Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition).

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Phase II Study of Compliance and Morbidity with 4 Cycles of Taxotere Followed by 4 of Doxorubicin-Cyclophosphamide for Adjuvant Treatment of Operable Breast Cancer Patients.

BACKGROUND: In the adjuvant treatment of breast cancer, anthracycline and taxane based regimens can be used concomitantly or sequentially. The best order in the sequential regimens has yet to be well established. This study evaluated the feasibility of 4 cycles of adjuvant taxotere (100mg/m2) every 3 weeks followed by 4 cycles of doxorubicin (60 mg/m2) and cyclophosphamide (600mg/m2) every 3 weeks. The primary outcome was the safety profile. Secondary outcomes were disease free survival (DFS) and overall survival (OS). MATERIALS AND METHODS: This non-randomized prospective phase II study was performed at Jordan University of Science and Technology and its affiliated King Abdulla Teaching Hospital between July 2009 and August 2010. Data collection was closed on May 31th, 2015, giving a median follow up period of 62 months. The study was approved by the institutional review board and written informed consent was obtained for each patient. RESULTS: Fifty patients were enrolled. The median age was 53.1 years (range 34-76). One patient (2%) had stage I disease, 17 (34%) stage II, and 32 (64.0%) stage III. Forty-six patients were evaluable for efficacy analysis. The completion rate was 95.7%. No dose modifications were needed. The incidences of grade 3-4 neutropenia and febrile neutropenia were 14% and 10%. No grade 3-4 non-hematological adverse events were encountered. At a median follow up time of 62 months the OS and the DFS rates were 76.1% and 56.5%. Those for stages I and II combined were 100% and 75%. CONCLUSIONS: Taxotere first followed by doxorubicin-cyclophosphamide appears a feasible regimen as evidenced by an acceptable completion rate, a satisfactory safety profile, and OS and DFS rates comparable to other studies.