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Abramson Cancer CenterNCI CANCERLIT® Search: Radiotherapy for Breast Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Subcutaneous calcification following chest wall and breast irradiation: a late complication.
- Outcome with postmastectomy radiation with transverse rectus abdominis musculocutaneous flap breast reconstruction.
- Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast.
- Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast
- Treatment guidelines and techniques in delivery of postmastectomy radiotherapy in management of operable breast cancer.
- Long-term survival after radical operations for cancer treatment-induced sarcomas: how two survivors invite reflection on oncologic treatment
- Breast cancer: chest wall recurrences.
- [Radiation-induced cutaneous hamartoma in a patient with Cowden syndrome. Clinical evidence for heterozygosity]
- [Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Breast cancer]
Table of Contents
1
UI - 11932224
AU - Amin R; Hamilton-Wood C; Silver D
TI -
Subcutaneous calcification following chest wall and breast irradiation:
a late complication.
SO - Br J Radiol 2002 Mar;75(891):279-82
AD - Department of Radiation Oncology, Royal Devon & Exeter Hospital, Barrack
Road, Exeter, Devon EX2 5DW, UK.
Subcutaneous calcification as a complication of chest wall irradiation
has only been described once before in the literature. Six patients who
developed heavy calcification of soft tissue following chest wall and
breast irradiation are described here, and relevant literature is
reviewed.
2
UI - 12013281
AU - Proulx GM; Loree T; Edge S; Hurd T; Stomper P
TI -
Outcome with postmastectomy radiation with transverse rectus abdominis
musculocutaneous flap breast reconstruction.
SO - Am Surg 2002 May;68(5):410-3
AD - Department of Radiation Oncology, Roswell Park Cancer Institute,
Buffalo, New York 14263, USA.
The effects of radiation on the outcome of patients undergoing
transverse rectus abdominis musculocutaneous (TRAM) flap breast
reconstruction have not been extensively studied. Concern still exists
of a possible negative impact secondary to irradiation as related to
control of disease, cosmetic outcome, and flap viability. Thirty-six
patients underwent both a modified radical mastectomy (MRM) with TRAM
flap reconstruction and irradiation to the chest wall to include the
TRAM flap and/or regional nodes either before reconstruction or after
TRAM flap reconstruction. Fifteen patients had all of their treatment
and follow-up at our institution and were retrospectively reviewed to
assess treatment and outcome. During a median follow-up of 36 months
there were no local-regional failures. One patient at Stage IIIA failed
with distant metastases 3 years after treatment. One patient had a flap
loss from a nonhealing wound after reconstruction performed 2 years
after MRM and radiotherapy. Only one patient expressed dissatisfaction
with the cosmetic outcome. Patients undergoing MRM with TRAM flap
reconstruction and irradiation before or after reconstruction can
achieve excellent local-regional control and satisfactory cosmesis. Risk
of flap loss is low. Further follow-up is needed for assessing
longer-term outomes in this patient group. Larger prospective studies
are necessary for more definitive conclusions.
3
UI - 11992392
AU - Neuschatz AC; DiPetrillo T; Safaii H; Lowther D; Landa M; Wazer DE
TI -
Margin width as a determinant of local control with and without
radiation therapy for ductal carcinoma in situ (DCIS) of the breast.
SO - Int J Cancer 2001;96 Suppl():97-104
AD - Department of Radiation Oncology, New England Medical Center, Tufts
University School of Medicine, Boston, Massachusetts 02111, USA.
In order to assess the utility of margin width in relation to other
histopathologic features as a determinant of local control in ductal
carcinoma in situ (DCIS) of the breast, we retrospectively examined the
treatment of 109 breasts treated with (n = 54) or without adjuvant
radiotherapy (n = 55). Median follow-up was 49 and 54 months for
patients treated with excision alone (E) or excision plus adjuvant
radiotherapy (E+XRT), respectively. Cases treated with E+XRT were
significantly larger and had a trend towards closer surgical margins
than those treated with E alone. For all cases, margin width < or = 1 mm
and lesion diameter >15 mm were significantly associated with increased
local recurrence. Lesion size < or = 15 mm was associated with no cases
of local failure regardless of treatment arm. For lesions >15 mm in
diameter, there was a significant decrease in 5-year local failure with
E+XRT compared to E alone (21% vs. 36%, P = 0.03). Tumor margin >1 mm
was associated with a low rate of 5-year local failure for either E
alone or E+XRT (10.9% vs. 4.6%, P = NS). Tumor margin < = 1 mm had a
high rate of local failure that was not significantly decreased by the
addition of adjuvant radiotherapy. These results show that large
diameter (>15 mm) and close surgical margins (< or = 1 mm) are the
dominant risk factors for local recurrence in DCIS. E+XRT significantly
decreased local failure risk compared to E alone for large lesions but
not for those with close margins. Copyright 2002 Wiley-Liss, Inc.
