Postmastectomy Radiation Treatment Research Articles

Clinicopathologic Features and Radiation Therapy Utilization in Patients with Male Breast Cancer: A National Cancer Database Study.

Male breast cancer (MBC) accounts for approximately 1% of all breast cancers, limiting the data characterizing clinicopathologic features and treatment outcomes in patients with MBC. This paucity of data has led to most of our treatment guidance being extrapolated from patients with female breast cancer (FBC). From 1998 to 2012, data were captured using the National Cancer Database to identify patients with nonmetastatic MBC (n = 23 305) and FBC (n = 2 678 061). Tumor and clinicopathologic features were obtained and compared. Patients with MBC were more likely to have invasive disease, T2-4 tumors, centrally located tumors, positive lymph nodes, estrogen receptor–positive or progesterone receptor–positive tumors, lymphovascular space invasion, and were less likely to have Her2/neu-positive or triple-negative tumors. All of these differences were statistically significant (P < .001). Treatment comparisons showed that patients with MBC were more likely to undergo mastectomy and less likely to undergo breast-conserving surgery with postoperative radiation utilization found to be less in patients with MBC, both as part of breast-conserving therapy (BCT) and for postmastectomy radiation treatment (PMRT) (P < .001). Stage-by-stage comparisons showed that median survival, 5-year, and 10-year overall survival (OS) rates are lower in patients with MBC vs patients with FBC (P < .001). The utilization of adjuvant radiation, both BCT and PMRT, was shown to improve 5- and 10-year OS (P < .001). Male breast cancer clinicopathologic features appear to be unfavorable in relation to FBC and adjuvant radiation is shown beneficial in survival outcomes. Further investigation is needed to help guide future utilization and treatment with radiation, systemic, and endocrine manipulation in this small population of patients with MBC.

Interaction of Postmastectomy Radiation Treatment With Breast Reconstruction: Many Questions, Emerging Data.

Interaction of Postmastectomy Radiation Treatment With Breast Reconstruction: Many Questions, Emerging Data.

National Evaluation of the New Commission on Cancer Quality Measure for Postmastectomy Radiation Treatment for Breast Cancer.

Current guidelines recommend postmastectomy radiotherapy (PMRT) for patients with ≥4 positive lymph nodes and suggest strong consideration of PMRT in those with 1-3 positive nodes. These recommendations were incorporated into a Commission on Cancer quality measure in 2014. However, national adherence with these recommendations is unknown. Our objectives were to describe PMRT use in the United States in patients with stage I to III invasive breast cancer and to examine possible factors associated with the omission of PMRT. From the National Cancer Data Base, 753,536 mastectomies at 1123 hospitals were identified from 1998 to 2011. PMRT use over time was examined using random effects logistic regression analyses, adjusting for patient, tumor, and hospital characteristics. Analyses were stratified by nodal status (≥4 nodes positive, 1-3 nodes positive, node negative). The proportion of patients receiving PMRT increased from 1998 to 2011 (>4 positive nodes: 56.2 to 66.6%; 1-3 positive nodes: 28.0 to 39.1%; node-negative: 8.3 to 10.0%, p<0.001 for all). In adjusted analyses, patients with ≥4 positive nodes were more likely to have PMRT omitted if they had smaller tumors. Patients with 1-3 positive nodes were more likely to have PMRT omitted if they had lower grade or smaller tumors. Irrespective of patients' nodal status, PMRT utilization rates decreased as age increased. Though PMRT rates increased over time in patients with ≥4 and 1-3 positive nodes, PMRT in patients with ≥4 positive nodes remains underutilized. Feedback to hospitals using the new Commission on Cancer PMRT measure may help to improve adherence rates.

Evaluation of the new Commission on Cancer Quality measure for post-mastectomy radiation treatment for breast cancer.

1058 Background: Current National Comprehensive Cancer Network (NCCN) guidelines recommend post-mastectomy radiation therapy (PMRT) for patients with ≥ 4 positive lymph nodes and suggests strong co...

