Radiation treatment improves local-regional control and survival in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy

Huang, Eugene; Tucker, Susan L.; Strom, E. A.; McNeese, Marsha D.; Kuerer, HM; Hortobágyi, G. N.; Buzdar, A.; Valero, Vicente; Perkins, George H.; Hunt, KK; Şahin, Ahmet Bilgehan; Buchholz, TA

doi:10.1016/s0360-3016(03)01064-2

Cited by 5 publications

(4 citation statements)

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“…However, further data are needed to define the risk of LRR after mastectomy and postmastectomy radiotherapy for patients considered to be at high risk by the MDAPI, because removing the breast may not necessarily lower the risk for LRR in patients with more aggressive tumors. For example, our group has demonstrated that clinical N2–N3 disease is also a risk factor for LRR after neoadjuvant chemotherapy, mastectomy, and postmastectomy radiotherapy 28. In addition, decisions regarding locoregional therapy for patients at high risk for IBTR and LRR should also consider the corresponding risk of developing distant metastasis, in that the factors used in the MDAPI also affect this risk.…”

Section: Discussionmentioning

confidence: 99%

Breast conservation after neoadjuvant chemotherapy

Chen

Meric‐Bernstam

Hunt

et al. 2005

Cancer

126

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BACKGROUND The appropriate selection criteria for breast‐conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision‐making for patients treated by this multimodality approach. METHODS From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0–4. RESULTS The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5‐year IBTR‐free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5‐year LRR‐free survival rates were 94%, 83%, and 58%, respectively (P < 0.001). CONCLUSIONS Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Breast conservation after neoadjuvant chemotherapy

Chen

Meric‐Bernstam

Hunt

et al. 2005

Cancer

126

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“…Locally advanced breast cancer tumours include those that are more than 5 cm, with or without lymph node involvement, or tumours that protrude beyond the breast tissue into nearby skin or muscle (Singletary, Allred, Ashley, et al, 2002). Despite advances in early detection and treatment, the five-year survival for women with LABC is poor at around 55% (Huang, Tucker, Strom, et al, 2003;Sant, Allemani, Capocaccia et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Why women delay seeking assistance for locally advanced breast cancer

Gould¹,

Fitzgerald²,

Fergus³

et al. 2010

CONJ

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Locally advanced breast cancer (LABC) occurs in 10% to 30% of all new primary breast cancer diagnoses. For reasons that are not well-understood, 20% to 30% of women with breast cancer (at all stages) wait eight weeks or more from the time they notice the breast symptom(s) to when they seek assistance from a health care provider. Comprehending the mechanisms that support the health appraisal and health seeking behaviour is paramount and not well understood, particularly for women with LABC. The purpose of this study was to qualitatively explore the cognitive, emotional, and contextual experience of women with locally advanced breast cancer in the time between symptom discovery and seeking health care. In-depth qualitative interviews and a cross-case, content analysis revealed that the participants delayed their search for assistance because they did not perceive themselves to be at risk for developing breast cancer, had a symptom other than a lump, and so misattributed or minimized the gravity of the symptom, had a previous experience with a benign tumour, and/or were experiencing concurrent stressful life events. These participants were motivated to seek attention if they had an already scheduled appointment with a health professional for another matter, felt the symptom worsen over time, or were motivated by a loved one to seek help. Implications for health promotion and for education with women with benign breast disease, as well as the general public, are discussed.

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“…Les tumeurs associées à un cancer du sein localement avancé incluent celles qui font plus de 5 cm, avec ou sans envahissement ganglionnaire et les tumeurs qui font saillie du tissu mammaire pour toucher l'épiderme ou le muscle avoisinant (Singletary, Allred, Ashley et al, 2002). Malgré les avancées de la détection précoce et du traitement, la survie à 5 ans des femmes atteintes de CSLA se situe autour de 55 %, un taux peu encourageant (Huang, Tucker, Strom et al, 2003;Sant, Allemani, Capocaccia et al, 2003).…”

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