreted within the framework of classical diffusion theory. Social and cultural norms in local medical communities have a strong effect on the degree to which innovations diffuse rapidly or not. This analysis is useful in the understanding of geographic and hospital-based variations in treatment for early stage breast cancer and other illnesses that have long and strongly held traditions of treatment.

  13. True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer

    Science.gov (United States)

    Sarsenov, Dauren; Ilgun, Serkan; Ordu, Cetin; Alco, Gul; Bozdogan, Atilla; Elbuken, Filiz; Nur Pilanci, Kezban; Agacayak, Filiz; Erdogan, Zeynep; Eralp, Yesim; Dincer, Maktav

    2016-01-01

    Background: This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy. Methods: 1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded. Results: 53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p 20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p 2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy strategies should be explored further in young patients with large and high-risk tumors to reduce the risk of TR. PMID:27158571

  14. Sonographic diagnosis of abscess following breast-conserving surgery with insertion of nonabsorbable mesh.

    Science.gov (United States)

    Song, Sung Eun; Seo, Bo Kyoung; Son, Gil-Soo; Kim, Young-Sik

    2014-09-01

    Immediate mesh insertion has been recently used for breast reconstruction after breast-conserving surgery. We report a case of abscess formation following immediate nonabsorbable mesh insertion with breast-conserving surgery. In this article, we demonstrate multimodal breast imaging features and pathologic correlations of the case. In addition, we illustrate characteristic sonographic findings of nonabsorbable mesh fibers to differentiate them from a gossypiboma caused by a retained surgical sponge or tumor recurrence. © 2014 Wiley Periodicals, Inc.

  15. Cirurgia conservadora no câncer de mama Breast-conserving surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Daniel Guimarães Tiezzi

    2007-08-01

    Full Text Available O tratamento cirúrgico do câncer de mama sofreu expressivas mudanças nas últimas décadas. A cirurgia conservadora é o tratamento padrão para o câncer de mama em estádio inicial. Com a implementação dos programas de rastreamento e o uso emergente de tratamento sistêmico neoadjuvante, um crescente número de pacientes está sendo considerado elegível para o tratamento conservador. No entanto, uma série de fatores importantes merecem ser considerados no planejamento terapêutico destas pacientes. Esta revisão fornece uma visão geral da metodologia cirúrgica no tratamento conservador do carcinoma da mama.The surgical strategy for breast cancer treatment has changed considerably over the last decade. The breast conserving surgery (BCS is the standard treatment for early stage breast cancer nowadays. With the current population breast cancer screening programs and the emerging use of systemic neoadjuvant therapy, an increasing number of patients have been eligible to BCS. However, several specific factors must be considered for the therapeutic planning for these patients. This review provides a surgical methodology overview for the BCS in breast carcinoma.

  16. Survey on breast cancer patients in China toward breast-conserving surgery.

    Science.gov (United States)

    Zhang, Li; Jiang, Ming; Zhou, Yi; Du, Xiao-Bo; Yao, Wen-Xiu; Yan, Xi; Jiang, Yu; Zou, Li-Qun

    2012-05-01

    We sought to investigate attitudes toward breast-conserving therapy (BCS) in early-stage breast cancer (EBC) patients from P. R. China and assess the factors influencing their decision. There exists geographical difference in decision to perform mastectomy or BCS for EBC patients. To date, there has been no report on attitudes toward BCS or factors influencing the surgical choice in mainland China. A structured questionnaire was delivered to 1800 EBC patients. The questionnaire elicited information about general patients' characteristics, attitudes toward BCS, the roles of doctors and spouses, the levels of understanding of BCS, and the reasons for their preferences. Of 1590 participants, only 7.3% anticipated BCS and this was significantly associated with patient age, income, occupation, martial status, education, levels of self-understanding of the disease, and doctors' and spouses' suggestions (Pwomen (39.2%), even if given another opportunity, only 32.5% of patients preferred to choose it. Moreover, the level of understanding BCS among patients is low (well-known: less-known: never-heard, 2.3 vs 47.4 vs 13.3%). These results suggested that Chinese EBC patients lack accurate and comprehensive understanding of BCS. More efforts are needed to educate breast cancer patients in mainland China toward BCS. Copyright © 2011 John Wiley & Sons, Ltd.

  17. Higher Volume at Time of Breast Conserving Surgery Reduces Re-Excision in DCIS

    Directory of Open Access Journals (Sweden)

    J. H. Wolf

    2011-01-01

    Full Text Available Purpose. The purpose of this study was to compare the surgical and pathological variables which impact rate of re-excision following breast conserving therapy (BCS with or without concurrent additional margin excision (AM. Methods. The pathology database was queried for all patients with DCIS from January 2004 to September 2008. Pathologic assessment included volume of excision, subtype, size, distance from margin, grade, necrosis, multifocality, calcifications, and ER/PR status. Results. 405 cases were identified and 201 underwent BCS, 151-BCS-AM, and 53-mastectomy. Among the 201 BCS patients, 190 underwent re-excision for close or involved margins. 129 of these were treated with BCS and 61 with BCS-AM (P<.0001. The incidence of residual DCIS in the re-excision specimens was 32% (n=65 for BCS and 22% (n=33 for BCS-AM (P<.05. For both the BCS and the BCS-AM cohorts, volume of tissue excised is inversely correlated to the rate of re-excision (P=.0284. Multifocality (P=.0002 and ER status (P=.0382 were also significant predictors for rate of re-excision and variation in surgical technique was insignificant. Conclusions. The rate of positive margins, re-excision, and residual disease was significantly higher in patients with lower volume of excision. The performance of concurrent additional margin excision increases the efficacy of BCS for DCIS.

  18. The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy

    NARCIS (Netherlands)

    Jobsen, J.J.; van der Palen, Jacobus Adrianus Maria; Meerwaldt, J.H.

    2001-01-01

    The aim of the study was to evaluate the importance of young age with regard to local control in a prospective cohort of 1085 women with pathological T1 tumours treated with breast conservative treatment (BCT). Patients were divided into two age groups: 40 years or younger, 7.8%, and older than 40

  19. Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer.

    Science.gov (United States)

    Liu, Qian; Liu, Yinhua; Xu, Ling; Duan, Xuening; Li, Ting; Qin, Naishan; Kang, Hua; Jiang, Hongchuan; Yang, Deqi; Qu, Xiang; Jiang, Zefei; Yu, Chengze

    2014-01-01

    This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer. The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group. The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P surgery were 100% and 88.54%, respectively. There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.

  20. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Risk-modifying factors

    Energy Technology Data Exchange (ETDEWEB)

    Hille-Betz, Ursula; Soergel, Philipp; Kundu, Sudip; Klapdor, Ruediger; Hillemanns, Peter [Hannover Medical School, Department of Obstetrics and Gynaecology, Hannover (Germany); Vaske, Bernhard [Hannover Medical School, Institute of Medical Biometry and Informatics, Hannover (Germany); Bremer, Michael; Henkenberens, Christoph [Hannover Medical School, Department of Radiation Oncology and Special Oncology, Hannover (Germany)

    2016-01-15

    The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis. LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5). Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters. (orig.) [German] Ziel dieser Arbeit war es, Parameter zu identifizieren, die Spaetschaeden nach Radiotherapie, ein unguenstiges

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

    Energy Technology Data Exchange (ETDEWEB)

    Vaidya, Jayant S., E-mail: jayant.vaidya@ucl.ac.uk [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Baum, Michael [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Tobias, Jeffrey S. [Department of Radiation Oncology, University College London Hospitals, London (United Kingdom); Wenz, Frederik [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Massarut, Samuele [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Keshtgar, Mohammed [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Hilaris, Basil [Radiation Oncology, Our Lady of Mercy, New York Medical College, New York (United States); Saunders, Christobel [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Williams, Norman R.; Brew-Graves, Chris [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Corica, Tammy [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Roncadin, Mario [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Kraus-Tiefenbacher, Uta; Suetterlin, Marc [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Bulsara, Max [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Joseph, David [Radiation Oncology, Sir Charles Gairdner Hospital and School of Surgery, University of Western Australia, Perth (Australia)

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  2. Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kolberg, Hans-Christian; Akpolat-Basci, Leyla; Stephanou, Miltiades [Marienhospital Bottrop gGmbH, Department of Gynecology and Obstetrics, Bottrop (Germany); Loevey, Gyoergy [BORAD, Bottrop (Germany); Fasching, Peter A. [University of Erlangen, Erlangen (Germany); Untch, Michael [Helios Klinikum Berlin-Buch, Berlin (Germany); Liedtke, Cornelia [University Hospital Schleswig-Holstein/Campus Luebeck, Luebeck (Germany); Bulsara, Max [University of Notre Dame, Fremantle (Australia); University College, London (United Kingdom); Vaidya, Jayant S. [University College, London (United Kingdom)

    2017-01-15

    The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT). In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared. Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5-year Kaplan-Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5-99.2), EBRT 9 events (81.7%, 95%CI 67.6-90.1), hazard ratio (HR) 0.19 (0.04-0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3-95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5-98.4), EBRT 12 events (69.0%, 49.1-82.4), HR 0.23 (0.06-0.80), log rank p = 0.012. IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost. (orig.) [German] Die intraoperative Radiotherapie (TARGIT-IORT) als vorgezogener Boost im Rahmen der brusterhaltenden Therapie (BET) ist seit 1998 Gegenstand der wissenschaftlichen Diskussion. Wir praesentieren Daten zum Einsatz der IORT bei der BET nach neoadjuvanter Therapie (NACT). In diese retrospektive Analyse

  3. Identification of Patients at Very Low Risk of Local Recurrence After Breast-Conserving Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Sally L., E-mail: ssmith11@bccancer.bc.ca [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Truong, Pauline T. [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Lu, Linghong; Lesperance, Mary [Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia (Canada); Olivotto, Ivo A. [Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)

    2014-07-01

    Purpose: To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). Methods and Materials: Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. Results: The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). Conclusions: Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR.

  4. Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

    LENUS (Irish Health Repository)

    Smith, Myles J

    2012-02-03

    OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase\\/Akt (PI3K\\/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb\\/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K\\/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K\\/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.

  5. The Influence of Repeat Surgery and Residual Disease on Recurrence After Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Bodilsen, Anne; Bjerre, Karsten; Offersen, Birgitte V

    2015-01-01

    BACKGROUND: A significant proportion of women who have breast-conserving surgery (BCS) subsequently undergo re-excision or proceed to mastectomy. This study aimed to identify factors associated with residual disease after repeat surgery and to determine their effect on ipsilateral breast tumor re...

  6. Why do younger women have higher breast cancer recurrence rates after breast-conserving surgery?

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Matsuda, Masakazu; Miyayama, Haruhiko; Okazaki, Shinji; Kai, Chiharu; Ozaki, N.

    2003-01-01

    Preventing breast cancer recurrence after breast-conserving surgery is an important issue. The main factors contributing to such recurrence are positive margins, absence of radiotherapy and young age. To investigate the clinical significance of age in breast-conserving surgery, we examined the relationship between clinicopathological findings or outcome and age, especially young age. The cases were divided into three groups by age; 35 years old or less, 36-50y.o. and 51y.o. or higher. Between April 1989 and March 2003, 743 patients were treated with breast-conserving surgery. There were 49 patients aged 35 years old or less (6.6%). Younger age significantly correlated with positive surgical margin, lymph node metastases, higher proliferative activity, negative estrogen receptor (ER) or progesterone receptor (PgR), larger tumor size, and shorter nipple-tumor distances. Although younger patients had a higher recurrence rate irrespective of radiotherapy, margin status had an impact on recurrence rate. Thus, the reason young age was a significant factor for breast recurrence after breast-conserving surgery was that young patients frequently had numerous risk factors such as positive margin, higher proliferative activity, positive nodes, negative ER/PgR and larger tumor. However, negative surgical margins could reduce recurrence rates even in young women. These results suggest that more suitable criteria and strategies may be needed for young patients with breast cancer. (author)

  7. The Impact of Comorbidities on Outcomes for Elderly Women Treated With Breast-Conservation Treatment for Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Harris, Eleanor E.R.; Hwang, W.-T.; Urtishak, Sandra L.; Plastaras, John; Kinosian, Bruce; Solin, Lawrence J.

    2008-01-01

    Purpose: Breast cancer incidence increases with age and is a major cause of morbidity and mortality in elderly women, but is not well studied in this population. Comorbidities often impact on the management of breast cancer in elderly women. Methods and Materials: From 1979 to 2002, a total of 238 women aged 70 years and older with Stage I or II invasive carcinoma of the breast underwent breast-conservation therapy. Outcomes were compared by age groups and comorbidities. Median age at presentation was 74 years (range, 70-89 years). Age distribution was 122 women (51%) aged 70-74 years, 71 women (30%) aged 75-79 years, and 45 women (19%) aged 80 years or older. Median follow-up was 6.2 years. Results: On outcomes analysis by age groups, 10-year cause-specific survival rates for women aged 70-74, 75-79, and 80 years or older were 74%, 81%, and 82%, respectively (p = 0.87). Intercurrent deaths at 10 years were significantly higher in older patients: 20% in those aged 70-74 years, 36% in those aged 75-79 years, and 53% in those 80 years and older (p = 0.0005). Comorbidities were not significantly more common in the older age groups and did not correlate with cause-specific survival adjusted for age. Higher comorbidity scores were associated with intercurrent death. Conclusions: Older age itself is not a contraindication to standard breast-conservation therapy, including irradiation. Women of any age with low to moderate comorbidity indices should be offered standard breast-conservation treatment if otherwise clinically eligible

  8. The role of a prone setup in breast radiation therapy

    Directory of Open Access Journals (Sweden)

    Nelly eHuppert

    2011-10-01

    Full Text Available Most patients undergoing breast conservation therapy (BCT receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy (IMRT and image-guided radiation therapy (IGRT have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  9. Tumour bed boost radiotherapy for women after breast-conserving surgery.

    Science.gov (United States)

    Kindts, Isabelle; Laenen, Annouschka; Depuydt, Tom; Weltens, Caroline

    2017-11-06

    Breast-conserving therapy, involving breast-conserving surgery followed by whole-breast irradiation and optionally a boost to the tumour bed, is a standard therapeutic option for women with early-stage breast cancer. A boost to the tumour bed means that an extra dose of radiation is applied that covers the initial tumour site. The rationale for a boost of radiotherapy to the tumour bed is that (i) local recurrence occurs mostly at the site of the primary tumour because remaining microscopic tumour cells are most likely situated there; and (ii) radiation can eliminate these causative microscopic tumour cells. The boost continues to be used in women at high risk of local recurrence, but is less widely accepted for women at lower risk. Reasons for questioning the boost are twofold. Firstly, the boost brings higher treatment costs. Secondly, the potential adverse events are not negligible. In this Cochrane Review, we investigated the effect of the tumour bed boost on local control and side effects. To assess the effects of tumour bed boost radiotherapy after breast-conserving surgery and whole-breast irradiation for the treatment of breast cancer. We searched the Cochrane Breast Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to 1 March 2017), Embase (1980 to 1 March 2017), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on 1 March 2017. We also searched the European Society of Radiotherapy and Oncology Annual Meeting, the St Gallen Oncology Conferences, and the American Society for Radiation Oncology Annual Meeting for abstracts. Randomised controlled trials comparing the addition and the omission of breast cancer tumour bed boost radiotherapy. Two review authors (IK and CW) performed data extraction and assessed risk of bias using Cochrane's 'Risk of bias' tool, resolving any disagreements through discussion. We entered data into Review Manager 5 for

  10. Breast conservation treatment of early stage breast cancer: patterns of failure

    Energy Technology Data Exchange (ETDEWEB)

    Leborgne, Felix; Leborgne, Jose H; Ortega, Bettys; Doldan, Raquel; Zubizarreta, Eduardo

    1995-02-15

    Purpose: This study retrospectively assesses the patterns of failure in conservatively treated early stage breast cancer patients by correlating various clinical, pathologic, and treatment-related factors with local, axillary, and distant relapse. Methods and Materials: Between 1973 and 1990, 796 patients (817 breasts) received breast conservation surgery followed by radiotherapy. Local recurrences were counted as events even if they occurred simultaneously or after the appearance of axillary or distant metastases. Results: The 10-year actuarial relative disease-free survival (DFS) rate for T1N0, T2N0, and T1-2N1 was 82%, 71%, and 54%, respectively. Stage N0 patients had a significant DFS advantage over N1 patients (p = 0.02). The 15-year actuarial local recurrence-free rate for T1 and T2 tumors was 82% and 87%, respectively (p = nonsignificant). Univariate analysis identified three significant risk factors for local relapse: (a) 48 breasts with tumors showing an extensive intraductal component had a crude local recurrence rate of 23% compared to 8% for 769 breasts without intraductal component (p 0.0016); (b) the actuarial 10-year local recurrence-free rate for patients under age 40 years was 64% compared to 88% for patients over 40 years (p < 0.0001); (c) the 10-year actuarial local recurrence-free rate for 416 postmenopausal women without adjuvant tamoxifen was 83% compared to 97% for 107 postmenopausal women with tamoxifen (p = 0.0479). Salvage therapy for operable local recurrent patients resulted in a 8-year actuarial DFS rate of 47%, significantly lower than that obtained with primary treatment. The incidence of axillary relapse as the first sign of recurrence was 2%, and could be correlated with the lack of axillary dissection (p < 0.0000005) and primary tumor size (p = 0.03). Radiotherapy to the axilla did not influence axillary relapse. Actuarial 5-year DFS rate after treatment of isolated axillary recurrence was 27%. Axillary failure was a marker for

  11. Breast conservation treatment of early stage breast cancer: patterns of failure

    International Nuclear Information System (INIS)

    Leborgne, Felix; Leborgne, Jose H.; Ortega, Bettys; Doldan, Raquel; Zubizarreta, Eduardo

    1995-01-01

    Purpose: This study retrospectively assesses the patterns of failure in conservatively treated early stage breast cancer patients by correlating various clinical, pathologic, and treatment-related factors with local, axillary, and distant relapse. Methods and Materials: Between 1973 and 1990, 796 patients (817 breasts) received breast conservation surgery followed by radiotherapy. Local recurrences were counted as events even if they occurred simultaneously or after the appearance of axillary or distant metastases. Results: The 10-year actuarial relative disease-free survival (DFS) rate for T1N0, T2N0, and T1-2N1 was 82%, 71%, and 54%, respectively. Stage N0 patients had a significant DFS advantage over N1 patients (p = 0.02). The 15-year actuarial local recurrence-free rate for T1 and T2 tumors was 82% and 87%, respectively (p = nonsignificant). Univariate analysis identified three significant risk factors for local relapse: (a) 48 breasts with tumors showing an extensive intraductal component had a crude local recurrence rate of 23% compared to 8% for 769 breasts without intraductal component (p 0.0016); (b) the actuarial 10-year local recurrence-free rate for patients under age 40 years was 64% compared to 88% for patients over 40 years (p < 0.0001); (c) the 10-year actuarial local recurrence-free rate for 416 postmenopausal women without adjuvant tamoxifen was 83% compared to 97% for 107 postmenopausal women with tamoxifen (p = 0.0479). Salvage therapy for operable local recurrent patients resulted in a 8-year actuarial DFS rate of 47%, significantly lower than that obtained with primary treatment. The incidence of axillary relapse as the first sign of recurrence was 2%, and could be correlated with the lack of axillary dissection (p < 0.0000005) and primary tumor size (p = 0.03). Radiotherapy to the axilla did not influence axillary relapse. Actuarial 5-year DFS rate after treatment of isolated axillary recurrence was 27%. Axillary failure was a marker for

  12. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: Long-term results of the ARCOSEIN multicenter randomized study

    International Nuclear Information System (INIS)

    Toledano, Alain; Garaud, Pascal; Serin, Daniel; Fourquet, Alain; Bosset, Jean-Francois; Breteau, Noel; Body, Gilles; Azria, David; Le Floch, Olivier; Calais, Gilles

    2006-01-01

    Purpose: In 1996, a multicenter randomized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) after breast-conserving surgery (ARCOSEIN study). After a median follow-up of 6.7 years (range, 4.3-9 years), we decided to prospectively evaluate the late effects of these 2 strategies. Methods and Materials: A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination. Seventy-two percent (214 patients) were eligible for evaluation of late toxicity. After breast-conserving surgery, patients were treated either with sequential treatment with CT first followed by RT (Arm A) or CT administered concurrently with RT (Arm B). In all patients, CT regimen consisted of mitoxantrone (12 mg/m 2 ), 5-FU (500 mg/m 2 ), and cyclophosphamide (500 mg/m 2 ), 6 cycles (Day 1 to Day 21). Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy (± boost to the primary tumor bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist, according to the LENT/SOMA scale. Skin pigmentation was also evaluated according to a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results: Among the 214 evaluable patients, 107 were treated in each arm. The 2 populations were homogeneous for patient, tumor, and treatment characteristics. Subcutaneous fibrosis (SF), telangectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain, breast edema, or lymphedema. No deaths were caused by late toxicity. Conclusion: After breast-conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects

  13. Local tumor control and cosmetic outcome following breast-conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer patients

    International Nuclear Information System (INIS)

    Bayerl, A.

    2001-01-01

    Purpose: To evaluate overall survival, local tumor control and cosmetic outcome after breast-conserving surgery followed by radiotherapy without boost irradiation. Patients and Methods: In a retrospective study 270 breast cancer patients were treated with breast conserving surgery combined with a homogenous radiation of the tumor bearing breast up to a total dose of 56 Gy without local boost irradiation. Mean follow-up was 48 months. Local tumor control, side effects, cosmetic results and contentment with treatment were assessed using physical examinations and interviews based on a standardized questionnaire. Results: Cause-specific survival at 5 years after treatment was 88.3%, actuarial disease-free survival at 5 years was 76.1%. Within 23 to 78 months after treatment 12 patients suffered from ipsilateral breast recurrence. The actuarial freedom from local recurrence (single tumor manifestation) was 96.8% at 5 years after treatment, 89% at 10 years. The occurrence of local failures was not significantly correlated to tumor size, margins, grading, nodal status, age or lymphangiosis. 15.6% of the patients developed distant metastases. In all patients treatment was performed without interruption. Side effects were predominantly of mild degree, no severe side effects were detected. 73% of physicians and 81% of patients scored their cosmetic outcome as excellent or good. 93% of patients would again decide in favor of this procedure. Whereas, use of adjuvant chemotherapy as well as subcutaneous reconstruction of breast tissue did not significantly affect breast cosmesis, analysis demonstrated impaired cosmetic results related to a larger breast size. Conclusion: The data of this study show that tumor control achieved by breast conserving surgery in combination with a radiation technique up to a total dose of 56 Gy which omits boost irradiation is within the range of literature data. Side effects of the therapy were tolerable. The treatment displayed a good

  14. Methods and clinical utility of intraoperative radiotherapy (IORT) in breast-conserving surgery

    International Nuclear Information System (INIS)

    Miyauchi, Mitsuru; Yamamoto, Naoto; Fujita, Yoshihiro; Honda, Ichiro; Hatano, Kazuo; Sekiya, Yuichi; Suzuki, Masato; Nakajima, Nobuyuki.

    1996-01-01

    We have developed an intraoperative radiotherapy technique in breast-conserving surgery. Following lumpectomy and axillary dissection up to Level II, the subcutaneous fat layer was lifted from the gland over the entire breast. Electron beams of 25 Gy were irradiated within cylinder, avoiding the skin and subcutaneous tissue. The surface of the gland was covered with cotton swabs saturated with normal saline to equalize the energy depth to the chest wall. This technique has so far been applied to 8 patients, all of whom went through a successful postoperative period without serious complications. The cosmetic results were satisfactory from immediately after the operation. Intraoperative radiotherapy combined with breast-conserving surgery may be helpful in improving the QOL of patients by eliminating the adverse effects associated radiation injury to the skin of the breast and long-term postoperative follow-up. (author)

  15. 40 CFR 451.13 - Effluent limitations attainable by the application of the best conventional technology (BCT).

    Science.gov (United States)

    2010-07-01

    ... application of the best conventional technology (BCT). 451.13 Section 451.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CONCENTRATED AQUATIC ANIMAL... limitations attainable by the application of the best conventional technology (BCT). Except as provided in 40...

  16. 40 CFR 451.23 - Effluent limitations attainable by the application of the best conventional technology (BCT).

    Science.gov (United States)

    2010-07-01

    ... application of the best conventional technology (BCT). 451.23 Section 451.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CONCENTRATED AQUATIC ANIMAL... application of the best conventional technology (BCT). Except as provided in 40 CFR 125.30 through 125.32, any...

  17. Breast conservation surgery versus total mastectomy among women with localized breast cancer in Soweto, South Africa

    Science.gov (United States)

    Dietz, Donald; Rosenbaum, Evan; Murugan, Nivashni; Chih, Ming Tsai; Ayeni, Oluwatosin; Dickens, Caroline; Crew, Katherine

    2017-01-01

    Purpose Breast conserving surgery (BCS) has become the preferred surgical option for the management of patients with nonmetastatic breast cancer in high-income countries. However, little is known about the distribution and determinants of BCS in low-and middle-income countries, especially those with high HIV prevalence. Methods We compared demographic and clinical characteristics of female patients who received BCS and those who received total mastectomy (TM) for nonmetastatic invasive carcinoma of the breast in Soweto, South Africa, 2009–2011. We also developed a multivariable logistic regression model of predictors of type of surgery. Results Of 445 patients, 354 (80%) underwent TM and 91 (20%) BCS. Of 373 patients screened for HIV, 59 (15.8%) tested positive. Eighty-two of 294 patients with stage I/II disease (28%), but just 9 of 151 (6%) with stage III disease had BCS (p<0.001). All women who received BCS (except for seven who received completion mastectomy within 6 weeks of BCS) and 235 (66.4%) women who received TM were referred for radiation therapy (RT). In our multivariable analysis, age group 50–59 years (OR = 2.28, 95% CI = 1.1–4.8) and ≥70 years (OR = 9.55, 95% CI = 2.9–31.2) vs. age group <40 years, stage at diagnosis (stage II (OR = 3.79, 95% CI = 1.6–8.2) and stage III (OR = 27.8, 95% CI = 9.0–78.8) vs. stage 1, HIV (HIV positive (OR = 3.19, 95% CI = 1.3–7.9) vs. HIV negative) and HER2-enriched subtype (OR = 3.50, 95% CI = 1.2–10.1) vs. triple negative were independently associated with TM. Conclusion TM was more common than BCS among patients with nonmetastatic breast cancer in Soweto, not only among patients with locally advanced disease at diagnosis, but also among women with stage I and II disease. PMID:28797046

  18. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  19. Breast conserving surgery in locoregional treatment of breast carcinoma after Hodgkin lymphoma

    International Nuclear Information System (INIS)

    Haberer, S.; Le Scodan, R.; Kirova, Y.M.; Moisson, P.; Campana, F.; Fourquet, A.; Bollet, M.A.; Belin, L.; Savignoni, A.; Stevens, D.; Decaudin, D.; Pierga, J.Y.; Reyal, F.

    2012-01-01

    Purpose. - To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery. Patients and methods. - Medical records of 72 women who developed either ductal carcinoma in situ or stage I-III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed. Results. - Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40 Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%). Conclusions. - Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position. (authors)

  20. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] (and others)

    2001-06-01

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  1. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    2001-01-01

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  2. Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy

    International Nuclear Information System (INIS)

    Lupe, Krystine; Truong, Pauline T.; Alexander, Cheryl; Lesperance, Mary; Speers, Caroline; Tyldesley, Scott

    2011-01-01

    Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age 10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.

