Outcomes of Breast-Conserving Therapy in Patients With Inflammatory Breast Cancer: A Meta-Analysis.

INTRODUCTION: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Currently, patients who respond to neoadjuvant chemotherapy (NAC) are treated with mastectomy and axillary lymph node dissection. This study aimed to synthesize real-world data to evaluate the feasibility of breast-conserving therapy (BCT), sentinel lymph node (SLN), and sentinel lymph node biopsy (SLNB) for patients with IBC who respond to NAC. METHODS: PubMed, Embase, and Cochrane Library databases were searched for relevant articles. Clinical studies that compared mastectomy with BCT for IBC treatment were reviewed. The primary outcomes were local recurrence rate and 5-y survival rate in patients with IBC who responded to NAC. Furthermore, the SLN detection rate and false-negative rate (FNR) for SLNB were also evaluated. RESULTS: In the final analysis, 17 studies were included. The pooled estimates of the local recurrence rate for mastectomy and no surgical intervention were 18.6% and 15.9%, respectively (P = 0.956). Five-y survival was similar for mastectomy, partial mastectomy, and no surgical intervention (45.8%, 57.1%, and 39.4%, respectively). The pooled estimates of the SLN detection rate and FNR for SLNB were 81.9% and 21.8%, respectively. CONCLUSIONS: Among patients with IBC who respond to NAC, the local recurrence and 5-y survival rates in those undergoing BCT are noninferior to the rates in those undergoing mastectomy; therefore, BCT could be a feasible option for surgical management. However, a poor SLN detection rate and a high FNR were found in patients undergoing SLNB. Further large-scale clinical studies are required to confirm our findings.

Calidad de vida y satisfacción posterior a cirugía oncoplástica unilateral. Experiencia de un hospital oncológico de Latinoamérica / Quality of life and satisfaction after unilateral oncoplastic surgery. Experience of a Latin American cancer hospital

Introducción: la cirugía oncoplástica (COP), ha tenido un gran desarrollo, permitiendo resecciones oncológicas seguras y previniendo potenciales deformidades y asimetrías. Evaluamos el impacto en la calidad de vida en pacientes con COP nivel I y II, mediante el cuestionario BREAST Q BCT y el deseo de simetrización posterior a la terapia adyuvante. Metodología: se estudiaron 50 pacientes, con diagnóstico de cáncer de mama, tratadas con COP (nivel I y nivel II) unilateral, durante el periodo entre octubre de 2017 y mayo de 2022, a quienes se les aplicó el cuestionario BREAST Q BCT postoperatorio, además de una encuesta sobre el deseo de simetrización. Resultados: en los dominios del BREAST Q estudiados se registraron: «bienestar psicosocial» (mediana de 83) «bienestar sexual» (mediana de 66), «bienestar físico» (mediana de 76), «satisfacción con la mama operada» (mediana de 80), «satisfacción con la información recibida» (mediana de 76) y «satisfacción con el equipo de salud» (mediana de 100). No se encontró relación estadística entre las variables estudiadas y las puntuaciones de la mediana del dominio «satisfacción de mama operada». Solo el 10% de las pacientes expresaron el deseo de simetrización. Conclusión: los resultados demuestran niveles altos de satisfacción en COP nivel I y II unilateral, teniendo un impacto en la calidad de vida de las pacientes; expresando el deseo de simetrización, predominante en mamoplastias de nivel II y COP extrema. (AU)

Introduction: Oncoplastic surgery (COP) has had a great development, allowing safe oncological resections, preventing potential deformities and asymmetries. We evaluated the impact on quality of life in patients with COP level I and II, using the BREAST Q BCT questionnaire and the desire for symmetrization after adjuvant therapy. Methodology: 50 patients diagnosed with breast cancer, treated with unilateral COP (Level I and Level II), were studied during the period between October 2017 and May 2022, to whom the BREAST Q BCT postoperative questionnaire was applied, in addition to survey on the desire for symmetrization. Results: In the domains of the BREAST Q studied, they recorded: "psychosocial well-being" (median of 83), "sexual well-being" (median of 66), "physical well-being" (median of 76), "satisfaction with the operated breast" (median of 80), "satisfaction with the information received" (median of 76) and "satisfaction with the health team" (median of 100). No statistical relationship was found between the variables studied and the median scores of the "satisfaction of operated breast" domain. Only 10% of the patients expressed the desire for symmetrization. Conclusion: The results show high levels of satisfaction in COP level I and II unilateral, having an impact on the quality of life of the patients; expressing the desire for symmetrization, predominant in level II mammoplasties and extreme COP. (AU)

Influence of minimum segment width on intensity-modulated radiotherapy plan for left-sided breast cancer after breast conserving surgery.

