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1.
RA Greenup MS Camp AG Taghian J Buckley SB Coopey M Gadd K Hughes M Specht BL Smith 《Annals of surgical oncology》2012,19(10):3275-3281
Background
Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options.Methods
An institutional review board (IRB)-approved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort.Results
Median patient age was 56.5 years (range 32–93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2–5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated.Conclusions
A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation. 相似文献2.
Donald M. Cannon MD Derek R. McHaffie MD Rakesh R. Patel MD Jarrod B. Adkison MD Rupak K. Das PhD Bethany D. Anderson MD Heather M. Geye MS Søren M. Bentzen DSc George M. Cannon MD 《Annals of surgical oncology》2013,20(11):3446-3452
Background
Understanding risk factors for locoregional recurrence (LRR) after accelerated partial breast irradiation (APBI) can help to guide patient selection for treatment with APBI. Published findings to date have not been consistent. More data are needed as these risk factors continue to be defined.Methods
A total of 277 women with early-stage invasive breast cancer underwent lumpectomy and were treated adjuvantly at our institution with APBI using high-dose rate brachytherapy. APBI was delivered using multicatheter interstitial brachytherapy (91 %) or single-entry catheter brachytherapy (9 %) to a dose of 32–34 Gy in 8–10 twice daily fractions. Failure patterns and risk factors for recurrence were analyzed.Results
With a median follow-up of 61 months, the 5-year locoregional control rate was 94.4 %. Negative estrogen receptor (ER) status was strongly associated with LRR on multivariate analysis (p < 0.005). Lobular histology, the presence of an extensive intraductal component, and lymphovascular invasion also were significant but to a lesser degree than ER-negative status. Patients with multiple risk factors were at highest risk for LRR. Age was not significantly associated with increased risk for LRR.Conclusions
The presence of specific pathological features, particularly ER negative status, was associated with increased risk of LRR in this cohort of women treated with APBI. Further investigation is warranted to determine whether patients with adverse pathological risk factors are at higher risk of LRR after APBI than after conventional whole breast irradiation (WBI), as these same features also may place women at risk for LRR after WBI. 相似文献3.
Frank Vicini MD Chirag Shah MD J. Ben Wilkinson MD Martin Keisch MD Peter Beitsch MD Maureen Lyden MS 《Annals of surgical oncology》2013,20(4):1275-1281
Purpose
To analyze outcomes in patients with ductal carcinoma-in-situ (DCIS) treated with accelerated partial breast irradiation (APBI) within a pooled set of patients.Methods
A total of 300 women with DCIS underwent APBI between April 1993 and November 2010 as part of American Society of Breast Surgeons MammoSite Registry Trial (n = 192) or at William Beaumont Hospital (n = 108). Patients with pure DCIS <3 cm (n = 125) were assigned to the cautionary risk group per American Society of Radiation Oncology consensus panel guidelines for off-protocol use of APBI and analyzed compared to a pooled invasive suitable (n = 653) risk group and pooled invasive suitable/cautionary (n = 1,298) risk group.Results
The rate of ipsilateral breast tumor recurrence (IBTR) for all 300 DCIS patients was 2.6 % at 5 years with no regional recurrences, while cause-specific survival was 99.5 % and overall survival (OS) was 96.4 %. When comparing the cautionary DCIS group to the invasive suitable/cautionary group, no difference in IBTR was noted (2.6 vs. 3.1 %, P = 0.90) with significant improvements in distant metastases (0 vs. 2.5 %, P = 0.05), disease-free survival (98.5 vs. 94.4 %, P = 0.05), and OS (95.7 vs. 90.8 %, P = 0.03) noted for DCIS patients. When comparing cautionary DCIS patients to invasive suitable patients, no difference in IBTR were noted (2.6 vs. 2.4 %, P = 0.76), while improved OS for DCIS patients was noted (95.7 vs. 90.9 %, P = 0.02).Conclusions
This analysis of the largest cohort of patients with DCIS treated with APBI supports previously reported excellent outcomes; as a result of small numbers of events, further data are necessary to confirm these findings. 相似文献4.
