Standard Treatment For Breast Cancer Research Articles

乳腺癌乳房切除术后放射治疗的疗效分析

目的：总结乳腺癌乳房切除术后的放疗效果，并探讨相关预后影响因素。材料与方法：2005年1月至2012年12月共有241例入组，中位年龄51岁，最小27岁，最大75岁。0期1例，IA期11例，IIA期51例，IIB期41例，IIIA期82例，IIIB期3例，IIIC期42例，IV期10例。全组患者均接受乳房切除术，其中改良根治术210例，根治术29例，扩大根治术2例。除3例不详，其余患者均接受术后化疗，其中有50例接受新辅助化疗。全组患者均接受放射治疗，中位剂量50 Gy (30~60 Gy)，照射部位包括同侧胸壁、淋巴引流区(锁骨上和/或内乳)，147例照射同侧胸壁、锁骨上和内乳(61.0%)，47例照射胸壁和锁骨上(19.5%)，39例未照射胸壁，仅照射锁骨上和/或内乳(16.2%)，6例仅照射胸壁(2.5%)，2例照射胸壁和内乳(0.8%)。结果：中位随访5.5年(0~10年)，全组5年OS为87.5%。单因素分析显示肿瘤分期是影响OS的重要因素(P = 0.002)，I、II期的5年OS为95.9%，III、IV期的5年OS为81.0%。LRR有14例(5.8%)，DM是主要失败原因，有49例(20.3%)。死亡36例，均死于肿瘤。结论：仅5.8%的复发，提示乳房切除术后的放射治疗仍是乳腺癌术后规范治疗标准，5年OS接近国内外先进水平。 Objective: To summarize the outcome of radiotherapy in breast cancer after mastectomy, and to explore the relevant prognostic factors. Material and Methods: From January 2005 to December 2012, a total of 241 women who had undergone mastectomy were analyzed. The median age was 51 years old, with minimum 27 years old and maximum 75 years old. The pathological stage 0 were 1 case, IA of 11 cases, IIA of 51 cases, IIB of 41 cases, IIIA of 82 cases, IIIB of 3 cases, IIIC of 42 cases, IV of 10 cases, which performed in all patients by using AJCC 7th. All patients underwent mastectomy, which 210 cases of modified radical mastectomy, 29 cases of radical mastectomy, and 2 cases of extended radical mastectomy. In addition to three cases were unknown, the remaining patients received postoperative chemotherapy, while 50 patients received neoadjuvant chemotherapy. All patients were treated with radiation therapy, the median dose 50 Gy (30 - 60 Gy), irradiated sites included ipsilateral chest wall, lymph drainage area (supraclavicular and/or internal mammary). 147 cases were treated with chest wall, ipsilateral supraclavicular and internal mammary nodes irradiation (61.0%), 47 cases were treated with chest wall and supraclavicular irradiation (19.5%), 39 cases were treated with non-irradiated chest wall, only supraclavicular and/or internal mammary nodes (16.2%), 6 cases were only irradiated to chest wall (2.5%), two cases to chest wall and internal mammary irradiation (0.8%). Results: The median follow-up was 5.5 years (0 - 10 years), the 5-year OS was 87.5%. Univariate analysis showed that tumor stage was an important factor affecting the OS, 5-year OS of the pathological stage I and II was 95.9% while the OS of stage III and IV was 81.0% (P = 0.002). LRR in 14 cases (5.8%), whereas DM was the main causes of failure, which included 49 cases (20.3%). 36 patients died, all died of cancer. Conclusions Only 5.8% patients have locoregional recurrence, suggesting that radiation therapy after mastectomy is still the standard treatment in breast cancer. 5-year OS is approaching the world advanced level.