  3. Breast conserving surgery following primary irradiation in 3-7 cm breast cancer: pathologic response and outcome

    International Nuclear Information System (INIS)

    Saint-Gaudens, Anne Bareille; Vilcoq, Jacques R.; Campana, Francois; Gautier, Chantal; Asselain, Bernard; Rocherfordiere, Anne de la; Clough, Krishna B.; Fourquet, Alain

    1997-01-01

    Purpose: To retrospectively evaluate histologic response and outcome of patients treated by primary irradiation followed by conservative surgery. Materials and Methods: Between 1981 and 1993, 1742 patients (pts.) with large 3-7 cm invasive breast cancer were treated by primary breast and nodes irradiation in our institution. Of these, 311 pts. (18%) further underwent a wide excision of the residual tumor. Median age was 55 years (yrs.) (29 - 79 yrs.). Median breast tumor size was 40 mm (35 - 70mm). 149 pts. (48%) were premenopausal. 142 pts (46%) had clinically palpable axillary nodes. Diagnosis of invasive breast cancer was performed in all patients by drill biopsy. Following diagnosis, all 311 patients were treated by external irradiation to the breast and regional nodes. Median dose to the breast was 55 Gy (50 - 64 Gy) over 5.5 weeks. Following this irradiation, all patients underwent a wide surgical excision with (140 pts; 45%) or without (171 pts; 55%) axillary node dissection. In addition, 70 pts (22.5%) received adjuvant chemotherapy and 70 pts. received hormone therapy after local treatment. All patients were then regularly followed. Results: Median residual breast tumor size after completion of irradiation was 20 mm (0 - 50mm). On pathologic examination, 34 (11%) tumors had no residual malignant cells (complete response), 137 tumors (44%) had residual fibrosis with clusters of viable cells (partial response), and 138 tumors (45%) had residual viable malignant cells (no response). Median follow up was 106 months (10 - 188 months). Actuarial 9-year overall survival rate was 69 % ± 6%. The 9-year metastasis-free interval was 58 % ± 6%. The 9-year breast recurrence rate was 22 % ± 5 %. The 9-year breast preservation rate was 84% ± 5%. Pathologic response was not predictive of outcome, either distant or local. Conclusion: This retrospective study showed that in patients with tumors too large to be treated by upfront breast-conserving surgery, primary breast

  4. Intraoperative boost radiation effects on early wound complications in breast cancer patients undergoing breast-conserving surgery

    Science.gov (United States)

    Gülçelik, Mehmet Ali; Doğan, Lütfi; Karaman, Niyazi; Turan, Müjdat; Kahraman, Yavuz Selim; Akgül, Gökhan Giray; Özaslan, Cihangir

    2017-08-23

    Background/aim: Intraoperative radiation therapy (IORT) may pose a risk for wound complications. All technical aspects of IORT regarding early wound complications were evaluated. Materials and methods: Ninety-three consecutive patients operated on with the same surgical technique and given (study group) or not given (control group) IORT were included. Wound complications were evaluated in two groups. Results: Forty-three patients were treated with boost dose IORT and 50 patients were treated with breast-conserving surgery without IORT. When both groups were compared in terms of early postoperative complications, there were 11 (25.5%) patients with seroma in the IORT group and 3 patients (6%) in the control group (P = 0.04). While 9 (21%) patients were seen to have surgical site infection (SSI) in the IORT group, there was 1 (2%) SSI in the control group (P = 0.005). There were 15 (35%) patients with delayed wound healing in the IORT group and 4 patients (8%) in the control group (P = 0.006). Conclusion: IORT could have a negative effect on seroma formation, SSI, and delayed healing. It should be kept in mind, however, that in centers with IORT implementation, the complication rate could also increase. Necessary measures for better sterilization in the operating room should be taken, while patient wound healing should be monitored closely.

  5. Volatiles emitted by Bacillus sp. BCT9 act as growth modulating agents on Lactuca sativa seedlings.

    Science.gov (United States)

    Fincheira, Paola; Parra, Leonardo; Mutis, Ana; Parada, Maribel; Quiroz, Andrés

    2017-10-01

    Chemical products are applied during horticulture to increase food production, but the environmental problems resulting from these applications have led to a search for more sustainable products. Volatile organic compounds (VOCs) demonstrating plant growth promoter (PGP) activity released by bacterial species have emerged as alternatives, but their effects on Lactuca sativa growth are unknown. In this study, VOCs released by Bacillus sp. BCT9 cultures grown in different media (Methyl Red & Voges Proskauer, Murashige & Skoog and nutrient media) at concentrations of 0.1, 0.2, 0.5 and 0.7 (measured as the absorbance, λ=600nm) were tested to evaluate their activity as growth inducers of L. sativa after 10days of exposure. Lower concentrations of BCT9 increased root length, and higher concentrations induced shoot length and lateral root length. The dry weight and number of lateral roots increased similarly, independent of concentration, for VOCs produced in all culture media. BCT9 cultures grown in Methyl Red & Voges Proskauer medium as bioactive compounds with or without lanolin. These VOCs increased shoot length, root length and dry weight at low concentrations, independent of the presence of lanolin. Lateral root length increased with the application of 2-nonanone (50ppm) and 2-undecanone (0.05ppm). Based on these results, the use of bioactive volatiles as growth inducers of horticultural species represents an alternative or complementary strategy. Copyright © 2017 Elsevier GmbH. All rights reserved.

  6. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

    Directory of Open Access Journals (Sweden)

    Guilherme Freire Angotti Carrara

    Full Text Available OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04. A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01. CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

  7. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2013-07-01

    Full Text Available BackgroundBreast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.MethodsFrom September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.ResultsThe average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.ConclusionsPartial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

  8. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ho Yong Park

    2013-07-01

    Full Text Available Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

  9. Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia.

    Science.gov (United States)

    Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon; Yi, Jae-Woo

    2017-09-01

    Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

  10. Reduction mammaplasty and radiation therapy can allow breast conservation in patients with breast cancers not initially treatable by tumor-ectomy; Apport de la plastie mammaire de reduction, associee a la radiotherapie, dans le traitement conservateur des cancers du sein non accessibles a une tumorectomie de premiere intention

    Energy Technology Data Exchange (ETDEWEB)

    Otmezguine, Y.; Calitchi, E.; Cothier, I.; Feuilhade, F.; Le Bourgeois, J.P.; Baruch, J. [Hopital Henri-Mondor, 94 - Creteil (France)

    1997-09-01

    A protocol combining reduction mammaplasty (RM) and radiation therapy was developed as an alternative of mastectomy in patients with breast cancers larger than 3 cm in diameter. This protocol was used in 51 patients between 1983 and 1990. Indications were extensive microcalcifications (n = 17; 33 %) ; residual tumor after neo-adjuvant therapy larger than 4 cm in diameter (n 18 ; 35 %); extensive DCIS (n = 4; 8 %) or tumor located within an area of fibrocystic disease (n = 6; 12 %); presence of a bifocal lesion (n = 12 %); area of fibrocystic disease (n = 6; 12 %); and presence of bifocal lesion (n 6; 12 %). Surgery consisted of tumor-ectomy removing a wide margin of skin and mammary gland, followed by immediate remodeling of the breast, same-side axillary node clearance, and symmetrization of the other breast. A radiation dose of 45 Gy was delivered to the entire mammary gland. Adjuvant therapy was given before and/or after therapy according to the institution`s routine breast cancer protocol. During the mean follow-up of 8.1 years, four patients (8 %) developed a local recurrence, which has treated surgically. The five-year disease-free survival rate was 76 %. The cosmetic result was good or very good in 78% of cases. RM plus RT is a reasonable alternative to mastectomy in patients with large breast cancers, although further work is needed to refine its indications. (authors). 15 refs.

  11. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Sun Young [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Surgery, Kyung Hee University, Seoul (Korea, Republic of); Lee, Seung Ju [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Tae Hyun [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kang, Han-Sung [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Cho, Kwan Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2011-12-01

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  12. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    International Nuclear Information System (INIS)

    Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

    2011-01-01

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  13. Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines.

    Science.gov (United States)

    Heelan Gladden, Alicia A; Sams, Sharon; Gleisner, Ana; Finlayson, Christina; Kounalakis, Nicole; Hosokawa, Patrick; Brown, Regina; Chong, Tae; Mathes, David; Murphy, Colleen

    2017-12-01

    In 2014, SSO-ASTRO published guidelines which recommended "no ink on tumor" as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision rates at our institution. Patients treated with breast conservation surgery from January 1, 2010-March 1, 2016 were identified. Re-excision rates, tumor characteristics, and presence of residual disease were recorded. The 2016 guidelines were retrospectively applied to the same cohort and expected re-excision rates calculated. Re-excision rates did not significantly decline before and after 2014 guideline adoption (11.9% before, 10.9% after; p = 0.65) or when the 2016 guidelines were retrospectively applied (8.4%; p = 0.10). The 2014 and 2016 guidelines had minimal impact on our re-excision rates, as most re-excisions were done for DCIS and 2016 guidelines supported our prior institutional practices of 2 mm margins for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

    NARCIS (Netherlands)

    van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J. A.; Siesling, Sabine

    BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

  15. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study

    NARCIS (Netherlands)

    Maaren, M.C. van; Munck, L.; Bock, G.H. de; Jobsen, J.J.; Dalen, T. van; Linn, S.C.; Poortmans, P.; Strobbe, L.J.A.; Siesling, S.

    2016-01-01

    BACKGROUND: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving

  16. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

    NARCIS (Netherlands)

    van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J A; Siesling, Sabine

    Background Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery

  17. Role of 10-Gy boost radiation after breast-conserving surgery for stage I-II breast cancer with a 5-mm negative margin

    International Nuclear Information System (INIS)

    Notani, Masafumi; Uchida, Nobue; Kitagaki, Hajime

    2007-01-01

    According to the Guidelines for breast-conserving therapy of the Japanese Breast Cancer Society, the surgical margin is ''negative'' when the minimum distance between the tumor edge and the margin of the resected specimen is more than 5 mm. The value of boost radiation for early breast cancer with a 5-mm negative margin remains unclear. A total of 137 patients with stage I-II breast cancer underwent breast-conserving surgery between July 1987 and August 2002. All of the patients had negative margins according to the Japanese guidelines. Their median age was 50 years and the median follow-up period was 62 months. The entire ipsilateral breast was irradiated to a total dose of 50 Gy (25 fractions). Then an additional 10 Gy (5 fractions) was given to 79 patients, using 6- to 12-MeV electrons (boost group), while 58 patients (no-boost group) received no further radiation. Factors influencing local recurrence were evaluated by univariate and multivariate analyses. For the entire population, the 5-year overall survival, cause-specific survival, disease-free survival, and local recurrence rates were 96.0%, 96.8%, 94.2%, and 1.67%, respectively. Boost radiation reduced local recurrence, but the improvement was not significant (P=0.070). Univariate and multivariate analyses failed to detect any factors that were significantly associated with local control. There were no severe complications in either group and there were no differences between the groups in the cosmetic outcome. Boost radiation can be performed for stage I-II breast cancer with negative margins (Japanese guidelines), and showed a tendency to decrease local recurrence. A large randomized controlled study is necessary to establish final conclusions. (author)

  18. [Second operation more frequent following breast-conserving treatment for invasive lobular than for invasive non-lobular carcinoma

    NARCIS (Netherlands)

    Zeeuw, S. de; Wildenberg, F.; Strobbe, L.; Wobbes, T.

    2009-01-01

    OBJECTIVE: To establish the frequency of re-excision or mastectomy in women who had breast-conserving treatment for invasive lobular mammary carcinoma. DESIGN: Retrospective. METHOD: Data on the number of patients with invasive carcinoma from 1998-2006 were obtained from the national pathology

  19. Attaining pathological complete regression for breast conservation – A pilot experience in a developing country

    Directory of Open Access Journals (Sweden)

    E.A. Sule

    2016-08-01

    Conclusion: Extended chemotherapy sessions alongside re-excisions were successful in achieving much enhanced rates of pathologically complete remissions at 100% in this yet early report, thus improving breast conservation rates even for T3 and T4 tumours. Our study reports higher PCR rates.

  20. Three-Dimensional Conformal Simultaneously Integrated Boost Technique for Breast-Conserving Radiotherapy

    International Nuclear Information System (INIS)

    Laan, Hans Paul van der; Dolsma, Wil V.; Maduro, John H.; Korevaar, Erik W.; Hollander, Miranda; Langendijk, Johannes A.

    2007-01-01

    Purpose: To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB) and the sequential boost technique in breast cancer, and to evaluate the incidence of acute skin toxicity in patients treated with the SIB technique. Methods and Materials: Thirty patients with early-stage left-sided breast cancer underwent breast-conserving radiotherapy using the SIB technique. The breast and boost planning target volumes (PTVs) were treated simultaneously (i.e., for each fraction, the breast and boost PTVs received 1.81 Gy and 2.3 Gy, respectively). Three-dimensional conformal beams with wedges were shaped and weighted using forward planning. Dose-volume histograms of the PTVs and organs at risk with the SIB technique, 28 x (1.81 + 0.49 Gy), were compared with those for the sequential boost technique, 25 x 2 Gy + 8 x 2 Gy. Acute skin toxicity was evaluated for 90 patients treated with the SIB technique according to Common Terminology Criteria for Adverse Events, version 3.0. Results: PTV coverage was adequate with both techniques. With SIB, more efficiently shaped boost beams resulted in smaller irradiated volumes. The mean volume receiving ≥107% of the breast dose was reduced by 20%, the mean volume outside the boost PTV receiving ≥95% of the boost dose was reduced by 54%, and the mean heart and lung dose were reduced by 10%. Of the evaluated patients, 32.2% had Grade 2 or worse toxicity. Conclusion: The SIB technique is proposed for standard use in breast-conserving radiotherapy because of its dose-limiting capabilities, easy implementation, reduced number of treatment fractions, and relatively low incidence of acute skin toxicity

  1. Limited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost

    International Nuclear Information System (INIS)

    Laan, Hans Paul van der; Dolsma, Wil V.; Schilstra, Cornelis; Korevaar, Erik W.; Bock, Geertruida H. de; Maduro, John H.; Langendijk, Johannes A.

    2010-01-01

    Background and purpose: To examine whether in breast-conserving radiotherapy (RT) with simultaneously integrated boost (SIB), application of inversely planned intensity-modulated radiotherapy (IMRT-SIB) instead of three-dimensional RT (3D-CRT-SIB) has benefits that justify the additional costs, and to evaluate whether a potential benefit of IMRT-SIB depends on specific patient characteristics. Material and methods: 3D-CRT-SIB and various IMRT-SIB treatment plans were constructed and optimised for 30 patients with early stage left-sided breast cancer. Coverage of planning target volumes (PTVs) and dose delivered to organs at risk (OARs) were determined for each plan. Overlap between heart and breast PTV (OHB), size of breast and boost PTVs and boost location were examined in their ability to identify patients that might benefit from IMRT-SIB. Results: All plans had adequate PTV coverage. IMRT-SIB generally reduced dose levels delivered to heart, lungs, and normal breast tissue relative to 3D-CRT-SIB. However, IMRT-SIB benefit differed per patient. For many patients, comparable results were obtained with 3D-CRT-SIB, while patients with OHB > 1.4 cm and a relatively large boost PTV volume (>125 cm 3 ) gained most from the use of IMRT-SIB. Conclusions: In breast-conserving RT, results obtained with 3D-CRT-SIB and IMRT-SIB are generally comparable. Patient characteristics could be used to identify patients that are most likely to benefit from IMRT-SIB.

  2. A population-based study of the effectiveness of breast conservation for newly diagnosed breast cancer

    International Nuclear Information System (INIS)

    Paszat, Lawrence F.; Groome, Patti A.; Schulze, Karleen; Holowaty, Eric J.; Mackillop, William J.

    2000-01-01

    Purpose: Our objective was to evaluate the effectiveness of breast conservation for newly diagnosed breast cancer. Effectiveness was operationalized as two outcomes within 5 years of the diagnosis of breast cancer: the probability of mastectomy-free survival (either death or mastectomy count as event, whichever comes first), and the probability of mastectomy conditional on survival (mastectomy counts as event, observations censored at death). Methods and Materials: We linked records of 46,687 new cases of breast cancer from 1982 to 1991 in the Ontario Cancer Registry to records of surgery from 1982 to 1995, radiotherapy (RT) from 1982 to 1992, and median household income from the 1986 census. We labeled breast surgery within 4 months and postoperative RT within 12 months of diagnosis as treatment for newly diagnosed breast cancer. Surgery was categorized as mastectomy, lumpectomy plus RT, lumpectomy alone, or no surgical procedure. Among cases that did not undergo mastectomy within 4 months of diagnosis, we labeled mastectomy subsequent to 4 months after diagnosis as treatment failure. We performed life-table analysis and Cox proportional hazards regression, to describe the probability of mastectomy conditional on survival and the probability of mastectomy-free survival. Results: A total of 16,279 cases underwent lumpectomy as the maximum procedure on the breast within 4 months of diagnosis, and 49.7% of these received postoperative RT. Compared to the provincial mean, regions with higher rates of lumpectomy plus RT have higher probability of mastectomy-free survival and lower probability of mastectomy conditional upon survival 5 years after diagnosis of breast cancer. Conclusions: These findings are consistent with a hypothesis that breast conservation is effective in the overall breast cancer population of Ontario within the first 5 years after diagnosis

  3. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

    Energy Technology Data Exchange (ETDEWEB)

    Wen Bixiu [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 (China); Hsu, Howard; Formenti-Ujlaki, George F.; Lymberis, Stella; Magnolfi, Chiara; Zhao Xuan; Chang Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States)

    2012-11-15

    Purpose: The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Methods and Materials: Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. Results: One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required >90% of prescribed dose covering 90% of PTV{sub E}VAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1 {+-} 3.0% (with V100% and V95%, 89.4 {+-} 12.8%, 96.4 {+-} 5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30 <15% and Dmax <3%), heart (V5 <40%), and thyroid (Dmax <3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences

  4. Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique

    International Nuclear Information System (INIS)

    Li, J.G.; Williams, S.S.; Goffinet, D.R.; Boer, A.L.; Xing, L.

    2000-01-01

    An electron beam with appropriate energy was combined with four intensity modulated photon beams. The direction of the electron beam was chosen to be tilted 10-20 laterally from the anteroposterior direction. Two of the intensity-modulated photon beams had the same gantry angles as the conventional tangential fields, whereas the other two beams were rotated 15-25' toward the anteroposterior directions from the first two photon beams. An iterative algorithm was developed which optimizes the weight of the electron beam as well as the fluence profiles of the photon beams for a given patient. Two breast cancer patients with early-stage breast tumors were planned with the new technique and the results were compared with those from 3D planning using tangential fields as well as 9-field intensity-modulated radiotherapy (IMRT) techniques. The combined electron and IMRT plans showed better dose conformity to the target with significantly reduced dose to the ipsilateral lung and, in the case of the left-breast patient, reduced dose to the heart, than the tangential field plans. In both the right-sided and left-sided breast plans, the dose to other normal structures was similar to that from conventional plans and was much smaller than that from the 9-field IMRT plans. The optimized electron beam provided between 70 to 80% of the prescribed dose at the depth of maximum dose of the electron beam. The combined electron and IMRT technique showed improvement over the conventional treatment technique using tangential fields with reduced dose to the ipsilateral lung and the heart. The customized beam directions of the four IMRT fields also kept the dose to other critical structures to a minimum. (author)

  5. Assessment of factors connected with radiotherapy influencing the cosmetic effect in breast conserving therapy

    International Nuclear Information System (INIS)

    Blaszczyk, P.; Roszkowski, K.; Blaszczyk, E.; Kowalewski, J.

    2009-01-01

    Aim: To compare cosmetic results of different radiotherapy schedules used in the treatment of breast cancer after breast radiotherapy and to identify factors affecting cosmetic outcomes. Material and methods: Ninety-four patients irradiated. Median follow-up of 29 months (range 18-154 mo.). Patients were treated with standard fractionation 45-50 Gy/20-25 fx/4-5 weeks. Boost up to 10 Gy. Late effects were evaluated using the LENT-SOMA scoring scale. The cosmetic results were assessed on a four-point scale and presence of concomitant chemotherapy. Results: LENT-SOMA grade 3 toxicity was observed only in 8 (8,5%) patients. The factor associated with hyperpigmentation is large breast size. The significant risk factors for teleangiectasia are high dose and use photon energy 1,33 MeV beam. Factors found to impact significantly cosmetics adversely fibrosis was large breast size. Breast fibrosis were more frequent observed in woman after whole dose 50 Gy. There were no differences in breast skin thick between analysed factors. Conclusions: After irradiating large breasts more often than one observes the fibrosis of the breast in the case of small and average breasts and discolour of the skin. Irradiating photons from the cobalt source in the comparison with photons about higher energy at women with large breasts, there is the reason more frequent occurrence of the skin angioma. For the final cosmetic effect of radiotherapy in saving treatment, they do not have the impact: tumor size, boost method, chemical treatment, patients age. (authors)

  6. Breast-Conserving Therapy: Radiotherapy Margins for Breast Tumor Bed Boost

    International Nuclear Information System (INIS)

    Topolnjak, Rajko; Vliet-Vroegindeweij, Corine van; Sonke, Jan-Jakob; Minkema, Danny; Remeijer, Peter; Nijkamp, Jasper; Elkhuizen, Paula; Rasch, Coen

    2008-01-01

    Purpose: To quantify the interfraction position variability of the excision cavity (EC) and to compare the rib and breast surface as surrogates for the cavity. Additionally, we sought to determine the required margin for on-line, off-line and no correction protocols in external beam radiotherapy. Methods and Materials: A total of 20 patients were studied who had been treated in the supine position for 28 daily fractions. Cone-beam computed tomography scans were regularly acquired according to a shrinking action level setup correction protocol based on bony anatomy registration of the ribs and sternum. The position of the excision area was retrospectively analyzed by gray value cone-beam computed tomography-to-computed tomography registration. Subsequently, three setup correction strategies (on-line, off-line, and no corrections) were applied, according to the rib and breast surface registrations, to estimate the residual setup errors (systematic [Σ] and random [σ]) of the excision area. The required margins were calculated using a margin recipe. Results: The image quality of the cone-beam computed tomography scans was sufficient for localization of the EC. The margins required for the investigated setup correction protocols and the setup errors for the left-right, craniocaudal and anteroposterior directions were 8.3 mm (Σ = 3.0, σ = 2.6), 10.6 mm (Σ = 3.8, σ = 3.2), and 7.7 mm (Σ = 2.7, σ = 2.9) for the no correction strategy; 5.6 mm (Σ = 2.0, Σ = 1.8), 6.5 mm (Σ = 2.3, σ = 2.3), and 4.5 mm (Σ = 1.5, σ = 1.9) for the on-line rib strategy; and 5.1 mm (Σ = 1.8, σ = 1.7), 4.8 mm (Σ = 1.7, σ = 1.6), and 3.3 mm (Σ = 1.1, σ = 1.6) for the on-line surface strategy, respectively. Conclusion: Considerable geometric uncertainties in the position of the EC relative to the bony anatomy and breast surface have been observed. By using registration of the breast surface, instead of the rib, the uncertainties in the position of the EC area were reduced

  7. Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer

    Directory of Open Access Journals (Sweden)

    Wiseman Janice

    2011-05-01

    Full Text Available Abstract Background Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS, Disease Free Survival (DFS and Overall Survival (OS. Methods Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m2 or four cycles of 3-weekly docetaxel (100 mg/m2. The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed. Results At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%, pathological complete response (20% vs. 27%, and breast-conserving surgery (BCS rates (49% vs. 42%. Disease-free survival and overall survival were similar between treatment groups. Conclusions Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS or survival outcomes in the neoadjuvant setting. Trial registration ISRCTN: ISRCTN09184069

  8. A patient with angiosarcoma of the breast after breast-conserving surgery and radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Yasuoka, Rie; Mitsuo, Manabu; Hanioka, Keisuke

    2014-01-01

    An 89-year-old woman underwent breast-conserving surgery and axillary lymph node dissection (right AC region, T2N0M0, stage 2A, invasive ductal carcinoma, papillotubular type) for right breast cancer in February 2005. She received postoperative radiotherapy to the residual breast. She then developed marked edema of the right arm and right breast. A mass developed in the right breast in March 2011 and March 2013. This was originally suspected to be an ipsilateral breast recurrence of the cancer, but turned to be angiosarcoma after developing recurrent mass in March 2013, which histopathology was proved to be showed angiosarcoma of the breast. The patient subsequently had repeated intradermal and subcutaneous metastases and recurrence. She is currently receiving chemotherapy with docetaxel (30 mg/m 2 biweekly). This interesting case of angiosarcoma of the breast after breast-conserving surgery for breast cancer is reported. (author)

  9. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

    DEFF Research Database (Denmark)

    Johansen, Jørgen; Overgaard, Jens; Overgaard, Marie

    2007-01-01

    To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed......-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg per m(2)) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia....... In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p = 0.32). However...

  10. Body image of Greek breast cancer patients treated with mastectomy or breast conserving surgery.

    Science.gov (United States)

    Anagnostopoulos, Fotios; Myrgianni, Spyridoula

    2009-12-01

    The aim of this study was to assess and compare the body image of breast cancer patients (n = 70) whom underwent breast conserving surgery or mastectomy, as well as to compare patients' scores with that of a sample of healthy control women (n = 70). A secondary objective of this study was to examine the reliability and validity of the 10-item Greek version of the Body Image Scale, a multidimensional measure of body image changes and concerns. Exploratory and confirmatory factor analyses on the items of this scale resulted in a two factor solution, indicating perceived attractiveness, and body and appearance satisfaction. Comparison of the two surgical groups revealed that women treated with mastectomy felt less attractive and more self-conscious, did not like their overall appearance, were dissatisfied with their scar, and avoided contact with people. Hierarchical regression analysis showed that more general body image concerns were associated with belonging to the mastectomy group, compared to the cancer-free group of women. Implications for clinical practice and recommendations for future investigations are discussed.

  11. The influence of radiotherapy on cosmetic outcome after breast conservative surgery

    International Nuclear Information System (INIS)

    McCormick, Beryl; Sacchini, Virgilio; Luini, Alberto; Agresti, Roberto; Greco, Marco; Manzari, Antonella; Mariani, Luigi; Zucali, Roberto

    1995-01-01

    Purpose: The influence of radiotherapy in the cosmetic outcome after conservative surgery for breast cancer was evaluated using an objective method of calculating the asymmetry between the two breasts. Methods and Materials: One hundred and one patients treated with the same conservative surgery were evaluated for cosmetic outcome. Sixty-one of them received external radiotherapy (50 + 10 Gy) to the residual breast; the remaining 40 underwent surgery only. The aspect of the patients' breasts was objectively assessed for symmetry by means of a computerized technique. A subjective assessment of the cosmetic outcome was performed both by physician and patient. These objective and subjective assessments were compared in the two groups treated with or without radiotherapy. Results: The results obtained did not show significant differences in terms of cosmetic outcome in the two groups. Skin telangectasia was noted in two radiotherapy patients, while hypertrophic breast scars were only noted in six nonirradiated patients. Conclusions: We found that standard radiotherapy does not seem to influence the symmetry and the cosmetic results in breast conservative treatment when compared to a similar group of patients with the same quadrantectomy procedure and no radiotherapy

  12. A Regression Model for Predicting Shape Deformation after Breast Conserving Surgery

    Directory of Open Access Journals (Sweden)

    Hooshiar Zolfagharnasab

    2018-01-01

    Full Text Available Breast cancer treatments can have a negative impact on breast aesthetics, in case when surgery is intended to intersect tumor. For many years mastectomy was the only surgical option, but more recently breast conserving surgery (BCS has been promoted as a liable alternative to treat cancer while preserving most part of the breast. However, there is still a significant number of BCS intervened patients who are unpleasant with the result of the treatment, which leads to self-image issues and emotional overloads. Surgeons recognize the value of a tool to predict the breast shape after BCS to facilitate surgeon/patient communication and allow more educated decisions; however, no such tool is available that is suited for clinical usage. These tools could serve as a way of visually sensing the aesthetic consequences of the treatment. In this research, it is intended to propose a methodology for predict the deformation after BCS by using machine learning techniques. Nonetheless, there is no appropriate dataset containing breast data before and after surgery in order to train a learning model. Therefore, an in-house semi-synthetic dataset is proposed to fulfill the requirement of this research. Using the proposed dataset, several learning methodologies were investigated, and promising outcomes are obtained.

  13. A Regression Model for Predicting Shape Deformation after Breast Conserving Surgery

    Science.gov (United States)

    Zolfagharnasab, Hooshiar; Bessa, Sílvia; Oliveira, Sara P.; Faria, Pedro; Teixeira, João F.; Cardoso, Jaime S.