4
UI - 12039934
AU - Lee JH; Glick HA; Hayman JA; Solin LJ
TI -
Decision-analytic model and cost-effectiveness evaluation of
postmastectomy radiation therapy in high-risk premenopausal breast
cancer patients.
SO - J Clin Oncol 2002 Jun 1;20(11):2713-25
AD - Department of Radiation Oncology, Division of General Internal Medicine,
University of Pennsylvania Medical Center, Philadelphia, PA, USA.
jasonlee@massmed.org
PURPOSE: To present a decision model that describes the clinical and
economic outcomes of node-positive breast cancer with and without
postmastectomy radiation therapy (PMRT). METHODS: A Markov process was
constructed to project the natural history of breast cancer following
mastectomy in premenopausal node-positive women. Biannual hazards of
local and distant recurrence without PMRT were derived from a large
meta-analysis of adjuvant systemic therapy trials for breast cancer. The
addition of PMRT reduced the risk of disease relapse by an odds ratio of
0.69. Costs of PMRT ($11,600) and recurrent breast cancer ($4,250 to
16,200/year) were estimated from available literature. The model
projected number of recurrences, relapse-free and overall survival, and
costs to 15 years, using a discount rate of 3%. Cost-effectiveness
ratios were calculated per incremental year of life and quality-adjusted
year of life gained. One- and two-way sensitivity analyses were
performed to determine the sensitivity of results to clinical and
economic assumptions. RESULTS: The model projected 15-year relapse-free
survival of 52% and 43% with and without PMRT, respectively. Overall
survival was increased from 48% to 55% with PMRT, resulting in an
incremental 0.29 years of life gained per subject. PMRT increased
15-year costs from $40,800 to $48,100. Cost per year of life gained was
$24,900, or $22,600 when survival was adjusted for quality of life.
Results of the model were relatively sensitive to radiation therapy cost
and breast cancer relapse risk. CONCLUSION: This analysis suggests that
PMRT offers substantial clinical benefits achieved in a cost-effective
manner, with an average cost per year of life gained of $24,900. Results
of the model were robust under a wide range of clinical and economic
parameters.
5
UI - 11773304
AU - Pierce LJ
TI -
Treatment guidelines and techniques in delivery of postmastectomy
radiotherapy in management of operable breast cancer.
SO - J Natl Cancer Inst Monogr 2001;(30):117-24
AD - Department of Radiation Oncology, University of Michigan School of
Medicine UHB2C490, Box 0010, 1500 E. Medical Center Dr., Ann Arbor, MI
48109, USA. ljpierce@umich.edu
Radiation therapy has been shown to statistically significantly reduce
the risk of locoregional recurrence in high-risk patients with operable
breast cancer following mastectomy and systemic therapy. Recent trials
have also demonstrated a significant survival benefit following
radiotherapy in high-risk patients. Therefore, it is important to
identify the patients who could potentially derive that survival benefit
and to not offer treatment to those patients who are not at increased
risk for failure. Established risk factors that predict for increased
rates of locoregional recurrence include axillary lymph node involvement
and T3 (or T4) disease. While treatment-related factors, such as the
extent of the axillary dissection and extent of lymph nodal positivity,
also undoubtedly affect locoregional recurrence, additional studies are
needed to define the magnitude of their risk. Locoregional patterns of
failure have identified the chest wall and
supraclavicular/infraclavicular regions to be the most common sites of
locoregional failure following mastectomy, which justifies treatment to
these regions. While long-term complications are uncommon following
locoregional radiotherapy, careful treatment planning is critical to
minimize cardiac (and pulmonary) toxicity.
6
UI - 12040281
AU - Schwarz RE; Hillebrand G; Peralta EA; Chu DZ; Weiss LM
TI -
Long-term survival after radical operations for cancer treatment-induced
sarcomas: how two survivors invite reflection on oncologic treatment
concepts.
SO - Am J Clin Oncol 2002 Jun;25(3):244-7
AD - Department of General Surgical Oncology, City of Hope National Medical
Center, Duarte, California, USA.
Extent and radicality of surgical oncologic treatment has changed in the
past 30 years. Two patients with node-positive breast cancer are
presented, who underwent (total or radical) mastectomy with
lymphadenectomy and postoperative radiation 24 and 40 years ago. A
radiation-associated sarcoma of the parascapular soft tissue developed
in one patient 9 years after treatment; the other one sought treatment
for a lymphedema-associated Stewart-Treves lymphangiosarcoma 16 years
after initial therapy. Both patients underwent a forequarter amputation
for their treatment-associated high-grade sarcoma. Both are currently
alive and cancer-free 15 and 24 years after amputation. These reports
remind us that radical locoregional treatment can cure some solid
cancers in the absence of systemic therapy; that such extensive
treatment may induce significant disability or secondary malignancies
long-term; that even advanced treatment-associated sarcomas can be cured
with aggressive resection; that today's multimodality therapy approaches
and appropriate patient selection have rendered such extensive
locoregional treatment for many tumors obsolete or unnecessary; and that
if no effective alternative treatment exists and organ or limb
preservation is not feasible, an aggressive resection approach for
high-grade cancer should not be discounted unless systemic failure is
certain or imminent.