High accuracy gene signature for chemosensitivity prediction in breast cancer

Neoadjuvant chemotherapy is usually offered to breast cancer patients to shrink the tumor and any involved lymph nodes. Pathologic complete response is a way of measuring response to this treatment, which is normally defined as the absence of residual invasive disease in the breast and in the axillary lymph nodes at the completion of the treatment. Clinically patients who achieve pCR tend to have a very good prognosis. As a standard treatment for breast cancer, neoadjuvant chemotherapy offers several benefits to patients. But not all patients benefit equally from this treatment. Therefore it is of great value to investigate what molecular information obtained from a patient’s tumor could be used to determine if the patient would benefit from a particular chemotherapy. In practice the estrogen receptor status could be used to guide the decisions on hormonal therapy. Further, the gene expression data that reflect subtle differences in tumors could be utilized to build a predictor of response to cancer drugs. In this study we sought to use gene expression data to predict who might achieve pCR to sequential anthracycline paclitaxel preoperative chemotherapy. Our aim was to uncover one gene signature for developing predictors of pCR to neoadjuvant chemotherapy that have a much higher accuracy than DLDA-30, so it might have the potential for clinical applications. With the ability to account for multiple gene interactions, the multivariable techniques, such as genetic algorithm and SLR, have demonstrated their utility in identifying robust gene signatures of clinical relevance.

Androgen receptor CAG repeat length and estrogen receptor status in postmenopausal breast cancer prognosis.

The influence of the androgen receptor (AR) CAG repeat polymorphism on breast cancer is controversial. We investigated the combined effects of CAG repeat length and estrogen receptor (ER) status on prognosis in 355 postmenopausal women with primary breast cancer. CAG repeat length was determined by the HUMARA test. Relapse-free survival (RFS) and overall survival (OS) according to the X-weighted CAG repeat biallelic mean (XWBM) were investigated by univariate and multivariate analysis. XWBM was not associated with RFS or OS, but a significant interaction between XWBM and ER status (p = 0.002) was found for OS. ER-negative patients with median XWBM <20 showed lower OS than ER-negative/XWBM ≥20 patients (HR = 0.270; 95% Cl: 0.073-0.999). ER-negative/XWBM <20 patients also had significantly lower OS than ER-positive women, irrespective of CAG repeat length (p<0.001). Accordingly, estimated OS was lowest in ER-negative patients with XWBM <20 (OS: 0.63, 95% CI: 0.41-0.79) and highest in ER-positive patients with XWBM <20 (OS: 0.95, 95% CI: 0.90-0.97). Our data suggest that short CAG repeat length is associated with increased risk of death in ER-negative disease but is related to better survival when ER is expressed. These findings are in agreement with the hypothesis that AR may stimulate or inhibit breast cancer growth depending on ER status, AR transactivation, and the endocrine-metabolic environment of breast tumors. Evaluation of CAG repeat length together with ER status could help improve the estimation of the risk of death, with possible implications for the optimization of standard breast cancer treatment and implementation of prevention strategies.

Cognitive Impairment after Chemotherapy Related to Atypical Network Architecture for Executive Control

Objectives: A common complaint of cancer patients is the experience of cognitive difficulty during and after chemotherapy. We hypothesized that cognitive impairment may result from dysfunction in large-scale brain networks, particularly those involved in attentional control. Methods: Using a case-control design, this study includes women with a history of invasive ductal or lobular triple-negative breast cancer who completed standard adjuvant chemotherapy within 2 years of study entry. Women who reported cognitive impairment by the Global Rating of Cognition question were considered to be cases (n = 15). Women who reported no cognitive impairment were considered to be controls (n = 13). All enrolled participants were eligible for MRI investigation and underwent resting-state functional connectivity MRI. Results: Women who self-reported cognitive impairment were found to have disrupted resting-state functional connectivity, as measured by MRI, when compared to women who did not self-report cognitive impairment. These findings suggest that some women may be more sensitive to the standard treatments for breast cancer and that this increased sensitivity may result in functional connectivity alterations in the brain networks supporting attention and executive function. Conclusions: Neuroimaging analyses confirmed self-reported cognitive deficits in women with breast cancer treated with chemotherapy.