    2018-01-01

    Breast cancer treatments can have a negative impact on breast aesthetics, in case when surgery is intended to intersect tumor. For many years mastectomy was the only surgical option, but more recently breast conserving surgery (BCS) has been promoted as a liable alternative to treat cancer while preserving most part of the breast. However, there is still a significant number of BCS intervened patients who are unpleasant with the result of the treatment, which leads to self-image issues and emotional overloads. Surgeons recognize the value of a tool to predict the breast shape after BCS to facilitate surgeon/patient communication and allow more educated decisions; however, no such tool is available that is suited for clinical usage. These tools could serve as a way of visually sensing the aesthetic consequences of the treatment. In this research, it is intended to propose a methodology for predict the deformation after BCS by using machine learning techniques. Nonetheless, there is no appropriate dataset containing breast data before and after surgery in order to train a learning model. Therefore, an in-house semi-synthetic dataset is proposed to fulfill the requirement of this research. Using the proposed dataset, several learning methodologies were investigated, and promising outcomes are obtained. PMID:29315279

  14. The use of breast conserving surgery: linking insurance claims with tumor registry data

    International Nuclear Information System (INIS)

    Maskarinec, Gertraud; Dhakal, Sanjaya; Yamashiro, Gladys; Issell, Brian F

    2002-01-01

    The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer. Breast cancer cases registered in the Hawaii Tumor Registry (HTR) from 1995 to 1998 were linked with insurance claims from a local health plan. We identified 722 breast cancer cases with stage I and II disease. Surgical treatment patterns and comorbidities were identified using diagnostic and procedural codes in the claims data. The HTR database provided information on demographics and disease characteristics. We used logistic regression to assess determinants of BCS vs. mastectomy. The linked data set represented 32.8% of all early stage breast cancer cases recorded in the HTR during the study period. Due to the nature of the health plan, 79% of the cases were younger than 65 years. Women with early stage breast cancer living on Oahu were 70% more likely to receive BCS than women living on the outer islands. In the univariate analysis, older age at diagnosis, lower tumor stage, smaller tumor size, and well-differentiated tumor grade were related to receiving BCS. Ethnicity, comorbidity count, menopausal and marital status were not associated with treatment type. In addition to developing solutions that facilitate access to radiation facilities for breast cancer patients residing in remote locations, future qualitative research may help to elucidate how women and oncologists choose between BCS and mastectomy

  15. Magnetic resonance imaging-guided navigation with a thermoplastic shell for breast-conserving surgery.

    Science.gov (United States)

    Abe, M; Kiryu, T; Sonoda, K; Kashiki, Y

    2011-11-01

    The aim of this study was to evaluate the accuracy of a magnetic resonance imaging (MRI) marking technique with a drape-type thermoplastic shell for planning breast-conserving surgery (BCS). A prospective review was performed on 35 consecutive patients who underwent MRI in the supine position and used the specified MRI marking technique. Eleven cases underwent pre-operative chemotherapy and 24 cases did not. After immobilizing the breast mound with a drape-type thermoplastic shell, patients underwent MRI, and the location of the lesion was marked on the shell. Resection lines were dyed blue by indigo carmine, which was pushed through the pores of the shell. Specimens obtained during BCS were sliced into 5-mm contiguous sections, and the margin was assessed for each specimen. Cancer foci less than 5 mm from the margin were classified as positive. Of 35 patients, 33 were included in the analysis; 2 were excluded due to a lack of effect of pre-operative chemotherapy. Of these 33 patients, 25 (75.8%) had negative margins and 7 (21.2%) had positive margins. Our MRI marking technique may be useful for evaluating the extent of tumors that were determined by MRI alone. Long-term outcomes of this technique should be evaluated further. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

    Science.gov (United States)

    Fedeli, Ugo; Alba, Natalia; Schievano, Elena; Visentin, Cristiana; Rosato, Rosalba; Zorzi, Manuel; Ruscitti, Giancarlo; Spolaore, Paolo

    2007-01-01

    Background Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. Methods Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. Results Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18) and high-volume (1.09, 1.03–1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. Conclusion The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers. PMID:17945000

  17. One life saved by four prevented recurrencies? Update of the early breast cancer trialists confirms. Postoperative radiotherapy improves survival after breast conserving surgery

    International Nuclear Information System (INIS)

    Sautter-Bihl, M.L.; Budach, W.

    2012-01-01

    The debate about the impact of local control on survival in early breast cancer patients is still going on, in spite of the continuously growing evidence that avoidance of locoregional disease reduces the risk of tumor-specific death. Recently, B. Fisher, one of the pioneers of breast conserving therapy claimed that during the last two decades, as a result of the use of systemic therapy in conjunction with breast conserving surgery and radiation, the incidence of locoregional recurrence has been reduced to a level where further reduction is likely to have little impact on survival. The penultimate meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) reported the effect of radiotherapy in early breast cancer on recurrence and survival in 2005 and provided the essential message that four prevented local recurrences at 5 years would avoid one breast cancer death in 15 years. The scientific community has eagerly awaited the quinquennial update of the EBCTCG which has now been published. A total of 17 randomized studies comparing postoperative radiotherapy vs. none were analyzed and comprised 7 new studies in addition to follow-up data of from 9 previously reported trials. A total of 10,801 patients with pT1-2 tumors were included, the majority of whom (n=7,287) were node negative, while 1,050 were node positive (2,464 unknown). In contrast to the previous meta-analysis, all patients received breast conserving surgery, consisting of lumpectomy (n=8,422) or more extensive techniques like quadrantectomy or sectoral resection (n= 2,399). The effect of radiotherapy on 10-year recurrences of any type and their relation to the 15-year breast cancer death rate were studied in correlation to various prognostic parameters and treatment characteristics (e.g., surgery, tamoxifen use). Moreover, a subgroup analysis was performed according to low, intermediate, and high initial risk of recurrence, from which the expected absolute benefit was derived by

  18. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Rodrigues, Neesha; Carter, Darryl; Dillon, Deborah; Parisot, Nicole; Choi, Doo Ho; Haffty, Bruce G.

    2002-01-01

    Purpose: Although breast-conserving surgery followed by radiotherapy (RT) has become a standard treatment option for patients with ductal carcinoma in situ of the breast, risk factors for ipsilateral breast tumor recurrence (IBTR) in these patients remain an active area of investigation. The purpose of this study was to evaluate the impact of clinical and pathologic features on long-term outcome in a cohort of DCIS patients treated with breast-conserving surgery plus RT. Methods and Materials: Between 1973 and 1998, 230 patients with DCIS were treated with breast-conserving surgery plus RT at our institution. All patients were treated by local excision followed by RT to the breast to a total median tumor bed dose of 64 Gy. Adjuvant hormonal therapy was used in only 20 patients (9%). All available clinical, pathologic, and outcome data, including ipsilateral and contralateral events, were entered into a computerized database. The clinical and pathologic variables evaluated included detection method, mammographic appearance, age, family history, histologic subtype, presence of necrosis, nuclear grade, final margin status, and use of adjuvant hormonal therapy. Results: As of December 15, 2000, with a median follow-up of 8.2 years, 17 patients had developed a recurrence in the ipsilateral breast, resulting in a 5- and 10-year IBTR rate of 5% and 13%, respectively. Contralateral breast cancer developed in 8 patients, resulting in a 10-year contralateral recurrence rate of 5%. Patient age, family history, histologic subtype, margin status, and tumor grade were not significantly associated with recurrence on univariate analysis. A significantly higher rate of local relapse was observed in patients with the presence of necrosis. The 10-year relapse rate was 22% in 88 patients with necrosis compared with 7% in 142 patients without necrosis (p <0.01). In multivariate analysis, the presence of necrosis remained a significant predictor of local relapse. No breast relapses

  19. Association of single nucleotide polymorphisms in the genes ATM, GSTP1, SOD2, TGFB1, XPD and XRCC1 with risk of severe erythema after breast conserving radiotherapy

    International Nuclear Information System (INIS)

    Raabe, Annette; Derda, Katharina; Reuther, Sebastian; Szymczak, Silke; Borgmann, Kerstin; Hoeller, Ulrike; Ziegler, Andreas; Petersen, Cordula; Dikomey, Ekkehard

    2012-01-01

    To examine the association of polymorphisms in ATM (codon 158), GSTP1 (codon 105), SOD2 (codon 16), TGFB1 (position −509), XPD (codon 751), and XRCC1 (codon 399) with the risk of severe erythema after breast conserving radiotherapy. Retrospective analysis of 83 breast cancer patients treated with breast conserving radiotherapy. A total dose of 50.4 Gy was administered, applying 1.8 Gy/fraction within 42 days. Erythema was evaluated according to the Radiation Therapy Oncology Group (RTOG) score. DNA was extracted from blood samples and polymorphisms were determined using either the Polymerase Chain Reaction based Restriction-Fragment-Length-Polymorphism (PCR-RFL) technique or Matrix-Assisted-Laser-Desorption/Ionization –Time-Of-Flight-Mass-Spectrometry (MALDI-TOF). Relative excess heterozygosity (REH) was investigated to check compatibility of genotype frequencies with Hardy-Weinberg equilibrium (HWE). In addition, p-values from the standard exact HWE lack of fit test were calculated using 100,000 permutations. HWE analyses were performed using R. Fifty-six percent (46/83) of all patients developed erythema of grade 2 or 3, with this risk being higher for patients with large breast volume (odds ratio, OR = 2.55, 95% confidence interval, CI: 1.03–6.31, p = 0.041). No significant association between SNPs and risk of erythema was found when all patients were considered. However, in patients with small breast volume the TGFB1 SNP was associated with erythema (p = 0.028), whereas the SNP in XPD showed an association in patients with large breast volume (p = 0.046). A risk score based on all risk alleles was neither significant in all patients nor in patients with small or large breast volume. Risk alleles of most SNPs were different compared to a previously identified risk profile for fibrosis. The genetic risk profile for erythema appears to be different for patients with small and larger breast volume. This risk profile seems to be specific for erythema as

  20. Should breast density influence patient selection for breast-conserving surgery?

    Science.gov (United States)

    Kapoor, Nimmi S; Eaton, Anne; King, Tari A; Patil, Sujata; Stempel, Michelle; Morris, Elizabeth; Brogi, Edi; Morrow, Monica

    2013-02-01

    In a previous study of the relationship between breast density and primary tumor features, we observed a higher mastectomy rate in patients with extremely dense breasts. Here we examine possible reasons for this finding. Data were obtained from a prospectively maintained database of 1,056 invasive breast cancer patients from January 2005 to June 2007. Mammographic density was assigned by Breast Imaging-Reporting and Data System (BI-RADS) classification. Initial and final surgical procedures, and patient and tumor variables were recorded. Breast-conserving surgery (BCS) was attempted in 758 patients (72 %), 385 (51 %) of whom had preoperative magnetic resonance imaging (MRI). Initial BCS was less common among patients with the highest (BI-RADS 4) breast density compared to patients with less-dense breasts (52 vs. 74 %; p mastectomy compared to patients with less-dense breasts. After initial BCS, 387 patients (51 %) had positive shaved margins, 96 (25 %) of whom converted to mastectomy. MRI did not correlate with the rate of positive margins overall or among those with dense breasts. Adjusting for clinical and pathologic variables, density did not predict margin status or conversion to mastectomy. In a multivariate model, age, histologic grade, extensive intraductal component, and multicentricity/multifocality were independently associated with conversion to mastectomy. Density alone seems to influence the decision to proceed with initial mastectomy. When BCS was attempted, breast density was not associated with positive margins or conversion to mastectomy. A benefit of MRI in decreasing positive margins was not observed. These data do not support the use of breast density as a selection criterion for BCS.

  1. Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation.

    Science.gov (United States)

    Shearer, Rosalyn; Rashid, Majid; Hubbard, Gill; Abbott, Nick; Daltrey, Ian; Mullen, Russell

    2016-08-01

    Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations. A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%). Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.

  2. Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Adriaenssens, Nele; Belsack, Dries; Buyl, Ronald; Ruggiero, Leonardo; Breucq, Catherine; De Mey, Johan; Lievens, Pierre; Lamote, Jan

    2012-01-01

    Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema. The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation. Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema. Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings

  3. Breast-conservation treatment without any surgical procedure using new enzyme-targeting radiosensitization treatment for aged and/or op. refused patients with breast cancer

    International Nuclear Information System (INIS)

    Ogawa, Yasuhiro; Kubota, Kei; Miyatake, Kana

    2008-01-01

    We developed a new radiosensitizer containing hydrogen peroxide and sodium hyaluronate for topical tumor injection for various types of tumors, and the method was named KORTUC II (Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, Type II). KORTUC II trial was accepted by our local ethical committee concerning of the injection for advanced skin cancer, advanced bone/soft tissue malignant neoplasms, breast cancer of op refused or aged patients, and metastatic lymph nodes. Concerning breast cancer, ten patients were enrolled in the KORTUC II trial upon fully informed consent. All of them showed clinically complete response by the new enzyme-targeting radiosensitization treatment (KORTUC II) without any severe complications excluding mild dermatitis (grade I). Nine of the 10 patients have so far shown neither local recurrence nor distant metastasis, and the mean follow-up period at the end of December 2007 was still short and approximately 12 months. Especially for patients with breast cancer, breast-conservation treatment without any surgical procedure can be performed by using our new radiosensitizer for topical injection into the tumor tissue. (author)

  4. Effect of breast augmentation after breast-conserving surgery for breast cancer on radiation dose. Silicone prosthesis and changes in radiation dose

    International Nuclear Information System (INIS)

    Tonari, Ayako; Nako, Yasunobu; Ikezaki, Hiromi; Maruyama, Yasushi; Ikeda, Ikuo; Kusuda, Junko; Harii, Kiyonori; Takayama, Makoto

    2008-01-01

    The results of a study simulating postoperative radiation therapy of remaining breast tissue with a silicone bag prosthesis implanted to examine the effects of the prosthesis on radiation dosage and surrounding tissue are reported. The evaluation was conducted in two stages: a water phantom was used to evaluate scattering effects of a prosthesis installed inside the phantom using glass rod detector (GRD) set around the prosthesis. Measurements were conducted on both entrance and rear sides of the prosthesis. A Rand phantom was used to measure radiation doses around the prosthesis. The first evaluation resulted in a less than 5.4% reduction in dose at the rear side of the prosthesis whereas the second evaluation, for opposing portal irradiation used with breast-conserving surgical treatment, showed the effects of the prosthesis on radiation dosage being within ±2%, the permitted treatment range. In conclusion, for treating breast cancer, combining surgical treatment of the cancer with implanting of prosthesis for breast reconstruction followed by radiation treatment appears feasible as no effects on dosage were observed on treatment effectiveness. (author)

  5. Recovery of sensation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps after breast-conservative surgery and skin-sparing mastectomy.

    Science.gov (United States)

    Tomita, Koichi; Yano, Kenji; Hosokawa, Ko

    2011-04-01

    In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

  6. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study.

    Science.gov (United States)

    Howes, Benjamin H L; Watson, David I; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R

    2016-09-01

    Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

  7. Conservative therapy of breast cancer in Queensland

    International Nuclear Information System (INIS)

    Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

    1995-01-01

    Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers

  8. Conservative therapy of breast cancer in Queensland

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

    1995-01-15

    Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers.

  9. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Leon Paola G

    2007-08-01

    Full Text Available Abstract Background To investigate whether Radiation therapy (RT should follow breast conserving surgery in women with ductal carcinoma in situ from breast cancer (DCIS with objective of decreased mortality, invasive or non invasive recurrence, distant metastases and contralateral breast cancer rates. We have done a meta-analysis of these results to give a more balanced view of the total evidence and to increase statistical precision. Methods A meta-analysis of randomized controlled trials (RCT was performed comparing RT treatment for DCIS of breast cancer to observation. The MEDLINE, EMBASE, CANCERLIT, Cochrane Library databases, Trial registers, bibliographic databases, and recent issues of relevant journals were searched. Relevant reports were reviewed by two reviewers independently and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. Results The reviewers identified four large RCTs, yielding 3665 patients. Pooled results from this four randomized trials of adjuvant radiotherapy showed a significant reduction of invasive and DCIS ipsilateral breast cancer with odds ratio (OR of 0.40 (95% CI 0.33 – 0.60, p Conclusion The conclusion from our meta-analysis is that the addition of radiation therapy to lumpectomy results in an approximately 60% reduction in breast cancer recurrence, no benefit for survival or distant metastases compared to excision alone. Patients with high-grade DCIS lesions and positive margins benefited most from the addition of radiation therapy. It is not yet clear which patients can be successfully treated with lumpectomy alone; until further prospective studies answer this question, radiation should be recommended after lumpectomy for all patients without contraindications.

  10. Accelerated superfractionated radiotherapy for inflammatory breast carcinoma: complete response predicts outcome and allows for breast conservation

    International Nuclear Information System (INIS)

    Arthur, Douglas W.; Schmidt-Ullrich, Rupert K.; Friedman, Richard B.; Wazer, David E.; Kachnic, Lisa A.; Amir, Cyrus; Bear, Harry D.; Hackney, Mary Helen; Smith, Thomas J.; Lawrence, Walter

    1999-01-01

    Purpose: Chemotherapy and accelerated superfractionated radiotherapy were prospectively applied for inflammatory breast carcinoma with the intent of breast conservation. The efficacy, failure patterns, and patient tolerance utilizing this approach were analyzed. Methods and Materials: Between 1983 and 1996, 52 patients with inflammatory breast carcinoma presented to the Medical College of Virginia Hospitals of VCU and the New England Medical Center. Thirty-eight of these patients were jointly evaluated in multidisciplinary breast clinics and managed according to a defined prospectively applied treatment policy. Patients received induction chemotherapy, accelerated superfractionated radiotherapy, selected use of mastectomy, and concluded with additional chemotherapy. The majority were treated with 1.5 Gy twice daily to field arrangements covering the entire breast and regional lymphatics. An additional 18-21 Gy was then delivered to the breast and clinically involved nodal regions. Total dose to clinically involved areas was 63-66 Gy. Following chemoradiotherapy, patients were evaluated with physical examination, mammogram, and fine needle aspiration x 3. Mastectomy was reserved for those patients with evidence of persistent or progressive disease in the involved breast. All patients received additional chemotherapy. Results: Median age was 51 years. Median follow-up was 23.9 months (6-86) months. The breast preservation rate at the time of last follow-up was 74%. The treated breast or chest wall as the first site of failure occurred in only 13%, and the ultimate local control rate with the selected use of mastectomy was 74%. Ten patients underwent mastectomy, 2 of which had pathologically negative specimens despite a clinically palpable residual mass. Response to chemotherapy was predictive of treatment outcome. Of the 15 patients achieving a complete response, 87% remain locoregionally controlled without the use of mastectomy. Five-year overall survival for

  11. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    International Nuclear Information System (INIS)

    Doyle, Timothy E; Neumayer, Leigh A; Factor, Rachel E; Ellefson, Christina L; Sorensen, Kristina M; Ambrose, Brady J; Goodrich, Jeffrey B; Hart, Vern P; Jensen, Scott C; Patel, Hemang

    2011-01-01

    In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate

  12. Using surface markers for MRI guided breast conserving surgery: a feasibility survey

    Science.gov (United States)

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M. B.; Plewes, Donald B.; Martel, Anne L.

    2014-04-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

  13. Using surface markers for MRI guided breast conserving surgery: a feasibility survey

    International Nuclear Information System (INIS)

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Martel, Anne L; Holloway, Claire M B; Plewes, Donald B

    2014-01-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm 3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion

  14. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    Directory of Open Access Journals (Sweden)

    Hart Vern P

    2011-10-01

    Full Text Available Abstract Background In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Methods Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. Results The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each

  15. Model-based approach for quantitative estimates of skin, heart, and lung toxicity risk for left-side photon and proton irradiation after breast-conserving surgery.

    Science.gov (United States)

    Tommasino, Francesco; Durante, Marco; D'Avino, Vittoria; Liuzzi, Raffaele; Conson, Manuel; Farace, Paolo; Palma, Giuseppe; Schwarz, Marco; Cella, Laura; Pacelli, Roberto

    2017-05-01

    Proton beam therapy represents a promising modality for left-side breast cancer (BC) treatment, but concerns have been raised about skin toxicity and poor cosmesis. The aim of this study is to apply skin normal tissue complication probability (NTCP) model for intensity modulated proton therapy (IMPT) optimization in left-side BC. Ten left-side BC patients undergoing photon irradiation after breast-conserving surgery were randomly selected from our clinical database. Intensity modulated photon (IMRT) and IMPT plans were calculated with iso-tumor-coverage criteria and according to RTOG 1005 guidelines. Proton plans were computed with and without skin optimization. Published NTCP models were employed to estimate the risk of different toxicity endpoints for skin, lung, heart and its substructures. Acute skin NTCP evaluation suggests a lower toxicity level with IMPT compared to IMRT when the skin is included in proton optimization strategy (0.1% versus 1.7%, p < 0.001). Dosimetric results show that, with the same level of tumor coverage, IMPT attains significant heart and lung dose sparing compared with IMRT. By NTCP model-based analysis, an overall reduction in the cardiopulmonary toxicity risk prediction can be observed for all IMPT compared to IMRT plans: the relative risk reduction from protons varies between 0.1 and 0.7 depending on the considered toxicity endpoint. Our analysis suggests that IMPT might be safely applied without increasing the risk of severe acute radiation induced skin toxicity. The quantitative risk estimates also support the potential clinical benefits of IMPT for left-side BC irradiation due to lower risk of cardiac and pulmonary morbidity. The applied approach might be relevant on the long term for the setup of cost-effectiveness evaluation strategies based on NTCP predictions.

  16. CT-guided thermoplastic assisted segmentectomy is an optimal breast conserving surgery for breast cancer with nipple discharge

    International Nuclear Information System (INIS)

    Makita, Masujiro; Gomi, Naoya; Tachikawa, Tomohiro

    2004-01-01

    Improvement of imaging by injecting contrast agents into the discharging duct and immobilizing the breast mound with a drape-type thermoplastic shell in breast conserving surgery was assessed by evaluating 96 cases of breast cancer patients with nipple discharge treated by partial mastectomy between April 1998 and August 2003. These patients were divided to three groups: Group A was treated by ordinary partial mastectomy or microdochectomy without new methods. Group B underwent contrast imaging without shell immobilization, and Group C received both shell immobilization and contrast imaging. The negative rates of surgical margins in Groups A, B and C were 19.0%, 17.2%, and 37.5%, respectively. The rates of negative ''lateral'' surgical margins in Groups A, B and C were 23.8%, 27.6%, and 50%, respectively. The rate of negative ''lateral'' surgical margins in Group C was significantly higher than that in Group A. Our findings suggest CT-guided thermoplastic assisted segmentectomy, adopting both ductography CT and immobilization by shell, is an optimal breast conserving surgery for breast cancer with nipple discharge. (author)

  17. Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment

    International Nuclear Information System (INIS)

    Yoshida, Ken; Takenaka, Tadashi; Tanaka, Eiichi; Kuriyama, Keiko; Yoshida, Mineo; Yamazaki, Hideya; Nishimura, Tsunehiko; Kotsuma, Tadayuki; Fujita, Yuka; Masuda, Norikazu

    2010-01-01

    To evaluate radiation dermatitis objectively in patients with breast cancer who had undergone post-operative radiotherapy after breast-conserving surgery. Skin color (L * , a * , and b * values) and moisture analyses were performed for both breasts (before, after, 1 month, 6 months, and 1 year after radiotherapy) to examine irradiated and non-irradiated skin divided into four quadrants in 118 patients. These patients underwent breast conservative surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost irradiation (10 Gy/5 fractions). L * , a * , and moisture values were changed by irradiation and maximized at completion or 1 month after radiotherapy. One year after radiotherapy, the skin color had returned to the range observed prior to radiotherapy. However, moisture did not return to previous values even 1 year after treatment. The lateral upper side (quadrant C) showed greater changes than other quadrants in the L * value (darker) at the end of radiotherapy. The Common Toxicity Criteria version 3 scores were found to correlate well with a * and L * values at the completion and 1 month after radiotherapy. Boost radiotherapy intensified reddish and darker color changes at the completion of radiotherapy, while chemotherapy did not intensify the skin reaction caused by radiotherapy. Moisture impairment as a result of irradiation lasts longer than color alterations. Objective assessments are useful for analyzing radiation dermatitis. (orig.)

  18. Identification of the boundary between normal breast tissue and invasive ductal carcinoma during breast-conserving surgery using multiphoton microscopy

    Science.gov (United States)

    Deng, Tongxin; Nie, Yuting; Lian, Yuane; Wu, Yan; Fu, Fangmeng; Wang, Chuan; Zhuo, Shuangmu; Chen, Jianxin

    2014-11-01

    Breast-conserving surgery has become an important way of surgical treatment for breast cancer worldwide nowadays. Multiphoton microscopy (MPM) has the ability to noninvasively visualize tissue architectures at the cellular level using intrinsic fluorescent molecules in biological tissues without the need for fluorescent dye. In this study, MPM is used to image the microstructures of terminal duct lobular unit (TDLU), invasive ductal carcinoma and the boundary region between normal and cancerous breast tissues. Our study demonstrates that MPM has the ability to not only reveal the morphological changes of the cuboidal epithelium, basement membrane and interlobular stroma but also identify the boundary between normal breast tissue and invasive ductal carcinoma, which correspond well to the Hematoxylin and Eosin (H and E) images. Predictably, MPM can monitor surgical margins in real time and provide considerable accuracy for resection of breast cancerous tissues intraoperatively. With the development of miniature, real-time MPM imaging technology, MPM should have great application prospects during breast-conserving surgery.

  19. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2012-09-01

    Full Text Available BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap (n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

  20. Feasibility of Breast Conservation after Neoadjuvant Chemotherapy in 58 Patients with Locally Advanced Breast Cancer Using p53 and MDRI Genes as Predictors of Response

    International Nuclear Information System (INIS)

    Elsawy, W.H.; Abdel Kader, M.; Abdulla, M.H.

    2002-01-01

    The aim of this prospective trial was to evaluate the feasibility and outcome of breast conservation therapy for patients with locally advanced breast cancer after neoadjuvant chemotherapy. We studied also the value of p53 and MDR1 as predictors to neoadjuvant chemotherapy. Patients and methods: Bet ween August 1997 and May 2000, 58 patients with locally advanced breast carcinoma (stages IlIA and lllB) completed treatment consisting of 5 fluorouracil 600 mg/m 2 , epirubicin 60 mg/m 2 and cyclophosphamide 600 mg/m 2 (FEC) administered intravenously, at intervals of 3 weeks. The number of cycles of chemotherapy given depended on the clinical tumor response. Surgery (local excision if sufficiently down staged, or mastectomy if not, both with axillary dissection) was performed. Surgery was followed by radiation therapy and 4 more cycles of FEC chemotherapy as an adjuvant therapy. P53 and MDR1 were assessed in the initial tissue biopsy by means of reverse transcriptase-mediated polymerase chain reaction (RT-PCR). p53 and MDR1 findings were correlated with treatment response and linkage between p53 function and cellular response was assessed by terminal deoxynucleotidyl transferase-mediated nick end labeling assay. Results: The overall response (CR+PR) was 87.9%, with a clinical complete response rate of 29.3%. Six patients had a pathological complete response and 10 patients had only minimal residual disease. Median followup from the start of chemotherapy was 24 months (range 6 to 40). Twenty two patients (43%) underwent BCS with actuarial 3-year disease-free and overall survival of 58% and 75% respectively. Cosmetic results were good to excellent in 77.2% of the patients. Modified radical mastectomy was done in 29/51 (56.9%) patients with actuarial 3 year disease-free and overall survival of 60% and 78% respectively.In 13 out of 58 patients (22.4%), p53 mutations could be identified, including eight point mutations, three minor deletions and two complex deletions

  1. Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2011-06-03

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  2. Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2012-02-01

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  3. Value of multiparametric magnetic resonance imaging of the breast for the differentiation of fat necrosis and tumor recurrence after breast-conserving surgery. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Doerner, Jonas; Krug, Kathrin Barbara [University Hospital Cologne (Germany). Dept. of Diagnostic and Interventional Radiology; Malter, Wolfram [University Hospital Cologne (Germany). Dept. of Obstetrics and Gynaecology; Markiefka, Birgid [University Hospital Cologne (Germany). Inst. of Pathology

    2018-02-15

    In rare cases the differentiation of tumor recurrence and fat necrosis in patients with breast-conserving surgery with or without radiotherapy can be challenging. In such cases magnetic resonance imaging features, in particular strong vs. faint contrast enhancement and diffusion restriction vs. non-restriction can help to characterize such lesions.

  4. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ

    NARCIS (Netherlands)

    Solin, Lawrence J.; Fourquet, Alain; Vicini, Frank A.; Taylor, Marie; Haffty, Bruce; Strom, Eric A.; Wai, Elaine; Pierce, Lori J.; Marks, Lawrence B.; Bartelink, Harry; Campana, Francois; McNeese, Marsha D.; Jhingran, Anuja; Olivotto, Ivo A.; Bijker, Nina; Hwang, Wei-Ting

    2005-01-01

    The present study evaluated the outcome of salvage treatment for women with local or local-regional recurrence after initial breast conservation treatment with radiation for mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast. The study cohort consisted of

  5. Patients with Invasive Lobular Breast Cancer Are Less Likely to Undergo Breast-Conserving Surgery: A Population Based Study in The Netherlands

    NARCIS (Netherlands)

    Truin, W.; Roumen, R.M.; Siesling, Sabine; van der Heiden-van der Loo, M.; Duijm, E.M.; Tjan-Heijnen, V.C.G.; Voogd, A.C.

    2015-01-01

    Purpose The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Methods Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the

  6. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M

    2017-01-01

    Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs...... to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS......) and to examine whether the risk of reoperation is associated with DCIS or histologic type of the IBC. Design, Setting, and Participants: This nationwide study including women with histologically verified IBC or DCIS having wire-guided BCS performed between January 1, 2010, and December 31, 2013, used data from...

  7. Nursing Approach Based on Roy Adaptation Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer.

    Science.gov (United States)

    Ursavaş, Figen Erol; Karayurt, Özgül; İşeri, Özge

    2014-07-01

    The use of models in nursing provides nurses to focus on the role of nursing and its applications rather than medical practice. In addition, it helps patient care to be systematic, purposeful, controlled and effective. One of the commonly used models in nursing is Roy Adaptation Model. According to Roy adaptation model, the aim of nursing is to increase compliance and life expectancy. Roy Adaptation Model evaluates the patient in physiologic mode, self-concept mode, role function mode and interdependence mode aiming to provide holistic care. This article describes the use of Roy Adaptation Model in the care of a patient who has been diagnosed with breast cancer and had breast-conserving surgery. Patient data was evaluated in the four modes of Roy adaptation model (physiologic, self-concept, role function, and interdependence modes) and the nursing process was applied.

  8. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review.

