Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

Coates, Alan S.; Winer, Eric P.; Goldhirsch, Aron; Gelber, Richard D.; Gnant, Michael; Piccart‐Gebhart, Martine; Thürlimann, Beat; Senn, Hans

doi:10.1093/annonc/mdv221

Cited by 1,565 publications

(1,298 citation statements)

References 116 publications

(131 reference statements)

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“…A meta‐analysis56 of a non‐randomized comparison between 3165 TM procedures with standard BCS in 5494 patients with unifocal cancers showed that the former significantly reduced rates of cancer margin positivity ( P < 0·001) and surgical re‐excisions ( P < 0·001). Recently, the St Gallen panel2 recommended a minimal acceptable surgical margin of ‘no ink on invasive tumour or DCIS’. Other interventions significantly reducing intraoperative tumour margin positivity have been described: digital specimen radiology ( P = 0·012 for digital versus conventional mammography)59, tumour margin cavity shaves60 and real‐time cancer margin assessments61 62.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical surveillance informing cancer outcomes should optimally extend to at least 10 years2 3. The Association of Breast Surgery guidelines50 recommend a target of 5‐year breast cancer LRR rates of 5 per cent or less from diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Risk ratios and 95 per cent confidence intervals were calculated with Revman 5.3 software (Nordic Cochrane Centre, Copenhagen, Denmark) and presented as a forest plot. Heterogeneity among studies was assessed by means of the I 2 statistic.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical evidence is well established for the treatment of unifocal cancers by breast‐conserving surgery (BCS) and whole‐breast radiotherapy (RT) in preference to mastectomy2 3. In contrast, there are no a priori randomized trials evaluating the clinical safety of BCS for treating multiple ipsilateral breast cancers (MIBC).…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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“…A lack of timely access to supportive oncodermatology care during the immediate post-treatment transition period, when recommended follow-up consultations occur at 3-4-or 6-month intervals (Carlson et al, 2011;Coates et al, 2015;Senkus et al, 2015), may lead to inadequate management of long-lasting dAEs.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a global supportive skin care programme with hydrotherapy after non-metastatic breast cancer treatment: A randomised, controlled study

et al. 2017

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This study investigated the efficacy of post-treatment hydrotherapy as supportive care for management of persistent/long-lasting dermatologic adverse events (dAEs) induced in breast cancer survivors by adjuvant therapy, and its impact on quality of life (QoL).Patients in complete remission after standardised (neo)adjuvant chemotherapy, surgery and radiotherapy combination treatment for infiltrating HR+/HER2-breast carcinoma were enrolled in this randomised, multicentre controlled study 1-5 weeks after completing radiotherapy. The control group (CG, n = 33) received best supportive care and the treatment group (HG, n = 35) received 3-weeks of specific hydrotherapy. The primary criterion was change in QoL (QLQ-BR23) after hydrotherapy. Clinical grading of dAEs, cancer-related QoL (QLQ-C30), dermatologic QoL (DLQI) and general psychological well-being (PGWBI) were assessed. Significant dAEs were found at inclusion in both groups (n = 261). Most items showed significantly greater improvement in the HG

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Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function, Pregnancies, and Disease-Free Survival

Lambertini

Boni²,

Michelotti

et al. 2015

JAMA

188

141

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Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

Cited by 1,565 publications

References 116 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Efficacy of a global supportive skin care programme with hydrotherapy after non-metastatic breast cancer treatment: A randomised, controlled study

Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function, Pregnancies, and Disease-Free Survival

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