Radiation promotes malignant phenotypes through SRC in breast cancer cells.

Despite the fact that ionizing radiation (IR) is widely used as a standard treatment for breast cancer, much evidence suggests that IR paradoxically promotes cancer malignancy. However, the molecular mechanisms underlying radiation-induced cancer progression remain obscure. Here, we report that irradiation activates SRC signaling among SRC family kinase proteins, thereby promoting malignant phenotypes such as invasiveness, expansion of the cancer stem-like cell population, and resistance to anticancer agents in breast cancer cells. Importantly, radiation-activated SRC induced SLUG expression and caused epithelial–mesenchymal cell transition through phosphatidylinositol 3-kinase/protein kinase B and p38 MAPK signaling. In agreement, either inhibition of SRC or downstream signaling of p38 MAPK or protein kinase B effectively attenuated radiation-induced epithelial–mesenchymal cell transition along with an increase in the cancer stem-like cell population. In addition, downregulation of SRC also abolished radiation-acquired resistance of breast cancer cells to anticancer agents such as cisplatin, etoposide, paclitaxel, and IR. Taken together, our findings suggest that combining radiotherapy with targeting of SRC might attenuate the harmful effects of radiation and enhance the efficacy of breast cancer treatment.

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

BackgroundWhole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT).ObjectivesPrimary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken.DesignMulticentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT.SettingFive radiotherapy departments, participating in IMPORT-HIGH.ParticipantsTwo-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH.InterventionsThere was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images.Main outcome measuresDifference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging.ResultsThe primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3(range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is more important than volume of tissue irradiated.Conclusions and implications for clinical practiceMargins of less than 8 mm cannot be used safely without clip-based IGRT for patients receiving concomitant tumour bed boost, as there is a risk of geographical miss of the tumour bed being treated. In principle, smaller but accurately placed margins may influence local control and toxicity rates, but this needs to be evaluated from mature clinical trial data in the future.FundingThe National Institute for Health Research Efficacy and Mechanism Evaluation programme.

Estimates of young breast cancer survivors at risk for infertility in the U.S.

Standard treatments for breast cancer can impair fertility. It is unknown how many U.S. survivors are at risk for infertility. We estimated the population at risk for infertility secondary to treatment among reproductive-aged breast cancer survivors. We combined data from three sources: the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results cancer registry data on incident breast cancers diagnosed in women aged 15-44 years between 2004 and 2006; treatment data from NPCR's 2004 Breast and Prostate Cancer Data Quality and Patterns of Care (PoC) study; and data on women's intentions to have children from the 2006-2010 National Survey of Family Growth (NSFG). In the cancer registry data, an average of 20,308 women with breast cancer aged <45 years were diagnosed annually. Based on estimates from PoC data, almost all of these survivors (97%, 19,416 women) were hormone receptor positive or received chemotherapy and would be at risk for infertility. These women need information about the impact of treatments on fertility. Estimates based on NSFG data suggest approximately half of these survivors (9,569 women) might want children and could benefit from fertility counseling and fertility preservation. Nearly all young breast cancer survivors in the U.S. are at risk for infertility. Physicians should discuss the potential impact of treatment on fertility. A smaller but sizeable number of at-risk survivors may be interested in having children. Given the magnitude of potential infertility and its quality-of-life implications, these survivors should have access to and potential coverage for fertility services.

Cardiovascular magnetic resonance imaging compared to echocardiogram for detecting doxorubicin-induced cardiotoxicity.

1068 Background: Doxorubicin is a standard treatment for breast cancer, lymphoma, and leukemia. The benefits of doxorubicin are limited by its potential for cardiotoxicity. In this study we investi...