Chirag Shah MD Shahed Badiyan MD J. Ben Wilkinson MD Frank Vicini MD FACR Peter Beitsch MD Martin Keisch MD Douglas Arthur MD Maureen Lyden MS 《Annals of surgical oncology》2013,20(10):3279-3285
Background
The purpose of this study was to examine data on treatment efficacy, cosmesis and toxicities for the final analysis of the American Society of Breast Surgeons MammoSite® breast brachytherapy registry trial.Methods
A total of 1,449 cases of early-stage breast cancer underwent breast conserving therapy. The single-lumen MammoSite® device was used to deliver accelerated partial breast irradiation (APBI) (34 Gy in 3.4 Gy fractions). Of these, 1,255 cases (87 %) had invasive breast cancer (IBC) and 194 cases had DCIS. Median follow-up was 63.1 months with 45 % of all patients having follow-up of 6 years or longer.Results
There were 41 cases (2.8 %) that developed an ipsilateral breast tumor recurrence (IBTR) for a 5-year actuarial rate of 3.8 % (3.7 % for IBC and 4.1 % for DCIS). Tumor size (odds ratio [OR] = 1.1, p = 0.03) and estrogen receptor negativity (OR = 3.0, p = 0.0009) were associated with IBTR, while a trend was noted for positive margins (OR = 2.0, p = 0.06) and cautionary/unsuitable status compared with suitable status (OR = 1.8, p = 0.07). The percentage of patients with excellent/good cosmetic results at 60, 72, and 84 months was 91.3, 90.5, and 90.6 %, respectively. The overall rates of fat necrosis and infections remained low at 2.5 and 9.6 % with few late toxicity events beyond 2 years. The overall symptomatic seroma rate was 13.4 and 0.6 % beyond 2 years.Conclusions
The final analysis of treatment efficacy, cosmesis, and toxicity from the American Society of Breast Surgeons MammoSite® breast brachytherapy registry trial confirms previously noted excellent results and compares favorably with other forms of APBI with similar follow-up and to outcomes seen in selected patients treated with whole breast irradiation. 相似文献5.
Jeruss JS Vicini FA Beitsch PD Haffty BG Quiet CA Zannis VJ Keleher AJ Garcia DM Snider HC Gittleman MA Whitacre E Whitworth PW Fine RE Arrambide S Kuerer HM 《Annals of surgical oncology》2006,13(7):967-976
Background The MammoSite device was designed as a breast brachytherapy applicator and is currently used to deliver accelerated partial
breast irradiation (APBI). We hypothesized that APBI delivered with the MammoSite device would be well tolerated and be associated
with a good cosmetic outcome in patients with ductal carcinoma-in-situ (DCIS).
Methods From 2002 to 2004, 191 patients with DCIS were enrolled in a registry trial to assess the MammoSite applicator. Fifteen patients
were excluded from analysis because of device- or patient-related factors; 7 patients were excluded after receiving a radiotherapy
boost, thus leaving 169 patients available for study. Follow-up information was available for 158 patients. The average length
of follow-up was 7.35 months. Forty-three patients had at least 1 year of follow-up.
Results Skin spacing for the MammoSite applicator was as follows: < 5 mm, 3 patients (1.78%); 5 to 7 mm, 18 patients (10.65%); and
≥7 mm, 148 patients (87.57%). Patients with a device-to-skin distance of ≥7 mm had the best cosmetic result. Patients with
a device-to-skin distance of ≥7 mm also had a lower incidence of radiation dermatitis. Data on 43 patients who were followed
up for at least 1 year confirmed these findings. Additional adverse events were primarily related to skin changes, with breast
infections occurring in five patients (3.16%). No patient in the study has experienced a recurrence.
Conclusions APBI delivered via MammoSite is well tolerated in patients with DCIS, and the lowest toxicity was obtained in patients with
the greatest device-to-skin distance. Long-term follow-up data regarding patient satisfaction, cosmesis, and efficacy are
needed and will be determined from a recently opened large randomized study. 相似文献
6.