Temporary tissue expanders and post-mastectomy radiation treatment: A literature review

Temporary tissue expanders and post-mastectomy radiation treatment: A literature review

Factors predicting the nodal involvement in early breast cancer

s / The Breast 23 (2014) S1eS6 S5 FACTORS PREDICTING THE NODAL INVOLVEMENT IN EARLY BREAST CANCER A. Elmadahm, P. Gill , G. Farshid , V. Gebski , M. Bilous , S. Lord , L. Chee , N. Wetzig . University of Adelaide, North Terrace, Adelaide, SA, Australia; NHRMC Clinical trial Centre, University of Sydney, Sydney, NSW, Australia; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Wesley Medical Centre, Brisbane, QLd, Australia Background: The nodal status is an important prognostic factor in early breast cancer. This study assessed association between clinicopathological factors and involvement of Sentinel Lymph Node (SLN) and Non Sentinel Lymph Node (NSLN) in the SNAC 1 trial. Accurate statistical models can assist surgical counselling and potentially avoid axillary surgery in selected cases. Method: This is a retrospective analysis of 1088 patients. Lymphoscintigraphy, blue dye injection and gamma probe were used for SLN mapping and retrieved nodes were examined with HE 16:266-75. TREATMENT DELAY FOR M AORI WOMEN WITH BREAST CANCER IN NEW ZEALAND S.A. Seneviratne, I.D. Campbell, N. Scott, R. Lawrenson. Waikato Clinical School, University of Auckland, New Zealand Background: Delays in diagnosis and treatment of breast cancer are associated with lower survival rates 1. Indigenous M aori women have 60% higher overall and 32% higher stage adjusted breast cancer mortality compared to European women in New Zealand (NZ) 2. We sought to evaluate factors associated with delays of >31 and >90 days for surgical treatment of breast cancer among NZ womenwith newly diagnosed breast cancer. Methods: A retrospective analysis of prospectively collected data included in the Waikato Breast Cancer Register from 01/01/2005 through 31/12/ 2010 was performed. Results: 1449 (out of 1510, 96%) breast cancers diagnosed within Waikato, over the study period were included. Out of women undergoing primary surgery (n1⁄41264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among M aori (mean 36.9, p with NZ European women, higher proportions of M aori and Pacific Island women (statistically non-significant) experienced delays longer than 31 days (40.2% vs. 47.8% and 52.1%, P>0.05) and 90 days (1.6% vs. 2.7% and 4.3%, p>0.05). Multivariate analysis identified public sector treatment (OR 5.93 and 8.14), DCIS (OR 1.53 and 3.17), mastectomy as treatment (OR 1.75 and 6.60) and earlier year of diagnosis (1.21 and 1.03) as factors significantly associated with delays longer than 31 and 90 days. Conclusions: A high proportion of women not initiating surgical treat- ment of breast cancer within the stipulated guideline limit of 31 days and significantly longer delays experienced by ethnic minority women were highlighted in this study. Urgent steps are needed to improve performance and to shorten treatment delays in public sector to minimize delays overall, and to reduce ethnic inequities in breast cancer treatment in NZ.

Dosimetric impact of the AeroForm tissue expander in postmastectomy radiation therapy: An ex vivo analysis

PurposeTo evaluate the effect of the AeroForm (AirXpanders Inc, Palo Alto, CA) tissue expander on the dose distribution in a phantom from a simulated postmastectomy radiation treatment for breast cancer. Methods and materialsExperiments were conducted to determine the effect on the dose distribution with the metallic reservoir irradiated independently and with the entire AeroForm tissue expander placed on a RANDO phantom (The Phantom Laboratory, Salem, NY). The metallic reservoir was irradiated on a block of solid water with film at various depths ranging from 0 to 8.2 cm from the surface. The intact 400 cc AeroForm was inflated to full capacity and irradiated while positioned on a RANDO phantom, with 12 optically stimulated luminescent dosimeters (OSLDs) placed at clinically relevant expander-tissue interface points. ResultsFilm dosimetry with the reservoir perpendicular to film reveals 40% transmission at a depth of 0.7 cm, which increases to 60% at a depth of 8.2 cm. In the parallel position, the results vary depending on which area under the reservoir is examined, indicating that the reservoir is not a uniformly dense object. Testing of the intact expander on the phantom revealed that the average percent difference (measured vs expected dose) was 2.7%, σ = 6.2% with heterogeneity correction and 3.7%, σ = 2.4% without heterogeneity correction. The only position where the OSLD readings were consistently higher than the calculated dose by >5% was at position 1, just deep to the canister at the expander-phantom interface. At this position, the readings varied from 5.2% to 14.5%, regardless of heterogeneity correction. ConclusionsFilm dosimetry demonstrated beam attenuation in the shadow of the metallic reservoir in the expander. This decrease in dose was not reproduced on the intact expander on the phantom designed to replicate a clinical setup.