Sorting Out the Complications of Brachytherapy for Breast Cancer

Accelerated partial breast irradiation with brachytherapy following lumpectomy versus traditional whole-breast irradiation (WBI) has become a standard treatment for breast cancer despite minimal comparative data. Use of brachytherapy can shorten treatment duration from 6 weeks to 5 days, theoretically with less risk for toxicity to the heart and lungs because radiation exposure is limited to the lumpectomy site. However, some have postulated that risk for acute skin and wound complications is higher with this approach. Investigators conducted an observational study …

Abstract S2-3: Disparities in the utilization of axillary sentinel lymph node biopsy among black and white patients with node-negative breast cancer from 2002–2007.

Abstract Background: Disparities exist in many aspects of standard breast cancer treatment in certain patient populations. In the mid-1990s, axillary sentinel lymph node biopsy (SLNB) was introduced as an alternative to axillary lymph node dissection (ALND) for staging clinically node-negative breast cancer. During the early 2000s, the validity of SLNB was being determined and its technique was being disseminated throughout the surgical community. By the mid to late-2000s, SLNB had been shown to provide accurate axillary staging with lower complications and no difference in survival compared to ALND in node-negative patients. SLNB has now replaced ALND as the accepted method for staging early breast cancer. The purpose of this study is to examine differences in the utilization of SLNB in pathologic node-negative invasive black breast cancer patients compared to white patients as SLNB became standard axillary staging and whether this difference impacted patient complications. Methods: Using the population-based Surveillance, Epidemiology, and End Results (SEER)-Medicare data, cases of incident, non-metastatic, pathologic node-negative breast cancer in women age≥66 were identified. Patients were considered to have undergone SLNB if specified by SEER records or if a billing claim for axillary lymphatic mapping was identified. Unadjusted associations of SLNB with race were evaluated using the chi-square test. The Cochran-Armitage test evaluated trends over time. Multivariate logistic regression tested whether race was associated with the use of SLNB after adjustment for clinicopathologic factors. Five-year cumulative incidence of lymphedema assessed via ICD-9 diagnosis codes was measured using the Kaplan-Meier method. Adjusted proportional hazards regression evaluated assiciations of race and ALND with lymphedema risk. Results: Of 31,274 women identified, 1,767 (5.7%) were Black, 27,856 (89%) were White and 1,651 (5.3%) were of other/unknown race. SLNB was performed in 74% of white patients compared to 62% of black patients (P&amp;lt;0.001). Although use of SLNB increased by year for both black and white patients (P&amp;lt;0.001), a fixed disparity in the use of SLNB persisted through 2007. In adjusted analysis, black patients were 33% less likely than white patients to undergo SLNB (relative risk = 0.74, 95% CI 0.67-0.81; P&amp;lt;0.001). Five-year cumulative incidence of lymphedema was 11.4% in patients undergoing ALND vs. 6.3% in patients undergoing SLNB (adjusted HR 1.92, 95% CI 1.75-2.10; P&amp;lt;0.001). Overall, black race was also associated with a higher risk of lymphedema (adjusted HR 1.40; 95% CI 1.20-1.63; P&amp;lt;0.001). However, among patients undergoing SLNB, whites and blacks had similar risks of lymphedema (6.2% and 7.7%, respectively; P=0.08). Conclusion: Even with the increased use of SLNB and its acceptance as standard axillary staging for node-negative breast cancer patients, disparities persist in its underutilization in appropriate black patients compared to white patients by as much as 26%. This racial disparity in SLNB use translated to a higher risk of lymphedema for black patients. Improving surgeon practices, the multidisciplinary team approach, and patient education are important in optimizing the beneficial impact of SLNB and reducing complications from unnecessary ALNDs in all patients with early stage breast cancer. Future research is needed to delineate mechanisms underlying this persistent disparity and to identify strategies to mitigate it. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S2-3.