DiFronzo LA Tsai PI Hwang JM Lee JJ Ryoo MC Rahimian J Tome M Takasugi JK Haigh PI 《Archives of surgery (Chicago, Ill. : 1960)》2005,140(8):787-794
HYPOTHESIS: Balloon catheter-based accelerated partial breast irradiation (APBI) may result in desirable short-term outcomes in patients undergoing breast conserving surgery. DESIGN: Prospective consecutive case series. SETTING: Tertiary multidisciplinary referral center. PATIENTS: Forty selected patients with invasive breast carcinoma undergoing breast conserving surgery and MammoSite device placement. INTERVENTIONS: Breast conserving surgery, sentinel and/or axillary node dissection, placement of the new balloon catheter applicator (MammoSite device), and APBI. MAIN OUTCOME MEASURES: Infection, early and late seroma, device explantation, time to initiating APBI, acute toxic effects on the skin, and cosmesis using the Harvard Scale. RESULTS: Thirty-nine patients underwent MammoSite device placement at the time of lumpectomy; 1 patient underwent percutaneous device placement after lumpectomy. Nineteen patients (49%) had drainage catheters placed in the breast cavity at the time of lumpectomy. Wound infection developed in 3 patients (8%). Five devices (12%) were explanted because of unfavorable final pathological findings or infection. The mean time to the start of APBI in patients who did not undergo simultaneous drain placement was 7.2 days (range, 5-12 days), compared with 5.1 days (range, 3-8 days) in patients who did (P = .008). With a mean follow-up of 13.3 months (range, 2-28 months), patients completing APBI had limited toxic effects on the skin, with excellent or good cosmetic results in 39 patients (97%). CONCLUSIONS: Use of the MammoSite system in APBI has favorable short-term outcomes. Infection and radiation treatment delay are common and may warrant use of perioperative antibiotics and drain placement, respectively. A small number of patients who have device placement at the time of lumpectomy will require explantation because of unfavorable final pathological findings. Short-term outcomes of MammoSite brachytherapy support further studies comparing APBI with standard whole breast irradiation in patients undergoing breast conserving surgery. 相似文献
7.
PD Beitsch JB Wilkinson FA Vicini B Haffty R Fine P Whitworth H Kuerer V Zannis M Lyden 《Annals of surgical oncology》2012,19(10):3165-3170
Background
Randomized trials demonstrate that lumpectomy plus whole-breast irradiation (WBI) yields survival equivalent to mastectomy. Studies that use WBI, however, typically report higher tumor bed recurrence rates than elsewhere failures (EF) (historically considered new primary lesions). The rate of true recurrence (TR) versus EF was queried for a large patient cohort treated with accelerated partial breast irradiation (APBI).Methods
A total of 1,449 cases of early-stage breast cancer were treated on the American Society of Breast Surgeons MammoSite? Registry Trial with lumpectomy plus balloon-based APBI (34?Gy, 10 BID fractions). A total of 1,255 cases (87?%) had invasive breast cancer, and 194 patients (13?%) had ductal carcinoma in situ. Rates of TR versus EF were calculated and compared to historical WBI controls.Results
Median follow-up was 60 (range 0?C109) months. Fifty patients (3.5?%) developed an ipsilateral breast tumor recurrence (IBTR). The 5-year actuarial rate of IBTR was 3.6?% (invasive breast cancer 3.6?%, ductal carcinoma in situ 3.4?%). Fourteen IBTR (1.1?%) were TR, while 36 (2.6?%) were EF. Estrogen receptor?Cnegative status was associated with IBTR for invasive malignancies as well as for EF only (p?0.001). Trends for increased rates of EF were noted for increased tumor size (p?=?0.067) and extensive intraductal component (p?=?0.087). No pathologic factors were explicitly associated with TR.Conclusions
IBTR after balloon-based APBI is low and similar to rates reported for WBI. In this data set, APBI had fewer tumor bed recurrences (presumably initial cancer recurrences) than EF (presumably new primary lesions). This suggests that balloon-based APBI has a tumor bed control rate that is at least equal to (and potentially higher than) WBI. 相似文献8.