To research the influence of the minimum segment width (MSW) on intensity-modulated radiotherapy (IMRT) plan for left breast cancer after breast conserving surgery and provide a reference for plan optimization. Ten patients with left-sided early-stage breast cancer after breast-conserving surgery (BCS) were selected for postoperative radiotherapy. The Monaco 5.11 treatment planning system (TPS) was used, and the optimization parameters of the plan were fixed, while MSW were set to 0.5, 1, 1.5, and 2 cm, and four 5 field-IMRT plans were designed for every patient. The plan quality and execution efficiency of each plan were compared, including planning target volume (PTV) dose, organs at risk (OAR) dose, segments number (SN), monitor units (MU), delivery time (DT), and dose verification results. With the increase of the MSW, the dose indexes of the OAR were similar (P > .05). The D2%, D98%, and D50% of the PTV gradually deviated from the prescription dose, and the uniformity gradually deteriorated (P < .05). The gamma passing rates (GPR) of dose verification and the dose deviation of the PTV were similar (P > .05). The SN, MU, and DT gradually decreased (P < .05), but the amplitude change caused by each increase of 0.5 cm gradually decreased, the decrease of 0.5 to 1 cm was the largest, reaching 16.41%, 21.25%, and 0.35 minutes, respectively, while the 3 values of 1.5 and 2 cm were close. When using Monaco 5.11 TPS to design IMRT plan for left breast cancer after BCS, 1.5 cm MSW could ensure better dose coverage and uniformity of the PTV, as little as possible exposure dose to the OAR, and high dose verification accuracy. The SN, MU, and DT were significantly reduced, and the treatment efficiency was improved.

Mastectomy patterns among older women with early invasive breast cancer in England and Wales: A population-based cohort study.

INTRODUCTION: Older women with early invasive breast cancer (EIBC) are more likely to receive a mastectomy compared with younger women. This study assessed factors associated with receiving a mastectomy among older women with EIBC, with a particular focus on comorbidity and frailty. MATERIALS AND METHODS: Women diagnosed with EIBC (stages I-IIIa) aged ≥50 years from 2014 to 2019 in English and Welsh NHS organisations who received breast surgery were identified from cancer registration datasets linked to routine hospital data. Separate multivariable logistic regression models explored factors associated with mastectomy use, within each tumour stage (T1-T3). For each tumour stage, risk-adjusted rates of mastectomy were calculated for each NHS organisation and displayed using funnel plots. RESULTS: We included 106,952 women with EIBC: 23.4% received a mastectomy as their first breast cancer surgery. Receipt of mastectomy was more common among patients with a higher tumour stage (T1: 12.3%; T2: 37.6%; T3: 77.5%), and mastectomy use increased with age within each tumour stage category (50-59 vs 80 + years: 11.8% vs 26.3% for T1; 31.5% vs 56.9% for T2; 73.4% vs 90.3% for T3). Results from a multivariable regression model showed that more severe frailty was associated with mastectomy use for women with T1 (p = 0.002) or T2 (p = 0.003) tumours, but may not be for women with T3 tumours (p = 0.041). There was no association between comorbidity and mastectomy use after accounting for frailty (all p > 0.1). Adjusting for clinical and patient factors only slightly reduced the association between age and mastectomy use. Variation in mastectomy use between NHS organisations was greatest for women with T2 EIBC (unadjusted range: 17.7% to 68.4%). DISCUSSION: Older women with EIBC are more commonly treated with mastectomy. This could not be explained by tumour characteristics or physical fitness, raising questions about whether surgical decision-making inconsistently incorporates information on patient fitness and functional age.

Does oncoplastic breast-conserving surgery cause unnecessary additional evaluations?