    Science.gov (United States)

    Recio-Saucedo, Alejandra; Gerty, Sue; Foster, Claire; Eccles, Diana; Cutress, Ramsey I

    2016-02-01

    Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  10. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Suzanne; Chavez-MacGregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica

    2014-01-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs

  11. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

    International Nuclear Information System (INIS)

    Johansen, Joergen; Overgaard, Jens; Overgaard, Marie

    2007-01-01

    To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed. The patients were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. High-risk patients (n 94), as well as 31 low-risk patients, received additional radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg/m 2 ) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia, and dyspigmentation which were scored on a 4-point categorical scale after median 6.6 years. The observations were analyzed in multivariate logistic regression analysis which included potential risk factors on outcome related to systemic treatment, surgery, radiation technique, tumor, and patient characteristics. In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p 0.32). However, univariate analysis showed that tamoxifen was significantly associated with breast fibrosis (p <0.004), as was radiation to the regional lymph nodes (p <0.0001). A strong interaction between axillary irradiation and tamoxifen treatment occurred since 26 of 27 high-risk postmenopausal patients had received both tamoxifen and axillary irradiation. In multivariate regression analysis, axillary irradiation independently predicted moderate/severe breast fibrosis with a relative risk of 5

  12. Dosimetric consequences of the shift towards computed tomography guided target definition and planning for breast conserving radiotherapy

    Directory of Open Access Journals (Sweden)

    Korevaar Erik W

    2008-01-01

    Full Text Available Abstract Background The shift from conventional two-dimensional (2D to three-dimensional (3D-conformal target definition and dose-planning seems to have introduced volumetric as well as geometric changes. The purpose of this study was to compare coverage of computed tomography (CT-based breast and boost planning target volumes (PTV, absolute volumes irradiated, and dose delivered to the organs at risk with conventional 2D and 3D-conformal breast conserving radiotherapy. Methods Twenty-five patients with left-sided breast cancer were subject of CT-guided target definition and 3D-conformal dose-planning, and conventionally defined target volumes and treatment plans were reconstructed on the planning CT. Accumulated dose-distributions were calculated for the conventional and 3D-conformal dose-plans, taking into account a prescribed dose of 50 Gy for the breast plans and 16 Gy for the boost plans. Results With conventional treatment plans, CT-based breast and boost PTVs received the intended dose in 78% and 32% of the patients, respectively, and smaller volumes received the prescribed breast and boost doses compared with 3D-conformal dose-planning. The mean lung dose, the volume of the lungs receiving > 20 Gy, the mean heart dose, and volume of the heart receiving > 30 Gy were significantly less with conventional treatment plans. Specific areas within the breast and boost PTVs systematically received a lower than intended dose with conventional treatment plans. Conclusion The shift towards CT-guided target definition and planning as the golden standard for breast conserving radiotherapy has resulted in improved target coverage at the cost of larger irradiated volumes and an increased dose delivered to organs at risk. Tissue is now included into the breast and boost target volumes that was never explicitly defined or included with conventional treatment. Therefore, a coherent definition of the breast and boost target volumes is needed, based on

  13. Dosimetric consequences of the shift towards computed tomography guided target definition and planning for breast conserving radiotherapy

    International Nuclear Information System (INIS)

    Laan, Hans Paul van der; Dolsma, Wil V; Maduro, John H; Korevaar, Erik W; Langendijk, Johannes A

    2008-01-01

    The shift from conventional two-dimensional (2D) to three-dimensional (3D)-conformal target definition and dose-planning seems to have introduced volumetric as well as geometric changes. The purpose of this study was to compare coverage of computed tomography (CT)-based breast and boost planning target volumes (PTV), absolute volumes irradiated, and dose delivered to the organs at risk with conventional 2D and 3D-conformal breast conserving radiotherapy. Twenty-five patients with left-sided breast cancer were subject of CT-guided target definition and 3D-conformal dose-planning, and conventionally defined target volumes and treatment plans were reconstructed on the planning CT. Accumulated dose-distributions were calculated for the conventional and 3D-conformal dose-plans, taking into account a prescribed dose of 50 Gy for the breast plans and 16 Gy for the boost plans. With conventional treatment plans, CT-based breast and boost PTVs received the intended dose in 78% and 32% of the patients, respectively, and smaller volumes received the prescribed breast and boost doses compared with 3D-conformal dose-planning. The mean lung dose, the volume of the lungs receiving > 20 Gy, the mean heart dose, and volume of the heart receiving > 30 Gy were significantly less with conventional treatment plans. Specific areas within the breast and boost PTVs systematically received a lower than intended dose with conventional treatment plans. The shift towards CT-guided target definition and planning as the golden standard for breast conserving radiotherapy has resulted in improved target coverage at the cost of larger irradiated volumes and an increased dose delivered to organs at risk. Tissue is now included into the breast and boost target volumes that was never explicitly defined or included with conventional treatment. Therefore, a coherent definition of the breast and boost target volumes is needed, based on clinical data confirming tumour control probability and normal

  14. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer

    OpenAIRE

    Clymer, Jeffrey; Cheng,Hang; Ferko,Nicole; Patel,Leena; Soleas,Ireena M; Cameron,Chris G; Hinoul,Piet

    2016-01-01

    Hang Cheng,1 Jeffrey W Clymer,1 Nicole C Ferko,2 Leena Patel,2 Ireena M Soleas,2 Chris G Cameron,2 Piet Hinoul1 1Ethicon Inc., Cincinnati, OH, USA; 2Cornerstone Research Group, Burlington, ON, Canada Background: Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However...

  15. Clinical efficacy of breast-conserving surgery combined with neoadjuvant chemotherapy for locally advanced breast cancer: a report of 81 cases

    Directory of Open Access Journals (Sweden)

    Zhi-yu CAO

    2015-07-01

    Full Text Available Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with breast-conserving surgery for locally advanced breast cancer. Methods Eighty-one patients with locally advanced breast cancer were selected from those who were admitted into 309 Hospital of PLA from January 2009 to October 2013, consisting of 65 patients in stage Ⅲa and 16 in stage Ⅲb, and they were treated with neoadjuvant chemotherapy combined with breast-conserving surgery. The clinical efficacy [complete response (CR, partial response (PR, stable disease (SD and progress disease (PD] was observed during follow-up. Results All the patients were followed-up for 12-60 months with a median of 34 months. There were 12 CR patients (14.8%, including 4 with pathological complete response (4.9%, and 52 PR patients (64.2%, 17 SD patients (21.0%. No PD was observed. The overall response rate(ORR was 79.0%(64/81. After follow-up for 12-60 months (median 34 months, distant metastasis to the lung, liver, meninges and bone occurred in 3 patients (3.7%, 3/81 and 1 of them died. Forty-eight patients received breastconserving surgery. The local recurrence rate was 6.3% (3/48. Assessment of cosmetic result was carried out in 48 patients who received breast-conserving surgery and comprehensive treatment for one year, and excellent results were obtained in 14.6% (7/48, good in 43.8% (21/48, and poor in 41.7% (20/48. Conclusions The therapeutic efficacy of locally advanced breast cancer is satisfactory by neoadjuvant chemotherapy and breast-conserving surgery. Standardization of excision and postoperative radiotherapy, systemic comprehensive treatment is the key to the success of the treatment. DOI: 10.11855/j.issn.0577-7402.2015.06.14

  16. Strong and anisotropic magnetoelectricity in composites of magnetostrictive Ni and solid-state grown lead-free piezoelectric BZT–BCT single crystals

    Directory of Open Access Journals (Sweden)

    Haribabu Palneedi

    2017-03-01

    Full Text Available Aimed at developing lead-free magnetoelectric (ME composites with performances as good as lead (Pb-based ones, this study employed (001 and (011 oriented 82BaTiO3-10BaZrO3-8CaTiO3 (BZT–BCT piezoelectric single crystals, fabricated by the cost-effective solid-state single crystal growth (SSCG method, in combination with inexpensive, magnetostrictive base metal Nickel (Ni. The off-resonance, direct ME coupling in the prepared Ni/BZT–BCT/Ni laminate composites was found to be strongly dependent on the crystallographic orientation of the BZT–BCT single crystals, as well as the applied magnetic field direction. Larger and anisotropic ME voltage coefficients were observed for the composite made using the (011 oriented BZT–BCT single crystal. The optimized ME coupling of 1 V/cm Oe was obtained from the Ni/(011 BZT–BCT single crystal/Ni composite, in the d32 mode of the single crystal, when a magnetic field was applied along its [100] direction. This performance is similar to that reported for the Ni/Pb(Mg1/3Nb2/3O3-Pb(Zr,TiO3 (PMN–PZT single crystal/Ni, but larger than that obtained from the Ni/Pb(Zr,TiO3 ceramic/Ni composites. The results of this work demonstrate that the use of lead-free piezoelectric single crystals with special orientations permits the selection of desired anisotropic properties, enabling the realization of customized ME effects in composites.

  17. Recent advances in radiotherapy: Partial Breast Irradiation (PBI) in breast cancer patients after breast conserving surgery

    International Nuclear Information System (INIS)

    Niwinska, A.

    2003-01-01

    The interest in accelerated partial breast irradiation (PBI) after conservative surgery has increased over the past decade as a result of many factors, including clinical and pathological data questioning the efficacy of whole breast irradiation in highly selected patients, as well as factors related to patient's convenience. High dose rate and low dose rate brachytherapy, brachytherapy MammoSite, Electron Intraoperative Therapy - ELIOT and Targeted Intraoperative Radiotherapy - TARGIT are the subject of investigation. The tolerability and efficacy of the treatment are of special interest. In this review article, methods of accelerated PBI, eligibility criteria, techniques of radiotherapy, early results and side effects are reviewed. (author)

  18. Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

    Science.gov (United States)

    Persing, Sarah; Jerome, Mairin A; James, Ted A; Callas, Peter; Mace, John; Sowden, Michelle; Goodwin, Andrew; Weaver, Donald L; Sprague, Brian L

    2015-10-01

    Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates. We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Real-time 3-dimensional virtual reality navigation system with open MRI for breast-conserving surgery

    International Nuclear Information System (INIS)

    Tomikawa, Morimasa; Konishi, Kozo; Ieiri, Satoshi; Hong, Jaesung; Uemura, Munenori; Hashizume, Makoto; Shiotani, Satoko; Tokunaga, Eriko; Maehara, Yoshihiko

    2011-01-01

    We report here the early experiences using a real-time three-dimensional (3D) virtual reality navigation system with open magnetic resonance imaging (MRI) for breast-conserving surgery (BCS). Two patients with a non-palpable MRI-detected breast tumor underwent BCS under the guidance of the navigation system. An initial MRI for the breast tumor using skin-affixed markers was performed immediately prior to excision. A percutaneous intramammary dye marker was applied to delineate an excision line, and the computer software '3D Slicer' generated a real-time 3D virtual reality model of the tumor and the puncture needle in the breast. Under guidance by the navigation system, marking procedures were performed without any difficulties. Fiducial registration errors were 3.00 mm for patient no.1, and 4.07 mm for patient no.2. The real-time 3D virtual reality navigation system with open MRI is feasible for safe and accurate excision of non-palpable MRI-detected breast tumors. (author)

  20. Rescue mastectomy in 192 breast cancer patients with T2 tumors larger than 3 cm or T3 tumors first treated by breast conservation protocols and followed-up for at least ten years

    International Nuclear Information System (INIS)

    Khayat, D.; Baillet, F.; Simon, J.M.; Sahraoui, S.; Voican, D.; Housset, M.

    1997-01-01

    Breast conservation therapy was used in 192 breast cancer patients treated between 1980 and 1986 for T2 tumors larger than 3 cm or T3 tumors. Primary chemotherapy was followed by external beam radiation therapy then by boost brachytherapy and adjuvant chemotherapy. Locoregional recurrences were treated whenever possible by tumor-ectomy and/or axillary node clearance. Median follow-up was 13 years. Of the three patients with local therapeutic failures at completion of the locoregional treatment, two were treated by tumor-ectomy and one by mastectomy. Subsequently, 21 mastectomies were performed, for oncological reasons in 20 cases. Overall survival was 55 % after five years, 60 % after ten years, and 56 % after 15 years. Local control rates were 82 %, 77 %, and 75 % after five, ten, and 15 years, respectively. After exclusion of the patients who required mastectomy, cosmetic results were satisfactory in 68 % of patients overall, 67 % of five-year survivors, and 73 % of ten-year survivors. These results show that the conventional approach involving routine initial mastectomy is no longer appropriate in patients with T3 or large T2 breast cancers. (authors)

  1. Long-term outcome of adipose-derived regenerative cell-enriched autologous fat transplantation for reconstruction after breast-conserving surgery for Japanese women with breast cancer.

    Science.gov (United States)

    Ito, Shuhei; Kai, Yuichiro; Masuda, Takaaki; Tanaka, Fumiaki; Matsumoto, Toshifumi; Kamohara, Yukio; Hayakawa, Hiroshi; Ueo, Hiroaki; Iwaguro, Hideki; Hedrick, Marc H; Mimori, Koshi; Mori, Masaki

    2017-12-01

    More effective methods are needed for breast reconstruction after breast-conserving surgery for breast cancer. The aim of this clinical study was to assess the perioperative and long-term outcomes of adipose-derived regenerative cell (ADRC)-enriched autologous fat grafting. Ten female patients who had undergone breast-conserving surgery and adjuvant radiotherapy for breast cancer were enrolled. An ADRC-enriched fat graft prepared from the patient's adipose tissue was implanted at the time of adipose tissue harvest. The perioperative and long-term outcomes of the grafts, which included safety, efficacy, and questionnaire-based patient satisfaction, were investigated. The mean operation time was 188 ± 30 min, and the mean duration of postoperative hospitalization was 1.2 ± 0.4 days. No serious postoperative complications were associated with the procedure. Neither recurrence nor metastatic disease was observed during the follow-up period (7.8 ± 1.5 years) after transplantation. Of 9 available patients, "more than or equal to average" satisfaction with breast appearance and overall satisfaction were reported by 6 (66.7%) and 5 (55.6%) patients, respectively. ADRC-enriched autologous fat transplantation is thus considered to be safe perioperatively, with no long-term recurrence, for patients with breast cancer treated by breast-conserving surgery, and it may be an option for breast reconstruction, even after adjuvant radiotherapy.

  2. Association between cumulative radiation dose, adverse skin reactions, and changes in surface hemoglobin among women undergoing breast conserving therapy

    Directory of Open Access Journals (Sweden)

    Michael S. Chin

    2017-06-01

    Conclusion: HSI demonstrates promise in the assessment of skin dose as well as an objective measure of skin reaction. The ability to easily identify adverse skin reactions and to modify the treatment plan may circumvent the need for detrimental treatment breaks.

  3. Use of Combination Thermal Therapy and Radiation in Breast-Conserving Treatment of Extensive Intraductal Breast Cancer

    Science.gov (United States)

    1997-07-01

    dose reirradiation in combination with hyperthermia: a palliative treatment for patients with breast cancer recurring in previously irradiated areas...Additional monitoring: 5.61 The P.I. or a physician designated by the P.I. will be in attendance during every treatment. 5.62 The treatment nurse will...device will obtain blood pressure every 5 minutes. 5.64 General anesthesia cannot be used, but light sedation (e.g. Ativan, Percocet, etc.) can be

  4. Breast-Conserving Surgery Followed by Radiation Therapy With MRI-Detected Stage I or Stage II Breast Cancer

    Science.gov (United States)

    2011-12-07

    Ductal Breast Carcinoma in Situ; Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Stage I Breast Cancer; Stage II Breast Cancer; Tubular Ductal Breast Carcinoma

  5. Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers' experience

    International Nuclear Information System (INIS)

    Cutuli, Bruno; Cohen-Solal-le Nir, Christine; Lafontan, Brigitte de; Mignotte, Herve; Fichet, Virginie; Fay, Renaud; Servent, Veronique; Giard, Sylvia; Charra-Brunaud, Claire; Lemanski, Claire; Auvray, Hugues; Jacquot, Stephane; Charpentier, Jean-Christophe

    2002-01-01

    Purpose: To assess the long-term outcome for women with ductal carcinoma in situ of the breast treated in current clinical practice by conservative surgery with or without definitive breast irradiation. Methods and Materials: We analyzed 705 cases of ductal carcinoma in situ treated between 1985 and 1995 in nine French regional cancer centers; 515 underwent conservative surgery and radiotherapy (CS+RT) and 190 CS alone. The median follow-up was 7 years. Results: The 7-year crude local recurrence (LR) rate was 12.6% (95% confidence interval [CI] 9.4-15.8) and 32.4% (95% CI 25-39.7) for the CS+RT and CS groups, respectively (p<0.0001). The respective 10-year results were 18.2% (95% CI 13.3-23) and 43.8% (95% CI 30-57.7). A total of 125 LRs occurred, 66 and 59 in the CS+RT and CS groups, respectively. Invasive or microinvasive LRs occurred in 60.6% and 52% of the cases in the same respective groups. The median time to LR development was 55 and 41 months. Nine (1.7%) and 6 (3.1%) nodal recurrences occurred in the CS+RT and CS groups, respectively. Distant metastases occurred in 1.4% and 3% of the respective groups. Patient age and excision quality (final margin status) were both significantly associated with LR risk in the CS+RT group: the LR rate was 29%, 13%, and 8% among women aged ≤40, 41-60, and ≥61 years (p<0.001). Even in the case of complete excision, we observed a 24% rate of LR (6 of 25) in women <40 years. Patients with negative, positive, or uncertain margins had a 7-year crude LR rate of 9.7%, 25.2%, and 12.2%, respectively (p=0.008). RT reduced the LR rate in all subgroups, especially in those with comedocarcinoma (17% vs. 59% in the CS+RT and CS groups, respectively, p<0.0001) and mixed cribriform/papillary tumors (9% vs. 31%, p<0.0001). In the multivariate Cox regression model, young age and positive margins remained significant in the CS+RT group (p=0.00012 and p=0.016). Finally, the relative LR risk in the CS+RT group compared with the CS group was 0.35 (95% CI 0.25-0.51, p=0.0001). Subsequent contralateral breast cancer occurred in 7.1% and 7.5% of the patients in the CS+RT and CS groups, respectively. Conclusion: Despite the absence of randomization, our results are extremely consistent with the updated National Surgical Adjuvant Breast Project B17 and European Organization for Research and Treatment of Cancer 10853 trials. We also noted that the LR risk was very high in women <40 years and/or in the case of incomplete excision

  6. Influence of temperature and glucose addition on growth and survival of bacteria from BCT culture in soymilk

    Directory of Open Access Journals (Sweden)

    Galja Pletikapić

    2008-05-01

    Full Text Available Soymilk was fermented using culture composed of Lactobacillus casei, Bifidobacterium spp. and Streptococcus thermophilus (BCT culture, Chr. Hansen’s, Denmark at two temperatures 37 °C and 41 °C with and without 5 % of glucose addition. Fermentation was conducted until pH value 4.6 was reached. During fermentation and storage time (28 days at +4 °C changes of pH values and viable cells counts were observed. All fermentations lasted between 6 and 7.5 hours. At temperature 41 °C fermentation was approximately 1 hour shorter, while glucose addition had reduced fermentation time for 30 minutes. Higher temperature of fermentation, as well as glucose addition, had negligible influence on portions and viable cells count of particular bacterial species in the product. In all fermented soymilk samples the viable cells count of particular bacterial strains was roughly equal: Str. thermophilus have grown the best (~ 108 CFU/mL while lactobacilli have grown the weakest (~ 105 - 106 CFU/mL. Generally, for soymilk fermentation mainly Str. thermophilus was responsible. On its growth rate glucose addition and higher fermentation temperature had strong positive influence. During 28 days of refrigerated storage, the product was stable. A remarkable decrease of viable cells count of lactobacilli was noticed in the last week of storage.

  7. Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: a comparative evaluation in community-based addiction treatment centers.

    Science.gov (United States)

    Vedel, Ellen; Emmelkamp, Paul M G; Schippers, Gerard M

    2008-01-01

    Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol consumption and enhancing marital functioning, but no study has directly tested the comparative effectiveness of stand-alone BCT versus an individually focused cognitive-behavioral therapy (CBT) in a clinical community sample. The present study is a randomized clinical trial evaluating the effectiveness of stand-alone BCT (n = 30) compared to individual CBT (n = 34) in the treatment of alcohol use disorders in community treatment centers in Dutch male and female alcoholics and their partners. Results show both BCT and CBT to be effective in changing drinking behavior after treatment. BCT was not found to be superior to CBT. Marital satisfaction of the spouse increased significantly in the BCT condition but not in the CBT condition, the differences being significant at the post-test. Patients' self-efficacy to withstand alcohol-related high-risk situations increased significantly in both treatment conditions, but more so in CBT than in BCT after treatment. Treatment involvement of the spouse did not increase retention. Regular practitioners in community treatment centers can effectively deliver both treatments. Stand-alone BCT is as effective as CBT in terms of reduced drinking and to some extent more effective in terms of enhancing relationship satisfaction. However, BCT is a more costly intervention, given that treatment sessions lasted almost twice as long as individual CBT sessions. Copyright 2008 S. Karger AG, Basel.

  8. Impact of the Radiation Boost on Outcomes After Breast-Conserving Surgery and Radiation

    International Nuclear Information System (INIS)

    Murphy, Colin; Anderson, Penny R.; Li Tianyu; Bleicher, Richard J.; Sigurdson, Elin R.; Goldstein, Lori J.; Swaby, Ramona; Denlinger, Crystal; Dushkin, Holly; Nicolaou, Nicos; Freedman, Gary M.

    2011-01-01

    Purpose: We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. Methods and Materials: A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). Results: The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. Conclusions: Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.

  9. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer.

    Science.gov (United States)

    Fan, Lin-Jun; Jiang, Jun; Yang, Xin-Hua; Zhang, Yi; Li, Xing-Gang; Chen, Xian-Chun; Zhong, Ling

    2009-12-20

    Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P > 0.05). The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P > 0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -one of these patients died of multiple organ metastasis. After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants - the new surgery of choice for breast cancer - warrants serious consideration as the prospective next standard surgical procedure.

  10. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes.

    Science.gov (United States)

    Kelsall, Jennett E; McCulley, Stephen J; Brock, Lisa; Akerlund, Malin T E; Macmillan, R Douglas

    2017-10-01

    Oncoplastic breast conserving surgery (OBCS) allows women who may otherwise have mastectomy and immediate reconstruction (MxIR) the choice to conserve their breast yet avoid deformity. We compared the outcome of these options. Two cohorts meeting study criteria were identified from prospectively audited series of women undergoing OBCS or MxIR. After case matching for age, tumour size and date of surgery, stratification by breast size and controlling for radiotherapy; body image scale (BIS) scores of psychosocial function and patient reported outcome measures (PROMs) for breast appearance and return to function were analysed. A total of 567 women (286 treated by OBCS and 281 by MxIR) fulfilled inclusion criteria. Demographics were similar between the two unmatched cohorts, except for radiotherapy, age and tumour size (all p < 0.001). Overall, BIS score (p = 0.002), self-rated breast appearance, return to work and function (all p < 0.001) significantly favoured OBCS. Case-matched women with larger breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p < 0.001) than MxIR, whereas no significant difference was observed for smaller breasts. BIS and appearance favoured OBCS, regardless of whether radiotherapy would have been avoided if treated by MxIR. OBCS offers suitable women the option to avoid MxIR while providing faster recovery. Better psychosocial and self-rated satisfaction with breast appearance is achieved for OBCS in all groups, regardless of the need for radiotherapy, apart from those women with smaller breasts for whom the results are comparable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    International Nuclear Information System (INIS)

    Martin, Michael A; Meyricke, Ramona; O'Neill, Terry; Roberts, Steven

    2006-01-01

    A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS) – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of 'propensity' is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients

  12. Patterns of Utilization of Adjuvant Radiotherapy and Outcomes in Black Women After Breast Conservation at a Large Multidisciplinary Cancer Center

    International Nuclear Information System (INIS)

    Edwards-Bennett, Sophia M.; Jacks, Lindsay M.; McCormick, Beryl; Zhang, Zhigang; Azu, Michelle; Ho, Alice; Powell, Simon; Brown, Carol

    2011-01-01

    Purpose: Population-based studies have reported that as many of 35% of black women do not undergo radiotherapy (RT) after breast conservation surgery (BCS). The objective of the present study was to determine whether this trend persisted at a large multidisciplinary cancer center, and to identify the factors that predict for noncompliance with RT and determine the outcomes for this subset of patients. Methods and Materials: Between January 2002 and December 2007, 83 black women underwent BCS at Memorial Sloan-Kettering Cancer Center and were therefore eligible for the present study. Of the 83 women, 38 (46%) had Stage I, 38 (46%) Stage II, and 7 (8%) Stage III disease. Of the study cohort, 31 (37%) had triple hormone receptor-negative tumors. RT was recommended for 81 (98%) of the 83 patients (median dose, 60 Gy). Results: Of the 81 women, 12 (15%) did not receive the recommended adjuvant breast RT. Nonreceipt of chemotherapy (p = .003) and older age (p = .009) were associated with nonreceipt of RT. With a median follow-up of 70 months, the 3-year local control, locoregional control, recurrence-free survival, disease-free survival, and overall survival rate was 99% (actuarial 5-year rate, 97%), 96% (actuarial 5-year rate, 93%), 95% (actuarial 5-year rate, 92%), 92% (actuarial 5-year rate, 89%), and 95% (actuarial 5-year rate, 91%), respectively. Conclusion: We found a greater rate of utilization adjuvant breast RT (85%) among black women after BCS than has been reported in recent studies, indicating that excellent outcomes are attainable for black women after BCS when care is administered in a multidisciplinary cancer center.

  13. The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer

    Science.gov (United States)

    McGuire, Kandace; Alco, Gul; Nur Pilanci, Kezban; Koksal, Ulkuhan I; Elbüken, Filiz; Erdogan, Zeynep; Agacayak, Filiz; Ilgun, Serkan; Sarsenov, Dauren; Öztürk, Alper; İğdem, Şefik; Okkan, Sait; Eralp, Yeşim; Dincer, Maktav; Ozmen, Vahit

    2016-01-01

    Background Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. Methods Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). Results Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). Conclusion Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival. PMID:27433412

  14. Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients' and Doctors' Views

    International Nuclear Information System (INIS)

    Toledano, Alain H.; Bollet, Marc A.; Fourquet, Alain; Azria, David; Gligorov, Joseph; Garaud, Pascal; Serin, Daniel; Bosset, Jean-Francois; Miny-Buffet, Joelle; Favre, Anne; Le Foch, Olivier; Calais, Gilles

    2007-01-01

    Purpose: To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. Methods and Materials: From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. Results: Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (κ = 0.62). Conclusion: After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis

  15. A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone

    OpenAIRE

    Rakovitch, Eileen; Nofech-Mozes, Sharon; Hanna, Wedad; Baehner, Frederick L.; Saskin, Refik; Butler, Steven M.; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Jani, Prashant A.; Bonin, Michel; Chang, Martin C.; Robertson, Susan J.; Slodkowska, Elzbieta; Fong, Cindy

    2015-01-01

    Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX? DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DC...

  16. Influence of surgery-radiotherapy interval on recurrence in breast-conserving treatment of small breast cancer

    International Nuclear Information System (INIS)

    Fourquet, A.; Dreyfus, H.; Maher, M.; Gozy, M.; Campana, F.; Vilcoq, J. R.; Colombani, H.

    1995-01-01

    Purpose: To retrospectively evaluate the possible influence of surgery-radiotherapy interval (SRI) on breast recurrence in patients (pts.) with small breast cancers who had a breast-conserving treatment. Materials and Methods: Between January 1981 and December 1988, of 2012 pts. with stage I-II breast cancers treated with wide excision, axillary node dissection and breast irradiation, 1839 (91%) did not received adjuvant chemotherapy and were included in this study. Median age was 51 yrs. [23-88]. Mean tumor size was 2.1 cm [0.5-5]. Median tumor bed irradiation dose was 65 Gy [50-90]. The median SRI was 32 days [5-137]. Pts. were distributed among three SRI groups: 56 days (61 pts). Breast recurrence risk and survival were determined by Kaplan-Meier estimates. The following prognostic factors were evaluated for their possible influence on breast recurrence: age, tumor size, node involvement, estrogen receptor levels, Bloom and Richardson grading (SBR). Therapeutic factors were also analyzed: place of surgery (inside or outside the institution), breast and tumor bed radiation dose, and SRI as a time-dependent variable. A multivariate analysis of breast recurrence risk was performed to adjust for the various confounding factors. A prognostic index was established and the influence of SRI on recurrence was determined within the various prognostic groups. Results: Median follow-up for living pts. was 78 months [3-158]. Breast recurrence rate at 7 years was 11 % [10-13]. The 7-year survival rate was 89 % [88-91]. The 7-year breast recurrence risks in the three SRI groups were 12 %, 9 %, and 18%, respectively (p=0.045). The relative risk (RR) of breast failure was significantly lower in the 35-56 days SRI group compared with the 56 days) were also associated with a higher risk of recurrence, though not statistically significant because of the small numbers. The effect of SRI was time-dependent, i. e. influencing early recurrences and disappearing after 5 years. It was

  17. Prognostic Significance of Clinicopathologic Features in Patients With Breast Ductal Carcinoma-in-Situ Who Received Breast-Conserving Surgery.