Tunon-de-Lara C André G Macgrogan G Dilhuydy JM Bussières JE Debled M Mauriac L Brouste V de Mascarel I Avril A 《Annals of surgical oncology》2011,18(5):1372-1379
Background
The objective of this retrospective study was to identify prognostic, diagnostic, and therapeutic disparities between younger (≤40 years) and older (>40 years) women with ductal carcinoma in situ (DCIS) of the breast.Methods
From 1971 to 2001, all patients treated for DCIS at Institut Bergonié were included in our analyses. Follow-up data was collected over 10 years. We used univariate and multivariate analyses to investigate patient-, disease-, and treatment-related factors predictive of diagnostic, histological, therapeutic, and prognostic DCIS criteria.Results
A total of 812 patients were eligible including 731 women aged >40 years and 81 women ≤40 years. Younger women with DCIS were more likely to receive a mastectomy and less likely to receive radiotherapy. Young age and initial surgical treatment (lumpectomy and especially nonfree margins) were revealed as predictive of recurrence in multivariate analyses.Conclusions
Young age represents a recurrence risk independent of histological and clinical characteristics of the tumor. Initial treatment, especially for nonfree margins, is also a predictive factor. Appropriate initial surgery with particularly wide margins appears essential for the treatment of young women with DCIS. 相似文献9.
Freya Schnabel MD Susan K. Boolbol MD Mark Gittleman MD Tami Karni MD Lorraine Tafra MD Sheldon Feldman MD Alice Police MD Neil B. Friedman MD Scott Karlan MD Dennis Holmes MD Shawna C. Willey MD Moshe Carmon MD Kristen Fernandez MD Stephanie Akbari MD Jay Harness MD Lisa Guerra MD Thomas Frazier MD Karen Lane MD Rache M. Simmons MD Alison Estabrook MD Tanir Allweis MD 《Annals of surgical oncology》2014,21(5):1589-1595
Background
The presence of tumor cells at the margins of breast lumpectomy specimens is associated with an increased risk of ipsilateral tumor recurrence. Twenty to 30 % of patients undergoing breast-conserving surgery require second procedures to achieve negative margins. This study evaluated the adjunctive use of the MarginProbe device (Dune Medical Devices Ltd, Caesarea, Israel) in providing real-time intraoperative assessment of lumpectomy margins.Methods
This multicenter randomized trial enrolled patients with nonpalpable breast malignancies. The study evaluated MarginProbe use in addition to standard intraoperative methods for margin assessment. After specimen removal and inspection, patients were randomized to device or control arms. In the device arm, MarginProbe was used to examine the main lumpectomy specimens and direct additional excision of positive margins. Intraoperative imaging was used in both arms; no intraoperative pathology assessment was permitted.Results
In total, 596 patients were enrolled. False-negative rates were 24.8 and 66.1 % and false-positive rates were 53.6 and 16.6 % in the device and control arms, respectively. All positive margins on positive main specimens were resected in 62 % (101 of 163) of cases in the device arm, versus 22 % (33 of 147) in the control arm (p < 0.001). A total of 19.8 % (59 of 298) of patients in the device arm underwent a reexcision procedure compared with 25.8 % (77 of 298) in the control arm (6 % absolute, 23 % relative reduction). The difference in tissue volume removed was not significant.Conclusions
Adjunctive use of the MarginProbe device during breast-conserving surgery improved surgeons’ ability to identify and resect positive lumpectomy margins in the absence of intraoperative pathology assessment, reducing the number of patients requiring reexcision. MarginProbe may aid performance of breast-conserving surgery by reducing the burden of reexcision procedures for patients and the health care system. 相似文献10.
