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Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.

ABSTRACT: We examined the clinical/pathologic features of ipsilateral second breast cancers (IP-SBCs) following breast-conserving surgery (BCS) for DCIS among community-treated patients and ascertained the degree of correlation between the features of index DCIS and IP-SBC events. From a Cancer Research Network cohort of DCIS patients diagnosed 1990-2001 and treated with BCS, we identified women who subsequently developed an ipsilateral DCIS or invasive breast cancer. All index DCIS tumors underwent expert pathology review. Pathologic characteristics of IP-SBCs were abstracted from available medical records. Logistic regression was used to examine associations between pathologic characteristics and identify factors associated with invasive versus non-invasive IP-SBC. Of 1969 DCIS patients, 182 developed an IP-SBC within a median of 38 months (range 6-160). IP-SBCs were slightly more commonly non-invasive (53 %) versus invasive (47 %). Of invasive IP-SBCs, 31 % were high grade, 67 % were <20 mm, 74 % were estrogen receptor positive, 7 % were HER2 positive, and 16 % were node positive. Of non-invasive IP-SBCs, 33 % were high grade. Comparing index DCIS and IP-SBC specimens, there was moderate-high correlation for HR status and grade. Among patients with IP-SBCs, those who were younger and whose index DCIS tumors were HR negative had shorter intervals (within 3 years) between index and IP-SBC diagnoses. No index DCIS feature was statistically significantly associated with an IP-SBC that was invasive versus non-invasive. Understanding the characteristics of SBCs and identifying correlations between these and index DCIS events could influence treatment choices for DCIS, and may help patients and providers develop treatment paradigms for SBCs.

SUBMITTER: Hassett MJ

PROVIDER: S-EPMC4767622 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.

Hassett Michael J MJ Jiang Wei W Habel Laurel A LA Nekhlyudov Larissa L Achacoso Ninah N Acton Luana L Schnitt Stuart J SJ Schrag Deb D Punglia Rinaa S RS

Breast cancer research and treatment 20160203 3

We examined the clinical/pathologic features of ipsilateral second breast cancers (IP-SBCs) following breast-conserving surgery (BCS) for DCIS among community-treated patients and ascertained the degree of correlation between the features of index DCIS and IP-SBC events. From a Cancer Research Network cohort of DCIS patients diagnosed 1990-2001 and treated with BCS, we identified women who subsequently developed an ipsilateral DCIS or invasive breast cancer. All index DCIS tumors underwent exper ...[more]

PMID: 26843057

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Project description:The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11-5.44; distant metastasis, 2.24 and 1.19-4.24; mortality, 2.50 and 1.06-5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26-16.98), DFS (RR=6.81; 95% CI, 2.86-16.20) and OS (RR=9.14; 95% CI, 2.53-33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.

Project description:BACKGROUND AND PURPOSES:This study compared VMAT and IMRT plans for intact breast radiotherapy for left sided breast cancer and evaluated the irradiated dose of planning target volume and OARs, especially focusing on heart and coronary artery. MATERIALS AND METHODS:Eleven patients with left sided breast cancer whose breast was relatively smaller (the mean volumes is 296 cc) treated with breast-conserving surgery were prescribed radiotherapy of 50 Gy in 25 fractions using two or four-field step and shoot IMRT (2 or 4-F IMRT), and one or two-arc VMAT (1 or 2-arc VMAT). The 10 Gy electron boost to the tumor bed after delivery of 50 Gy was not included in the analysis. Multiple planning parameters for the PTV and the PRV-OARs were measured and analyzed. RESULTS:Treatment plans generated using VMAT had better PTV homogeneity than the IMRT plans. For the PRV-OARs, the 1-arc VMAT had significantly higher Dmean and V5 for left lung and heart, and showed worse Dmean for liver, esophagus, spinal cord, contralateral lung and breast. In contrast, the 2-arc VMAT and the 2-F or 4-F IMRT plans showed better results for the PRV-OARs than the 1-arc VMAT. However, for the heart and coronary artery, the 1-arc VMAT showed better V20 and V40 compared with the other plans. Moreover, the 2 F-IMRT had specially advantage on V5 and V20 for heart and V5 for coronary arteries, the 2-F IMRT also showed a greater MU and treatment times. Using the table of quality score to evaluate the plans, we found that 2-F IMRT had the highest scores of 13, followed by the 2-arc VMAT plan (10 points) and 1-arc VMAT plan (8 points), and finally the 4-F IMRT plan (6 points). Moreover, when a dose comparison for heart minus coronary artery was calculated, the V20 and V40 for the rest of heart in all plans were very small and closed, indicating the dose to the coronary artery contributed dramatically to the high dose volumes for the entire heart. CONCLUSIONS:Compared to other plans, the 2-F IMRT plan with fewer monitor units and shorter delivery time is an appropriate technique for left sided breast cancer, which achieved good PTV coverage and sparing of organs at risk besides for the heart and coronary artery.

Dataset Information

Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.

Publications

Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.

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