    Science.gov (United States)

    Kuo, Sung-Hsin; Lo, Chiao; Chen, Yu-Hsuan; Lien, Huang-Chun; Kuo, Wen-Hung; Wang, Ming-Yang; Lee, Yi-Hsuan; Huang, Chiun-Sheng

    2018-04-10

    To identify whether a certain group of breast ductal carcinoma-in-situ (DCIS) patients can be treated with breast-conserving surgery (BCS) alone; to analyze the clinicopathologic features of DCIS and tamoxifen administration in patients treated with BCS who developed ipsilateral breast tumor recurrence (IBTR). Data for 375 women with breast DCIS who underwent BCS at our institute between June 2003 and October 2010 were analyzed. The patients were divided into different categories according to the recurrence risk predicted using the California/Van Nuys Prognostic Index (USC/VNPI) score (4-6, 7-9, and 10-12), Eastern Cooperative Oncology Group (ECOG) E5194 criteria, or combined risk features with USC/VNPI score and ECOG E5194 criteria. The IBTR and disease-free survival (DFS) rates were calculated by the Kaplan-Meier method. The prognostic effects of age, tumor size, tumor grade, margin width, estrogen receptor status, USC/VNPI score, low-risk characteristics, and tamoxifen use were evaluated by log-rank tests. Of the patients, 168 were treated with breast irradiation after BCS and 207 were not. The patients who were treated with radiotherapy (RT) tended to be younger (USC/VNPI scores (7-9), and to meet the ECOG E5194 non-cohort 1 criteria. The 7-year risk of IBTR was 6.2% (n = 11) in the patients who received irradiation and 9.0% (n = 22) in those who did not. DFS rates were better in the patients who underwent RT than in those who did not (93.3% vs. 88.5%, P = .056). Among the patients who underwent BCS alone, age ≥ 40 years, margin width > 10 mm, USC/VNPI scores 4-6, ECOG E5194 cohort 1 criteria, estrogen receptor-positive status, and tamoxifen use predicted lower IBTR and better DFS rates. In the multivariate analysis, combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1 criteria) were identified as an independent prognostic factor of lower IBTR (P = .028) and better DFS (P = .005). RT reduces the risk of IBTR after

  18. Breast cancer in patients carrying a germ-line CHEK2 mutation: Outcome after breast conserving surgery and adjuvant radiotherapy

    International Nuclear Information System (INIS)

    Meyer, Andreas; Doerk, Thilo; Sohn, Christof; Karstens, Johann H.; Bremer, Michael

    2007-01-01

    Background and purpose: Women carrying mutations in the CHEK2 gene are at an increased breast cancer risk. Data about outcome and prognosis for these patients after standard multimodality treatment are scarce at present. Materials and methods: One-hundred and fifty (150) patients with non-metastasized early-stage breast cancer (T1-2) receiving postoperative radiotherapy following breast-conservative surgery at our department were included in this analysis. Carriers were identified using mutation-specific restriction enzyme-based screening assays in previous investigations. Twenty-five breast cancer patients were heterozygous for one of three CHEK2 gene mutations (I157T, n = 13; 1100delC, n = 10; IVS2+1G > A, n = 2). The comparison group consisted of 125 early-stage breast cancer patients without a CHEK2 gene mutation (non-carriers). Median follow-up was 87 months for the total cohort of patients. Results: Local recurrences occurred in 13 patients (carriers, 3 (12%); non-carriers, 10 (8%)) and distant metastases occurred in 27 patients (carriers, 8 (32%); non-carriers, 19 (15%)). Twenty-five patients had deceased (carriers, 8 (32%); non-carriers, 17 (14%)) with all but 3 deaths related to breast cancer. Actuarial 7-year local relapse-free survival was 86% in carriers versus 90% in non-carriers (p = 0.48). Actuarial metastasis-free, disease-free and overall survival at 7 years were 64% vs. 84% (p = 0.045), 59% vs. 78% (p = 0.07) and 69% vs. 87% (p = 0.10), respectively. In a multivariate step-wise Cox regression analysis presence of a CHEK2 mutation remained a borderline significant discriminator for metastasis-free survival (p = 0.048; OR = 0.4; 95% CI 0.2-1.0) next to T-stage (p = 0.001; OR 0.3; 95% CI 0.1-0.6). Conclusions: Heterozygosity for a germline CHEK2 mutation appears to represent an adverse prognostic factor in patients with early-stage breast cancer. If confirmed in larger studies these data may serve as a basis for future surveillance and treatment

  19. Timing of radiotherapy (RT) and chemotherapy (CT) following breast conserving surgery (BCS) for patients with node-positive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wallgren, A; Bernier, J; Gelber, RD; Roncadin, M; Joseph, D; Castiglione, M

    1995-07-01

    Purpose: To evaluate the effects of delaying RT until after different durations of initial courses of CT for pts with node-positive breast cancer. Methods and Materials: From 7/86-4/93, the IBCSG enrolled 1475 eligible node-positive pre- and perimenopausal pts in Trial 6 and 1212 eligible node-positive postmenopausal pts in Trial 7. Pts in Trial 6 were randomized to receive one of four treatments: (1) CMF x 6 cycles (1 cycle=28 days; cyclophosphamide 100 mg/m{sup 2} orally days 1-14; methotrexate 40 mg/m{sup 2} iv. days 1 and 8; 5-fluorouracil 600 mg/m{sup 2} iv days 1 and 8); (2) CMF x 6 cycles followed by single cycles at months 9, 12 and 15; (3) CMF x 3 cycles; (4) CMF x 3 followed by single cycles at months 6, 9 and 12. Pts in Trial 7 were randomized to receive one of four treatments: (5) tamoxifen (TAM: 20 mg daily) plus CMF x 3 cycles, months 1,2,3; (6) TAM plus CMF x 3 plus single cycles of CMF at months 9, 12 and 15; (7) TAM alone for five yrs; (8) TAM plus single cycles of CMF at months 9, 12 and 15. The randomizations were stratified according to type of surgery; 434 pts in Trial 6 (29%) and 285 pts in Trial 7 (24%) had breast conserving surgery and are the subjects of this report. Pts were randomized to receive RT to the conserved breast AFTER completing the initial block of CT if assigned; i.e. month 7 for arms 1 and 2; month 4 for arms 3 and 4; month 4 for arms 5 and 6; month 1 for arms 7 and 8. 24% of pts in Trial 6 and 27% of pts in Trial 7 had four or more axillary lymph nodes involved. Possible prognostic factors including age, estrogen receptor status, nodal status and tumor size were balanced across randomized groups. Four-year actuarial total failure rates (failure at any site), risks of developing distant metastases (DM) (at any time during observation), and overall survival (OS) were estimated using the Kaplan-Meier method. To avoid potential bias due to competing causes of failure, only patients who could be followed for at least 4 years

  20. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials

    DEFF Research Database (Denmark)

    Darby, S; McGale, P; Correa, C

    2011-01-01

    After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute...

  1. Ten-year results of the treatment of early-stage breast carcinoma in elderly women using breast-conserving surgery and definitive breast irradiation

    International Nuclear Information System (INIS)

    Solin, Lawrence J.; Schultz, Delray J.; Fowble, Barbara L.

    1995-01-01

    Purpose: The optimal management of breast cancer in elderly women is not well established. Therefore, the present study was undertaken to evaluate the outcome of breast cancer in elderly women treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 558 women age ≥ 50 years treated with breast-conserving surgery and definitive breast irradiation for Stages I-II invasive carcinoma of the breast. Of the 558 total women, there were 173 elderly women age ≥ 65 years and a comparison group of 385 women age 50-64 years. Treatment for all women included complete gross excision of the primary tumor, pathologic axillary lymph node staging, and definitive breast irradiation. Adjuvant systemic chemotherapy was used in 18% (102 out of 558) of the overall group. Adjuvant tamoxifen was used in 17% (94 out of 558) of the overall group. The median follow-up after treatment was 6.2 years (mean = 6.4 years; range 0.1-15.4 years). Results: Elderly patients age ≥ 65 years and patients age 50-64 years were both found to have tumors with adverse prognostic features, including clinical T2 lesions (43 vs. 34%, respectively; p = 0.055), estrogen receptor negativity (9 vs. 16%, respectively; p = 0.13), and progesterone receptor negativity (17 vs. 21%, respectively; p = 0.50). Pathologic axillary lymph node staging showed that 24% of the elderly women were node positive, including 8% with four or more positive nodes, which was not different from women age 50-64 years (p = 0.23). There was no difference between the two age groups for the rate of deaths from breast cancer at 10 years (13 vs. 13%, respectively; p = 0.71). However, there was a significant difference between the two age groups for the rate of deaths from intercurrent disease at 10 years (11 vs. 2%, respectively; p = 0.0006). There were no differences between the two age groups for the 10-year rates of overall survival (77 vs. 85%, respectively; p = 0

  2. Re-resection rates after breast-conserving surgery as a performance indicator: introduction of a case-mix model to allow comparison between Dutch hospitals.

    Science.gov (United States)

    Talsma, A K; Reedijk, A M J; Damhuis, R A M; Westenend, P J; Vles, W J

    2011-04-01

    Re-resection rate after breast-conserving surgery (BCS) has been introduced as an indicator of quality of surgical treatment in international literature. The present study aims to develop a case-mix model for re-resection rates and to evaluate its performance in comparing results between hospitals. Electronic records of eligible patients diagnosed with in-situ and invasive breast cancer in 2006 and 2007 were derived from 16 hospitals in the Rotterdam Cancer Registry (RCR) (n = 961). A model was built in which prognostic factors for re-resections after BCS were identified and expected re-resection rate could be assessed for hospitals based on their case mix. To illustrate the opportunities of monitoring re-resections over time, after risk adjustment for patient profile, a VLAD chart was drawn for patients in one hospital. In general three out of every ten women had re-surgery; in about 50% this meant an additive mastectomy. Independent prognostic factors of re-resection after multivariate analysis were histological type, sublocalisation, tumour size, lymph node involvement and multifocal disease. After correction for case mix, one hospital was performing significantly less re-resections compared to the reference hospital. On the other hand, two were performing significantly more re-resections than was expected based on their patient mix. Our population-based study confirms earlier reports that re-resection is frequently required after an initial breast-conserving operation. Case-mix models such as the one we constructed can be used to correct for variation between hospitals performances. VLAD charts are valuable tools to monitor quality of care within individual hospitals. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Effect of deposition temperature & oxygen pressure on mechanical properties of (0.5) BZT-(0.5)BCT ceramic thin films

    Science.gov (United States)

    Sailaja, P.; Kumar, N. Pavan; Rajalakshmi, R.; Kumar, R. Arockia; Ponpandian, N.; Prabahar, K.; Srinivas, A.

    2018-05-01

    Lead free ferroelectric thin films of {(0.5) BZT-(0.5) BCT} (termed as BCZT) were deposited on Pt/TiO2/SiO2/Si substrates by pulsed laser deposition at four deposition temperatures 600, 650, 700, 750°C and at two oxygen pressures viz. 75mtorr and 100 mtorr using BCZT ceramic target (prepared by solid state sintering method). The effect of deposition temperature and oxygen pressure on the structure, microstructure and mechanical properties of BCZT films were studied. X-ray diffraction patterns of deposited films confirm tetragonal crystal symmetry and the crystallinity of the films increases with increasing deposition temperature. Variation in BCZT grain growth was observed when the films are deposited at different temperatures andoxygen pressures respectively. The mechanical properties viz. hardness and elastic modulus were also found to be high with increase in the deposition temperature and oxygen pressure. The results will be discussed.

  4. Prospective comparison of breast pain in patients participating in a randomized trial of breast-conserving surgery and tamoxifen with or without radiotherapy

    International Nuclear Information System (INIS)

    Rayan, Gamal; Dawson, Laura A.; Bezjak, Andrea; Lau, Anthea; Fyles, Anthony W.; Yi, Q.-L.; Merante, Pat; Vallis, Katherine A.

    2003-01-01

    Purpose: To determine whether breast pain affects quality of life (QOL) after breast-conserving surgery and tamoxifen (TAM) with or without adjuvant breast radiotherapy (RT). Methods and Materials: A randomized clinical trial was carried out at the Princess Margaret Hospital between 1992 and 2000 to evaluate the need for breast RT in addition to TAM in women ≥50 years treated with breast-conserving surgery for T1-T2N0 breast cancer. A companion study to assess breast pain was carried out during the last 2 years of the randomized clinical trial. The short-form McGill Pain Questionnaire (SF-MPQ), the European Organization for Research and Treatment of Cancer (EORTC) QOL (QLQ-C30) and EORTC breast cancer module (QLQ-BR23) questionnaires were completed by patients within 1 week of randomization in the randomized clinical trial (baseline) and at 3, 6, and 12 months. Results: Eighty-six patients participated in the breast pain study; 41 received RT plus TAM and 45 received TAM alone. The median age was 70 years (range 51-80). The baseline pain and QOL scores were similar for the two groups. No significant difference was found between the two groups for each scale of the QLQ-C30 and QLQ-BR23 questionnaires at 3, 6, or 12 months (p>0.100), except that at 12 months, the score for role function (QLQ-C30) was higher in the RT plus TAM group than in the RT-only group (p=0.02). At 3 months, the difference between the mean scores for the SF-MPQ was 0.553 (p=0.47). At 12 months, the pain scores had decreased in both groups; the difference was 0.199 (p=0.71). The number of breast operations or surgical complications did not correlate with breast pain in either group. Acute RT toxicity scores did not correlate with breast pain or QOL scores at 12 months. Conclusion: These results suggest that breast RT does not significantly contribute to breast pain or adversely impact the QOL up to 12 months after treatment in postmenopausal patients with node-negative breast cancer who take

  5. Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery

    International Nuclear Information System (INIS)

    Sun, Li-Min; Huang, Eng-Yen; Liang, Ji-An; Meng, Fan-Yun; Chang, Gia-Hsin; Tsao, Min-Jen

    2013-01-01

    To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations

  6. Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 Patients treated with a prospective margin-directed policy

    International Nuclear Information System (INIS)

    Livi, Lorenzo; Meattini, Icro; Franceschini, Davide; Saieva, Calogero; Meacci, Fiammetta; Marrazzo, Livia; Gerlain, Elena; Desideri, Isacco; Scotti, Vieri; Nori, Jacopo; Sanchez, Luis Jose; Orzalesi, Lorenzo; Bonomo, Pierluigi; Greto, Daniela; Bianchi, Simonetta; Biti, Giampaolo

    2013-01-01

    Purpose: To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). Methods and materials: A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence. Conclusions: Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype

  7. Tumor cell expression of CD163 is associated to postoperative radiotherapy and poor prognosis in patients with breast cancer treated with breast-conserving surgery.

    Science.gov (United States)

    Garvin, Stina; Oda, Husam; Arnesson, Lars-Gunnar; Lindström, Annelie; Shabo, Ivan

    2018-05-03

    Cancer cell fusion with macrophages results in highly tumorigenic hybrids that acquire genetic and phenotypic characteristics from both maternal cells. Macrophage traits, exemplified by CD163 expression, in tumor cells are associated with advanced stages and poor prognosis in breast cancer (BC). In vitro data suggest that cancer cells expressing CD163 acquire radioresistance. Tissue microarray was constructed from primary BC obtained from 83 patients treated with breast-conserving surgery, 50% having received postoperative radiotherapy (RT) and none of the patients had lymph node or distant metastasis. Immunostaining of CD163 in cancer cells and macrophage infiltration (MI) in tumor stroma were evaluated. Macrophage:MCF-7 hybrids were generated by spontaneous in vitro cell fusion. After irradiation (0, 2.5 and 5 Gy γ-radiation), both hybrids and their maternal MCF-7 cells were examined by clonogenic survival. CD163-expression by cancer cells was significantly associated with MI and clinicopathological data. Patients with CD163-positive tumors had significantly shorter disease-free survival (DFS) after RT. In vitro generated macrophage:MCF-7 hybrids developed radioresistance and exhibited better survival and colony forming ability after radiation compared to maternal MCF-7 cancer cells. Our results suggest that macrophage phenotype in tumor cells results in radioresistance in breast cancer and shorter DFS after radiotherapy.

  8. Factors affecting local recurrence and distant metastases of invasive breast cancer after breast-conserving surgery in Chiang Mai University Hospital.

    Science.gov (United States)

    Ditsatham, Chagkrit; Somwangprasert, Areewan; Watcharachan, Kirati; Wongmaneerung, Phanchaporn; Khorana, Jiraporn

    2016-01-01

    The purpose of this study was to collect data regarding breast cancer profiles and factors that affect local recurrence and distant metastasis after breast-conserving surgery (BCS) in Chiang Mai University Hospital. This study was a retrospective review in a single institution of newly diagnosed invasive breast cancer patients who were treated with BCS between April 9, 2001 and December 25, 2011. A total of 185 patients treated with BCS were included in this study, with an average age of 46.83 years. The average recurrence age was 41.1 years and the average nonrecurrence age was 47.48 years, with a recurrence rate of 10.27%. Premenopause was significant in recurrence (P=0.047), as well as non-estrogen-expression patients (P=0.001) and patients who did not receive antihormonal treatment (P=0.011). The recurrence rate in our institute was 10.27%. Factors affecting recurrence after BCS included young age, premenopausal status, nonexpression of the estrogen receptor, and patients who had not received antihormonal treatment. The recurrence rate was higher in the first 90 postoperative months.

  9. Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first

    International Nuclear Information System (INIS)

    Bollet, Marc A.; Sigal-Zafrani, Brigitte; Mazeau, Valerie; Savignoni, Alexia; Rochefordiere, Anne de la; Vincent-Salomon, Anne; Salmon, Remy; Campana, Francois; Kirova, Youlia M.; Dendale, Remi; Fourquet, Alain

    2007-01-01

    Purpose: To ascertain the loco-regional recurrence (LRR) rate and its major prognostic factors in patients younger than 40 and to determine the influence of age on the features of breast cancer and its treatment in two age groups: ≤35 years and [36-39] years. Methods and materials: Between 1985 and 1995, 209 premenopausal women, younger than 40, were treated for early breast cancers with primary breast conserving surgery followed by radiotherapy ± chemotherapy. Median age was 37 years with 66 patients (32%) ≤35 years and 143 older (68%). Median follow-up was 12 years. Tumours' characteristics were: cT1 in 75%, pN0 in 60%. Results: LRR rate was 38% at 10 years, contralateral breast cancer rate 12%. Age was the only prognostic factor for LRR. The relative risk of LRR increased by 7% for every decreasing year of age. The annual risk of local recurrence peaked between 2 and 3 years after the initial diagnosis and returned to the level of contra-lateral breast cancer at 10 years. The younger population had infiltrating carcinomas that were significantly more commonly ductal, less commonly lobular, and of higher grade - they received chemotherapy more often. Conclusion: Using conventional methods we could find no explanation as to why age remained the most important prognostic factor for breast cancer LRR. Known prognostic factors such as involved surgical margins seemed erased by adequate radiotherapy doses

  10. A correlation study on the displacement of the whole breast target after breast-conserving surgery based on four-dimensional computed tomography

    International Nuclear Information System (INIS)

    Wang Wei; Li Jianbin; Wang Suzhen; Zhang Yingjie; Li Fengxiang; Xu Min; Shang Dongping

    2011-01-01

    Objective: To investigate the correlations of the whole breast displacement in different respiratory cycle during free breathing (FB) following breast-conserving surgery to the displacement of selected skin marker, nipple, and selected surgical clip based on four-dimensional computed tomography (4D-CT). Methods: Thirteen breast cancer patients who had undergone breast-conserving surgery received whole breast intensity-modulated radiotherapy (IMRT). Respiration-synchronized 4D-CT image data were gathered during FB and were exported to the Varian Eclipse treatment planning system, and the whole breast target, nipple, superior clip,and metal marker on the skin at the anterior body midline were delineated on the CT images of ten phases of the respiratory cycle by the same radiotherapist based on the same delineating criteria. The displacement distances of the delineated target in the mediolateral (x), anteroposterior (y), and superoinferior (z) axles were achieved,and the correlations of the whole breast target displacement to the displacement of the clip, nipple, and skin marker were analyzed. The ipsilateral lung was delineated on the CT images of every phase of the respiratory cycle, and the changes in ipsilateral lung volume were analyzed during the respiratory cycle relative to the displacement of the breast. Results: The maximal displacement distances of the whole breast target in the x, y, and z axles during FB were 0.71, 0.76 and 1.29 mm, respectively (F=5.755, P<0.05). There was no relationship between the three-dimensional (3D) displacement of the whole breast and the volume of the whole breast (r=-0.264, P<0.05), and there was no relationship between the displacement of the whole breast and the volume change of the ipsilateral lung (r=0.346, P<0.05). There was no significant difference among the mean target displacement distances in 3 axles,and among 2 selected successive end-inspiration (EI) phases and 3 selected successive end-expiration (EE) phases. There

  11. Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Doo-Hwan Kim

    2018-01-01

    Full Text Available Objectives. The pectoral nerve block type II (PECS II block is widely used for postoperative analgesia after breast surgery. This study evaluated the analgesic efficacy of PECS II block in patients undergoing breast-conserving surgery (BCS and sentinel lymph node biopsy (SNB. Methods. Patients were randomized to the control group (n=40 and the PECS II group (n=40. An ultrasound-guided PECS II block was performed after induction of anesthesia. The primary outcome measure was opioid consumption, and the secondary outcome was pain at the breast and axillary measured using the Numerical Rating Scale (NRS 24 hours after surgery. Opioid requirement was assessed according to tumor location. Results. Opioid requirement was lower in the PECS II than in the control group (43.8 ± 28.5 µg versus 77.0 ± 41.9 µg, p<0.001. However, the frequency of rescue analgesics did not differ between these groups. Opioid consumption in the PECS II group was significantly lower in patients with tumors in the outer area than that in patients with tumors in the inner area (32.5 ± 23.0 µg versus 58.0 ± 29.3 µg, p=0.007. The axillary NRS was consistently lower through 24 hr in the PECS II group. Conclusion. Although the PECS II block seemed to reduce pain intensity and opioid requirements for 24 h after BCS and SNB, these reductions may not be clinically significant. This trial is registered with Clinical Research Information Service KCT0002509.

  12. A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone.

    Science.gov (United States)

    Rakovitch, Eileen; Nofech-Mozes, Sharon; Hanna, Wedad; Baehner, Frederick L; Saskin, Refik; Butler, Steven M; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Jani, Prashant A; Bonin, Michel; Chang, Martin C; Robertson, Susan J; Slodkowska, Elzbieta; Fong, Cindy; Anderson, Joseph M; Jamshidian, Farid; Miller, Dave P; Cherbavaz, Diana B; Shak, Steven; Paszat, Lawrence

    2015-07-01

    Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DCIS treated with BCS alone from 1994 to 2003 with validation of treatment and outcomes. Central pathology assessment excluded cases with invasive cancer, DCIS < 2 mm or positive margins. Cox model was used to determine the relationship between independent covariates, the DS (hazard ratio (HR)/50 Cp units (U)) and LR. Tumor blocks were collected for 828 patients. Final evaluable population includes 718 cases, of whom 571 had negative margins. Median follow-up was 9.6 years. 100 cases developed LR following BCS alone (DCIS, N = 44; invasive, N = 57). In the primary pre-specified analysis, the DS was associated with any LR (DCIS or invasive) in ER+ patients (HR 2.26; P < 0.001) and in all patients regardless of ER status (HR 2.15; P < 0.001). DCIS Score provided independent information on LR risk beyond clinical and pathologic variables including size, age, grade, necrosis, multifocality, and subtype (adjusted HR 1.68; P = 0.02). DCIS was associated with invasive LR (HR 1.78; P = 0.04) and DCIS LR (HR 2.43; P = 0.005). The DCIS Score independently predicts and quantifies individualized recurrence risk in a population of patients with pure DCIS treated by BCS alone.

  13. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer.

    Science.gov (United States)

    Cheng, Hang; Clymer, Jeffrey W; Ferko, Nicole C; Patel, Leena; Soleas, Ireena M; Cameron, Chris G; Hinoul, Piet

    2016-01-01

    Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection. A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables. Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002), seroma by 46% (Pmastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup. In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.

  14. Patients with invasive lobular breast cancer are less likely to undergo breast-conserving surgery: a population based study in the Netherlands.

    Science.gov (United States)

    Truin, W; Roumen, R M; Siesling, S; van der Heiden-van der Loo, M; Duijm, L E M; Tjan-Heijnen, V C G; Voogd, A C

    2015-05-01

    The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the NCR. All patients underwent BCS or primary mastectomy without neoadjuvant treatment and proportions per year were calculated. Logistic regression analysis with adjustment for period, age, nodal status and tumor size was performed to determine the impact of histology on the likelihood of undergoing BCS. A total of 152,574 patients underwent surgery in the period between 1990 and 2010, of which 89 % had IDC and 11 % had ILC. In the group of IDC with pT1 and pT2 tumors combined, 54 % underwent BCS compared with 43 % of patients with ILC (p < 0.0001). The proportion of patients with IDC treated by BCS increased from 46 % in 1990 to 62 % in 2010. The BCS rate among ILC patients increased from 39 % in 1990 to 48 % in 2010. Patients with ILC were less likely to undergo BCS compared with patients with IDC (odds ratio 0.69; 95 % confidence interval 0.66-0.71). The incidence of BCS for patients with IDC or ILC is rising in The Netherlands. However, the increase of BCS is less explicit in patients with ILC, with a higher chance of undergoing mastectomy compared with patients with IDC.

  15. Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy for the treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Beatty J David

    2011-03-01

    Full Text Available Abstract Background Accelerated partial breast irradiation (APBI may be used to deliver radiation to the tumor bed post-lumpectomy in eligible patients with breast cancer. Patient and tumor characteristics as well as the lumpectomy technique can influence patient eligibility for APBI. This report describes a lumpectomy procedure and examines patient, tumor, and surgical characteristics from a prospective, multicenter study of electronic brachytherapy. Methods The study enrolled 65 patients of age 45-84 years with ductal carcinoma or ductal carcinoma in situ, and 44 patients, who met the inclusion and exclusion criteria, were treated with APBI using the Axxent® electronic brachytherapy system following lumpectomy. The prescription dose was 34 Gy in 10 fractions over 5 days. Results The lumpectomy technique as described herein varied by site and patient characteristics. The balloon applicator was implanted by the surgeon (91% or a radiation oncologist (9% during or up to 61 days post-lumpectomy (mean 22 days. A lateral approach was most commonly used (59% for insertion of the applicator followed by an incision site approach in 27% of cases, a medial approach in 5%, and an inferior approach in 7%. A trocar was used during applicator insertion in 27% of cases. Local anesthetic, sedation, both or neither were administered in 45%, 2%, 41% and 11% of cases, respectively, during applicator placement. The prescription dose was delivered in 42 of 44 treated patients. Conclusions Early stage breast cancer can be treated with breast conserving surgery and APBI using electronic brachytherapy. Treatment was well tolerated, and these early outcomes were similar to the early outcomes with iridium-based balloon brachytherapy.

  16. Cavity Shaving plus Lumpectomy versus Lumpectomy Alone for Patients with Breast Cancer Undergoing Breast-Conserving Surgery: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Ke Wang

    Full Text Available The margin status is a well-established prognostic predictor for patients undergoing breast-conserving surgery (BCS. Recent data suggested that cavity shaving in addition to lumpectomy might be a promising approach for improving the clinical outcomes. We aimed to compare the efficacy and safety between cavity shaving plus lumpectomy and lumpectomy alone with a systematic review and meta-analysis. We searched the PubMed, Embase, and Cochrane CENTRAL databases for studies comparing cavity shaving with lumpectomy before June 10, 2016. Both comparative studies and self-control studies were included. A random-effects model was used to estimate the odds ratios (ORs for positive margin rate, reoperation rate, recurrence rate, and weighted mean difference (WMD for excised tissue volume. Twenty-six studies were included in the meta-analysis. The cavity shaving group had a significantly lower positive margin rate than the BCS-alone group (16.4% vs. 31.9%; OR = 0.41, 95% CI 0.32-0.53, P < 0.05. Cavity shaving was associated with a significantly decreased rate of reoperation (OR = 0.42, 95% CI 0.30-0.59, P < 0.05. The overall locoregional rate was low for cavity shaving and BCS-alone (3% vs. 4%. Cavity shaving had no significant effect on the risk of locoregional recurrence (OR = 0.86, 95% CI 0.32-2.35; P = 0.78. The excised tissue volume did not differ substantially between cavity shaving and BCS alone (WMD = -23.88, 95% CI -55.20 to 7.44, P = 0.14. For patients undergoing BCS, additional cavity shaving was an effective method to decrease the positive margin rate and avoid reoperation. The addition of cavity shaving did not appear to have excessive excised tissue volume compared with partial mastectomy alone.

  17. Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: a comparative evaluation in community-based addiction treatment centers

    NARCIS (Netherlands)

    Vedel, Ellen; Emmelkamp, Paul M. G.; Schippers, Gerard M.

