The evolution of adjuvant radiation therapy for early‐stage and locally advanced breast cancer

Ohri, Nisha; Haffty, Bruce G.

doi:10.1111/tbj.13715

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Hypo-fractionated adjuvant radiotherapy of the whole breast (HF-WBI) is also accepted for the adjuvant treatment of the left breast, with the results indicating a non-inferior loco-regional control and overall survival compared to the case when standard fractionation treatment was used. The HF-WBI is also associated with a 10-year heart rate toxicity equal to that of the control group in which 50 Gy was delivered in 25 daily fractions ( 1 , 2 ).…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity—A Narrative Review

Mireștean

Iancu

2022

Front. Oncol.

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Breast cancer is the most common cancer among women worldwide, which is often treated with radiotherapy. Whole breast irradiation (WBI) is one of the most common types of irradiation. Hypo-fractionated WBI (HF-WBI) reduces the treatment time from 5 to 3 weeks. Recent radiobiological and clinical evidence recommended the use of HF-WBI regardless of the age or stage of disease, and it is proven that hypo-fractionation is non-inferior to conventional fractionation regimen irradiation. However, some studies report an increased incidence of heart-related deaths in the case of breast irradiation by hypo-fractionation, especially in patients with pre-existing cardiac risk factors at the time of treatment. Due to the new technical possibilities of radiotherapy techniques, HF-WBI can reduce the risk of cardiac toxicity by controlling the doses received both by the heart and by the anatomical structures of the heart. The radiobiological “double trouble”, in particular “treble trouble”, for hypo-fractionated regimen scan be avoided by improving the methods of heart sparing based on image-guided irradiation (IGRT) and by using respiration control techniques so that late cardiac toxicity is expected to be limited. However, long-term follow-up of patients treated with HF-WBI with modern radiotherapy techniques is necessary considering the progress of systemic therapy, which is associated with long-term survival, and also the cardiac toxicity of new oncological treatments. The still unknown effects of small doses spread in large volumes on lung tissue may increase the risk of second malignancy, but they can also be indirectly involved in the later development of a heart disease. It is also necessary to develop multivariable radiobiological models that include histological, molecular, clinical, and therapeutic parameters to identify risk groups and dosimetric tolerance in order to limit the incidence of late cardiac events. MR-LINAC will be able to offer a new standard for reducing cardiac toxicity in the future, especially in neoadjuvant settings for small tumors.

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Section: Introductionmentioning

confidence: 99%

Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity—A Narrative Review

Mireștean

Iancu

2022

Front. Oncol.

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Autologe Brustrekonstruktion und Bestrahlung: Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM)

Heine-Geldern,

Hirche,

Kremer

et al. 2024

Handchir Mikrochir Plast Chir

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ZusammenfassungDie autologe Brustrekonstruktion nach Mastektomie mittels freien Lappenplastiken (kurz: autologe Brustrekonstruktion) zeigt im Vergleich zur Implantat-basierten Rekonstruktion günstige klinische Langzeitergebnisse und eine höhere Patientenzufriedenheit. Traditionell galt die adjuvante Strahlentherapie als relative Kontraindikation für die sofortige autologe Brustrekonstruktion aufgrund der unvorhersehbaren Strahlenfolgen. Moderne adjuvante Strahlentherapien (PMRT) konnten jedoch akute und chronische Strahlenschäden deutlich reduzieren. Dennoch zögern Plastische Chirurgen immer noch, Patientinnen, die eine adjuvante Strahlentherapie benötigen, eine sofortige autologe Brustrekonstruktion anzubieten. In jüngster Zeit gibt es jedoch Hinweise auf einen Paradigmenwechsel, der eine solche Rekonstruktion trotz anschließender Strahlentherapie befürwortet. Im Rahmen eines Konsensus-Workshops der 44. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM) in Bern (Schweiz) wurde die Evidenz zur PMRT und autologer Brustrekonstruktion dargestellt und Konsensus-Formulierungen zum zukünftigen chirurgischen Management und zur zeitlichen Koordinierung erarbeitet. Dabei wurde betont, dass das Ziel jeder Rekonstruktion eine weiche und möglichst sensible Brust sein sollte, welche durch ein sicheres Verfahren eine bestmögliche Symmetrie in Form und Größe zur nicht betroffenen Gegenseite schafft. Es wurde konsentiert, dass die Erhaltung des originären Haut- und Weichteilmantels im Sinne einer hautsparenden oder sogar Mamillen-Areolen-Komplex (MAK) sparenden Mastektomie bei gleicher onkologischer Sicherheit die besten ästhetischen Ergebnisse erbringt. Abschließend konnte ein Konsens gefunden werden, dass eine PMRT und die zu erwartenden Strahlenfolgen entgegen dem ursprünglichen Meinungsbild vor dem Workshop nicht mehr eine Kontraindikation für eine autologe Sofortrekonstruktion darstellen sollten.

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NDRG1 expression is an independent prognostic factor in inflammatory breast cancer

Villodre

Gong

Huo

et al. 2020

Preprint

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NDRG1 is widely described as a metastasis suppressor in breast cancer. However, we found that NDRG1 is critical in promoting tumorigenesis and brain metastasis in mouse models of inflammatory breast cancer (IBC), a rare but highly aggressive form of breast cancer. We hypothesized that NDRG1 is a prognostic marker associated with poor outcome in patients with IBC. Microarray gene expression data from the IBC Consortium dataset were analyzed to compare NDRG1 expression between IBC and non-IBC tumors and among breast cancer subtypes. NDRG1 levels in tissue microarrays from 64 IBC patients were evaluated by immunohistochemical staining with anti-NDRG1 primary antibody (32 NDRG1-low [≤ median], 32 NDRG1-high [>median]). Overall and disease-free survival (OS and DSS) were analyzed with Kaplan–Meier curves and log-rank test. NDRG1 mRNA expression was higher in IBC than in non-IBC tumors (p=0.007), and in more aggressive HER2+ and basal-like vs luminal IBC subtypes (p<0.0001). Univariate analysis showed NDRG1 expression, tumor grade, disease stage, estrogen receptor (ER) status, and receipt of adjuvant radiation to be associated with OS and DSS. NDRG1-high patients had poorer 10-year OS and DSS than NDRG1-low patients (OS, 19% vs 45%, p=0.0278; DSS, 22% vs 52%, p=0.0139). On multivariable analysis, NDRG1 independently predicted OS (hazard ratio [HR]=2.034, p=0.0274) and DSS (HR=2.287, p=0.0174). NDRG1-high ER-negative tumors had worse outcomes OS, p=0.0003; DSS, p=0.0003; and NDRG1-high tumors that received adjuvant radiation treatment had poor outcomes (OS, p=0.0088; DSS, p=0.0093). NDRG1 correlated positively with aggressive tumor characteristics in IBC and was a significant independent prognostic factor for DSS and OSS in IBC patients. Targeting NDRG1 may represent a novel strategy for improving clinical outcomes for patients with IBC.

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The evolution of adjuvant radiation therapy for early‐stage and locally advanced breast cancer

Cited by 4 publications

References 31 publications

Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity—A Narrative Review

Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity—A Narrative Review

Autologe Brustrekonstruktion und Bestrahlung: Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM)

NDRG1 expression is an independent prognostic factor in inflammatory breast cancer

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