Treatment of Recurrent Breast Cancer Following Breast Conserving Surgery

Burger, Amy; Pain, Simon; Péley, Gábor

doi:10.1111/tbj.12105

Cited by 30 publications

(17 citation statements)

References 33 publications

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“…The study demonstrated that patients who received repeat lumpectomy plus RT achieved comparable 5‐ and 10‐year DFS and OS to those who underwent a mastectomy. It is commonly accepted that a second full‐dose course of whole breast radiotherapy therapy after repeat lumpectomy cannot be tolerated by the tissues and would lead to unacceptable levels of toxicities and poor cosmetic result . However, several published articles demonstrate that accelerated partial breast irradiation after repeat lumpectomy is safe and feasible and can achieve acceptable skin, fibrosis, and breast pain toxicity, as well as satisfactory cosmetic results .…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality with Repeat Lumpectomy Alone After Ipsilateral Breast Tumor Recurrence

Guo

Xue

et al. 2019

The Oncologist

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Background The benefit of repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery is currently inconclusive. Materials and Methods Patients with IBTR with definitive surgery were identified in the Surveillance, Epidemiology, and End Results registry between 1973 and 2013. The effect of different IBTR surgeries on overall and cancer‐specific mortality was assessed using risk‐adjusted Cox proportional hazard regression modeling and stratified propensity score‐matching analysis (PSMA). Results Of the 5,098 patients with IBTR, 4,048 (79.4%) women underwent mastectomy and 1,050 (20.1%) underwent repeat lumpectomy. In multivariable Cox regression analysis, repeat lumpectomy was associated with increased overall mortality (hazard ratio for death [HR], 1.522; 95% confidence interval [CI], 1.317–1.759; p < .001) and cancer‐specific mortality (HR, 1.666; 95% CI, 1.319–2.105; p < .001). Similar HRs were derived from the PSMA cohort. However, we found no significant difference in overall mortality for women who underwent repeat lumpectomy followed by radiation therapy (RT) compared with that for those who underwent mastectomy. Moreover, patients with IBTR with small tumors (≤1 cm) who underwent repeat lumpectomy with RT rather than without had similar overall and cancer‐specific survival rates to those who underwent mastectomy. Conclusion Our investigation suggests that compared with mastectomy, repeat lumpectomy for IBTR is associated with higher overall and cancer‐specific mortality under real‐world observational conditions. Furthermore, repeat lumpectomy with RT is equivalent to mastectomy with respect to overall mortality and may influence treatment decision making for patients with small IBTR. Implications for Practice Although mastectomy has been regarded as the standard treatment for ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery, many patients diagnosed with small and early‐detected recurrent tumor might be technically suitable for a less invasive surgical procedure. However, different studies have drawn inconsistent conclusions. The present study is a population‐based analysis, which demonstrated the overall unfavorable impact of repeat lumpectomy over mastectomy on survival outcomes for patients with IBTR. However, patients with small IBTR (≤1 cm) that can tolerate radiation therapy may be the optimal candidates for repeat lumpectomy.

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Section: Discussionmentioning

confidence: 99%

Increased Mortality with Repeat Lumpectomy Alone After Ipsilateral Breast Tumor Recurrence

Guo

Xue

et al. 2019

The Oncologist

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“…Many of these patients present with bulky, large volume disease, further complicating management. Hyperthermia has emerged as a useful adjunct treatment that can improve the radiosensitivity of cancer cells, thus achieving greater tumor control with lower doses of radiation compared to radiation alone [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Clinical and dosimetric evaluation of recurrent breast cancer patients treated with hyperthermia and radiation

Dharmaiah

Zeng

Rao

et al. 2019

International Journal of Hyperthermia

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Background: Treatment for locally recurrent breast cancer poses a significant challenge because the benefits in local control must be weighed against the increased risk of side effects of the treatment. Frequently, patients have been heavily pre-treated with radiation and several types of chemotherapy. Moreover, they often present with large volumes of bulky disease, further complicating management. Hyperthermia can be used to improve the efficacy of radiation, particularly in the setting of recurrent disease. Methods: We reviewed our clinical and dosimetric experience of breast cancer patients who received hyperthermia and radiation for recurrent breast cancer from 2011 to 2017. Thirty-six patients were treated with hyperthermia and radiation. Median follow-up was 11 months. Thirty patients (83.3%) received prior radiotherapy. The most commonly used radiation fraction scheme was 32 Gy in 8 fractions. The median radiation dose at the time of recurrence was 35.5 Gy (range 20-64 Gy). Mild temperature hyperthermia was delivered two times per week. Results: The median repeat radiation volume was 574 cc (range 11-3620 cc). Electrons, conventional photons, and IMRT radiation techniques were used. IMRT was used for large and complex treatment volumes and showed acceptable doses to organs at risk. The overall response rate was 61.1%. Complete response was observed in 17 patients (47.2%), partial response in 5 patients (13.9%), stable disease in 11 patients (30.6%), and progressive disease in 3 patients (8.3%). Twenty-six patients experienced acute grade 1 and 2 toxicities, primarily pain and erythema; and 26 experienced long-term grade 1 and 2 toxicities, mainly hyperpigmentation and lymphedema. Three patients developed new ulcerations that healed with conservative management. One patient developed pulmonary fibrosis resulting in mild dyspnea on exertion. Conclusion: Hyperthermia and radiation provide good local control with a favorable side effect profile. Thermoradiotherapy may be offered to patients with recurrent breast cancer, including those with extensive volumes of disease.

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“…Before 1990, the CMU program (colchicine, methotrexate, and uramustine) was widely used; since 1990, CEF (cyclophosphamide, doxorubicin/epirubicin, and fluorouracil), CMF (cyclophosphamide, methotrexate, and fluorouracil), or TE (taxane and anthracyclines) has been used. Anthracyclines, such as doxorubicin or epirubicin, decrease the annual cancer recurrence risk by 2% and death risk by 11%, and further decrease the absolute benefit by 3.2% and 2.7%, respectively (Litière et al, 2012;Burger et al, 2013). Taxanes, such as paclitaxel and docetaxel, are suitable for patients with positive lymph nodes.…”

Section: A Brief Literature Review Of Male Accessory Breast Cancermentioning

confidence: 99%

Successful treatment of accessory breast cancer with endocrine therapy

Chun-xi

Guo

Han

2017

J. Zhejiang Univ. Sci. B

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Accessory breast cancers in males are extremely rare, and only a few cases have been reported in the literature. In this paper, an 87-year-old male patient was diagnosed with an accessory breast cancer by means of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), and immunohistochemistry based on needle biopsy, and has undergone successful resection and postoperative adjuvant endocrine therapy. He was the oldest male patient with an accessory breast cancer reported in the Chinese Hospital Knowledge Database and PubMed literature from 1975 to 2015.

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Treatment of Recurrent Breast Cancer Following Breast Conserving Surgery

Cited by 30 publications

References 33 publications

Increased Mortality with Repeat Lumpectomy Alone After Ipsilateral Breast Tumor Recurrence

Increased Mortality with Repeat Lumpectomy Alone After Ipsilateral Breast Tumor Recurrence

Clinical and dosimetric evaluation of recurrent breast cancer patients treated with hyperthermia and radiation

Successful treatment of accessory breast cancer with endocrine therapy

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