    2008-01-01

    BACKGROUND: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol

  18. Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: A comparative evaluation in community-based addiction treatment centers

    NARCIS (Netherlands)

    Vedel, E.; Emmelkamp, P.M.G.; Schippers, G.M.

    2008-01-01

    Background: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol

  19. Balance chiropractic therapy for cervical spondylotic radiculopathy: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Yang, Feng; Li, Wen-Xiong; Liu, Zhu; Liu, Li

    2016-10-22

    Cervical spondylosis is a very common disorder and cervical spondylotic radiculopathy (CSR) is the most common form of spinal degenerative disease. Its clinical manifestations focus on pain and numbness of the neck and arm as well as restricted movement of the neck, which greatly affect the patient's life and work. The orthopedic of traditional Chinese medicine (TCM) theory holds that the basic pathologic change in spinal degenerative diseases is the imbalance between the dynamic system and the static system of the cervical spine. Based on this theory, some Chinese physicians have developed a balance chiropractic therapy (BCT) to treat CSR, which has been clinically examined for more than 50 years to effectively cure CSR. The purpose of this study is to evaluate the therapeutic effect and safety of BCT on CSR and to investigate the mechanism by which the efficacy is achieved. We propose a multicenter, parallel-group, randomized controlled trial to evaluate the efficacy and safety of BCT for CSR. Participants aged 18 to 65 years, who are in conformity with the diagnostic criteria of CSR and whose pain score on a Visual Analog Scale (VAS) is more than 4 points and less than 8 points, will be included and randomly allocated into two groups: a treatment group and a control group. Participants in the treatment group will be treated with BCT, while the control group will receive traction therapy (TT). The primary outcome is pain severity (measured with a VAS). Secondary outcomes will include cervical curvature (measured by the Borden Index), a composite of functional status (measured by the Neck Disability Index, NDI), patient health status (evaluated by the SF-36 health survey) and adverse events (AEs) as reported in the trial. If BCT can relieve neck pain without adverse effects, it may be a novel strategy for the treatment of CSR. Furthermore, the mechanism of BCT for CSR will be partially elucidated. Clinical Trials.gov Identifier: NCT02705131 . Registered on 9

  20. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status

    International Nuclear Information System (INIS)

    Solin, Lawrence J.; Fourquet, Alain; Vicini, Frank A.; Haffty, Bruce; Taylor, Marie; McCormick, Beryl; McNeese, Marsha; Pierce, Lori J.; Landmann, Christine; Olivotto, Ivo A.; Borger, Jacques; Kim, Jung-Soo; Rochefordiere, Anne de la; Schultz, Delray J.

    2001-01-01

    Purpose: This study was performed to determine the long-term outcome for women with mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. Methods and Materials: An analysis was performed of 422 mammographically detected intraductal breast carcinomas in 418 women from 11 institutions in North America and Europe. All patients were treated with breast-conserving surgery followed by definitive breast irradiation. The median follow-up time was 9.4 years (mean, 9.4 years; range, 0.1-19.8 years). Results: The 15-year overall survival rate was 92%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 94%. There were 48 local failures in the treated breast, and the 15-year rate of any local failure was 16%. The median time to local failure was 5.0 years (mean, 5.7 years; range, 1.0-15.2 years). Patient age at the time of treatment and final pathology margin status from the primary tumor excision were both significantly associated with local failure. The 10-year rate of local failure was 31% for patient age ≤ 39 years, 13% for age 40-49 years, 8% for age 50-59 years, and 6% for age ≥ 60 years (p=0.0001). The 10-year rate of local failure was 24% when the margins of resection were positive, 9% when the margins of resection were negative, 7% when the margins of resection were close, and 12% when the margins of resection were unknown (p=0.030). Patient age ≤ 39 years and positive margins of resection were both independently associated with an increased risk of local failure (p=0.0006 and p=0.023, respectively) in the multivariable Cox regression model. Conclusions: The 15-year results from the present study demonstrated high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of mammographically detected ductal carcinoma in situ of the

  1. The study of target delineation and target movement of whole breast assisted by active breathing control in intensity modulated radiotherapy after breast conservative surgery

    International Nuclear Information System (INIS)

    Li Jianbing; Yu Jinming; Ma Zhifang; Lu Jie; Sun Tao; Guo Shoufang; Wang Jingguo

    2009-01-01

    Objective: To explore the influence of different delineators and different delineating time on target determination of the whole breast and to explore intrafraction and interfraction target displacements of the breast on moderate deep inspiration breathing hold (mDIBH) assisted by active breathing control (ABC) alter breast conservative surgery. Methods: Twenty patients received primary CT-simulation assisted by ABC to get five sets of CT image on the three breathing condition which included one set from free breath (FB), two sets from mDIBH and two sets from deep expiration breathing control (DEBH). After radiotherapy with ten to fifteen fractions, the repeat CT-simulation was carried out to get the same five sets of CT image as the primary CT- simulation. The whole breast target were delineated at different time by the same delineator and delineated respectively by five delineators on the first set of CT images got with mDIBH from the primary CT-simulation, and to compare the influence of delineator and delineating time on the whole breast target. The total silver clips in the cavity were marked respectively on the two sets of CT images got with mDIBH from the primary CT-simulation, and to compare the intrafraction displacement of geometric body structured by the total of silver clips. The two ribs near the isocentric plane of the breast target were delineated respectively on two sets of the mDIBH CT image from the primary CT-simulation and on one set of the mDIBH CT image from the repeat CT-simulation, and comparing the movement of the point of interest (POI) of the ribs delineated to get the value of intrafraction and interfraction thoracic expansion. Results: There was not statistically significant between the four volumes of whole breast targets delineated by the same delineator at different time, but with statistics significant between the volumes of whole breast target delineated by the different delineators ( F=19.681, P=0.000). There was not statistically

  2. [Accelerated partial breast irradiation with image-guided intensity-modulated radiotherapy following breast-conserving surgery - preliminary results of a phase II clinical study].

    Science.gov (United States)

    Mészáros, Norbert; Major, Tibor; Stelczer, Gábor; Zaka, Zoltán; Mózsa, Emõke; Fodor, János; Polgár, Csaba

    2015-06-01

    The purpose of the study was to implement accelerated partial breast irradiation (APBI) by means of image-guided intensity-modulated radiotherapy (IG-IMRT) following breast-conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive (St I-II) breast cancer who underwent BCS were enrolled in our phase II prospective study. Postoperative APBI was given by means of step and shoot IG-IMRT using 4 to 5 fields to a total dose of 36.9 Gy (9×4.1 Gy) using a twice-a-day fractionation. Before each fraction, series of CT images were taken from the region of the target volume using a kV CT on-rail mounted in the treatment room. An image fusion software was used for automatic image registration of the planning and verification CT images. Patient set-up errors were detected in three directions (LAT, LONG, VERT), and inaccuracies were adjusted by automatic movements of the treatment table. Breast cancer related events, acute and late toxicities, and cosmetic results were registered and analysed. At a median follow-up of 24 months (range 12-44) neither locoregional nor distant failure was observed. Grade 1 (G1), G2 erythema, G1 oedema, and G1 and G2 pain occurred in 21 (35%), 2 (3.3%), 23 (38.3%), 6 (10%) and 2 (3.3%) patients, respectively. No G3-4 acute side effects were detected. Among late radiation side effects G1 pigmentation, G1 fibrosis, and G1 fat necrosis occurred in 5 (8.3%), 7 (11.7%), and 2 (3.3%) patients, respectively. No ≥G2 late toxicity was detected. Excellent and good cosmetic outcome was detected in 45 (75%) and 15 (25%) patients. IG-IMRT is a reproducible and feasible technique for the delivery of APBI following conservative surgery for the treatment of low-risk, early-stage invasive breast carcinoma. Preliminary results are promising, early radiation side effects are minimal, and cosmetic results are excellent.

  3. Less increase of CT-based calcium scores of the coronary arteries. Effect three years after breast-conserving radiotherapy using breath-hold

    Energy Technology Data Exchange (ETDEWEB)

    Mast, M.E.; Kempen-Harteveld, M.L. van; Petoukhova, A.L. [Centre West, Radiotherapy, The Hague (Netherlands); Heijenbrok, M.W. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Scholten, A.N. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands); Wolterbeek, R. [Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics, Leiden (Netherlands); Schreur, J.H.M. [Medical Center Haaglanden, Department of Cardiology, The Hague (Netherlands); Struikmans, H. [Centre West, Radiotherapy, The Hague (Netherlands); Leiden University Medical Centre, Department of Clinical Oncology, Leiden (Netherlands)

    2016-10-15

    The aim of this prospective longitudinal study was to compare coronary artery calcium (CAC) scores determined before the start of whole breast irradiation with those determined 3 years afterwards. Changes in CAC scores were analysed in 99 breast cancer patients. Three groups were compared: patients receiving left- and right-sided radiotherapy, and those receiving left-sided radiotherapy with breath-hold. We analysed overall CAC scores and left anterior descending (LAD) and right coronary artery (RCA) CAC scores. Between the three groups, changes of the value of the LAD minus the RCA CAC scores of each individual patient were also compared. Three years after breath-hold-based whole breast irradiation, a less pronounced increase of CAC scores was noted. Furthermore, LAD minus RCA scores in patients treated for left-sided breast cancer without breath-hold were higher when compared to LAD minus RCA scores of patients with right-sided breast cancers and those with left-sided breast cancer treated with breath-hold. Breath-hold in breast-conserving radiotherapy leads to a less pronounced increase of CT-based CAC scores. Therefore, breath-hold probably prevents the development of radiation-induced coronary artery disease. However, the sample size of this study is limited and the follow-up period relatively short. (orig.) [German] Das Ziel dieser prospektiven Langzeitstudie war der Vergleich der Coronary-Artery-Calcium-(CAC-)Werte vor Beginn der Brustbestrahlung mit den Werten nach 3 Jahren. Aenderungen der CAC-Werte wurden bei 99 Brustkrebspatienten analysiert. Drei Gruppen wurden untersucht: Patienten nach links- und rechtsseitiger Strahlentherapie sowie mit Bestrahlung unter Atemanhalt. Wir analysierten die Gesamt-CAC-Werte sowie die CAC-Werte der vorderen linken absteigenden (''left anterior descending'', LAD) und der rechten Koronararterie (''right coronary artery'', RCA). Zwischen den drei Gruppen wurden auch die Veraenderungen

  4. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Neboori, Hanmanth J.R. [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Haffty, Bruce G., E-mail: hafftybg@umdnj.edu [Department of Radiation Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Wu Hao [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Yang Qifeng [Department of Breast Surgery, Qilu Hospital, Shandong University, Ji' nan (China); Aly, Amal [Division of Medical Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Goyal, Sharad; Schiff, Devora [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Moran, Meena S. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Golhar, Ryan [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Chen Chunxia; Moore, Dirk [Department of Biostatistics, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); and others

    2012-08-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log-rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence-free survival (IBRFS), distant metastasis-free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their clinical

  5. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    International Nuclear Information System (INIS)

    Neboori, Hanmanth J.R.; Haffty, Bruce G.; Wu Hao; Yang Qifeng; Aly, Amal; Goyal, Sharad; Schiff, Devora; Moran, Meena S.; Golhar, Ryan; Chen Chunxia; Moore, Dirk

    2012-01-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log–rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence–free survival (IBRFS), distant metastasis–free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their

  6. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer

    Directory of Open Access Journals (Sweden)

    Cheng H

    2016-07-01

    Full Text Available Hang Cheng,1 Jeffrey W Clymer,1 Nicole C Ferko,2 Leena Patel,2 Ireena M Soleas,2 Chris G Cameron,2 Piet Hinoul1 1Ethicon Inc., Cincinnati, OH, USA; 2Cornerstone Research Group, Burlington, ON, Canada Background: Mastectomy and breast-conserving surgery (BCS are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.Methods: A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.Results: Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002, seroma by 46% (P<0.0001, necrosis by 49% (P=0.04, postoperative chest wall drainage by 46% (P=0.0005, blood loss by 38% (P=0.0005, and length of stay by 22% (P=0.007. Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, ­Harmonic technology showed significant reductions in complications in the BCS study subgroup.Conclusion: In this meta-analysis of both mastectomy and

  7. A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients.

    Science.gov (United States)

    Romics, Laszlo; Macaskill, E Jane; Fernandez, Teresa; Simpson, Louise; Morrow, Elizabeth; Pitsinis, Vassilis; Tovey, Sian; Barber, Matthew; Masannat, Yazan; Stallard, Sheila; Weiler-Mithoff, Eva; Malyon, Andrew; Mansell, James; Campbell, Esther J; Doughty, Julie; Dixon, J Michael

    2018-04-13

    Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland. A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland. 589 patients were included from 11 units. Patients were diagnosed between September 2005 and March 2017. High volume units performed a mean of 19.3 OBCs per year vs. low volume units who did 11.1 (p = 0.012). 23 different surgical techniques were used. High volume units offered a wider range of techniques (8-14) than low volume units (3-6) (p = 0.004). OBC was carried out as a joint operation involving a breast and a plastic surgeon in 389 patients. Immediate contralateral symmetrisation rate was significantly higher when OBC was performed as a joint operation (70.7% vs. not joint operations: 29.8%; p < 0.001). The incomplete excision rate was 10.4% and was significantly higher after surgery for invasive lobular carcinoma (18.9%; p = 0.0292), but was significantly lower after neoadjuvant chemotherapy (3%; p = 0.031). 9.2% of patients developed major complications requiring hospital admission. Overall the complication rate was significantly lower after neoadjuvant chemotherapy (p = 0.035). The 5 year local recurrence rate was 2.7%, which was higher after OBC for DCIS (8.3%) than invasive ductal cancer (1.6%; p = 0.026). 5-year disease-free survival was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%. This study demonstrated that measured outcomes of OBC in a population-based multi-centre setting can be comparable to the outcomes of large volume single centre series. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  8. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Fastner, Gerd; Zehentmayr, Franz; Kopp, Peter; Fussl, Christoph; Sedlmayer, Felix [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Hauser-Kronberger, Cornelia [Landeskrankenhaus, Paracelsus Medical University, Department of Pathology, Salzburg (Austria); Moder, Angelika [Landeskrankenhaus, Paracelsus Medical University, Institute of Inborn Errors in Metabolism, Salzburg (Austria); Reitsamer, Roland; Fischer, Thorsten [Landeskrankenhaus, Paracelsus Medical University, Department of Special Gynecology, Salzburg (Austria); Landeskrankenhaus, Paracelsus Medical University, Department of Gynecology, Salzburg (Austria); Deutschmann, Heinrich [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Paracelsus Medical University, Institute for Research and Development of Advanced Radiation Technologies (radART), Salzburg (Austria)

    2016-01-15

    The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation. A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median D{sub max}) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %). After a median follow-up of 97 months (range 4-170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03). Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3. (orig.) [German] Ziel der Studie war es, im Rahmen einer retrospektiven Analyse Ueberlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen zu untersuchen. Die Tumoren waren in 5NP(5-Marker-negative)- und CB(core basal)-Subtypen klassifiziert und die Patientinnen hatten nach brusterhaltender Operation und

  9. Prognostic value of biologic subtype and the 21-gene recurrence score relative to local recurrence after breast conservation treatment with radiation for early stage breast carcinoma: results from the Eastern Cooperative Oncology Group E2197 study.

    Science.gov (United States)

    Solin, Lawrence J; Gray, Robert; Goldstein, Lori J; Recht, Abram; Baehner, Frederick L; Shak, Steven; Badve, Sunil; Perez, Edith A; Shulman, Lawrence N; Martino, Silvana; Davidson, Nancy E; Sledge, George W; Sparano, Joseph A

    2012-07-01

    The present study was performed to evaluate the significance of biologic subtype and 21-gene recurrence score relative to local recurrence and local-regional recurrence after breast conservation treatment with radiation. Eastern Cooperative Oncology Group E2197 was a prospective randomized clinical trial that compared two adjuvant systemic chemotherapy regimens for patients with operable breast carcinoma with 1-3 positive lymph nodes or negative lymph nodes with tumor size >1.0 cm. The study population was a subset of 388 patients with known 21-gene recurrence score and treated with breast conservation surgery, systemic chemotherapy, and definitive radiation treatment. Median follow-up was 9.7 years (range = 3.7-11.6 years). The 10-year rates of local recurrence and local-regional recurrence were 5.4 % and 6.6 %, respectively. Neither biologic subtype nor 21-gene Recurrence Score was associated with local recurrence or local-regional recurrence on univariate or multivariate analyses (all P ≥ 0.12). The 10-year rates of local recurrence were 4.9 % for hormone receptor positive, HER2-negative tumors, 6.0 % for triple negative tumors, and 6.4 % for HER2-positive tumors (P = 0.76), and the 10-year rates of local-regional recurrence were 6.3, 6.9, and 7.2 %, respectively (P = 0.79). For hormone receptor-positive tumors, the 10-year rates of local recurrence were 3.2, 2.9, and 10.1 % for low, intermediate, and high 21-gene recurrence score, respectively (P = 0.17), and the 10-year rates of local-regional recurrence were 3.8, 5.1, and 12.0 %, respectively (P = 0.12). For hormone receptor-positive tumors, the 21-gene recurrence score evaluated as a continuous variable was significant for local-regional recurrence (hazard ratio 2.66; P = 0.03). The 10-year rates of local recurrence and local-regional recurrence were reasonably low in all subsets of patients. Neither biologic subtype nor 21-gene recurrence score should preclude breast conservation treatment with radiation.

  10. Gamma-ray detector guidance of breast cancer therapy

    Science.gov (United States)

    Ravi, Ananth

    2009-12-01

    Breast cancer is the most common form of cancer in women. Over 75% of breast cancer patients are eligible for breast conserving therapy. Breast conserving therapy involves a lumpectomy to excise the gross tumour, followed by adjuvant radiation therapy to eradicate residual microscopic disease. Recent advances in the understanding of breast cancer biology and recurrence have presented the opportunity to improve breast conserving therapy techniques. This thesis has explored the potential of gamma-ray detecting technology to improve guidance of both surgical and adjuvant radiation therapy aspects of breast conserving therapy. The task of accurately excising the gross tumour during breast conserving surgery (BCS) is challenging, due to the limited guidance currently available to surgeons. Radioimmuno guided surgery (RIGS) has been investigated to determine its potential to delineate the gross tumour intraoperatively. The effects of varying a set of user controllable parameters on the ability of RIGS to detect and delineate model breast tumours was determined. The parameters studied were: Radioisotope, blood activity concentration, collimator height and energy threshold. The most sensitive combination of parameters was determined to be an 111Indium labelled radiopharmaceutical with a gamma-ray detecting probe collimated to a height of 5 mm and an energy threshold at the Compton backscatter peak. Using these parameters it was found that, for the breast tumour model used, the minimum tumour-to-background ratio required to delineate the tumour edge accurately was 5.2+/-0.4 at a blood activity concentration of 5 kBq/ml. Permanent breast seed implantation (PBSI) is a form of accelerated partial breast irradiation that dramatically reduces the treatment burden of adjuvant radiation therapy on patients. Unfortunately, it is currently difficult to localize the implanted brachytherapy seeds, making it difficult to perform a correction in the event that seeds have been misplaced

  11. Pre-Operative Planning Using Real-Time Virtual Sonography, an MRI/Ultrasound Image Fusion Technique, for Breast-Conserving Surgery in Patients with Non-Mass Enhancement on Breast MRI: A Preliminary Study.

    Science.gov (United States)

    Ando, Takahito; Ito, Yukie; Ido, Mirai; Osawa, Manami; Kousaka, Junko; Mouri, Yukako; Fujii, Kimihito; Nakano, Shogo; Kimura, Junko; Ishiguchi, Tsuneo; Watanebe, Rie; Imai, Tsuneo; Fukutomi, Takashi

    2018-07-01

    The purpose of this retrospective study was to evaluate the effect of pre-operative planning using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/ultrasound (US) image fusion technique on breast-conserving surgery (BCS) in patients with non-mass enhancement (NME) on breast MRI. Between 2011 and 2015, we enrolled 12 consecutive patients who had lesions with NME that exceeded the US hypo-echoic area, in which it was particularly difficult to evaluate the tumor margin. During pre-operative planning before breast-conserving surgery, RVS was used to delineate the enhancing area on the breast surface after additional supine breast MRI was performed. We analyzed both the surgical margin positivity rate and the re-operation rate. All NME lesions corresponded to the index cancer. In all patients, the diameter of the NME lesion was greater than that of the hypo-echoic lesion. The median diameters of the NME and hypo-echoic lesions were 24 mm (range: 12-39 mm) and 8.0 mm (range: 4.9-18 mm), respectively (p = 0.0002). After RVS-derived skin marking was performed on the surface of the affected breast, lumpectomy and quadrantectomy were conducted in 7 and 5 patients, respectively. The surgical margins were negative in 10 (83%) patients. Two patients with positive margins were found to have ductal carcinoma in situ in 1 duct each, 2.4 and 3.2 mm from the resection margin, respectively. None of the patients required additional resection. Although further prospective studies are required, the findings of our preliminary study suggest that it is very well possible that the use of RVS-derived skin marking during pre-operative planning for BCS in patients with NME would have resulted in surgical outcomes similar to or better than those obtained without the use of such marking. Copyright © 2018. Published by Elsevier Inc.

  12. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS)

    International Nuclear Information System (INIS)

    Kraus-Tiefenbacher, Uta; Sfintizky, Andreas; Welzel, Grit; Simeonova, Anna; Sperk, Elena; Siebenlist, Kerstin; Mai, Sabine; Wenz, Frederik

    2012-01-01

    Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy. Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19. After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema. In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005). Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade

  13. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro

    1998-01-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  14. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009)

    International Nuclear Information System (INIS)

    Polgar, Csaba; Limbergen, Erik Van; Poetter, Richard; Kovacs, Gyoergy; Polo, Alfredo; Lyczek, Jaroslaw; Hildebrandt, Guido; Niehoff, Peter; Guinot, Jose Luis; Guedea, Ferran; Johansson, Bengt; Ott, Oliver J.; Major, Tibor; Strnad, Vratislav

    2010-01-01

    Purpose: To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion. Methods and materials: Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords 'partial-breast irradiation' and 'APBI'. This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article. Results: The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1-2 (≤30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2 mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing ≤40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials. Conclusions: These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized

  15. Is elective nodal irradiation beneficial in patients with pathologically negative lymph nodes after neoadjuvant chemotherapy and breast-conserving surgery for clinical stage II–III breast cancer? A multicentre retrospective study (KROG 12-05)

    Science.gov (United States)

    Noh, J M; Park, W; Suh, C-O; Keum, K C; Kim, Y B; Shin, K H; Kim, K; Chie, E K; Ha, S W; Kim, S S; Ahn, S D; Shin, H S; Kim, J H; Lee, H-S; Lee, N K; Huh, S J; Choi, D H

    2014-01-01

    Background: To evaluate the effects of elective nodal irradiation (ENI) in clinical stage II–III breast cancer patients with pathologically negative lymph nodes (LNs) (ypN0) after neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS) and radiotherapy (RT). Methods: We retrospectively analysed 260 patients with ypN0 who received NAC followed by BCS and RT. Elective nodal irradiation was delivered to 136 (52.3%) patients. The effects of ENI on survival outcomes were evaluated. Results: After a median follow-up period of 66.2 months (range, 15.6–127.4 months), 26 patients (10.0%) developed disease recurrence. The 5-year locoregional recurrence-free survival and disease-free survival (DFS) for all patients were 95.5% and 90.5%, respectively. Pathologic T classification (0−is vs 1 vs 2–4) and the number of LNs sampled (ENI. Elective nodal irradiation also did not affect survival outcomes in any of the subgroups according to pathologic T classification or the number of LNs sampled. Conclusions: ENI may be omitted in patients with ypN0 breast cancer after NAC and BCS. But until the results of the randomised trials are available, patients should be put on these trials. PMID:24481403

  16. Is elective nodal irradiation beneficial in patients with pathologically negative lymph nodes after neoadjuvant chemotherapy and breast-conserving surgery for clinical stage II-III breast cancer? A multicentre retrospective study (KROG 12-05).

    Science.gov (United States)

    Noh, J M; Park, W; Suh, C-O; Keum, K C; Kim, Y B; Shin, K H; Kim, K; Chie, E K; Ha, S W; Kim, S S; Ahn, S D; Shin, H S; Kim, J H; Lee, H-S; Lee, N K; Huh, S J; Choi, D H

    2014-03-18

    To evaluate the effects of elective nodal irradiation (ENI) in clinical stage II-III breast cancer patients with pathologically negative lymph nodes (LNs) (ypN0) after neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS) and radiotherapy (RT). We retrospectively analysed 260 patients with ypN0 who received NAC followed by BCS and RT. Elective nodal irradiation was delivered to 136 (52.3%) patients. The effects of ENI on survival outcomes were evaluated. After a median follow-up period of 66.2 months (range, 15.6-127.4 months), 26 patients (10.0%) developed disease recurrence. The 5-year locoregional recurrence-free survival and disease-free survival (DFS) for all patients were 95.5% and 90.5%, respectively. Pathologic T classification (0-is vs 1 vs 2-4) and the number of LNs sampled (ENI. Elective nodal irradiation also did not affect survival outcomes in any of the subgroups according to pathologic T classification or the number of LNs sampled. ENI may be omitted in patients with ypN0 breast cancer after NAC and BCS. But until the results of the randomised trials are available, patients should be put on these trials.

  17. Survey on nursing of breast cancer patients treated with radiotherapy following to breast-conserving surgery. Actual states and problems for nursing care by certified nurses in breast cancer nursing

    International Nuclear Information System (INIS)

    Kobayashi, Mariko; Higuchi, Yuki; Hirose, Kiyomi; Nakanishi, Yoko; Ichikawa, Kayo; Horikoshi, Masataka; Futawatari, Tamae

    2011-01-01

    The purpose of the present study is to elucidate the actual states and problems of nursing care provided by certified nurses in breast cancer patients treated with radiotherapy following to breast-conserving surgery. The survey was conducted by a postal anonymous questionnaire. Participants were drawn from the list of certified nurses on the website of Japanese Nursing Association. The questionnaires consisted of multiple choice questions regarding the contents of care performed before, during and after radiotherapy, and free questionnaire on the related problems. The rate of valid replies was 41.2% (40 out of 97 subjects). Before radiotherapy, the accomplishing rate exceeded 70% in about half of all nursing cares. The accomplishing rates were 30 to 50% in about 90% of all cares and 40 to 60% in all cares during and after radiotherapy, respectively. Problems were classified into three categories high-quality practice of radiotherapy nursing, establishment of continuing care system and improvement of cooperation. It is recommended to achieve high quality radiotherapy nursing by certified nurses, the establishment of continuing care system and the improvement of cooperation in order to improve nursing care during and after radiotherapy. (author)

  18. Features of nursing care provided for breast cancer patients treated with radiotherapy following breast-conserving surgery. Comparison of nursing practices between certified nurses in breast cancer nursing and non-specialist nurses working with breast cancer patients

    International Nuclear Information System (INIS)

    Kobayashi, Mariko; Takahira, Yumi; Ichikawa, Kayo; Horikoshi, Masataka; Futawatari, Tamae

    2012-01-01

    This study aimed to identifying features of nursing care provided for breast cancer patients during the course of radiotherapy following breast-conserving surgery and improve the quality of nursing care. Subjects were certified nurses in breast cancer nursing (CN) and non-specialist nurses working with breast cancer patients (NS). An anonymous survey questionnaire on nursing care and other practices provided before, during, and after radiotherapy was conducted by postal mail and the results were compared between CN and NS. Valid responses were obtained from 40 CN (41.2%) and 102 NS (56.7%). Significant differences between CN and NS were observed for 15 of 27 (55.6%) care items before radiotherapy, 18 of 18 (100%) items during radiotherapy, and 9 of 20 (45.0%) items after radiotherapy. Among the items with significant differences, significantly more NS than CN performed all nursing care items during the course of radiotherapy, except for one item provided before radiotherapy. These results demonstrate that it is necessary to facilitate enhanced collaboration and coordination between CN and NS providing nursing care for breast cancer patients in order to improve the quality of nursing care delivered to patients. (author)

  19. A comparative study on the volume and localization of the internal gross target volume defined using the seroma and surgical clips based on 4DCT scan for external-beam partial breast irradiation after breast conserving surgery

    International Nuclear Information System (INIS)

    Ding, Yun; Li, Jianbin; Wang, Wei; Wang, Suzhen; Wang, Jinzhi; Ma, Zhifang; Shao, Qian; Xu, Min

    2014-01-01

    To explore the volume and localization of the internal gross target volume defined using the seroma and/or surgical clips based on the four-dimensional computed tomography (4DCT) during free-breathing. Fifteen breast cancer patients after breast-conserving surgery (BCS) were recruited for EB-PBI. On the ten sets CT images, the gross target volume formed by the clips, the seroma, both the clips and seroma delineated by one radiation oncologist and defined as GTVc, GTVs and GTVc + s, respectively. The ten GTVc, GTVs and GTVc + s on the ten sets CT images produced the IGTVc, IGTVs, IGTVc + s, respectively. The IGTV volume and the distance between the center of IGTVc, IGTVs, IGTVc + s were all recorded. Conformity index (CI), degree of inclusion (DI) were calculated for IGTV/IGTV, respectively. The volume of IGTVc + s were significantly larger than the IGTVc and IGTVs (p < 0.05). There was significant difference between the DIs of IGTVc vs IGTVc + s, the DIs of IGTVs vs IGTVc + s. There was significant difference among the CIs of IGTV/IGTV. The DIs and CIs of IGTV/IGTV were negatively correlated with their centroid distance (r < 0, p < 0.05). There were volume difference and spatial mismatch between the IGTVs delineated based on the surgical clips and seroma. The IGTV defined as the seroma and surgical clips provided the best overall representation of the ‘true’ moving GTV

  20. Local-regional control in breast cancer patients with a possible genetic predisposition

    International Nuclear Information System (INIS)

    Freedman, Laura M.; Buchholz, Thomas A.; Thames, Howard D.; Strom, Eric A.; McNeese, Marsha D.; Hortobagyi, Gabriel N.; Singletary, S. Eva; Heaton, Keith M.; Hunt, Kelly K.