Axillary Dissection Versus No Axillary Dissection in Older Patients With T1N0 Breast Cancer

To assess the role of axillary dissection in older breast cancer patients with a clinically clear axilla. Axillary dissection, once standard treatment for breast cancer, is associated with considerable morbidity. It has been substituted by sentinel node biopsy with dissection only if the sentinel node is positive. We aimed to determine whether axillary surgery can be omitted in older women, thereby sparing them morbidity, without compromising long-term disease control. We carried out a randomized clinical trial on 238 older (65-80 years) breast cancer patients, with clinically N0 disease of radiographic diameter 2 cm or less. Patients were randomized to quadrantectomy with or without axillary dissection. All received radiotherapy to the residual breast but not the axilla; all were prescribed tamoxifen for 5 years. Main outcome measures were overall survival and breast cancer mortality. We also assessed overt axillary disease in those who did not receive axillary dissection. After 15 years of follow-up, distant metastasis rate, overall survival, and breast cancer mortality in the axillary dissection and no axillary dissection arms were indistinguishable. The 15-year cumulative incidence of overt axillary disease in the no axillary dissection arm was only 6%. Older patients with early breast cancer and a clinically clear axilla treated by conservative surgery, postoperative radiotherapy, and adjuvant tamoxifen do not benefit from axillary dissection. This study was registered at clinicaltrials.gov (ID NCT00002720).

Computerized Decision Support System for Intraoperative Analysis of Margin Status in Breast Conservation Therapy

Background. Breast conservation therapy (BCT) is the standard treatment for breast cancer; however, 32–63% of procedures have a positive margin leading to secondary procedures. The standard of care to evaluate surgical margins is based on permanent section. Imprint cytology (IC) has been used to evaluate surgical samples but is limited by excessive cauterization thus requiring experienced cytopathologist for interpretation. An automated image screening process has been developed to detect cancerous cells from IC on cauterized margins. Methods. IC was prospectively performed on margins during lumpectomy operations for breast cancer in addition to permanent section on 127 patients. An 8-slide training subset and 8-slide testing subset were culled. H&E IC automated analysis, based on linear discriminant analysis, was compared to manual pathologist interpretation. Results. The most important descriptors, from highest to lowest performance, are nucleus color (23%), cytoplasm color (15%), shape (12%), grey intensity (9%), and local area (5%). There was 100% agreement between automated and manual interpretation of IC slides. Conclusion. Although limited by IC sampling variability, an automated system for accurate IC cancer cell identification system is demonstrated, with high correlation to manual analysis, even in the face of cauterization effects which supplement permanent section analysis.

Das Mammakarzinom - Therapiestandards und neue Therapiemöglichkeiten 2012, ein onkologisches Review

Breast cancer is the leading cancer in women with an annual incidence rate of 110/100.000 women in all age groups in Europe. The incidence rate increases in older women. Treatment includes surgery, radiotherapy, chemotherapy with or without antibody therapy and hormonal treatment. During the last 40 years the survival rate has significantly improved. From the 1970ies to 2010 the five year survival rate has risen from 85% to 98% early breast cancer. Similarly, in metastatic breast cancer 5-year survival has increased from below 10% in 1970 to 26% in 2010. This was possible because of better treatment options and better screening causing earlier diagnosis of breast cancer. This article reviews the standard treatment of breast cancer according to ESMO/ASCO guidelines and discusses new treatment options and new therapeutic strategies for breast cancer.

The elderly breast cancer patient: Association of age, tumor size, and grade with sentinel lymph node status.

