A multi‐institutional prediction model to estimate the risk of recurrence and mortality after mastectomy for <scp>T1‐2N1</scp> breast cancer

Sittenfeld, S.M.C.; Zabor, Emily C.; Hamilton, Sarah; Kuerer, Henry Mark; El‐Tamer, Mahmoud; Naoum, George E.; Truong, Pauline T.; Nichol, Alan; Smith, Benjamin D.; Woodward, Wendy A.; Moo, Tracy-Ann; Powell, Simon N.; Shah, Chirag; Taghian, Alphonse G.; Abu-Gheida, Ibrahim; Tendulkar, Rahul D.

doi:10.1002/cncr.34352

Cited by 8 publications

(3 citation statements)

References 32 publications

(56 reference statements)

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“…The decision regarding the indication for radiotherapy may be informed by the utilization of an online calculator designed for personalized decision-making regarding PMRT in patients with T1-2N1 breast cancer [ 40 ].…”

Section: The Number Of Positive Lymph Nodes and Axillary Dissectionmentioning

confidence: 99%

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Kolářová,

Melichar,

Sirák

et al. 2024

Current Oncology

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The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.

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Section: The Number Of Positive Lymph Nodes and Axillary Dissectionmentioning

confidence: 99%

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Kolářová,

Melichar,

Sirák

et al. 2024

Current Oncology

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“…As indicated in the latest regional report, breast cancer has now surpassed lung cancer in incidence among Chinese women for the first time, making it the most prevalent cancer, accounting for approximately 19.9% of newly diagnosed cases [ 1 ]. Minimizing the incidence of recurrence and metastasis five years after surgery, as well as length of life, are essential concerns and obstacles for breast cancer [ 2 ]. Present breast cancer treatment have hit a plateau; novel therapeutic strategies are sought [ 3 ].In 2019, the U.S. Food and Drug Administration initially authorized the anti-programmed cell death ligand 1 (PD-L1) inhibitor Atezolizumab for the first-line management of PD-L1-positive advanced triple-negative breast cancer, marking a new adventure in immunotherapy for breast cancer [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a machine learning-based radiomics signature for estimating breast cancer TME phenotypes and predicting anti-PD-1/PD-L1 immunotherapy response

Han,

Guo,

et al. 2024

Breast Cancer Res

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Backgrounds Since breast cancer patients respond diversely to immunotherapy, there is an urgent need to explore novel biomarkers to precisely predict clinical responses and enhance therapeutic efficacy. The purpose of our present research was to construct and independently validate a biomarker of tumor microenvironment (TME) phenotypes via a machine learning-based radiomics way. The interrelationship between the biomarker, TME phenotypes and recipients’ clinical response was also revealed. Methods In this retrospective multi-cohort investigation, five separate cohorts of breast cancer patients were recruited to measure breast cancer TME phenotypes via a radiomics signature, which was constructed and validated by integrating RNA-seq data with DCE-MRI images for predicting immunotherapy response. Initially, we constructed TME phenotypes using RNA-seq of 1089 breast cancer patients in the TCGA database. Then, parallel DCE-MRI images and RNA-seq of 94 breast cancer patients obtained from TCIA were applied to develop a radiomics-based TME phenotypes signature using random forest in machine learning. The repeatability of the radiomics signature was then validated in an internal validation set. Two additional independent external validation sets were analyzed to reassess this signature. The Immune phenotype cohort (n = 158) was divided based on CD8 cell infiltration into immune-inflamed and immune-desert phenotypes; these data were utilized to examine the relationship between the immune phenotypes and this signature. Finally, we utilized an Immunotherapy-treated cohort with 77 cases who received anti-PD-1/PD-L1 treatment to evaluate the predictive efficiency of this signature in terms of clinical outcomes. Results The TME phenotypes of breast cancer were separated into two heterogeneous clusters: Cluster A, an "immune-inflamed" cluster, containing substantial innate and adaptive immune cell infiltration, and Cluster B, an "immune-desert" cluster, with modest TME cell infiltration. We constructed a radiomics signature for the TME phenotypes ([AUC] = 0.855; 95% CI 0.777–0.932; p < 0.05) and verified it in an internal validation set (0.844; 0.606–1; p < 0.05). In the known immune phenotypes cohort, the signature can identify either immune-inflamed or immune-desert tumor (0.814; 0.717–0.911; p < 0.05). In the Immunotherapy-treated cohort, patients with objective response had higher baseline radiomics scores than those with stable or progressing disease (p < 0.05); moreover, the radiomics signature achieved an AUC of 0.784 (0.643–0.926; p < 0.05) for predicting immunotherapy response. Conclusions Our imaging biomarker, a practicable radiomics signature, is beneficial for predicting the TME phenotypes and clinical response in anti-PD-1/PD-L1-treated breast cancer patients. It is particularly effective in identifying the "immune-desert" phenotype and may aid in its transformation into an "immune-inflamed" phenotype.

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“…Post‐mastectomy radiation therapy (PMRT) decreases locoregional recurrence and improves overall survival for breast cancer patients after mastectomy (Chen et al, 2022; McGale et al, 2014; Overgaard et al, 1997, 2022; Ragaz et al, 1997, 2005; Sittenfeld et al, 2022). However, radiation therapy can have harmful effects on tissue healing and reconstructive outcomes (Jagsi et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

et al. 2023

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BackgroundThe optimal timing of post‐mastectomy radiation therapy (PMRT) in autologous breast reconstruction is controversial. Our study compares overall reconstructive outcomes in patients who received post‐mastectomy radiation therapy either before or after the autologous flap.MethodsA single‐center retrospective review was performed for patients who underwent free flap breast reconstruction and post‐mastectomy radiation from January 2004 through January 2021. Demographic, intraoperative, and post‐operative variables were recorded.ResultsA total of 452 free flaps were identified, and 82 underwent PMRT. 59.8% were radiated with an expander prior to free flap surgery (PreFlap), and 40.2% flaps underwent PMRT (PostFlap). PostFlap patients were significantly younger (43.0 vs. 47.9 years, p = .016). There were no significant differences in free flap outcomes between the two cohorts including thrombosis, venous congestion, flap loss, takebacks, fat necrosis, seroma, or infection. Mastectomy skin flap necrosis was significantly higher in the PostFlap cohort (9.1% vs. 0%, p = .032), but nipple necrosis rates did not differ. There were no significant differences in number or need for revision surgeries, fat necrosis, or fat grafting between groups. However, there were significantly more total reconstructive complications, including infection and wound breakdown, experienced by the PreFlap cohort (46.9% vs. 24.2%, p = .038).ConclusionsTiming of PMRT did not impact free flap outcomes, but those who had the expander radiated experienced significantly more complications overall. For the 34.7% of patients in the preFlap group who planned for autologous reconstruction form initial consultation, radiation after the flap may have improved their overall outcomes. As added complications cause delays in cancer therapy and final reconstruction, our results suggest that PMRT of the flap when possible may improve the overall experience for breast cancer patients.

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A multi‐institutional prediction model to estimate the risk of recurrence and mortality after mastectomy for T1‐2N1 breast cancer

Cited by 8 publications

References 32 publications

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Development of a machine learning-based radiomics signature for estimating breast cancer TME phenotypes and predicting anti-PD-1/PD-L1 immunotherapy response

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

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