    2000-01-01

    Purpose: Local control rates for breast cancer in genetically predisposed women are poorly defined. Because such a small percentage of breast cancer patients have proven germline mutations, surrogates, such as a family history for breast cancer, have been used to examine this issue. The purpose of this study was to evaluate local-regional control following breast conservation therapy (BCT) in patients with bilateral breast cancer and a breast cancer family history. Methods and Materials: We retrospectively reviewed records of all 58 patients with bilateral breast cancer and a breast cancer family history treated in our institution between 1959 and 1998. The primary surgical treatment was a breast-conserving procedure in 55 of the 116 breast cancer cases and a mastectomy in 61. The median follow-up was 68 months for the BCT patients and 57 months for the mastectomy-treated patients. Results: Eight local-regional recurrences occurred in the 55 cases treated with BCT, resulting in 5- and 10-year actuarial local-regional control rates of 86% and 76%, respectively. In the nine cases that did not receive radiation as a component of their BCT, four developed local-regional recurrences (5- and 10-year local-regional control rates of BCT without radiation: 49% and 49%). The 5- and 10-year actuarial local-regional control rates for the 46 cases treated with BCT and radiation were 94% and 83%, respectively. In these cases, there were two late local recurrences, developing at 8 years and 9 years, respectively. A log rank comparison of radiation versus no radiation actuarial data was significant at p = 0.009. In the cases treated with BCT, a multivariate analysis of radiation use, patient age, degree of family history, margin status, and stage revealed that only the use of radiation was associated with improved local control (Cox regression analysis p = 0.021). The 10-year actuarial rates of local-regional control following mastectomy with and without radiation were 91% and 89

  1. Regional Nodal Irradiation After Breast Conserving Surgery for Early HER2-Positive Breast Cancer: Results of a Subanalysis From the ALTTO Trial.

    Science.gov (United States)

    Gingras, Isabelle; Holmes, Eileen; De Azambuja, Evandro; Nguyen, David H A; Izquierdo, Miguel; Anne Zujewski, Jo; Inbar, Moshe; Naume, Bjorn; Tomasello, Gianluca; Gralow, Julie R; Wolff, Antonio C; Harris, Lyndsay; Gnant, Michael; Moreno-Aspitia, Alvaro; Piccart, Martine J; Azim, Hatem A

    2017-08-01

    Two randomized trials recently demonstrated that regional nodal irradiation (RNI) could reduce the risk of recurrence in early breast cancer; however, these trials were conducted in the pretrastuzumab era. Whether these results are applicable to human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with anti-HER2-targeted therapy is unknown. This retrospective analysis was performed on patients with node-positive breast cancer who were enrolled in the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization phase III adjuvant trial and subjected to BCS. The primary objective of the present study was to examine the effect of RNI on disease-free survival (DFS). A multivariable cox regression analysis adjusted for number of positive lymph nodes, tumor size, grade, age, hormone receptors status, presence of macrometastatis, treatment arm, and chemotherapy timing was carried out to investigate the relationship between RNI and DFS. One thousand six hundred sixty-four HER2-positive breast cancer patients were included, of whom 878 (52.8%) had received RNI to the axillary, supraclavicular, and/or internal mammary lymph nodes. Patients in the RNI group had higher nodal burden and more frequently had tumors larger than 2 cm. At a median follow-up of 4.5 years, DFS was 84.3% in the RNI group and 88.3% in the non-RNI group. No differences in regional recurrence (0.9 % vs 0.6 %) or in overall survival (93.6% vs 95.3%) were observed between the two groups. After adjustment in multivariable analysis, there was no statistically significant association between RNI and DFS (hazard ratio = 0.96, 95% confidence interval = 0.71 to 1.29). Our analysis did not demonstrate a DFS benefit of RNI in HER2-positive, node-positive patients treated with adjuvant HER2-targeted therapy. The benefit of RNI in HER2-positive breast cancer needs further testing within randomized clinical trials. © The Author 2017. Published by Oxford University Press. All

  2. Evaluation of Single Nucleotide Polymorphisms (SNPs) in the p53 Binding Protein 1 (TP53BP1) Gene in Breast Cancer Patients Treated With Breast-Conserving Surgery and Whole-Breast Irradiation (BCS + RT)

    International Nuclear Information System (INIS)

    Haffty, Bruce G.; Goyal, Sharad; Kulkarni, Diptee; Green, Camille; Vazquez, Alexi; Schiff, Devora; Moran, Meena S.; Yang Qifeng; Ganesan, Shridar; Hirsfield, Kim M.

    2011-01-01

    Purpose: TP53BP1 is a key component of radiation-induced deoxyribonucleic acid damage repair. The purpose of this study was to evaluate the significance of a known common single nucleotide polymorphism in this gene (rs560191) in patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT). Methods and Materials: The population consisted of 176 premenopausal women treated with BCS + RT (median follow-up, 12 years). Genomic deoxyribonucleic acid was processed by use of TaqMan assays. Each allele for rs560191 was either C or G, so each patient was therefore classified as CC, CG, or GG. Patients were grouped as GG if they were homozygous for the variant G allele or CC-CG if they carried at least one copy of the common C allele (CC or CG). Results: Of the 176 women, 124 (71%) were CC-CG and 52 (29%) were GG. The mean age was 44 years for GG vs. 38 years for CC-CG (p < 0.001). GG was more common in African-American women than white women (69% vs. 13%, p < 0.001) and more commonly estrogen receptor negative (70% vs. 49%, p = 0.02). There were no significant correlations of rs560191 with other critical variables. Despite the fact that GG patients were older, the 10-year rate of local relapses was higher (22% for GG vs. 12% for CC-CG, p = 0.04). Conclusions: This novel avenue of investigation of polymorphisms in radiation repair/response genes in patients treated with BCS + RT suggests a correlation to local relapse. Additional evaluation is needed to assess the biological and functional significance of these single nucleotide polymorphisms, and larger confirmatory validation studies will be required to determine the clinical implications.

  3. Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

    Science.gov (United States)

    Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

    2014-06-01

    In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

  4. Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis.

    Science.gov (United States)

    Sun, Yixuan; Liao, Mingjuan; He, Liu; Zhu, Chenfang

    2017-10-01

    The application of breast-conserving surgery (BCS) on patients with locally advanced breast cancer (LABC) with good response to neoadjuvant chemotherapy (NACT) still remains controversial. The objective in this study is to analyze the safety of BCS in the management of LABC in patients with good response to NACT. We searched the electronic databases of Medline (Pubmed) and Cochrane Library for reports on local recurrence (LR), regional recurrence (RR), distant recurrence (DR), 5-year disease-free survival (DFS) or 5-year overall survival (OS) in patients with LABC receiving BCS or mastectomy (MT) and with good response to NACT. Based on the research results, we conducted a meta-analysis using Review Manager 5.3. Our study showed that 16 studies with a combined total of 3531 patients, of whom 1465 patients underwent BCS, whereas 2066 patients underwent MT. There was no significant heterogeneity among these studies (Q statistic: P = .88; I = 0%). Patients with good response to NACT showed no significant difference in LR and RR [odd ratio (OR) = 0.83; 95% confidence interval (CI): 0.60-1.15; P = .26; OR = 0.56; 95% CI: 0.33-0.93; P = .03], while we figured out a lower DR (OR = 0.51; 95% CI: 0.42-0.63; P < .01), a higher DFS (OR = 2.35; 95% CI: 1.84 to 3.01, P < .01) and a higher OS (OR = 2.12; 95% CI: 1.51 to 2.98, P < .01) in BCS compared with MT. This meta-analysis concluded that BCS was a safe surgery for patients with LABC and had good response to NACT.

  5. Local recurrences and distant metastases after breast-conservative treatments in a population at very low risk of recurrence are very dependent events

    International Nuclear Information System (INIS)

    Cowen, Didier; Jacquemier, Jocelyne; Houvenaeghel, Gilles; Viens, Patrice; Maraninchi, Dominique; Puig, Brigitte; Bardou, Valerie-Jeanne; Resbeut, Michel

    1997-01-01

    PURPOSE: Assessment of the relative merits of individual factors influencing the risks of loco-regional failure (LRF) and metastases (M) after breast-preserving treatments is made difficult by the marked inhomogeneities within the published series: short follow-up, use of chemotherapy, nodal status, margins of resection. We therefore selected a very homogenous population with an expected low-risk of recurrence to identify high-risk subgroups which may need more aggressive treatments. MATERIALS AND METHODS: Between 1980 and 1995, 3697 women with breast cancer were referred to Paoli-Calmettes Cancer Center, Marseille. Patients included in the study had undergone axillary dissection and were node negative (n=1840), were treated with conservative surgery (usually lumpectomy) and standard radiotherapy (n=1241), had histological tumor sizes ≤ 50 mm, received no chemotherapy (n=1024), and had negative margins of resection (n=756). Hormonal therapy was given to 238 women (31.5%): castration for premenopausal women (n=92), tamoxifen for postmenopausal women (n=146). The following factors were entered in the univariate analysis: age (≤ 40 yrs. vs > 40 yrs.), menopausal status, hormonal treatment, peritumoral vessel invasion (PVI), histologic multifocality (HM), extensive intraductal component (EIC), estrogen receptor (ER) and progesterone receptor (PR) status, SBR grade (I vs II vs III) and histological size (≤20 mm vs >20 mm). Factors statistically significant (p + and 72.1% PR + tumors. PVI was found in 184 tumors and EIC only in 30 tumors whereas HM was found in 106 cases. There were 53 local recurrences, 8 locoregional failures and 65 metastases as first event. The yearly conditional event probability for LRF and M was 1.8% and 1.6% respectively, constant over the years. Five and ten-year freedom from recurrence rates were 92.7% [90.4%-94.9%] and 81.6% [76.2%-86.9%] respectively for LRFs, and 91.6% [89.2%-94%] and 83.6% [79%-88.1%] respectively for M. Patients with

  6. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Fein, Douglas A; Fowble, Barbara L; Hanlon, Alexandra L; Hoffman, John P; Sigurdson, Elin R; Eisenberg, Burton L

    1995-07-01

    PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had {>=} 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy {+-} tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2

  7. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

    International Nuclear Information System (INIS)

    Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

    1995-01-01

    PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had ≥ 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy ± tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2% at

  8. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation?

    International Nuclear Information System (INIS)

    Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

    1996-01-01

    Purpose: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early-stage breast cancer. The clips have been useful in delineating the borders of the tangential fields, especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed, then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips, controlling for other recognized prognostic factors. Methods and Materials: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had one to three nodes, and 7% had > four nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy + tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients, while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the two groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. Results: Twenty-five and 27 patients with and without surgical clips, respectively, developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast

  9. LiCa{sub 4}Si{sub 4}N{sub 8}F and LiSr{sub 4}Si{sub 4}N{sub 8}F. Nitridosilicate fluorides with a BCT-zeolite-type network structure

    Energy Technology Data Exchange (ETDEWEB)

    Horky, Katrin; Schnick, Wolfgang [Department of Chemistry, Inorganic Solid-State, Chemistry, University of Munich (LMU), Butenandtstrasse 5-13, 81377, Munich (Germany)

    2017-02-17

    LiCa{sub 4}Si{sub 4}N{sub 8}F and LiSr{sub 4}Si{sub 4}N{sub 8}F were synthesized from Si{sub 3}N{sub 4}, LiNH{sub 2}, CaH{sub 2}/SrH{sub 2}, and LiF through a metathesis reaction in a radiofrequency furnace. The crystal structures of both compounds were solved and refined on the basis of single-crystal X-ray diffraction data [LiCa{sub 4}Si{sub 4}N{sub 8}F: P2{sub 1}/c (no. 14), a = 10.5108(3), b = 9.0217(3), c = 10.3574(3) Aa, β = 117.0152(10) , R{sub 1} = 0.0422, wR{sub 2} = 0.0724, Z = 4; LiSr{sub 4}Si{sub 4}N{sub 8}F: P4nc (no. 104), a = 9.3118(4), b = 9.3118(4), c = 5.5216(2) Aa, R{sub 1} = 0.0160, wR{sub 2} = 0.0388, Z = 2]. The silicate substructure of both compounds is built up of vertex-sharing SiN{sub 4} tetrahedra, thereby forming a structure analogous to the BCT zeolite with Ca{sup 2+}/Sr{sup 2+}, Li{sup +}, and F{sup -} ions filling the voids. The crystal structure of LiSr{sub 4}Si{sub 4}N{sub 8}F is homeotypic with that of Li{sub 2}Sr{sub 4}Si{sub 4}N{sub 8}O as it exhibits the same zeolite-type [SiN{sub 2}]{sup 2-} framework, but incorporates LiF instead of Li{sub 2}O. In contrast to the respective Sr compound, LiCa{sub 4}Si{sub 4}N{sub 8}F shows a distortion of the BCT-zeolite-type network as well as an additional site for F. Both F sites in LiCa{sub 4}Si{sub 4}N{sub 8}F exhibit different coordination spheres to LiSr{sub 4}Si{sub 4}N{sub 8}F. The title compounds are the first reported lithium alkaline-earth nitridosilicates containing fluorine. The crystal structures were confirmed by lattice-energy calculations (MAPLE), energy-dispersive X-ray spectroscopy (EDX) measurements, and powder X-ray diffraction. IR spectra confirmed the absence of N-H bonds. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  10. [Partial breast irradiation (PBI): the therapy of the future?].

    Science.gov (United States)

    Koning, Caro C E; Bijker, Nina; van Tienhoven, Geertjan

    2010-01-01

    Breast-conserving therapy with radiation therapy of 50 Gy over 5 weeks to the entire breast plus a tumour bed boost is the standard treatment for patients with early stage breast cancer. Several attempts have been made to lower the treatment burden, such as omitting either all radiotherapy or the tumour bed boost, without success. Phase III trials are now being carried out to evaluate the treatment of the primary tumour area only (PBI). Various methods for selection of patient groups and of delivering the radiation dose have been employed. Vaidya et al. report the same favourable local recurrence rates following PBI with single dose intraoperative radiotherapy as with whole-breast irradiation. As the follow-up period so far has been short, long-time results should be awaited.

  11. Oncoplastia surgery breast conservation. First results

    International Nuclear Information System (INIS)

    Morales Tirado, Roxana; Breff Frometa, Alain; Alfonso Coto, Juan Carlos; Galvez Chavez, Julio Cesar

    2009-01-01

    Oncoplastic surgery is an important tool in the treatment patients with breast cancer stages I and II. A prospective study descriptive period between October 2005 and October 2006, which included 10 patients younger than 60 years in stages I and II, selected from the universe that came to the National Cancer Institute and Havana Radiobiology (INOR), following the inclusion criteria and exclusion. Were assessed before and after surgery from surveys that collected data questioning the patients and data clinical examination performed by the plastic surgeon. The predominant lesion was invasive ductal cancer and most patients were in stage I. There were no loco-regional recurrence in 2 year period. The most common complication was dehiscence surgical wound. Good aesthetic results were obtained in sixty percent of cases. It is confirmed that the surgery is Breast Oncoplastic very effective for the oncological safety and promising in terms of aesthetic results. (Author)

  12. Breast Cancer Surgery: Comparing Surgical Groups and Determining Individual Differences in Postoperative Sexuality and Body Change Stress

    Science.gov (United States)

    Yurek, Debora; Farrar, William; Andersen, Barbara L.

    2007-01-01

    Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different—with lower rates of activity and fewer signs of sexual responsiveness—than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes. PMID:10965644

  13. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Bondiau, Pierre-Yves; Courdi, Adel; Bahadoran, Phillipe; Chamorey, Emmanuel; Queille-Roussel, Catherine; Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc

    2013-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial

  14. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  15. Should Women Younger Than 40 Years of Age With Invasive Breast Cancer Have a Mastectomy?: 15-Year Outcomes in a Population-Based Cohort

    International Nuclear Information System (INIS)

    Cao, Jeffrey Q.; Truong, Pauline T.; Olivotto, Ivo A.; Olson, Robert; Coulombe, Genevieve; Keyes, Mira; Weir, Lorna; Gelmon, Karen; Bernstein, Vanessa; Woods, Ryan; Speers, Caroline; Tyldesley, Scott

    2014-01-01

    Purpose: Optimal local management for young women with early-stage breast cancer remains controversial. This study examined 15-year outcomes among women younger than 40 years treated with breast-conserving surgery plus whole-breast radiation therapy (BCT) compared with those treated with modified radical mastectomy (MRM). Methods and Materials: Women aged 20 to 39 years with early-stage breast cancer diagnosed between 1989 and 2003 were identified in a population-based database. Primary outcomes of breast cancer–specific survival (BCSS), overall survival (OS) and secondary outcomes of local relapse–free survival (LRFS), locoregional relapse–free survival (LRRFS), and distant relapse–free survival (DRFS) were calculated using Kaplan-Meier methods and compared between BCT and MRM cohorts using log-rank tests. A planned subgroup analysis was performed on patients considered “ideal” for BCT (ie, T1N0, negative margins and no extensive ductal carcinoma in situ) and in whom local therapy may have the largest impact on survival because of low systemic risk. Results: 965 patients were identified; 616 had BCT and 349 had MRM. The median follow-up time was 14.4 years (range, 8.4-23.3 years). Overall, 15-year rates of BCSS (76.0% vs 74.1%, P=.62), OS (74.2% vs 73.0%, P=.75), LRFS (85.4% vs 86.5%, P=.95), LRRFS (82.2% vs 81.6%, P=.61), and DRFS (74.4% vs 71.6%, P=.40) were similar between the BCT and MRM cohorts. In the “ideal” for BCT subgroup, there were 219 BCT and 67 MRM patients with a median follow-up time of 15.5 years. The 15-year BCSS (86.1% vs 82.9%, P=.57), OS (82.6% vs 82.9%, P=.89), LRFS (86.2% vs 84.2%, P=.50), LRRFS (83.1% vs 78.3%, P=.24), and DRFS (84.8% vs 79.1%, P=.17) were similar in the BCT and MRM cohorts. Conclusions: This population-based analysis with long-term follow-up confirmed that women younger than 40 years treated with BCT had similar 15-year outcomes compared with MRM. Young age alone is not a contraindication to BCT

  16. Prospective Study of Local Control and Late Radiation Toxicity After Intraoperative Radiation Therapy Boost for Early Breast Cancer

    International Nuclear Information System (INIS)

    Chang, David W.; Marvelde, Luc te; Chua, Boon H.

    2014-01-01

    Purpose: To report the local recurrence rate and late toxicity of intraoperative radiation therapy (IORT) boost to the tumor bed using the Intrabeam System followed by external-beam whole-breast irradiation (WBI) in women with early-stage breast cancer in a prospective single-institution study. Methods and Materials: Women with breast cancer ≤3 cm were recruited between February 2003 and May 2005. After breast-conserving surgery, a single dose of 5 Gy IORT boost was delivered using 50-kV x-rays to a depth of 10 mm from the applicator surface. This was followed by WBI to a total dose of 50 Gy in 25 fractions. Patients were reviewed at regular, predefined intervals. Late toxicities were recorded using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring systems. Results: Fifty-five patients completed both IORT boost and external-beam WBI. Median follow-up was 3.3 years (range, 1.4-4.1 years). There was no reported locoregional recurrence or death. One patient developed distant metastases. Grade 2 and 3 subcutaneous fibrosis was detected in 29 (53%) and 8 patients (15%), respectively. Conclusions: The use of IORT as a tumor bed boost using kV x-rays in breast-conserving therapy was associated with good local control but a clinically significant rate of grade 2 and 3 subcutaneous fibrosis

  17. Change in Seroma Volume During Whole-Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Sharma, Rajiv; Spierer, Marnee; Mutyala, Subhakar; Thawani, Nitika; Cohen, Hillel W.; Hong, Linda; Garg, Madhur K.; Kalnicki, Shalom

    2009-01-01

    Purpose: After breast-conserving surgery, a seroma often forms in the surgical cavity. If not drained, it may affect the volume of tumor bed requiring a boost after whole-breast radiation therapy (WBRT). Our objective was to evaluate the change in seroma volume that occurs during WBRT, before boost planning. Methods and Materials: A retrospective review was performed of women receiving breast-conserving therapy with evidence of seroma at the time of WBRT planning. Computed tomography (CT) simulation was performed before WBRT and before the tumor bed boost. All patients received either a hypofractionated (42.4 Gy/16 fraction + 9.6 Gy/4 fraction boost) or standard fractionated (50.4 Gy/28 fraction + 10 Gy/5 fraction boost) regimen. Seroma volumes were contoured and compared on CT at the time of WBRT simulation and tumor bed boost planning. Results: Twenty-four patients with evidence of seroma were identified and all patients received WBRT without drainage of the seroma. Mean seroma volume before WBRT and at boost planning were significantly different at 65.7 cm 3 (SD, 50.5 cm 3 ) and 35.6 cm 3 (SD, 24.8 cm 3 ), respectively (p < 0.001). Mean and median reduction in seroma volume during radiation were 39.6% (SD, 23.8%) and 46.2% (range, 10.7-76.7%), respectively. Fractionation schedule was not correlated with change in seroma volume. Length of time from surgery to start of radiation therapy showed an inverse correlation with change in seroma volume (Pearson correlation r = -0.53, p < 0.01). Conclusions: The volume of seroma changes significantly during WBRT. Consequently, the accuracy of breast boost planning is likely affected, as is the volume of normal breast tissue irradiated. CT-based boost planning before boost irradiation is suggested to ensure appropriate coverage.

  18. Análise computacional da textura de tumores de mama em imagens por ultrassom de pacientes submetidas a cirurgia conservadora Computer-assisted analysis of breast tumors texture on sonographic images of patients submitted to breast-conserving surgery

    Directory of Open Access Journals (Sweden)

    Carolina Maria de Azevedo

    2009-12-01

    Full Text Available OBJETIVO: Avaliar as características de textura de lesões de mama em imagens por ultrassom de pacientes submetidas a cirurgia conservadora que apresentaram, ou não, recidiva. MATERIAIS E MÉTODOS: As imagens de ultrassom de 36 pacientes submetidas a cirurgia conservadora, com 12 tendo apresentado recidiva local e 24 que não apresentaram recidiva no local da cirurgia, foram divididas em: 3 malignas na mama oposta, 7 nódulos benignos, 5 hiperplasias atípicas e 9 alterações fibrocísticas. A textura das lesões foi quantificada utilizando-se dez parâmetros calculados da matriz de coocorrência e da curva de complexidade. Análise discriminante linear foi aplicada aos parâmetros para discriminação de lesões de mama em pacientes submetidas a cirurgia conservadora que apresentaram, ou não, recidiva. RESULTADOS: Avaliando-se a capacidade dos parâmetros em distinguir as recidivas do grupo composto por lesões não recidivas benignas e hiperplasias atípicas, obteve-se especificidade de 100%, com valores de acurácia e sensibilidade superiores a 91%. Num segundo teste, foi possível distinguir as cinco hiperplasias, das lesões não recidivas benignas. CONCLUSÃO: Apesar do número reduzido de casos, os resultados obtidos são encorajadores, sugerindo que o uso da quantificação da textura pode auxiliar na diferenciação entre lesões benignas, hiperplasias atípicas e lesões malignas de origem recidiva.OBJECTIVE: The purpose of this study was to assess the features of breast lesion texture on sonographic images of patients submitted to breast-conserving surgery, with or without tumor recurrence. MATERIALS AND METHODS: Sonographic images of 36 patients submitted to conservative surgery for breast cancer, 12 of them with, and 24 without local recurrence, included 3 contralateral malignant lesions, 7 benign lumps (3 cysts and 4 fibroadenomas, 5 atypical hyperplasias and 9 fibrocystic changes. The quantification of features of breast

  19. Electrical and mechanical properties of 0.5Ba (Zr0.2Ti0.8)O3-0.5 (Ba0.7Ca0.3)TiO3 (BZT-BCT) lead free ferroelectric ceramics reinforced with Al2O3 nano-oxide

    International Nuclear Information System (INIS)

    Adhikari, Prativa; Mazumder, R.

    2014-01-01

    Piezoelectric ceramics are widely used as actuator, resonator, and spark igniter. Recently, much attention has been paid to prepare 0.5Ba (Zr 0.2 Ti 0.8 )O 3 -0.5 (Ba 0.7 Ca 0.3 )TiO 3 (BZT-BCT) piezoelectric ceramics because of its good dielectric, piezoelectric properties and environment friendly nature. However, piezoelectric ceramics based on BaTiO 3 suffer from low reliability and poor mechanical properties such as strength and toughness. For practical application improvement of the mechanical properties of BaTiO 3 -based ceramics is strongly required. A novel method has been used to improve the mechanical properties of structural ceramics by reinforcement of oxide (Al 2 O 3 , MgO, ZrO 2 and Stabilized-ZrO 2 ) or non-oxide (SiC) particles. It is well known that electrical properties of ferroelectric ceramics generally degrade with non-ferroelectric additives and decrease in sinterability usually encountered with refractory oxide additives. Use of nano-oxide additives may drastically reduce the amount of additive and electrical property may not degrade much. In this report we would show the electrical and mechanical properties of BZT-BCT with Al 2 O 3 nano oxide additive. Modified BZT-BCT nanocomposites were prepared by mixing and sintering of solid state synthesized Zr, Ca modified barium titanate powder and small amount (0.1-2.0 vol %) of nano-oxides, i.e. Al 2 O 3 . Effect of sintering temperature, time, particle size of the nano-oxide additives on electrical (dielectric constant, loss factor, Curie temperature, d 33 ) and mechanical (flexural strength, fracture toughness, hardness) properties were studied. We obtained ∼ 94% dense BZT-BCT reinforced with Al 2 O 3 nano-oxide at 1300℃ without degrading electrical properties (dielectric constant (4850), low dissipation factor (0.0242)) and superior mechanical properties (flexural strength - 60.3 MPa, Vickers hardness-750-800 MPa). (author)

  20. TEN-YEAR RECURRENCE RATES IN YOUNG WOMEN WITH BREAST CANCER BY LOCOREGIONAL TREATMENT APPROACH

    Science.gov (United States)

    Beadle, Beth M.; Woodward, Wendy A.; Tucker, Susan L.; Outlaw, Elesyia D.; Allen, Pamela K.; Oh, Julia L.; Strom, Eric A.; Perkins, George H.; Tereffe, Welela; Yu, Tse-Kuan; Meric-Bernstam, Funda; Litton, Jennifer K.; Buchholz, Thomas A.

    2011-01-01

    Purpose Young women with breast cancer have higher locoregional recurrence (LRR) rates than older patients. The goal of this study is to determine the impact of locoregional treatment strategy, breast-conserving therapy (BCT), mastectomy alone (M), or mastectomy with adjuvant radiation (MXRT), on LRR for patients 35 years or younger. Methods and Materials Data for 668 breast cancers in 652 young patients with breast cancer were retrospectively reviewed; 197 patients were treated with BCT, 237 with M, and 234 with MXRT. Results Median follow-up for all living patients was 114 months. In the entire cohort, 10-year actuarial LRR rates varied by locoregional treatment: 19.8% for BCT, 24.1% for M, and 15.1% for MXRT (p = 0.05). In patients with Stage II disease, 10-year actuarial LRR rates by locoregional treatment strategy were 17.7% for BCT, 22.8% for M, and 5.7% for MXRT (p = 0.02). On multivariate analysis, M (hazard ratio, 4.45) and Grade III disease (hazard ratio, 2.24) predicted for increased LRR. In patients with Stage I disease, there was no difference in LRR rates based on locoregional treatment (18.0% for BCT, 19.8% for M; p = 0.56), but chemotherapy use had a statistically significant LRR benefit (13.5% for chemotherapy, 27.9% for none; p = 0.04). Conclusions Young women have high rates of LRR after breast cancer treatment. For patients with Stage II disease, the best locoregional control rates were achieved with MXRT. For patients with Stage I disease, similar outcomes were achieved with BCT and mastectomy; however, chemotherapy provided a significant benefit to either approach. PMID:18707822

  1. Ten-Year Recurrence Rates in Young Women With Breast Cancer by Locoregional Treatment Approach

    International Nuclear Information System (INIS)

    Beadle, Beth M.; Woodward, Wendy A.; Tucker, Susan L.; Outlaw, Elesyia D.; Allen, Pamela K.; Oh, Julia L.; Strom, Eric A.; Perkins, George H.; Tereffe, Welela; Yu, T.-K.; Meric-Bernstam, Funda; Litton, Jennifer K.; Buchholz, Thomas A.