7
UI - 12057080
AU - Taylor ME
TI -
Breast cancer: chest wall recurrences.
SO - Curr Treat Options Oncol 2002 Apr;3(2):175-7
AD - Department of Radiation Oncology, Washington University School of
Medicine, 4939 Children's Place, Suite 5500, Box 8224/21, St. Louis, MO
63110, USA. taylor@radonc.wustl.edu
Irradiation is indicated for patients undergoing mastectomy as surgical
management for breast cancer treatment when clinical or pathologic tumor
and nodal features predict risk of local/regional recurrence. Such
features include: tumor size >/= 5 cm, inadequate surgical margins;
skin, facial, or skeletal muscle invasion; dermal lymphatic invasion;
poorly differentiated tumor histology; four or more lymph nodes
positive; gross extracapsular tumor nodal extension into soft tissues;
and matted lymph nodes or enlarged lymph nodes > 2 cm. Patients who were
treated with irradiation after mastectomy can develop local/regional
recurrences despite such adjuvant therapy. General management for chest
wall and nodal recurrences is structured on the extent and volume of
local/regional disease, the absence of distant metastases, the general
health of the patient, and the extent of prior local/regional therapies,
especially irradiation. Management of local/regional recurrence in the
setting of no prior irradiation includes tumor debulking by systemic or
surgical treatment followed by comprehensive chest wall and regional
lymphatic irradiation. Doses are selected by tissue tolerances and
volume of remaining disease. The management strategy for the patient
with a history of irradiation parallels the nonirradiated patient with
respect to systemic and surgical therapies to debulk the tumor to
maximal response or no gross clinical disease. Radiation field design is
determined by prior therapies. Doses to these fields are adjusted to
normal tissue tolerance. Irradiation is given with a sensitizer such as
hyperthermia or 5-fluorouracil chemotherapy. Use of radiation
sensitizers can allow for a more meaningful biologic tumor effect when
normal tissue tolerances prohibit delivery of standard tumor doses.
Hyperthermia has been used effectively to promote complete tumor
responses with use of irradiation in re-treatment cases.
8
UI - 11963223
AU - Happle R; Starink TM
TI -
[Radiation-induced cutaneous hamartoma in a patient with Cowden
syndrome. Clinical evidence for heterozygosity]
SO - Hautarzt 2002 Jan;53(1):47-9
AD - Dermatologische Klinik der Universitat Marburg, Deutschhausstrasse 9,
35033 Marburg. happle@mailer.uni-marburg.de
A 56-year-old woman had typical features of Cowden syndrome in the form
of hamartomas involving the skin, lips, and oral mucosa. At the age of
48, a mastectomy was performed for adenocarcinoma with a regional
metastasis, and X-ray treatment was applied to the left axilla.
Subsequently the patient developed approximately 30 skin-colored nodules
surrounding the irradiated axillary region within several months.
Histopathological examination of one of these lesions showed
characteristic features of sclerotic fibroma. The multiple
radiation-induced fibrous hamartomas observed may be best explained by
multiple events of loss of heterozygosity (LOH), because molecular
studies in other patients with Cowden syndrome have shown that both
benign and malignant tumors originate from LOH. The X-ray treatment
would have induced LOH in many cells, giving rise to either homo- or
hemizygosity for the Cowden mutation.
9
UI - 12043216
AU - Mitsumori M
TI -
[Current status of radiation therapy--evidence-based medicine (EBM) of
radiation therapy. Breast cancer]
SO - Nippon Igaku Hoshasen Gakkai Zasshi 2002 Mar;62(4):138-43
AD - Department of Therapeutic Radiology and Oncology, Graduate School of
Medicine, Kyoto University.
Evidenced-based medicine(EBM) is undergoing rapid acceptance as a
principle of decision making in radiation oncology clinics. Adjuvant
therapy for breast cancer is one of the most actively researched areas,
and there is a great deal of clinical evidence of high-quality treatment
of breast cancer. The case of 47-year-old premenopausal woman who
underwent consultation for postmastectomy radiotherapy (PMRT) is
presented, and the course of practice using EBM is described. Because
she had one positive axillary lymph node, she received systemic
chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel. She is
also receiving trastuzumab and tamoxifen. She underwent immediate
reconstruction with a TRAM flap. Existing guidelines point out that PMRT
significantly reduces the risk of local recurrence; however, none of
them recommend PMRT for a patient with < 4 positive lymph nodes because
of the lack of firm evidence for improvement of overall survival. There
is also some evidence that PMRT after immediate reconstruction reduces
the cosmetic result and that paclitaxel might increase the risk of
radiation pneumonitis even in sequential administration. She chose PMRT,
although our recommendation was not to do so. Expertise in the area of
breast cancer as well as high-level evidence developed in Japan is
essential to effectively implement EBM.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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