OBJECTIVE: Patients who have undergone breast-conserving surgery may experience fear of recurrence. Post-operative granulation tissue and fat necrosis are common issues for these patients. As a result, additional examinations may increase, which can entail increased costs and stress for patients. In this study, if oncoplastic breast-conserving surgery causes additional imaging and unnecessary additional evaluations. PATIENTS AND METHODS: We retrospectively analyzed data from 432 patients who had undergone breast-conserving surgery in the same surgical unit between 2013 and 2017. We separated the patients into two main groups: Group 1 were those operated with conservative breast-conserving surgery, while Group 2 had operations using oncoplastic breast-conserving surgery techniques. The two groups were compared in terms of post-operative radiological examinations, suspected radiological findings, and biopsy needs. RESULTS: There were 203 patients in Group 1 and 229 in Group 2. The median follow-up time was 66 months (range 12-109). Additional mammography use was higher in the second group (p=0.003). However, the two groups had no statistical differences for additional imaging and biopsy needs in general (p=0.138). Sixty-two patients (14.3%) had biopsies with suspicious radiological findings (15.8% vs. 13.1%). Eight (12.8%) of these patients had malignant results. There were local recurrences in six patients, one in the first group and five in the second group (p=0.084). CONCLUSIONS: Oncoplastic breast-conserving surgery may increase post-operative mammography use. However, there is no statistical difference between the two groups for either additional imaging in total or in biopsy needs.

Cardiac protective techniques in left breast radiotherapy: rapid selection criteria for routine clinical decision making.

OBJECTIVE: In left breast radiotherapy (RT) desired heart doses may be achieved without heart-sparing RT techniques in some patients. We aimed to examine the existence of predictive factors and cutoff points to determine which patients are the main candidates for heart-sparing RT techniques. MATERIAL AND METHOD: Dosimetric data for left breast cancer was examined. RT plans were made at conventional doses to the breast and peripheral lymph nodes. Statistical analyses were performed using SPSS 22.0 (SPSS Inc., IBM Corp., Armonk, NY). RESULT: 114 cases were evaluated by ROC (Receiver operating characteristic) analysis in the breast-conserving surgery (BCS) and mastectomy groups. While only left lung volume (AUC: 0.74, 95% CI 0.61-0.87, p = 0.002) was significant in BCS cases, in cases with mastectomy, left lung volume (AUC: 0.81, 95% CI 0.69-0.94, p = 0.002) and lung/heart volume ratio (AUC: 0.83, 95% CI 0.70-0.96, p = 0.001) had a significant relationship with the relevance of heart doses. The cutoff point of 1.92 was selected for the lung/heart volume ratio for the mastectomized patients. Moreover, the cutoff point 1154 cc and 1208 cc was determined for the left lung volume for the BCS and mastectomized patients, respectively. CONCLUSION: Various cutoff points in left breast RT can be used to predict whether RT plans will meet QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) heart dose limits. Evaluating only these few cutoff points before planning makes it possible to eliminate 70% of patients with BCS and 40% of patients with mastectomy from respiratory-controlled methods, which require time and effort. Patients with lung volume and lung/heart volume ratio smaller than the cutoff values can be considered primary candidates for heart-sparing techniques.

Comparison of adverse events in partial- or whole breast radiotherapy: investigation of cosmesis, toxicities and quality of life in a meta-analysis of randomized trials.