15 Background: Nodal evaluation of the elderly breast cancer patient remains controversial, and some have suggested that selected older women with breast cancer may not require sentinel lymph node biopsy (SLNB). Methods: An IRB-approved database was queried for patients undergoing SLNB for invasive breast cancer from 2000-2006. We compared 8 cohorts: age &lt;40 years, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, and &gt;70 years. Logistic regression and chi-square test were used. Results: Procedure success rate was above 95% for all groups in a total sample size of 1268 patients. Patients &gt;70 years had lower grade tumors than patients &lt;40 years (Grade 1: 25% vs. 7%; Grade 2: 53% vs. 47%; Grade 3: 17% vs. 40%, p&lt;0.0001) and higher ER expression (ER+: 83% vs. 59%, p&lt;0.0005). Patients &lt;40 years also had a higher proportion of multifocal disease (21% vs. 9%, p&lt;0.002), lymphovascular invasion (20% vs. 10%, p&lt;0.007), and number of positive sentinel lymph nodes (PSLN) removed (mean: 3.7 vs. 2.7, p&lt;0.028). Upon multivariate analysis, the odds of a PSLN decrease 9% for every 5-year increase in age (OR 0.91, p&lt;0.003), but increase significantly with certain tumor characteristics (ER+ vs. ER-: OR 1.7, p=0.002), larger size (0.5 cm increase: OR 1.26, p&lt;0.0001), and higher grade (Grades 2-3: OR 1.99, p&lt;0.0007). The predicted probability of a PSLN for patients age 35, 55, and 70 years is 27%, 22%, and 16%, assuming each had a ER+, low grade, 2 cm tumor. Conclusions: Older breast cancer patients have more favorable pathology, and the chance of a PSLN decreases as age increases. However, the odds of a PSLN are significantly higher in patients with certain tumor characteristics, which are known prior to definitive surgery. Given recent reports that older patients are less likely to receive standard treatment for breast cancer and prognosis may worsen as a result, tumor size and characteristics rather than age should dictate the decision to perform SLNB, and we should continue appropriate, aggressive staging of the older breast cancer patient.

10. Management of the axilla in women of 75 years or older with primary breast cancer

Background: The percentage of breast cancer patients aged ≥ 75 years old is rising. Standard treatment for breast cancer is often not given to elderly patients. The aim of this study was to investigate the reasons to omit surgical staging or further treatment of the axilla in case of a clinically positive axilla or after prior positive sentinel node biopsy (SNB). Secondary endpoints were the impact of limited axillary staging or treatment on regional control and survival.

Sequential treatment with epirubicin/cyclophosphamide, followed by docetaxel versus FEC120 in the adjuvant treatment of node-positive breast cancer patients: Final survival analysis of the German ADEBAR phase III study.

1081 Background: Based on meta-analytic evidence, taxane containing adjuvant chemotherapy has been established as standard treatment in breast cancer (BC). However, in the MA-21 study, adriamycin-cyclophosphamide, followed by paclitaxel was significantly inferior FEC120. We prospectively compared a sequential epirubicin-docetaxel chemotherapy regimen to FEC120. Methods: The ADEBAR study was a multicenter phase III trial (n=1502) to evaluate whether pts with &gt; 3 axillary lymph node metastases BC benefit from a sequential anthracycline-docetaxel regimen (E90C–D: 4 cycles epirubicin [E] 90 mg/m2 plus cyclophosphamide [C] 600 mg/m2 q21d followed by 4 cycles docetaxel [D] 100mg/m2 q21d) compared to dose-intensive anthracycline-containing polychemotherapy (FE120C: 6 cycles E 60 mg/m² d 1+8, 5-FU 500mg/m² d 1+8 and C 75 mg/m² d 1-14, q4w). The observation time (median – 95%CI) was 49.5 (47.4 – 51.3) m. Results: Treatment was stopped prematurely in 3.7% of the pts in the E90C–D arm and in 8.0% in the FE120C arm due to toxicity (p=0.0009). Antibiotic treatment was given in 10.4% (E90C–D) vs. 19.7% (FE120C), G-CSF support in 39.2% vs 61.4 % and erythropoietin stimulation in 8.7% vs. 20.0%, respectively (p&lt;0.0001). Haematological toxicity (leucopenia, neutropenic fever, thrombocytopenia, anemia) was significantly higher in the FEC-arm. At the time of the current analysis, 369 events of recurrence, were observed: 166 events in the FE120C group and 193 in the E90C–D group. The unadjusted hazard ratio (HR) was 0.877 (95 percent confidence interval, 0.722 to 1.065; p=0.3819, log-rank test). Overall survival in the two groups was not significantly different: (131 deaths with FEC vs. 134 with E90C–D (HR 0.996, 0.783-1.267, p=0.9691). Subgroup analyses, stratifying for tumor size, lymph node involvement, hormone receptor and HER2-neu status showed no significant difference between the two arms. Conclusions: Different toxicity profiles given, hematological toxicity in the FE120C group was more severe than in the E90C–D. In contrast to AC-P in earlier studies, EC-Doc provides a feasible and effective option to FEC120.

