Timing of radiotherapy in breast cancer conserving treatment

Redda, Maria Grazia Ruo; Verna, Roberta; Guarneri, Alessia; Sannazzari, G.L.

doi:10.1053/ctrv.2002.0252

Cited by 26 publications

(17 citation statements)

References 17 publications

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“…Fetal exposure doses during breast radiotherapy have been calculated for various stages of fetal development [25]. For those women who present with PABC in the late-second or early-third trimester, the decision to undergo breast conserving surgery followed by radiotherapy should be undertaken with the awareness that radiotherapy should start within 12 weeks of surgery and that any delay in treatment increases the likelihood of future metastases at a rate of 0.028-0.057% per day [26][27][28].…”

Section: Surgery and Radiation Therapymentioning

confidence: 99%

Breast cancer in pregnancy: a literature review

Molckovsky

Madarnas

2007

Breast Cancer Res Treat

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Purpose Breast cancer in pregnancy is a clinically challenging situation for patients and their physicians. A review of the literature was performed to help identify optimal treatment strategies. Methods A Medline search between 1966 to the present using the keywords ''breast'', ''carcinoma'', and ''pregnancy'' revealed numerous hits, from which English-language articles including epidemiologic studies, case series, and general summaries were reviewed. Results There is a paucity of prospective studies regarding diagnosis and treatment of breast cancer in pregnancy due to its rarity. However a general review of the literature database reveals that women diagnosed with breast cancer during pregnancy have similar disease characteristics to age-matched controls. Surgery remains the mainstay of treatment of breast cancer during pregnancy, and in some circumstances breast-conserving surgery is an acceptable option. Adjuvant treatment can proceed with some modifications that minimize harm to the fetus, namely limiting radiation exposure and timing chemotherapy properly. Post-partum decisions regarding lactation and future fertility should be addressed on a per-patient basis. Conclusion Breast cancer in pregnancy is an uncommon phenomenon but one which poses dilemmas for patients and their physicians. A multi-disciplinary approach is recommended for optimal clinical-decision making.

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Section: Surgery and Radiation Therapymentioning

confidence: 99%

Breast cancer in pregnancy: a literature review

Molckovsky

Madarnas

2007

Breast Cancer Res Treat

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“…Long wait criteria for adjuvant RT were six (node negative disease) or seven months (node positive disease) postsurgery if RT was preceded by CT, four months if it was not. 15,[42][43][44][45][46] These previous studies suggested that such waits, comprised of systemic delays and necessary waiting (investigations, preparation for treatment and post-surgical recovery periods) may be associated with disease recurrence, metastases and shorter survival. This study's descriptive epidemiologic analyses will allow for the practical empirical planning of future multivariate analyses of the relationships between breast cancer care waits and survival in Canada and the United States.…”

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confidence: 99%

Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

Gorey¹,

Luginaah²,

Holowaty³

et al. 2009

CIM

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Clin Invest Med 2009; 32 (3): E239-E249. AbstractPurpose. The demand for cancer care has increased among aging North American populations as cancer treatment innovations have proliferated. Gaps between supply and demand may be growing. This study examined whether socioeconomic status has a differential effect on waits for surgical and adjuvant radiation treatment (RT) of breast cancer in Canada and the US. Methods. Ontario and California cancer registries provided 929 and 984 breast cancer cases diagnosed between 1998 and 2000 in diverse urban and rural places. Residencebased socioeconomic data were taken from censuses. Cancer care variables were reliably abstracted from health records: stage, receipt of surgery and RT, and waits from diagnosis to initial and initial to adjuvant treatment. Median waits were compared within-and between-country with the non-parametric Mann-Whitney U-test. Categorically long, age-adjusted wait comparisons used the Mantel-Haenszel chi-square test.Results. There were significant associations between lower socioeconomic status and longer surgical waits, lower access to adjuvant RT and to longer RT waits across diverse places in California. None were observed in Ontario. The two cohorts did not practically differ on access to surgery or on surgical waits. Compared with their counterparts in California, low-income Ontarians, particularly those in small urban places, gained greater access to RT, while high-income Americans had shorter waits for RT. Conclusions. This historical study contextualized Canada's "waiting-list problems" with evidence on breast cancer care, where lower income Americans seemed to have waited as long as similar Canadians. Many more lowincome Americans seemed to experience the longest wait of all for adjuvant care. They simply did not receive it. In contrast to stark American socioeconomic inequity, this study evidenced remarkable equity in Canadian breast cancer care.Clinical and common wisdom converged in the 1990s to ignite scientific and political interest in Canada's "waiting-list problem. that the gap between supply and demand may have been getting larger in Canada than in America. 4,5 However, the only previous study to test that hypothesis found no significant treatment delay differences among women diagnosed with breast cancer in 1988 in Washington state and the province of British Columbia. 6 No study has since compared evidence on cancer care delays in Canada and the United States (US). Breast cancer care has been most studied in this field. For a number of reasons it seems a sentinel indicator of health care performance. The most common type of cancer among Canadian and American women, its prognosis is excellent with early diagnosis and timely access to the best treatments. 7,8 Moreover, surgical innovations and new adjuvant radiation therapies (RT) after both breast conserving surgery and mastectomy were advanced over the past 20 years, 4,9 so their timely access seems of legitimate clinical and policy concern. The possibility of socioeconomic status (...

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“…If no chemotherapy is given, this should start within 12 weeks of surgery. Any delay in treatment increases the likelihood of future metastases at a rate of 0.028-0.057% per day [24]. Radiotherapy has long been considered incompatible with pregnancy; however, a recent review supports its use during pregnancy, in cases where the treatment field was distant from the gravid uterus [25].…”

Section: Radiotherapymentioning

confidence: 99%

Being Pregnant and Diagnosed with Breast Cancer

Loibl

Han²,

Amant³

2012

Breast Care

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Breast cancer during pregnancy (BCP) is an important subgroup within the young and very young breast cancer patients. It accounts for about 1% of all breast cancers. Due to an increased awareness, the attitude towards breast cancer during pregnancy has changed and, today, women with BCP are more likely to receive standard chemotherapy and have a term delivery instead of being advised to interrupt the pregnancy or undergo an early preterm delivery. This increased knowledge is based on small cohort studies and international collaborations such as the registry by the German Breast Group for BCP and the initiative of the European Society of Gynaecological Oncology (ESGO). Guidelines and recommendations such as the German guidelines by the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie, www.ago-online.org) and the National Comprehensive Cancer Network (NCCN) guidelines include recommendations for BCP. In general, surgery and chemotherapy (beyond the 13th week of gestation) can be safely performed during pregnancy. Chemotherapy should follow the treatment recommendations for breast cancer in young women. Trastuzumab, endocrine treatment, and radiotherapy are not indicated during pregnancy. Preterm delivery should be avoided as far as possible because it bears a higher risk of infant morbidity and mortality. The treatment of BCP should be planned within a multidisciplinary team including perinatologists, obstetricians and neonatologists.

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Timing of radiotherapy in breast cancer conserving treatment

Cited by 26 publications

References 17 publications

Breast cancer in pregnancy: a literature review

Breast cancer in pregnancy: a literature review

Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

Being Pregnant and Diagnosed with Breast Cancer

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