Alex B. Haynes MD MPH Elizabeth S. Bloom MD Isabelle Bedrosian MD Henry M. Kuerer MD PhD Rosa F. Hwang MD Mark F. Munsell MS Roy F. Chemaly MD MPH Linda S. Graviss MT CIC Abigail S. Caudle MD Kelly K. Hunt MD Welela Tereffe MD Simona F. Shaitelman MD Gildy V. Babiera MD 《Annals of surgical oncology》2014,21(8):2512-2516
Background
Accelerated partial breast irradiation (APBI) has been used as an alternative to whole-breast irradiation as part of breast-conserving therapy. Indications and outcomes are topics of ongoing investigation. Previous publications have focused on early postoperative infections and reported low rates of delayed infection. We investigated the pattern of infection after catheter-based APBI at our institution.Methods
Patients who underwent single-entry catheter-based APBI were identified from an institutional prospective registry including data regarding comorbidities and outcomes. Time of infection was calculated from the date of definitive catheter insertion and classified as early (≤30 days) or delayed.Results
A total of 91 breast cancer patients were treated with APBI and enrolled in the registry from 2009 to 2011. The median follow-up was 484 days. Breast infection occurred in 13 (14.3 %), with 3 (3.3 %) occurring within 30 days of catheter placement and 10 (11.0 %) in a delayed fashion. Four patients required hospital admission, five underwent percutaneous aspiration, and one underwent incision and drainage. Eight were treated as outpatients with oral antibiotics alone.Conclusions
Consistent with other reports, we found an overall infection rate of 14.3 % with single-entry catheter-based APBI. There were substantially fewer infections in the early postoperative period than reported elsewhere, but there were more delayed infections. The intensive follow-up in our study likely identified late infections that may not have otherwise been recognized. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. These infections can range in severity but typically can be managed in an outpatient setting. 相似文献11.
Miral Amin MD Sheryl Gabram MD Harvey Bumpers MD Jerome Landry MD Ashesh B. Jani MD Roberto Diaz MD Monica Rizzo MD FACS 《Annals of surgical oncology》2012,19(13):4094-4098
Background
Breast conserving therapy (BCT) that include breast conserving surgery followed by adjuvant radiation therapy has revolutioned medicine by allowing women to avoid mastectomy. Accelerated partial breast irradiation (APBI) has emerged as a valid alternative to whole-breast irradiation that requires a shorter time commitment. We report our novel experience with APBI at a large public hospital that serves low-income and potentially noncompliant patients.Methods
A retrospective chart review was conducted of women who underwent BCT for stage 0?CIIA breast cancer from August 2007 to August 2010 treated with APBI with a brachytherapy catheter.Results
Twenty-four patients (20 African American) were considered for APBI. Average age was 61?years. Four patients could not undergo APBI for technical reasons and completed whole-breast irradiation over a 5?week period. Median follow-up was 19?months. Nine patients (37.5?%) had ductal carcinoma-in-situ, and 15 patients (62.5?%) had invasive ductal carcinoma with an average tumor size of 1.1?cm. All patients had negative margins of >2?mm. Two patients (8?%) treated with the brachytherapy catheter had in-breast tumor recurrence. Thus, all 24 patients initially identified for APBI successfully completed adjuvant radiotherapy.Conclusions
Patient compliance with postoperative irradiation is key to minimize local recurrence after BCT for breast cancer. This success with a brachytherapy catheter in underserved women in a U.S. public hospital setting indicates that outcomes of compliance and complications are comparable to nationally published results. 相似文献12.
Four-year clinical update from the American Society of Breast Surgeons MammoSite brachytherapy trial
Jonathan C. Nelson Peter D. Beitsch Frank A. Vicini Coral A. Quiet Delia Garcia Howard C. Snider Mark A. Gittleman Victor J. Zannis Pat W. Whitworth Richard E. Fine Angela J. Keleher Henry M. Kuerer 《American journal of surgery》2009,198(1):83-43
Background
We present a 4-year update on the efficacy, cosmetic results, and complications of MammoSite breast brachytherapy in patients enrolled in the American Society of Breast Surgeons registry trial.Methods
A total of 1,449 breasts in 1,440 patients with early stage breast cancer undergoing breast-conserving therapy were treated with adjuvant, accelerated partial breast irradiation (APBI) (34 Gy in 3.4-Gy fractions) delivered with the MammoSite device. The median follow-up period for the entire group was 36.1 months.Results
The 3-year actuarial rate of ipsilateral breast tumor recurrence was 2.15%. The 3-year actuarial rate of axillary recurrence was .36%. Complication rates were as follows: infection, 9.5%; seroma, 26.8% (symptomatic seroma, 12.7%); and fat necrosis, 2.0%. The percentages of breasts with good or excellent cosmetic results were as follows: 12 months, 95%; 24 months, 94%; 36 months, 94%; and 48 months, 91%.Conclusions
Locoregional control, complications, and cosmetic outcomes from MammoSite APBI at the 4-year update are acceptable and similar to results seen with other forms of APBI. 相似文献13.