Abstract P6-08-01: Analysis of patient-reported outcomes following nipple-sparing mastectomy and implant reconstruction

Abstract Background: Nipple-sparing mastectomy (NSM) is gaining popularity among women undergoing prophylactic and therapeutic mastectomy. Using the BREAST-Q, a validated condition-specific patient-reported outcome instrument which measures postsurgical patient satisfaction and health-related quality of life (HR-QoL), we sought to determine whether satisfaction and HR-QoL differ between patients undergoing NSM and skin-sparing mastectomy (SSM) with immediate implant reconstruction. Methods: From 2005 to 2012, a total of 572 patients underwent mastectomy; of these 261 patients (46%) had NSM. All mastectomy patients were mailed the BREAST-Q reconstruction questionnaire consisting of 3 scales (scored 0-100): Satisfaction with Breasts, Satisfaction with Outcome, and Psychosocial Well-Being. Excluded from this analysis were males, autologous tissue reconstruction, and conversion from NSM to SSM. Comparisons were made between NSM and SSM groups using univariable analysis and multivariable linear regression models (MVA). Results: The BREAST-Q completion rate was 27% with a median time from surgery to survey of 36 months (range 4 to 86). Women undergoing NSM, compared to SSM, were younger (mean 46 v 50 years; p = 0.01), more likely to be married (80% v 52%; p = 0.001), have bilateral mastectomies (79% v 59%; p = 0.01), and had less time between surgery and BREAST-Q completion (median 25 v 49 months; p&amp;lt;0.001). 19 NSM patients (25%) and 7 SSM patients (13%) underwent prophylactic mastectomy (p = 0.07). There were no differences regarding tumor characteristics or treatment. Patients undergoing NSM, compared to SSM, had a higher unadjusted mean score for Satisfaction with Breasts (71 v 60; p&amp;lt;0.001), Satisfaction with Outcome (80 v 69; p = 0.003), and Psychosocial Well-Being (84 v 74; p = 0.006). On MVA analysis, NSM (compared to SSM) was associated with greater Satisfaction with Breasts (adjusted mean difference: +13, 95% Confidence Interval[CI]: 6-21, p = 0.001), Satisfaction with Outcome (adjusted mean difference: +17, 95% CI: 7-27, p = 0.001), and Psychosocial Well-Being (adjusted mean difference: +12, 95% CI: 3-22, p = 0.013), after controlling for age at mastectomy, marital status, laterality, cancer vs. non-cancer diagnosis, post-mastectomy radiation treatment, and time from mastectomy to BREAST-Q completion. Not being married (adjusted mean difference: +8, 95% CI: 2-15, p = 0.014) and having a bilateral mastectomy (adjusted mean difference: +8, 95% CI: 1-14, p = 0.029) were also significant predictors of increased Satisfaction with Breasts. Conclusion: These findings suggest that, in the setting of implant reconstruction, NSM is associated with higher patient satisfaction with their breasts, overall outcome, and improved emotional/social well being. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-01.

Pretreatment Staging Positron Emission Tomography/Computed Tomography in Patients With Inflammatory Breast Cancer Influences Radiation Treatment Field Designs

Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC. We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change. PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients). For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes, mediastinal lymph nodes, and unsuspected sites of distant metastasis. This information is important in the design of radiotherapy treatment fields and, therefore, we recommend that PET/CT be a component of initial staging for IBC.