Search

BACKGROUND: The objective of this study was to examine clinical outcomes and patterns of failure in patients with early stage breast cancer who developed an ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) using accelerated partial breast irradiation (APBI). METHODS: In total, 1440 patients (1449 tumors) with early stage breast cancer who underwent BCT were treated with the MammoSite device to deliver APBI (34 Gray [Gy] in 3.4-Gy fractions). One thousand two hundred fifty-five patients (87%) had invasive breast cancer (IBC) (median tumor size, 10 mm), and 194 patients (13%) had ductal carcinoma in situ (DCIS) (median tumor size, 8 mm). The median follow-up was 60 months. RESULTS: Fifty patients (3.5%) developed an IBTR for a 5-year actuarial rate of 3.61% (3.65% for IBC and 3.36% for DCIS). It was determined that 36 recurrences (72%) represented new primary cancers, and 14 recurrences (28%) represented recurrences of the index lesion. Of the 32 recurrences with known histology, 78% were IBC, and 22% were DCIS. After IBTR, 28 of 38 patients (74%) underwent salvage mastectomy, and 9 of 38 patients (26%) had a second attempt at BCT. Adjuvant therapies included tamoxifen in 8 patients (16%) and systemic chemotherapy in 6 patients (12%). The 3-year rates of disease-free survival, cause-specific survival, and overall survival after IBTR were 58.7%, 92.1%, and 80.5%, respectively. CONCLUSIONS: With 5 years of follow-up, APBI produced clinical outcomes and patterns of failure comparable to those achieved with whole breast irradiation. Patients who developed an IBTR after APBI had excellent 3-year survival outcomes after salvage treatments. Cancer 2012. © 2012 American Cancer Society.

Lymphatic mapping with the identification and removal of axillary sentinel lymph nodes (SLNs) currently is standard practice in the surgical management of patients with early stage breast cancer.1-3 SLNs are accurate predictors of the status of nonsentinel lymph nodes, with a negative predictive value (NPV) approaching 100%.4 Intraoperative evaluation of SLNs allows for complete axillary dissection at the time of primary breast surgery if the SLNs are identified as positive for metastatic tumor, eliminating the need for a second surgical procedure with its associated costs, morbidity, and patient distress. Although there is general agreement that SLNs should be sliced at 2-mm intervals for pathologic evaluation, to our knowledge, no consensus exists regarding the optimal method for intraoperative and final pathologic examination of SLNs in breast cancer. Intraoperative evaluation may include frozen section, touch imprint cytology (IC), scrape cytology, or a combination of these techniques. Although the specificity of these techniques is excellent, the sensitivity varies widely, ranging from 50% to 75%.5-8 It has been reported that intraoperative frozen section analysis of the entire lymph node sectioned at 50-μm intervals dramatically increases the sensitivity of detecting metastatic disease, although it is not feasible or practical at most centers.4 Intraoperative rapid cytokeratin immunostaining also can improve the sensitivity of the evaluation9; however, this test is not widely available. There also is much variability in the protocols adopted by different laboratories for the final pathologic evaluation of SLNs in breast cancer. In addition, pathologic assessments examine a very small amount of the lymphoid tissue and are subject to interobserver variability in interpretation,10 prompting the development of standardized techniques. Molecular testing of SLNs can enable standardized, objective, and rapid evaluation. In this report, we describe a novel, fully automated molecular device, the “One Step Nucleic Acid Amplification (OSNA) Breast Cancer System” (Sysmex Corporation, Kobe, Japan), which combines reverse transcription (RT) with isothermal loop-mediated DNA amplification (RT-LAMP) for the detection of cytokeratin 19 (CK19) messenger RNA (mRNA) as a marker of metastatic carcinoma in SLNs. In a large, prospective, multicenter study, we compared the performance of the OSNA system with that of a detailed histopathologic examination of the lymph node and with IC for the detection of metastatic carcinoma in axillary SLNs in patients who had early stage breast cancer.

BACKGROUND: The American Society for Radiation Oncology (ASTRO) consensus statement (CS) for the application of accelerated partial breast irradiation (APBI) was applied to patients who were treated with this technique on the American Society of Breast Surgeons MammoSite Registry Trial to determine potential differences in clinical outcome based on classification group. METHODS: Patients were classified based on the CS groups of “suitable,” “cautionary,” and “unsuitable.” Rates of ipsilateral breast tumor recurrence (IBTR), regional lymph node failure, distant metastases, disease-free survival, cause-specific survival, and overall survival were assessed. RESULTS: Of the 1449 cases who were treated, 1025 patients (71%) could be classified according to the CS groupings, including 419 patients (41%) who fit the “suitable” criteria, 430 patients (42%) who fit the “cautionary” criteria, and 176 patients (17%) who fit the “unsuitable” criteria. At a median follow-up of 53.5 months, the 5-year actuarial rates of IBTR for the “suitable,” “cautionary,” and “unsuitable” groups were 2.59%, 5.43%, and 5.28%, respectively (P = .1884). Univariate analysis of factors potentially associated with IBTR indicated that negative estrogen receptor status was the only variable associated with IBTR among patients with invasive breast cancer (odds ratio [OR], 4.01; P = .0003). Larger tumor size was associated with a greater risk of distant metastasis (OR, 3.05; P = .0001). Among patients with ductal carcinoma in situ, only age

BACKGROUND. This report presents 3 years of data on treatment efficacy, cosmetic results, and toxicities for patients enrolled on the American Society of Breast Surgeons MammoSite (Cytyc, Bedford, Mass) Breast Brachytherapy Registry Trial. METHODS. A total of 1440 patients (1449 cases) with early stage breast cancer who were undergoing breast-conserving therapy were treated with the MammoSite device to deliver accelerated partial breast irradiation (APBI) (34 Gy in 3.4 Gy fractions). Of these, 1255 (87%) cases had invasive breast cancer (IBC; median size = 10 mm), and 194 (13%) cases had ductal carcinoma in situ (DCIS; median size = 8 mm). Median follow-up was 30.1 months. RESULTS. Twenty-three (1.6%) cases developed an ipsilateral breast tumor recurrence (IBTR) for a 2-year actuarial rate of 1.04% (1.11% for IBC and 0.59% for DCIS). No variables were associated with IBTR. Six (0.4%) patients developed an axillary failure. The percentages of breasts with good to excellent cosmetic results at 12 (n = 980), 24 (n = 752), 36 (n = 403), and 48 months (n = 67 cases) were 95%, 94%, 93%, and 93%, respectively. Breast seromas were reported in 23.9% of cases (30% in open-cavity implants and 19% in closed-cavity implants). Symptomatic seromas occurred in 10.6% of cases, and 1.5% of cases developed fat necrosis. A subset analysis of the first 400 consecutive cases enrolled was performed (352 with IBC, 48 DCIS). With a median follow-up of 37.5 months, the 3-year actuarial rate of IBTR was 1.79%. CONCLUSIONS. Treatment efficacy, cosmesis, and toxicity 3 years after treatment with APBI using the MammoSite device are good and similar to those reported with other forms of APBI with similar follow-up. Cancer 2008. © 2008 American Cancer Society.

BACKGROUND: The purpose of this study was to determine the ipsilateral breast tumor recurrence (IBTR) in ductal carcinoma in situ (DCIS) patients treated in the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial who met the criteria for E5194 treated with local excision and adjuvant accelerated partial breast irradiation (APBI). METHODS: A total of 194 patients with DCIS were treated between 2002 and 2004 in the Mammosite registry trial; of these, 70 patients met the enrollment criteria for E5194: 1) low to intermediate grade (LIG)—pathological size >0.3 but