PURPOSE/OBJECTIVE: Adjuvant whole breast radiotherapy and systemic therapy are part of the current evidence-based treatment protocols for early breast cancer, after breast-conserving surgery. Numerous randomized trials have investigated the therapeutic effects of partial breast irradiation (PBI) compared to whole breast irradiation (WBI), limiting the treated breast tissue. These trials were designed to achieve equal control of the disease with possible reduction in adverse events, improvements in cosmesis and quality of life (QoL). In this meta-analysis, we aimed to investigate the differences between PBI and WBI in side effects and QoL. MATERIAL/METHODS: We performed a systematic literature review searching for randomized trials comparing WBI and PBI in early-stage breast cancer with publication dates after 2009. The meta-analysis was performed using the published event rates and the effect-sizes for available acute and late adverse events. Additionally, we evaluated cosmetic outcomes as well as general and breast-specific QoL using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. RESULTS: Sixteen studies were identified (n = 19,085 patients). PBI was associated with a lower prevalence in any grade 1 + acute toxicity and grade 2 + skin toxicity (OR = 0.12; 95% CI 0.09-0.18; p < 0.001); (OR = 0.16; 95% CI 0.07-0.41; p < 0.001). There was neither a significant difference in late adverse events between the two treatments, nor in any unfavorable cosmetic outcomes, rated by either medical professionals or patients. PBI-technique using EBRT with twice-daily fractionation schedules resulted in worse cosmesis rated by patients (n = 3215; OR = 2.08; 95% CI 1.22-3.54; p = 0.007) compared to WBI. Maximum once-daily EBRT schedules (n = 2071; OR = 0.60; 95% CI 0.45-0.79; p < 0.001) and IORT (p = 0.042) resulted in better cosmetic results grade by medical professionals. Functional- and symptom-based QoL in the C30-scale was not different between PBI and WBI. Breast-specific QoL was superior after PBI in the subdomains of "systemic therapy side effects" as well as "breast-" and "arm symptoms". CONCLUSION: The analysis of multiple randomized trials demonstrate a superiority of PBI in acute toxicity as well breast-specific quality of life, when compared with WBI. Overall, late toxicities and cosmetic results were similar. PBI-technique with a fractionation of twice-daily schedules resulted in worse cosmesis rated by patients.

Breast conserving surgery versus mastectomy: the effect of surgery on quality of life in breast cancer survivors in Malaysia.

BACKGROUND: In the competitive health care environment, patient satisfaction and quality of life (QoL) have become the subject of interest to evaluate the efficacy of therapeutic interventions as we experience improved breast cancer survival in modern times. The knowledge of the long-term effects of surgery on the QoL in breast cancer patients is currently limited in the Asian setting. The purpose of this longitudinal study is to evaluate the QoL of early-stage breast cancer patients undergoing mastectomy and breast-conserving surgery (BCS). METHODS: In this prospective cohort study, the QoL of 208 patients who underwent mastectomy and the BCS treatment were assessed, using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The questionnaire was administered at the baseline, 6 and 12 months following diagnosis. One-way ANCOVA was used for statistical analysis. RESULTS: A total of 208 female survivors of Stage 0-II breast cancer were included, among them 47.1% underwent BCS and 52.9% underwent mastectomy. Older (63.3%), Chinese women (63.6%), and patients with primary education (71.7%) were more likely to undergo mastectomy. At baseline, no significant differences were observed for QoL in both treatment groups. At 6 months, patients who underwent BCS had better social functioning scales( P = 0.006) and worse symptom scales for dyspnoea (P = 0.031), compared to mastectomy patients. One year after diagnosis, the role functioning score of the mastectomy group was significantly higher than the BCS group, specifically among patients who had undergone chemotherapy (P = 0.034). CONCLUSION: Patients who underwent BCS had better social functioning and worse dyspnoea symptoms compared to patients undergoing mastectomy at six months. During one year, there were only significant improvements in the role functioning among the mastectomy groups compared to the BCS groups. After further stratification, only mastectomy patients who received chemotherapy exhibited improved role functioning compared to patients those who did not undergo chemotherapy. Providing social and physical support postoperatively and monitoring patients for cancer worry, or other symptoms in the long-term survivorship period would be important to ensure optimal QoL.

A robotic anterior (S3) segmentectomy of the left upper lobe.

A robotic approach might be more suitable for pulmonary segmentectomy than the conventional thoracoscopic approach, because the high-definition 3-dimensional surgical view and precise motion without tremor allow us to dissect pulmonary vessels and bronchi to the periphery. However, among several types of segmentectomies, the anterior segmentectomy (S3) of the left upper lobe may be one of the most difficult to achieve in the robotic approach because the dissected hilar region tends to be obstructed by the lung parenchyma in the "looking-up" view. We offer two technical tips to achieve robotic left S3 segmentectomy. The first is the proper retraction of the upper lobe using straw gauze, which allows us to get a good surgical view in the dissected hilar area where pulmonary vessels and bronchi are located. Second, when the intersegmental plane is divided by robotic staplers, the lung should be moved to the dividing line because the angulation of the inserted stapler is limited. Taking these two tips into consideration, we have successfully performed a robotic left S3 segmentectomy. We show the surgical steps of this procedure.

Correlation between AI-based CT organ features and normal lung dose in adjuvant radiotherapy following breast-conserving surgery: a multicenter prospective study.

