Breast-conserving therapy versus modified radical mastectomy in the treatment of early breast cancer in Japan

Horiguchi, Jun; Iino, Yuichi; Koibuchi, Yukio; Yokoe, Takao; Takei, Hiroyuki; Yamakawa, Michitaka; Nakajima, Takashi; Oyama, Tetsunari; Ando, Takao; Ishida, Tsunehiro; Endo, Keiichi; Tokura, Y.; Suzuki, Hideo; Fujii, Takanao; Yokomori, Tadahiro; Morishita, Yasuo

doi:10.1007/bf02967581

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…In the last couple of decades it has been demonstrated by various studies (Fisher et al 2002, Veronesi et al 2002, Horiguchi et al 2002, van Dongen et al 2000, Early Breast Cancer Trialists' Collaborative Group 1995 that the treatment of early-stage breast cancer with BCS plus radiotherapy yields equivalent results to mastectomy. As early detection increases, more cancers are diagnosed in the early stage and BCS treatments play a central role in the management of breast cancer.…”

Section: Comparison Of Multi-institutional and Multi-mode Radiotherapymentioning

confidence: 99%

“…Breast cancer is the most common cancer in women. In the last two decades it has been demonstrated by various randomized studies that the treatment of early-stage breast cancer with BCS plus radiotherapy yields an equivalent outcome to mastectomy (Fisher et al 2002, Veronesi et al 2002, Horiguchi et al 2002 van Dongen et al 2000, Early Breast Cancer Trialists' Collaborative Group 1995. Typically, after conservative surgery, the entire breast is treated with photon EBRT of 45-50 Gy in 1.8-2 Gy fractions over 5 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Guerrero

2003

Phys. Med. Biol.

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Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher T(pot) is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer: alpha = 0.3 Gy(-1), alpha/beta = 10 Gy and sub-lethal damage repair time T(rep) = 1 h (mono-exponential behaviour is assumed). This set of parameters is consistent with in vitro experiments and with previously reported analyses. Using this set of parameters, we have found that most of the studies, using BCS plus whole breast RT and a boost to the tumour bed, have EUDs ranging from 60-70 Gy. No correlation is found between BED and the local recurrence rate. The treatments of BCS plus brachytherapy alone have a wide range of EUD (30-50 Gy), which is significantly lower than the treatments with whole breast EBRT plus a boost of the tumour bed. The studies with different fractionation schemes for whole breast EBRT also show a significant variation of EUD. Carefully designed clinical studies with large numbers of patients are required to determine clinically the relative effectiveness of these treatment variations. The derived LQ parameter set based on clinical data is consistent with in vitro experiments and previous studies. As demonstrated in the present work, these radiobiological parameters can be pot...

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Section: Comparison Of Multi-institutional and Multi-mode Radiotherapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Guerrero

2003

Phys. Med. Biol.

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“…The downside of diagnostic criteria chosen to maintain high sensitivity is possible overstaging. If pretreatment MRI characterizes associated benign disease as multifocal lobular cancer, the use of MRI will result in a certain number of unnecessary mastectomies without a demonstrated benefit in increased survival (37). Therefore, diagnostic criteria for staging and assessing the extent of known breast cancer should optimize specificity.…”

Section: Tumor‐related Factorsmentioning

confidence: 99%

Challenges to interpretation of breast MRI

Kinkel¹,

Hylton²

2001

Magnetic Resonance Imaging

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Index terms: breast neoplasm; MRI; tissue characterization; staging; interpretation ALTHOUGH IMAGE ACQUISITION TECHNIQUES for MRI of the breast vary internationally, image interpretation follows similar rules. At a recent international consensus meeting, experts pointed out that both kinetic and morphologic enhancement characteristics are used to characterize enhancing lesions of the breast at MRI (1). In the absence of scientific evidence, the relative importance of kinetic and morphologic features for breast cancer diagnosis is unclear.In addition to differences arising from imaging strategies, the interpretation of enhancing lesions on breast MRI is challenged by many patient-related factors, such as the menstrual cycle (2), recent breast surgery (3) or chemotherapy. Moreover, patients evaluated by MRI for an indeterminate lesion of the breast usually present with a considerably higher pretest probability of breast cancer than do patients undergoing a screening mammogram. The complexity of the interpretation process in a clinical situation is partly due to a necessary integration of the results of prior imaging or clinical examination. Indeed, the probability of breast cancer increases with suspicious findings at physical examination, mammography, and ultrasound. Therefore, final image interpretation of breast lesions seen at MRI should take into account the patient's personal history, with complete knowledge of the results of all other tests.Tumor-related factors, such as the type of histologic tumor and the degree of tumor differentiation, contribute to the biological heterogeneity of breast cancer. Interpretation rules established on series of patients presenting with a similar clinical problem might not apply to all breast cancers, due to differences in tumor histology and enhancement characteristics.This review describes the current knowledge and challenges of lesion interpretation with MRI of the breast according to different image interpretation strategies, with particular emphasis on patient-and tumorrelated factors influencing image interpretation.