    2009-01-01

    Purpose: Young women with breast cancer have higher locoregional recurrence (LRR) rates than older patients. The goal of this study is to determine the impact of locoregional treatment strategy, breast-conserving therapy (BCT), mastectomy alone (M), or mastectomy with adjuvant radiation (MXRT), on LRR for patients 35 years or younger. Methods and Materials: Data for 668 breast cancers in 652 young patients with breast cancer were retrospectively reviewed; 197 patients were treated with BCT, 237 with M, and 234 with MXRT. Results: Median follow-up for all living patients was 114 months. In the entire cohort, 10-year actuarial LRR rates varied by locoregional treatment: 19.8% for BCT, 24.1% for M, and 15.1% for MXRT (p = 0.05). In patients with Stage II disease, 10-year actuarial LRR rates by locoregional treatment strategy were 17.7% for BCT, 22.8% for M, and 5.7% for MXRT (p = 0.02). On multivariate analysis, M (hazard ratio, 4.45) and Grade III disease (hazard ratio, 2.24) predicted for increased LRR. In patients with Stage I disease, there was no difference in LRR rates based on locoregional treatment (18.0% for BCT, 19.8% for M; p = 0.56), but chemotherapy use had a statistically significant LRR benefit (13.5% for chemotherapy, 27.9% for none; p = 0.04). Conclusions: Young women have high rates of LRR after breast cancer treatment. For patients with Stage II disease, the best locoregional control rates were achieved with MXRT. For patients with Stage I disease, similar outcomes were achieved with BCT and mastectomy; however, chemotherapy provided a significant benefit to either approach

  2. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography.

    Science.gov (United States)

    Onega, Tracy; Cook, Andrea; Kirlin, Beth; Shi, Xun; Alford-Teaster, Jennifer; Tuzzio, Leah; Buist, Diana S M

    2011-08-01

    Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.

  3. Partial breast irradiation as sole therapy for low risk breast carcinoma: Early toxicity, cosmesis and quality of life results of a MammoSite brachytherapy phase II study

    International Nuclear Information System (INIS)

    Belkacemi, Yazid; Chauvet, Marie-Pierre; Giard, Sylvia; Villette, Sylviane; Lacornerie, Thomas; Bonodeau, Francois; Baranzelli, Marie-Christine; Bonneterre, Jacques; Lartigau, Eric

    2009-01-01

    Purpose: The MammoSite is a device that was developed with the goal of making breast-conserving surgery (BCT) more widely available. Our objective was to evaluate the MammoSite device performances after an open cavity placement procedure and quality of life in highly selected patients with early-stage breast cancer. Methods and materials: From March 2003 to March 2005, 43 patients with T1 breast cancer were enrolled in a phase II study. The median age was 72 years. Twenty-five (58%) patients were treated with high-dose rate brachytherapy using the MammoSite applicator to deliver 34 Gy in 10 fractions. The main disqualifying factor was pathologic sentinel node involvement (10/43; 23%). There were no device malfunctions, migration or rupture of the balloon. Results: After a median follow-up of 13 months, there were no local recurrences and one contralateral lobular carcinoma. Seventeen (68%), 13 (52%), 8 (32%), 5 (20%) and 2 (8%) patients had erythema, seroma, inflammation, hematoma and sever infection, respectively. Only 2 patients developed telangiectasia. At 1 year the rate of 'good to excellent' cosmetic results was 84%. Significant changes in QoL were observed for emotional and social well-being between 3 and 12 months. At 24 months, only emotional well-being subscore changes were statistically significant (p = 0.015). Conclusions: Our data in patients older than 60 years support the previously published data. Histologic features were the main disqualifying criteria. With higher skin spacing levels we observed very low incidence of telangiectasia. QoL evaluation indicates that baseline scores were satisfactory. Changes concerned emotional and social well-being

  4. The role of a prone setup in breast radiation therapy.

    Science.gov (United States)

    Huppert, Nelly; Jozsef, Gabor; Dewyngaert, Keith; Formenti, Silvia Chiara

    2011-01-01

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  5. The Role of a Prone Setup in Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, Nelly; Jozsef, Gabor; DeWyngaert, Keith; Formenti, Silvia Chiara, E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York University Langone Medical Center, New York, NY (United States)

    2011-10-11

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  6. Radiation Use and Long-Term Survival in Breast Cancer Patients With T1, T2 Primary Tumors and One to Three Positive Axillary Lymph Nodes

    International Nuclear Information System (INIS)

    Buchholz, Thomas A.; Woodward, Wendy A.; Duan Zhigang; Fang Shenying; Oh, Julia L.; Tereffe, Welela; Strom, Eric A.; Perkins, George H.; Yu, T.-K.; Hunt, Kelly K.; Meric-Bernstam, Funda; Hortobagyi, Gabriel N.; Giordano, Sharon H.

    2008-01-01

    Background: For patients with Stage II breast cancer with one to three positive lymph nodes, controversy exists about whether radiation as a component of treatment provides a survival benefit. Methods and Materials: We analyzed data from patients with Stage II breast cancer with one to three positive lymph nodes diagnosed from 1988-2002 in the Surveillance, Epidemiology, and End Results registry and compared the outcome of 12,693 patients treated with breast-conservation therapy with radiation (BCT + XRT) with the 18,902 patients treated with mastectomy without radiation (MRM w/o XRT). Results: Patients treated with BCT + XRT were younger, were more likely to be treated in recent years of the study period, more commonly had T1 primary tumors, and had fewer involved nodes compared with those treated with MRM w/o XRT (p < 0.001 for all differences). The 15-year breast cancer-specific survival rate for the BCT + XRT group was 80% vs. 72% for the MRM w/o XRT group (p < 0.001). Cox regression analysis showed that MRM w/o XRT was associated with a hazard ratio for breast cancer death of 1.19 (p < 0.001) and for overall death of 1.25 (p < 0.001). The survival benefit in the BCT + XRT group was not limited to subgroups with high-risk disease features. Conclusions: Radiation use was independently associated with improved survival for patients with Stage II breast cancer with one to three positive lymph nodes. Because multivariate analyses of retrospective data cannot account for all potential biases, these data require confirmation in randomized clinical trials

  7. Health-Related Quality of Life and Patient Satisfaction After Treatment for Breast Cancer in Northern Taiwan

    International Nuclear Information System (INIS)

    Chang, Joseph Tung-Chieh; Chen, C.-J.; Lin, Y.-C.; Chen, Y.-C.; Lin, C.-Y.; Cheng, Ann-Joy

    2007-01-01

    Purpose: To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. Methods and Materials: Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. Result: There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). Conclusions: Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves

  8. The Role of the NCO Inside the BCT Command Post

    Science.gov (United States)

    2016-11-22

    formation. Doctrine 2015 introduced the importance of mission command doctrine into operations at all levels of leadership, and in the last five...utilizing tents is crucial to support the combined arms maneuver of the brigade. Physical layout of the command post can promote or hinder the ability to...equipment when a printer starting printing or a coffee maker was turned on? Understanding how PDISE configurations distribute loads in order to maintain

  9. Beam current transformer (BCT) for experiment WA1/2

    CERN Multimedia

    CERN PhotoLab

    1978-01-01

    In experiment WA1/2, a 400 GeV proton beam from the SPS was directed at a target, downstream of which a hadron line selected, in several narrow momentum bands, a beam of either pi+ and K+ or pi- and K-. These neutrino-parent particles, before entering a 292 m long decay tunnel, passed through a set of 2 BCTs of a design seen here. They measured the hadron intensity (10^10 to 10^11 particles/pulse) with a precision of the order of 1%. There were 2 of them, for enhanced precision and confidence. After the discovery of neutral currents in the Gargamelle-experiment, WA1/2 was the first follow-up, high-precision experiment (Z.Phys.C35, 443-452, 1987 and Z.Phys.C45, 361-379, 1990). See also 7706516X.

  10. Endoscope-assisted breast reconstruction. 1. Immediate breast reconstruction after lateral quadrantectomy with endoscopically harvested latissimus dorsi muscle flap

    International Nuclear Information System (INIS)

    Satake, Toshihiko; Hasegawa, Takamitsu; Kurihara, Kazunao; Kudo, Tetsuya; Kim, Shiei; Wakamatsu, Shingo.

    1996-01-01

    Breast conserving therapy (BCT) now is widely accepted in Japan. Quadrantectomy has been chosen from among the several available breast conserving operations for its minimal recurrence rate. Quadrantectomy, or excision of one-quarter volume of the breast, leaves a moderate degree of deformity which diminishes the quality of life. The authors have introduced immediate post-ectomy breast reconstruction utilizing an endoscopically harvested latissimus dorsi (LD) muscle flap which results in a minimal donor site scar. Five cases of endoscope-assisted LD muscle reconstruction of a quadrantectomized breast have been followed by irradiation therapy. Prior to reconstruction, with the patient in the supine position, quadrantectomy and dissection of axillary lymphnodes are performed through an incision extending from the anterior axillary to the inflamammary line. The patient then is placed in the lateral supine position. LD muscle flap dissection by electrocautery begins through the initial incision. Dissections of posterior portions of the muscle continue, under endoscopic visualization, through one or two ports along the anterior margin of the muscle. Moderate amount of adipose tissue is left attached to the muscle to obtain full augmentation. The raised flap then is transferred and secured to the post-quandrantectomy defect. Some post-irradiation shrinkage of the inserted LD muscle has been a common occurrence of breast reconstruction. An ample amount of adipose tissue left attached to the muscle margin will solve this matter since fatty tissue is more resistant to post-irradiation atrophy. (J.P.N.)

  11. Endoscope-assisted breast reconstruction. 1. Immediate breast reconstruction after lateral quadrantectomy with endoscopically harvested latissimus dorsi muscle flap

    Energy Technology Data Exchange (ETDEWEB)

    Satake, Toshihiko; Hasegawa, Takamitsu; Kurihara, Kazunao; Kudo, Tetsuya; Kim, Shiei [Kawaguchi Municipal Medical Center, Saitama (Japan); Wakamatsu, Shingo

    1996-08-01

    Breast conserving therapy (BCT) now is widely accepted in Japan. Quadrantectomy has been chosen from among the several available breast conserving operations for its minimal recurrence rate. Quadrantectomy, or excision of one-quarter volume of the breast, leaves a moderate degree of deformity which diminishes the quality of life. The authors have introduced immediate post-ectomy breast reconstruction utilizing an endoscopically harvested latissimus dorsi (LD) muscle flap which results in a minimal donor site scar. Five cases of endoscope-assisted LD muscle reconstruction of a quadrantectomized breast have been followed by irradiation therapy. Prior to reconstruction, with the patient in the supine position, quadrantectomy and dissection of axillary lymphnodes are performed through an incision extending from the anterior axillary to the inflamammary line. The patient then is placed in the lateral supine position. LD muscle flap dissection by electrocautery begins through the initial incision. Dissections of posterior portions of the muscle continue, under endoscopic visualization, through one or two ports along the anterior margin of the muscle. Moderate amount of adipose tissue is left attached to the muscle to obtain full augmentation. The raised flap then is transferred and secured to the post-quandrantectomy defect. Some post-irradiation shrinkage of the inserted LD muscle has been a common occurrence of breast reconstruction. An ample amount of adipose tissue left attached to the muscle margin will solve this matter since fatty tissue is more resistant to post-irradiation atrophy. (J.P.N.)

  12. Trends in primary surgical and radiation therapy for localized breast cancer in the detroit metropolitan area 1973-1992

    International Nuclear Information System (INIS)

    Chuba, Paul J.; Simon, Michael S.

    1997-01-01

    Purpose: The purpose of this report is to describe trends in primary surgical and radiation therapy for localized breast cancer from 1973 through 1992 among residents of the Detroit Metropolitan area. Methods and Materials: Data on surgical and radiation therapy procedures for women with local stage breast cancer were obtained from the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). Results: Women age 75 years and older were treated less aggressively than younger women (< age 75) as evidenced by higher rates of simple mastectomy or no treatment among older women. Younger women (< age 75) were more likely to have had optimal breast conservation therapy which consisted of partial mastectomy, axillary lymph node dissection (ALND), and radiation therapy, than were women who were older than 75. Partial mastectomy has increased proportionally from 4% of all breast cancer surgeries in the time period 1973 to 1977, to 39% of all surgeries from 1988 through 1992. Conclusion: A marked difference in surgical treatment of breast cancer exists for younger vs. older women. Despite changes in surgical treatment trends for breast cancer, a large proportion of women who are candidates for conservative therapy continue to undergo mastectomy

  13. Five-Year Outcomes, Cosmesis, and Toxicity With 3-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Rodríguez, Núria; Sanz, Xavier; Dengra, Josefa; Foro, Palmira; Membrive, Ismael; Reig, Anna; Quera, Jaume; Fernández-Velilla, Enric; Pera, Óscar; Lio, Jackson; Lozano, Joan; Algara, Manuel

    2013-01-01

    Purpose: To report the interim results from a study comparing the efficacy, toxicity, and cosmesis of breast-conserving treatment with accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy (3D-CRT). Methods and Materials: 102 patients with early-stage breast cancer who underwent breast-conserving surgery were randomized to receive either WBI (n=51) or APBI (n=51). In the WBI arm, 48 Gy was delivered to the whole breast in daily fractions of 2 Gy, with or without additional 10 Gy to the tumor bed. In the APBI arm, patients received 37.5 Gy in 3.75 Gy per fraction delivered twice daily. Toxicity results were scored according to the Radiation Therapy Oncology Group Common Toxicity Criteria. Skin elasticity was measured using a dedicated device (Multi-Skin-Test-Center MC-750-B2, CKelectronic-GmbH). Cosmetic results were assessed by the physician and the patients as good/excellent, regular, or poor. Results: The median follow-up time was 5 years. No local recurrences were observed. No significant differences in survival rates were found. APBI reduced acute side effects and radiation doses to healthy tissues compared with WBI (P 75% of patients in the APBI arm had excellent or good cosmesis, and these outcomes appear to be stable over time. The percentage of patients with excellent/good cosmetic results was similar in both groups. Conclusions: APBI delivered by 3D-CRT to the tumor bed for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with conventional WBI

  14. Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform

    Energy Technology Data Exchange (ETDEWEB)

    Shirvani, Shervin M. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona (United States); Jiang, Jing [Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Likhacheva, Anna [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona (United States); Hoffman, Karen E.; Shaitelman, Simona F. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Caudle, Abigail [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Giordano, Sharon H. [Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Smith, Benjamin D., E-mail: bsmith3@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-06-01

    Purpose: Older women with early-stage disease constitute the most rapidly growing breast cancer demographic, yet it is not known which local therapy strategies are most favored by this population in the current era. Understanding utilization trends and cost of local therapy is important for informing the design of bundled payment models as payers migrate away from fee-for-service models. We therefore used the Surveillance, Epidemiology, and End Results Medicare database to determine patterns of care and costs for local therapy among older women with breast cancer. Methods and Materials: Treatment strategy and covariables were determined in 55,327 women age ≥66 with Tis-T2N0-1M0 breast cancer who underwent local therapy between 2000 and 2008. Trends in local therapy were characterized using Joinpoint. Polychotomous logistic regression determined predictors of local therapy. The median aggregate cost over the first 24 months after diagnosis was determined from Medicare claims through 2010 and reported in 2014 dollars. Results: The median age was 75. Local therapy distribution was as follows: 27,896 (50.3%) lumpectomy with external beam radiation, 18,356 (33.1%) mastectomy alone, 6159 (11.1%) lumpectomy alone, 1488 (2.7%) mastectomy with reconstruction, and 1455 (2.6%) lumpectomy with brachytherapy. Mastectomy alone declined from 39.0% in 2000 to 28.2% in 2008, and the use of breast conserving local therapies rose from 58.7% to 68.2%. Mastectomy with reconstruction was more common among the youngest, healthiest patients, whereas mastectomy alone was more common among patients living in rural low-income regions. By 2008, the costs were $36,749 for lumpectomy with brachytherapy, $35,030 for mastectomy with reconstruction, $31,388 for lumpectomy with external beam radiation, $21,993 for mastectomy alone, and $19,287 for lumpectomy alone. Conclusions: The use of mastectomy alone in older women declined in favor of breast conserving strategies between 2000 and 2008

  15. Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform

    International Nuclear Information System (INIS)

    Shirvani, Shervin M.; Jiang, Jing; Likhacheva, Anna; Hoffman, Karen E.; Shaitelman, Simona F.; Caudle, Abigail; Buchholz, Thomas A.; Giordano, Sharon H.; Smith, Benjamin D.

    2016-01-01

    Purpose: Older women with early-stage disease constitute the most rapidly growing breast cancer demographic, yet it is not known which local therapy strategies are most favored by this population in the current era. Understanding utilization trends and cost of local therapy is important for informing the design of bundled payment models as payers migrate away from fee-for-service models. We therefore used the Surveillance, Epidemiology, and End Results Medicare database to determine patterns of care and costs for local therapy among older women with breast cancer. Methods and Materials: Treatment strategy and covariables were determined in 55,327 women age ≥66 with Tis-T2N0-1M0 breast cancer who underwent local therapy between 2000 and 2008. Trends in local therapy were characterized using Joinpoint. Polychotomous logistic regression determined predictors of local therapy. The median aggregate cost over the first 24 months after diagnosis was determined from Medicare claims through 2010 and reported in 2014 dollars. Results: The median age was 75. Local therapy distribution was as follows: 27,896 (50.3%) lumpectomy with external beam radiation, 18,356 (33.1%) mastectomy alone, 6159 (11.1%) lumpectomy alone, 1488 (2.7%) mastectomy with reconstruction, and 1455 (2.6%) lumpectomy with brachytherapy. Mastectomy alone declined from 39.0% in 2000 to 28.2% in 2008, and the use of breast conserving local therapies rose from 58.7% to 68.2%. Mastectomy with reconstruction was more common among the youngest, healthiest patients, whereas mastectomy alone was more common among patients living in rural low-income regions. By 2008, the costs were $36,749 for lumpectomy with brachytherapy, $35,030 for mastectomy with reconstruction, $31,388 for lumpectomy with external beam radiation, $21,993 for mastectomy alone, and $19,287 for lumpectomy alone. Conclusions: The use of mastectomy alone in older women declined in favor of breast conserving strategies between 2000 and 2008

  16. Cosmetic evaluation of breast conserving treatment for mammary cancer

    International Nuclear Information System (INIS)

    Van Limbergen, E.; Van der Schueren, E.; Van Tongelen, K.

    1989-01-01

    In a population of 142 patients with stage I and II breast cancer, treated with tumor excision and external radiotherapy, using a wide range of radiation doses and fractionation schedules, an attempt was made to quantify the cosmetic outcome. Quantitative measurements of nipple displacement and breast contour retraction were compared and correlated with qualitative scoring by a panel. In the vast majority, the quantitative assessments correlate very well with subjective, qualitative scoring, making this method relevant for clinical use. There are a few exceptions, mainly cases where localized skin changes such as severe teleangiectasia or skin necrosis affect strongly the cosmetic result but can go undetected in this measuring system. Also limited surgical deformations, which can detract seriously from cosmetic success, particularly when they occur in the medio inferior quadrants, taken in standard conditions is needed. Measurements can be carried out quickly, using the plottin device of a treatment planning system. This system may be of great use for follow-up of new treatment modalities and the study of the development of radiation fibrosis in breast cancer. (author). 15 refs.; 3 figs.; 2 tabs

  17. Breast irradiation causes pallor in the nipple-areolar complex in women with Celtic skin type (result from the St. George and Wollongong randomised breast boost trial)

    International Nuclear Information System (INIS)

    Lee, Yoo Young Dominique; Hau, Eric; Browne, Lois H.; Chin, Yaw; Lee, Jessica; Szwajcer, Alison; Cail, Stacy; Nolan, David N.; Graham, Peter H.

    2014-01-01

    The nipple-areolar complex (NAC) has special histological properties with higher melanocyte concentration than breast skin. To date, there are no data describing the late effects on the NAC following breast-conserving therapy (BCT). This study evaluated colour changes in the NAC in patients treated with breast-conserving surgery and adjuvant radiotherapy after 5 years. Digital photographs obtained at 5 years following breast irradiation from the St. George and Wollongong (SGW) trial (NCT00138814) were evaluated by five experts using an iPad® (Apple Inc., Cupertino, CA, USA) application specifically created for this study. The SGW trial randomised 688 patients with Tis-2, N0-1, M0 carcinoma to the control arm of 50Gy in 25 fractions and boost arm of 45Gy in 25 fractions and 16 Gy in 8 fractions electron boost. A total of 141/372 (38%) patients had altered NAC (86% lighter, 10% darker). Patients with Celtic skin type had increased likelihood of having an altered NAC (odds ratio (OR), 1.75 (CI 1.1–2.7, P=0.011)). On subgroup analysis, those with Celtic skin type receiving biologically equivalent dose (BED) Gy3 ≥ 80Gy had OR of 3.03 (95% CI 1.2–7.5, P=0.016) for having altered colour. There was a dose response with more profound changes seen in the NAC compared with irradiated breast skin if BED Gy3 ≥ 80Gy with OR of 2.42 (95% CI 1.1–5.6, P=0.036). In this Caucasian BCT population, over 30% of patients developed lighter NAC and more commonly in women with Celtic skin type. The degree of this effect increased with higher radiation dose.

  18. Results of conservative surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))

    1990-10-01

    For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

  19. Estimation of heart-position variability in 3D-surface-image-guided deep-inspiration breath-hold radiation therapy for left-sided breast cancer

    International Nuclear Information System (INIS)

    Alderliesten, Tanja; Betgen, Anja; Elkhuizen, Paula H.M.; Vliet-Vroegindeweij, Corine van; Remeijer, Peter

    2013-01-01

    Purpose: To investigate the heart position variability in deep-inspiration breath-hold (DIBH) radiation therapy (RT) for breast cancer when 3D surface imaging would be used for monitoring the BH depth during treatment delivery. For this purpose, surface setup data were compared with heart setup data. Materials and methods: Twenty patients treated with DIBH-RT after breast-conserving surgery were included. Retrospectively, heart registrations were performed for cone-beam computed tomography (CBCT) to planning CT. Further, breast-surface registrations were performed for a surface, captured concurrently with CBCT, to planning CT. The resulting setup errors were compared with linear regression analysis. Furthermore, geometric uncertainties of the heart (systematic [Σ] and random [σ]) were estimated relative to the surface registration. Based on these uncertainties planning organ at risk volume (PRV) margins for the heart were calculated: 1.3Σ − 0.5σ. Results: Moderate correlation between surface and heart setup errors was found: R 2 = 0.64, 0.37, 0.53 in left–right (LR), cranio-caudal (CC), and in anterior–posterior (AP) direction, respectively. When surface imaging would be used for monitoring, the geometric uncertainties of the heart (cm) are [Σ = 0.14, σ = 0.14]; [Σ = 0.66, σ = 0.38]; [Σ = 0.27, σ = 0.19] in LR; CC; AP. This results in PRV margins of 0.11; 0.67; 0.25 cm in LR; CC; AP. Conclusion: When DIBH-RT after breast-conserving surgery is guided by the breast-surface position then PRV margins should be used to take into account the heart-position variability relative to the breast-surface

  20. Combination of Cobe AutoPBSC and Gambro Elutra as a platform for monocyte enrichment in dendritic cell (DC) therapy: clinical study.

    Science.gov (United States)

    Chen, Ying; Hoecker, Paul; Zeng, Jia; Dettke, Markus

    2008-01-01

    Monocytes are a common source for generating dendritic cells (DCs). The aim of the present study was to evaluate the efficiency of a platform for monocyte collection and enrichment in a clinical setting. The platform was based on the combination of two semiautomated devices; the Cobe Spectra Auto PBSC for mononuclear cells (MNC) collection followed by counterflow elutriation for monocyte enrichment (Gambro BCT Elutra). Twenty-four patients with various types of epithelial cancer participated in the study. MNC collections were first performed as large volume leukapheresis (LVL). Subsequently, MNC products were processed with an elutriation system for monocyte isolation. LVL resulted in the collection of MNC at a median of 8.1 x 10(9) cells, containing of 31.4% monocytes. A similar efficacy was also shown in patients with lower peripheral blood counts. Elutriation of the MNC product with the Cobe Elutra device resulted in the enrichment of monocytes at a median of 2.7 x 10(9) cells, with a recovery of 80.2% and a purity of 90.7%. These monocytes were then successfully developed into DCs for clinical therapy after in vitro manipulation. These data suggest that the combination of the Cobe Spectra Auto PBSC and the Gambro BCT Elutra is an effective platform for monocyte enrichment in clinical practice according to GCP standards and GMP guidelines, and can be easily implemented in the clinical routine under current DC protocols. Copyright 2008 Wiley-Liss, Inc.

  1. Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

    International Nuclear Information System (INIS)

    Mose, Stephan; Budischewski, Kai Michael; Rahn, Angelika Notburga; Zander-Heinz, Anja Christina; Bormeth, Sabine; Boettcher, Heinz Dietrich

    2001-01-01

    Purpose: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. Methods and Materials: Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. Results: The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: ≤58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. Conclusion: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff

  2. Sentinel Lymph Node Frozen-Section Utilization Declines After Publication of American College of Surgeons Oncology Group Z0011 Trial Results With No Change in Subsequent Surgery for Axillary Lymph Node Dissection.

    Science.gov (United States)

    Jorns, Julie M; Kidwell, Kelley M

    2016-07-01

    To evaluate use of sentinel lymph node (SLN) frozen section (FS) before and after publication of the Z0011 trial. We identified 116 pre-Z0011 and 134 post-Z0011 patients from 18 months before and after Z0011-initiated changes. Clinicopathologic features were assessed by chart review. Post-Z0011 SLN FS use markedly declined when performed with breast-conserving therapy (BCT) (P < .0001), with SLN FS in 53 (73.6%) of 72 and 19 (25.0%) of 76 in pre- and post-Z0011 groups, respectively. There was post-Z0011 decline in axillary lymph node dissection (ALND) (P = .014) but no difference in later procedures for ALND. SLN positivity was associated with larger (≥1.6 cm) tumor size (P = .002). Nodal upstage was more frequent with invasive lobular (3/32; 9.4%) vs other invasive (2/188; 1.1%) subtypes. Our findings support reduced need for SLN FS for BCT patients post-Z0011. However, those with specific clinicopathologic features may derive greater benefit from SLN FS. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Intraoperative Radiotherapy for Breast Cancer: The Lasting Effects of a Fleeting Treatment

    Directory of Open Access Journals (Sweden)

    Harriet B. Eldredge-Hindy

    2014-01-01

    Full Text Available In well-selected patients who choose to pursue breast conservation therapy (BCT for early-stage breast cancer, partial breast irradiation (PBI delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT to be noninferior to whole breast external beam radiotherapy (EBRT when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT.

  4. Internal Mammary Lymph Node Irradiation Contributes to Heart Dose in Breast Cancer

    International Nuclear Information System (INIS)

    Chargari, Cyrus; Castadot, Pierre; MacDermed, Dhara; Vandekerkhove, Christophe; Bourgois, Nicolas; Van Houtte, Paul; Magne, Nicolas

    2010-01-01

    We assessed the impact of internal mammary chain radiotherapy (IMC RT) to the radiation dose received by the heart in terms of heart dose-volume histogram (DVH). Thirty-six consecutive breast cancer patients presenting with indications for IMC RT were enrolled in a prospective study. The IMC was treated by a standard conformal RT technique (50 Gy). For each patient, a cardiac DVH was generated by taking into account the sole contribution of IMC RT. Cardiac HDV were compared according to breast cancer laterality and the type of previous surgical procedure, simple mastectomy or breast conservative therapy (BCT). The contribution of IMC RT to the heart dose was significantly greater for patients with left-sided versus right-sided tumors (13.8% and 12.8% for left-sided tumors versus 3.9% and 4.2% for right-sided tumors in the BCT group and the mastectomy group, respectively; p < 0.0001). There was no statistically significant difference in IMC contribution depending on the initial surgical procedure. IMC RT contributes to cardiac dose for both left-sided and right-sided breast cancers, although the relative contribution is greater in patients with left-sided tumors.

  5. The Adoption of New Adjuvant Radiation Therapy Modalities Among Medicare Beneficiaries With Breast Cancer: Clinical Correlates and Cost Implications

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, Kenneth B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Soulos, Pamela R. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); Herrin, Jeph [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Health Research and Educational Trust, Chicago, Illinois (United States); Yu, James B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Long, Jessica B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); Dostaler, Edward [Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); and others

    2013-04-01

    Purpose: New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality. Methods and Materials: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient and regional characteristics. Results: Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007. Conclusions: IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy.

  6. The Adoption of New Adjuvant Radiation Therapy Modalities Among Medicare Beneficiaries With Breast Cancer: Clinical Correlates and Cost Implications

    Internation