BACKGROUND: Radiation pneumonitis (RP) is one of the common side effects after adjuvant radiotherapy in breast cancer. Irradiation dose to normal lung was related to RP. We aimed to propose an organ features based on deep learning (DL) model and to evaluate the correlation between normal lung dose and organ features. METHODS: Patients with pathology-confirmed invasive breast cancer treated with adjuvant radiotherapy following breast-conserving surgery in four centers were included. From 2019 to 2020, a total of 230 patients from four nationwide centers in China were screened, of whom 208 were enrolled for DL modeling, and 22 patients from another three centers formed the external testing cohort. The subset of the internal testing cohort (n = 42) formed the internal correlation testing cohort for correlation analysis. The outline of the ipsilateral breast was marked with a lead wire before the scanning. Then, a DL model based on the High-Resolution Net was developed to detect the lead wire marker in each slice of the CT images automatically, and an in-house model was applied to segment the ipsilateral lung region. The mean and standard deviation of the distance error, the average precision, and average recall were used to measure the performance of the lead wire marker detection model. Based on these DL model results, we proposed an organ feature, and the Pearson correlation coefficient was calculated between the proposed organ feature and ipsilateral lung volume receiving 20 Gray (Gy) or more (V20). RESULTS: For the lead wire marker detection model, the mean and standard deviation of the distance error, AP (5 mm) and AR (5 mm) reached 3.415 ± 4.529, 0.860, 0.883, and 4.189 ± 8.390, 0.848, 0.830 in the internal testing cohort and external testing cohort, respectively. The proposed organ feature calculated from the detected marker correlated with ipsilateral lung V20 (Pearson correlation coefficient, 0.542 with p < 0.001 in the internal correlation testing cohort and 0.554 with p = 0.008 in the external testing cohort). CONCLUSIONS: The proposed artificial Intelligence-based CT organ feature was correlated with normal lung dose in adjuvant radiotherapy following breast-conserving surgery in patients with invasive breast cancer. TRIAL REGISTRATION: NCT05609058 (08/11/2022).

[GMIA-Breast Oncoplastic and Reconstruction Society consensus on operative standards of breast cancer surgery].

OBJECTIVE: The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.

Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study.

BACKGROUND: The evidence of breast-conserving therapy (BCT) applied in centrally located breast cancer (CLBC) is absent. This study aims to investigate the long-term survival of breast-conserving therapy (BCT) in centrally located breast cancer (CLBC) compared with mastectomy in CLBC and BCT in non-CLBC. METHODS: Two hundred ten thousand four hundred nine women with unilateral T1-2 breast cancer undergoing BCT or mastectomy were identified from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier survival curves were assessed via log-rank test. Propensity score matching (PSM) was used to balance baseline features, and the multivariable Cox model was used to estimate the adjusted hazard ratio [HR] and its 95% confidence interval [CI] for breast cancer-specific survival (BCSS) and overall survival (OS). RESULTS: With a median follow-up of 91 months, the BCSS and OS rates in patients who received BCT were greater than those patients treated with mastectomy in the entire CLBC set. Multivariable Cox analyses showed that CLBC patients who received BCT had better BCSS (HR = 0.67, 95%CI: 0.55-0.80, p < 0.001) and OS (HR = 0.78, 95%CI: 0.68-0.90, p = 0.001) than patients who received a mastectomy, but there were no significant differences of BCSS (HR = 0.65, 95%CI: 0.47-0.90, p = 0.009) and OS (HR = 0.82, 95%CI: 0.65-1.04, p = 0.110) after PSM. In patients treated with BCT, CLBC patients had a similar BCSS (HR = 0.99, 95%CI: 0.87-1.12, p = 0.850) but a worse OS (HR = 1.09, 95%CI: 1.01-1.18, p = 0.040) compared to that of the non-CLBC patient, but there was no significant difference both BCSS (HR = 1.05, 95%CI: 0.88-1.24, p = 0.614) and OS (HR = 1.08, 95%CI: 0.97-1.20, p = 0.168) after PSM. CONCLUSION: Our findings revealed that BCT should be an acceptable and preferable alternative to mastectomy for well-selected patients with CLBC.

Large scale experience of two ultrahypofractionated 5 fractions regimes after breast conserving surgery from a single centre.