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“…During a median follow-up duration of 78 months, Sakurai et al reported a cancer recurrence rate at the NAC of 3.7% among 788 patients who underwent NSM without radiotherapy between 1985 and 2004. A few other series on NSM that reported follow-up durations of at least 5 years involved patients treated in the 1980s and/or 1990s, when the adjuvant systemic therapy and radiation therapy regimens currently used in clinics had not yet been established as the criterion standard. In our study, we included only patients with invasive breast cancer who underwent NSM and immediate breast reconstruction between 2003 and 2015 and identified a low 5-year cumulative incidence of cancer recurrence at the NAC of 3.5%, which we believe was acceptable given the study population in the current series and the relatively long follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer

Kim

Lee

et al. 2019

JAMA Surg

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IMPORTANCE The main concern associated with nipple-sparing mastectomy (NSM) is the risk of local breast cancer recurrence at the retained nipple-areola complex (NAC) consequent to occult nipple involvement. Long-term follow-up data regarding the oncologic safety of modern therapeutic NSM in terms of cancer recurrence at the NAC and survival are limited. OBJECTIVE To assess the incidence, risk factors, treatment, and long-term outcomes associated with cancer recurrence at the NAC in a large series of patients with invasive breast cancer who underwent NSM and immediate breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study at a single institution (Asan Medical Center) in Seoul, Republic of Korea, 962 breasts from 944 patients who underwent NSM and immediate breast reconstruction for invasive breast cancer were analyzed between March 3, 2003, and December 31, 2015. Patients who underwent neoadjuvant systemic therapy or palliative surgery were excluded. Data analysis was performed from June 4, 2018, to August 31, 2018. MAIN OUTCOMES AND MEASURES Univariate and multivariate Cox proportional hazards regression models were used to analyze the association between clinicopathologic variables and cancer recurrence at the NAC. To evaluate the association between cancer recurrence at the NAC and prognosis, distant metastasis-free survival, and overall survival were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Among the 944 study patients (median age at diagnosis, 43 years [range, 23-67 years]) during a median follow-up of 85 months (range, 14-185 months), 39 cases (4.1%) of cancer recurrence at the NAC were identified as the first event after NSM. The 5-year cumulative incidence of cancer recurrence at the NAC was 3.5% (n = 34). In multivariate analyses, multifocality or multicentricity (hazard ratio [HR], 3.309; 95% CI, 1.501-7.294; P = .003), negative hormone receptor or ERBB2 (formerly HER2 or HER2/neu)-positive subtype (HR, 3.051; 95% CI, 1.194-7.796; P = .02), high histologic grade (HR, 2.641; 95% CI, 1.132-6.160; P = .03), and extensive intraductal component (HR, 3.338; 95% CI, 1.262-8.824; P = .02) were independently associated with cancer recurrence at the NAC after NSM. All 39 recurrent cases involved wide local excision. Patients with and without cancer recurrence at the NAC as the first event did not differ significantly with regard to distant metastasis-free survival (P = .95) or overall survival (P = .21). The 10-year distant metastasis-free survival rates were 89.3% among patients with cancer recurrence at the NAC and 94.3% among patients without recurrence. The 10-year overall survival rates were 100% among patients with cancer recurrence at the NAC and 94.5% among those without recurrence. CONCLUSIONS AND RELEVANCE Patients had a low incidence of cancer recurrence at the NAC after NSM and immediate breast reconstruction in this study. The findings suggest that multifocal or multicentric disease, hormone receptor-negative/ERBB2-posit...

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Breast-conserving therapy versus modified radical mastectomy in the treatment of early breast cancer in Japan

Abstract: Breast-conserving therapy is comparable to modified radical mastectomy in overall survival and disease-free survival.

Cited by 9 publications

References 13 publications

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Challenges to interpretation of breast MRI

Breast Cancer Recurrence in the Nipple-Areola Complex After Nipple-Sparing Mastectomy With Immediate Breast Reconstruction for Invasive Breast Cancer

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