Evan Tummel MD Richard Betzold MD Kristalyn Gallagher DO V. Suzanne Klimberg MD 《Annals of surgical oncology》2014,21(10):3354-3355
Background
Margin negativity is a critical endpoint in breast-conserving surgery. Despite advances in technology, there is up to a 40 % positive margin rate in lumpectomy specimens, which results in a twofold increase in ipsilateral breast tumor recurrence. We have developed a new method for lumpectomy that could improve margin negativity.Methods
A novel method for partial mastectomy was developed using ultrasound to perform dissection of breast specimens in real time. Continuous ultrasound-guided breast excision (CUBE) was first tested on gel models and subsequently implemented in vivo. The step-by-step method for this technique was performed on 12 successive patients who had ultrasound-detectable lesions.Results
Twelve patients underwent lumpectomy for cancer using the CUBE technique. All patients had negative margins on final pathology. Three patients who had close margins on ex vivo ultrasound evaluation had additional shave margins taken, resulting in negative final margins.Conclusions
The CUBE technique is a novel technique that allows for dissection of breast lesions with continuous visualization of margins. This facilitates real-time adjustments to ensure margin negativity. Preliminary data is promising, but further research is needed for confirmation. 相似文献14.
Holm Eggemann MD A. Ignatov D. Elling D. Lampe T. Lantzsch M. Weise S.-D. Costa 《Annals of surgical oncology》2013,20(11):3438-3445
Purpose
To evaluate the oncologic safety and cosmetic results after breast cancer surgery for central breast cancer by the B technique.Methods
Seventy women with operable breast cancer located in the central portion of the breast that had received resection surgery with the B technique were recruited. The primary outcome was the oncological safety, quantified as rate of positive resection margins and the cosmetic outcome evaluated by postsurgical self-assessment of the cosmetic outcome via questionnaire. The median follow-up period was 61.4 months (range 7.9–142.6 months).Results
With one exception all patients had T1–2 tumors less than 5 cm in diameter. Most patients had invasive ductal breast cancers (57.1 %), followed by ductal carcinoma-in situ (27.1 %) and invasive lobular breast cancers (8.6 %). The incidence of positive resection margins was 17.1 %. No local tumor recurrence occurred during follow-up; one patient had distant metastases. In total, 80 % of the patients reported that the cosmetic results met or exceeded their expectations.Conclusions
The B technique is a safe breast conservation surgery for the excision of tumors located in the central portion of the breast and yields a high rate of satisfactory cosmetic results. 相似文献15.