Breast cancer recurrence after immediate and delayed reconstruction: a single institution study

Aim: The last decade has seen a remarkable shift towards offering breast reconstruction as a part of the standard treatment for breast cancer. Although literature strongly seems to endorse the oncological safety of the reconstructive procedures, concerns do remain with regard to breast cancer recurrence. As a regional referral centre for breast reconstruction, we wanted to assess the rates of local and distant recurrences in both immediate (IBR) and delayed (DBR) reconstruction in our institution.

The Transition of Breast Cancer Treatment and Japan Clinical Oncology Group Research Over Two Decades

The Japanese Breast Cancer Study Group (JABCSG) was established before the Japan Clinical Oncology Group (JCOG). The JABCSG became the JCOG Breast Cancer Group 20 years ago. The first chairman of the Breast Cancer Group was Dr Kaoru Abe (National Cancer Center Hospital). Since 1978, five doctors have chaired the Breast Cancer Group. Sixteen clinical trials (eight phase III and eight phase I/II) have been conducted by the Breast Cancer Group since 1985. The Breast Cancer Group was restructured in 2010, and in June 2011 a new clinical trial (JCOG 1017) was initiated. Standard treatment for breast cancer (surgery, radiotherapy and systemic therapy) has changed dramatically over the last two decades. This review describes the transition of breast cancer treatment along with the history of JCOG research in this setting.

Wide Excision without Radiation as Primary Treatment for Breast Cancer in Older Patients

Introduction: Prior to the introduction of sentinel lymph node sampling, wide excision and axillary dissection followed by radiation to the breast was considered a standard treatment for breast cancer. Not all patients who undergo breast conserving surgery receive radiation therapy, which is considered suboptimal care. We have evaluated our experience with wide excision alone and its effect on local-regional recurrence, development of metastatic disease and survival. Materials and Methods: Between 1987-1997 we identified 69 patients (70 breasts) treated with wide excision without radiation for their primary breast cancer. Results: The median age at diagnosis was 79 years. Median follow-up was 6.7 years. The median tumor size was 1.1 cm (range 0.2 - 3.5 cm). Fifty three percent of the patients received tamoxifen. Tumor size was significant for failure and survival. Seven (10%) patients failed. Only 6 patients (9%) had an ipsilateral recurrence requiring surgical intervention. Two of the six developed metastatic disease. One additional patient had distant spread without a detected local failure. Overall, 3 (4%) developed metastatic disease and died with breast cancer as a contributing factor. Sixty four percent of the patients died without contribution from the breast cancer, and 31% were alive without disease. Conclusions: Not all patients require radiation for cancer control after wide excision. Patients who can be considered for surgery alone without an unacceptable risk are the elderly (especially those with comorbid conditions with small low grade tumors treated with wide surgical margins).

Partial breast irradiation by brachytherapy, 1927

Purpose Examination of Geoffrey Keynes’s contributions to brachytherapy and the management of breast cancer. Methods and Materials Review of publications and texts of the era. Results In an era when radical mastectomy was accepted as standard treatment for breast cancer, Keynes demonstrated that brachytherapy (with or without local excision) was equally effective, while sparing body form and function. Conclusions Keynes established that conservative surgery, combined with radiotherapy, was the preferable option for managing breast cancer.