Triple-Negative Breast Cancer is Associated with Higher Risk of Local Recurrence after 3D-Conformal External Beam Accelerated Partial Breast Irradiation (3D-APBI)

Pashtan, Itai; Ancukiewicz, Marek; Wo, Jennifer Y.; Hirsch, Arica; Smith, B.L.; Powell, Simon N.; Recht, A.; Taghian, Alphonse G.

doi:10.1016/j.ijrobp.2010.07.158

Cited by 3 publications

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“…Yet, the impact of molecular phenotype on local therapy has lagged, despite mounting evidence of an association between molecular phenotype and local recurrence (LR) or locoregional recurrence (LRR) 7‐11. Most reports find a low risk of LRR in the luminal phenotypes and increased risk of LRR in the so‐called triple negative (TN; ER‐, PR‐, and Her2‐negative) and Her2‐enriched breast cancer phenotypes after breast conservation therapy, mastectomy with postmastectomy radiation therapy, and accelerated partial breast irradiation 7‐14. Although trastuzumab likely mitigates excess LR risk in the Her2‐enriched phenotype, the lack of targeted systemic agents for triple negative breast cancer (TNBC), makes TN status in patients a clinical challenge for surgical and radiation oncologists.…”

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confidence: 99%

Triple negative breast cancer is associated with an increased risk of residual invasive carcinoma after lumpectomy

Sioshansi

Ehdaivand

Cramer

et al. 2012

Cancer

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BACKGROUND:To assess the potential mechanisms that may underlie increased local failure in triple negative (TN) breast cancers, an analysis was performed of the risk of residual carcinoma after lumpectomy with correlation to pathologic factors, including molecular phenotype. METHODS: A review of pathologic specimens was performed for women with invasive breast cancer treated with lumpectomy followed by reexcision. Data were collected on age; tumor size, grade, and nodal stage; estrogen receptor, progesterone receptor, and human endothelial growth factor receptor 2 (Her2); extensive intraductal component; lymphovascular invasion; margins; and reexcision findings. Univariate and multivariate logistic regression analyses were performed to evaluate for associations between pathologic features of the lumpectomy specimen and reexcision findings. Molecular phenotypes were defined by conventionally used immunohistochemical pattern. RESULTS: Data were collected on 369 patients with breast cancer. The median age was 57 years, median tumor size was 1.5 cm, 36% had positive margins, 32% had positive lymph nodes, 73.5% had the luminal A subtype, 9.5% had the luminal B subtype, 4.5% were Her2-enriched, and 12.5% were TN. Overall, 32% of patients had invasive cancer in their reexcision specimens, and 51% of those with the TN subtype had residual invasive disease on reexcision compared with 30% to 31% for other subtypes. On univariate analysis, age, tumor size, margin status, lymphovascular invasion, nodal status, and TN subtype were associated with elevated risk of residual invasive cancer. On multivariate analysis using a forward stepwise model, TN subtype maintained significance, with an odds ratio of 3.28 (P ¼ .002). CONCLUSION: TN subtype has a statistically significant association with an increased risk of residual tumor. This suggests the putative increase in the risk of local failure in TN patients may be related to increased residual

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confidence: 99%

Triple negative breast cancer is associated with an increased risk of residual invasive carcinoma after lumpectomy

Sioshansi

Ehdaivand

Cramer

et al. 2012

Cancer

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“…They reported no LR in 20 TNBC patients treated with APBI. In contrast, Pashtan et al ( 2010 ) reported on a series of 99 Stage I patients treated with APBI and found that patients with TN tumors had a significantly higher rate of LR compared to other subtypes. With a median follow-up of 47.5 months, they had an overall 5 year actuarial LR rate of 6%.…”

Section: Apbi and Molecular Phenotypementioning

confidence: 93%

The Implications of Breast Cancer Molecular Phenotype for Radiation Oncology

Sioshansi¹,

Huber²,

Wazer³

2011

Front. Oncol.

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The identification of distinct molecular subtypes of breast cancer has advanced the understanding and treatment of breast cancer by providing insight into prognosis, patterns of recurrence, and effectiveness of therapy. The prognostic significance of molecular phenotype with regard to distant recurrences and overall survival are well established in the literature and has been readily incorporated into systemic therapy management decisions. However, despite the accumulating data suggesting similar prognostic significance for locoregional recurrence, integration of molecular phenotype into local management decision making has lagged. Although there are some conflicting reports, collectively the literature supports a low risk of local recurrence (LR) in the hormone receptor (HR) positive luminal subtypes compared to HR negative subtypes [triple negative (TN) and HER2-enriched]. The development of targeted therapies, such as trastuzumab for the treatment of HER2-enriched subtype, has been shown to mitigate the increased risk of LR. Unfortunately, no such remedy exists to address the increased risk of LR for patients with TN tumors, making it a clinical challenge for radiation oncologists. In this review we discuss the correlation between molecular subtype and LR following either breast conservation therapy or mastectomy. We also explore the possible mechanisms for increased LR in TN breast cancer and radiotherapeutic implications for this population, such as the safety of breast conservation, consideration of dose escalation, and the appropriateness of accelerated partial breast irradiation.

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Five-year Outcome of Patients Classified in the "Unsuitable" Category Using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel Guidelines for the Application of Accelerated Partial Breast Irradiation: An Analysis of Patients Treated on the American Society of Breast Surgeons MammoSite® Registry Trial

Recht¹

2011

Breast Diseases: A Year Book Quarterly

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Triple-Negative Breast Cancer is Associated with Higher Risk of Local Recurrence after 3D-Conformal External Beam Accelerated Partial Breast Irradiation (3D-APBI)

Cited by 3 publications

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Triple negative breast cancer is associated with an increased risk of residual invasive carcinoma after lumpectomy

Triple negative breast cancer is associated with an increased risk of residual invasive carcinoma after lumpectomy

The Implications of Breast Cancer Molecular Phenotype for Radiation Oncology

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