Bree R. Eaton MD Albert Losken MD Derick Okwan-Duodu MD PhD David M. Schuster MD Jeffrey M. Switchenko PhD Donna Mister Karen Godette MD Mylin A. Torres MD 《Annals of surgical oncology》2014,21(1):93-99
Background
The purpose of this study was to describe the incidence and location of ipsilateral breast tumor recurrence (IBTR) among breast cancer patients treated with oncoplastic reduction mammoplasty (ORM) and radiotherapy (RT).Methods
The medical records of 86 consecutive women with ductal carcinoma in situ (DCIS) (n = 11) or invasive carcinoma of the breast (n = 75) treated with ORM at Emory University between January 1994 and December 2010 were reviewed.Results
Following ORM, prolonged wound healing or surgical complications led to delay of adjuvant chemotherapy or RT in 11 patients. Surgical clips were found outside the primary tumor breast quadrant in 43 % of the patients with available RT planning CT images. When the clips were found outside the primary tumor quadrant, the RT boost was more frequently delivered outside versus inside the primary tumor quadrant (67 vs. 33 %, p < 0.001). After a median follow-up period of 4.5 years (range 0.1–17.9), 6 patients developed an IBTR and only 1 IBTR occurred outside the primary tumor quadrant. The 5-year ipsilateral breast tumor control rates were 91 % (95 % CI 0.82–0.99) and 93 % (95 % CI 0.90–0.97) for patients with DCIS and invasive carcinoma, respectively.Conclusions
The use of ORM yields acceptable rates of IBTR. ORM may displace breast tissue and surgical clips to breast quadrants outside of the original tumor location, but the majority of IBTRs still occur in the original tumor quadrant. This area remains at highest risk of in-breast recurrence in women treated with ORM irrespective of surgical clip location. 相似文献16.
17.
M Wilson S Korourian C Boneti L Adkins B Badgwell J Lee V Suzanne Klimberg 《Annals of surgical oncology》2012,19(10):3192-3198
Introduction
Clinical trials have yet to find a size or grade of invasive cancer which can be treated with lumpectomy alone due to the higher local recurrence (LR) rate without radiation (XRT). Excision followed by radiofrequency ablation (eRFA) is an intraoperative method which utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA after lumpectomy for invasive breast cancer could reduce the need for re-excision in close margins and potentially maintain local control without the need for XRT.Methods
This institutional review board-approved study from July 2002 to December 2010 involved patients undergoing eRFA. A standard lumpectomy was performed and then the RFA probe was deployed 1?cm circumferentially into the walls of the lumpectomy cavity and maintained at 100?°C for 15?min. Validated doppler sonography was used to determine final ablation size.Results
Seventy-three patients (mean age of 68.8?±?10.9?years) with invasive cancer who had an average tumor size of 1.0?±?0.54?cm (range of 0.2-2.6?cm) underwent eRFA. Margins were negative in 54, close in 10, focally positive in 6, and grossly positive in 3 patients. Sixteen out of 19 (84?%) of patients with close or positive margins were spared of re-excision. Median follow-up was 55?±?21?months. Only one patient (1.3?%) developed an in site recurrence. There were three recurrences, elsewhere.Conclusions
Long-term follow-up suggests that eRFA may reduce the need for re- excision as well as reduce LR for invasive breast cancer treated without XRT. 相似文献18.
19.
Talha Shaikh MD Venkat Narra PhD Sharad Goyal MD Stuti Ahlawat MD Laurie Kirstein MD Thomas Kearney MD Bruce G. Haffty MD Atif J. Khan MD 《Annals of surgical oncology》2013,20(4):1323-1328
Background
During the breast lumpectomy procedure, surgeons traditionally elect to use either a superficial or full-thickness closure when sealing the wound depending on surgeon preference as well as desired outcomes. The purpose of this study was to examine dosimetric endpoints in patients with superficial versus full-thickness closures with accelerated partial breast irradiation (APBI).Methods
Patients who underwent breast conservation surgery followed by 3D conformal external-beam APBI were identified (n = 45) and were separated according to the type of cavity closure performed: superficial and full thickness. Data gathered from the retrospective review of patient charts was analyzed according to criteria in the NSABP B-39 protocol in order to quantify the amount of radiation delivered to organs at risk. The patient seroma cavity was further given a cavity visualization score to assess the impact of wound closure on treatment planning.Results
There was no significant difference in the mean CVS score for the 2 groups. There were no statistical differences in all dosimetric endpoints compared for the 2 types of closure, and both groups met NSABP B-39 guidelines for the ipsilateral breast, heart, and ipsilateral lung dosimetry.Conclusions
We found no significant difference in dosimetric outcomes in either the superficial or deep closure treatment groups. Breast surgeons should not alter their preferred closure strategy in anticipation of 3D-CRT APBI. 相似文献20.