PURPOSE: Ultra-hypofractionation breast radiotherapy is a safe alternative to moderate hypofractionation. This study reports the results of two ultrahypofractionated regimens used in clinical practice in a high-volume radiotherapy center in terms of efficacy and of tolerance. METHODS: we included all patients treated in an adjuvant setting with five fractions after breast conserving surgery (BCS), for a histologically-confirmed invasive or in situ breast carcinoma. Radiotherapy regimens after BCS were either a 5-week schedule with 5 weekly fractions of 5,7 Gy or a one-week schedule with 5 daily fractions of 5,2 Gy. Adverse events were recorded and local-relapse free survival (LRFS), locoregional-relapse free survival (LRRFS), metastasis-free survival (MFS), for breast-cancer specific survival (BCSS) and overall survival (OS) were evaluated. RESULTS: Between December 2014 and December 2022, 396 patients (400 breasts) were treated with ultrahypofractionated radiotherapy. Five-year LRFS was 98.8% (95% confidence interval: 97.1%-100%), and 5-year OS was 96.0% (95%CI: 92.6-99.5%). Age was statistically associated with OS in univariate analysis (HR: 1.16, 95%CI: 1.04-1.42, p = .01). Four patients (1.0%) experienced acute grade 3 radiation-induced adverse events, and 8 patients (2.3%) acute grade 2 toxicities. Twenty-three patients (5.8%) experienced late toxicity, all of them being graded as grade 1. The use of the 5.7 Gy-weekly-fraction regimen and the delivery of a tumor bed boost were significantly associated with acute radiodermatitis (p < .01; p = .02; respectively) and late fibrosis (p < .01; p = .049; respectively). CONCLUSIONS: ultrahypofractionated radiotherapy was associated with an excellent tumor control rate in our 'real-life' cohort with low-risk breast cancer patients. However, delivery of a tumor bed boost and using weekly 5.7-Gy fractions were associated with an increased risk of acute and late cutaneous toxicities.

Association of DCIS size and margin status with risk of developing breast cancer post-treatment: multinational, pooled cohort study.

OBJECTIVE: To examine the association between size and margin status of ductal carcinoma in situ (DCIS) and risk of developing ipsilateral invasive breast cancer and ipsilateral DCIS after treatment, and stage and subtype of ipsilateral invasive breast cancer. DESIGN: Multinational, pooled cohort study. SETTING: Four large international cohorts. PARTICIPANTS: Patient level data on 47 695 women with a diagnosis of pure, primary DCIS between 1999 and 2017 in the Netherlands, UK, and US who underwent surgery, either breast conserving or mastectomy, often followed by radiotherapy or endocrine treatment, or both. MAIN OUTCOME MEASURES: The main outcomes were 10 year cumulative incidence of ipsilateral invasive breast cancer and ipsilateral DCIS estimated in relation to DCIS size and margin status, and adjusted hazard ratios and 95% confidence intervals, estimated using multivariable Cox proportional hazards analyses with multiple imputed data RESULTS: The 10 year cumulative incidence of ipsilateral invasive breast cancer was 3.2%. In women who underwent breast conserving surgery with or without radiotherapy, only adjusted risks for ipsilateral DCIS were significantly increased for larger DCIS (20-49 mm) compared with DCIS <20 mm (hazard ratio 1.38, 95% confidence interval 1.11 to 1.72). Risks for both ipsilateral invasive breast cancer and ipsilateral DCIS were significantly higher with involved compared with clear margins (invasive breast cancer 1.40, 1.07 to 1.83; DCIS 1.39, 1.04 to 1.87). Use of adjuvant endocrine treatment was not significantly associated with a lower risk of ipsilateral invasive breast cancer compared to treatment with breast conserving surgery only (0.86, 0.62 to 1.21). In women who received breast conserving treatment with or without radiotherapy, higher DCIS grade was not significantly associated with ipsilateral invasive breast cancer, only with a higher risk of ipsilateral DCIS (grade 1: 1.42, 1.08 to 1.87; grade 3: 2.17, 1.66 to 2.83). Higher age at diagnosis was associated with lower risk (per year) of ipsilateral DCIS (0.98, 0.97 to 0.99) but not ipsilateral invasive breast cancer (1.00, 0.99 to 1.00). Women with large DCIS (≥50 mm) more often developed stage III and IV ipsilateral invasive breast cancer compared to women with DCIS <20 mm. No such association was found between involved margins and higher stage of ipsilateral invasive breast cancer. Associations between larger DCIS and hormone receptor negative and human epidermal growth factor receptor 2 positive ipsilateral invasive breast cancer and involved margins and hormone receptor negative ipsilateral invasive breast cancer were found. CONCLUSIONS: The association of DCIS size and margin status with ipsilateral invasive breast cancer and ipsilateral DCIS was small. When these two factors were added to other known risk factors in multivariable models, clinicopathological risk factors alone were found to be limited in discriminating between low and high risk DCIS.

MRI-based radiomics approach for the prediction of recurrence-free survival in triple-negative breast cancer after breast-conserving surgery or mastectomy.

To explore the value of a radiomics signature and develop a nomogram combined with a radiomics signature and clinical factors for predicting recurrence-free survival in triple-negative breast cancer patients. We enrolled 151 patients from the cancer imaging archive who underwent preoperative contrast-enhanced magnetic resonance imaging. They were assigned to training, validation and external validation cohorts. Image features with coefficients not equal to zero in the 10-fold cross-validation were selected to generate a radiomics signature. Based on the optimal cutoff value of the radiomics signature determined by maximally selected log-rank statistics, patients were stratified into high- and low-risk groups in the training and validation cohorts. Kaplan-Meier survival analysis was performed for both groups. Kaplan-Meier survival distributions in these groups were compared using log-rank tests. Univariate and multivariate Cox regression analyses were used to construct clinical and combined models. Concordance index was used to assess the predictive performance of the 3 models. Calibration of the combined model was assessed using calibration curves. Four image features were selected to generate the radiomics signature. The Kaplan-Meier survival distributions of patients in the 2 groups were significantly different in the training (P < .001) and validation cohorts (P = .001). The C-indices of the radiomics model, clinical model, and combined model in the training and validation cohorts were 0.772, 0.700, 0.878, and 0.744, 0.574, 0.777, respectively. The C-indices of the radiomics model, clinical model, and combined model in the external validation cohort were 0.778, 0.733, 0.822, respectively. The calibration curves of the combined model showed good calibration. The radiomics signature can predict recurrence-free survival of patients with triple-negative breast cancer and improve the predictive performance of the clinical model.

Whole-breast Radiotherapy With Boost for Node-negative Breast Cancer: Conventional vs. Hypo-fractionation.

BACKGROUND/AIM: Many breast cancer patients receive adjuvant radiotherapy. Tumor bed boost may reduce risk of local failure in high risk patients. We compared hypofractionated whole-breast irradiation (WBI) plus boost (HF+boost) and conventionally fractionated WBI plus boost (CF+boost). PATIENTS AND METHODS: One-hundred-and-twenty-eight patients receiving HF-WBI (40 Gy in 15 fractions) plus boost (group A) were matched to 127 patients receiving CF-WBI (50.4 Gy in 28 fractions) plus boost (group B), utilizing 10 characteristics. RESULTS: Grade ≥2 dermatitis rates were 16.4% in group A vs. 44.1% in group B (p<0.0001), and grade ≥2 pneumonitis rates were 1.6% vs. 2.4% (p=0.68). Four-year rates of local control, metastases-free survival, and overall survival were 100% vs. 99% (p=0.81), 98% vs. 100% (p=0.29), and 98% vs. 100% (p=0.17), respectively. CONCLUSION: HF+boost was associated with significantly less grade ≥2 dermatitis with similar disease control and survival.

Radar reflector guidance system in breast surgery: A single-institution feasibility study.

Mammography breast cancer screening programs and continuing improvements in early diagnosis of the disease have led to more frequent detection of nonpalpable breast lesions. The commonly used technique in guiding the surgical removal of these lesions is hook wire-guided localization (WGL). However, the WGL procedure has been criticized for the last years. Key disadvantages of WGL are possible wire transection, wire migration before or during surgery, patient discomfort and pneumothorax. Over the last decade, alternatives to wire localization have emerged. In this study the authors present their initial experience with a wireless, nonradioactive, wave reflection implant system that enables surgeons to safely and accurately remove breast lesions (Tab. 2, Fig. 4, Ref. 20). Keywords: breast cancer, breast surgery, nonpalpable lesions, preoperative localization.