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8. Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial.

Author

Naoum, George E, Roberts, Sacha, Brunelle, Cheryl L, Shui, Amy M, Salama, Laura, Daniell, Kayla, Gillespie, Tessa, Bucci, Loryn, Smith, Barbara L, Ho, Alice Y, and Taghian, Alphonse G

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Breast Cancer, Prevention, Patient Safety, Clinical Research, Cancer, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Adult, Aged, Aged, 80 and over, Breast Cancer Lymphedema, Breast Neoplasms, Cohort Studies, Female, Humans, Incidence, Lymph Node Excision, Lymph Nodes, Lymphatic Metastasis, Middle Aged, Prospective Studies, Radiotherapy, Randomized Controlled Trials as Topic, Young Adult, Clinical Sciences, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

PurposeTo independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer-related lymphedema (BCRL) rates in patients with breast cancer.Patients and methodsFrom 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival.ResultsThe cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively).ConclusionAlthough RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

Published
2020

15. Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer

Author

Greenup, Rachel A, Blitzblau, Rachel C, Houck, Kevin L, Sosa, Julie Ann, Horton, Janet, Peppercorn, Jeffrey M, Taghian, Alphonse G, Smith, Barbara L, and Hwang, E Shelley

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Cancer, Clinical Research, Breast Cancer, Health Services, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Breast Neoplasms, Costs and Cost Analysis, Dose Fractionation, Radiation, Evidence-Based Practice, Female, Health Care Costs, Humans, Mastectomy, Segmental, Middle Aged, Neoplasm Grading, Neoplasm Staging, Postoperative Care, Radiotherapy Dosage, Radiotherapy, Adjuvant, Tumor Burden, Young Adult, Oncology & Carcinogenesis
Abstract

IntroductionBreast cancer treatment costs are rising, and identification of high-value oncology treatment strategies is increasingly needed. We sought to determine the potential cost savings associated with an evidence-based radiation treatment (RT) approach among women with early-stage breast cancer treated in the United States.Patients and methodsUsing the National Cancer Database, we identified women with T1-T2 N0 invasive breast cancers treated with lumpectomy during 2011. Adjuvant RT regimens were categorized as conventionally fractionated whole-breast irradiation, hypofractionated whole-breast irradiation, and omission of RT. National RT patterns were determined, and RT costs were estimated using the Medicare Physician Fee Schedule.ResultsWithin the 43,247 patient cohort, 64% (n = 27,697) received conventional RT, 13.3% (n = 5,724) received hypofractionated RT, 1.1% (n = 477) received accelerated partial-breast irradiation, and 21.6% (n = 9,349) received no RT. Among patients who were eligible for shorter RT or omission of RT, 57% underwent treatment with longer, more costly regimens. Estimated RT expenditures of the national cohort approximated $420.2 million during 2011, compared with $256.2 million had women been treated with the least expensive regimens for which they were safely eligible. This demonstrated a potential annual savings of $164.0 million, a 39% reduction in associated treatment costs.ConclusionAmong women with early-stage breast cancer after lumpectomy, use of an evidence-based approach illustrates an example of high-value care within oncology. Identification of high-value cancer treatment strategies is critically important to maintaining excellence in cancer care while reducing health care expenditures.

Published
2017

21. Randomized trial of medroxyprogesterone acetate for the prevention of endometrial pathology from adjuvant tamoxifen for breast cancer: SWOG S9630

Author

Potkul, Ronald K, Unger, Joseph M, Livingston, Robert B, Crew, Katherine D, Wilczynski, Sharon P, Salomon, Caryl G, Smith, Barbara L, Wong, Lucas, Campbell, David L, Einspahr, David E, Anderson, Garnet L, Hershman, Dawn, Goodman, Gary E, Brown, Powel H, Meyskens, Frank L, and Albain, Kathy S

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Health Sciences, Oncology and Carcinogenesis, Reproductive Medicine, Aging, Clinical Trials and Supportive Activities, Cancer, Clinical Research, Uterine Cancer, Breast Cancer, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Clinical sciences, Oncology and carcinogenesis, Epidemiology
Abstract

The proliferative effect of adjuvant tamoxifen on the endometrium can potentially result in endometrial abnormalities, including cancer in postmenopausal women. We conducted a randomized, controlled trial to assess endometrial pathological diagnoses in postmenopausal women with early stage, ER-positive breast cancer without endometrial pathology at baseline. They were assigned to tamoxifen alone versus tamoxifen plus cyclical medroxyprogesterone acetate (MPA 10 mg for 14 days every 3 months) for 5 years. Endovaginal sonograms (EVS) +/- endometrial biopsies (EMB) were required at baseline, 2 and 5 years. Of 313 patients registered, 296 were eligible and 169 (57%; 89, tamoxifen; 80, tamoxifen+MPA) were evaluable (completed year-2 EVS, with an EMB if stripe width was ⩾5 mm). Sixty (67%) of these in the tamoxifen arm had an endometrial stripe width ⩾5 mm (and underwent subsequent EMB) compared with 48 (60%) in the tamoxifen+MPA arm (P=0.40). There were four cases of proliferative endometrium and one simple hyperplasia on the tamoxifen arm (6% (95% confidence interval (CI): 2-13%) among evaluable patients and one proliferative endometrium on the tamoxifen+MPA arm (P=0.11). The overall fraction with benign endometrial abnormalities at year 2 was 3.6% (6/169; 95% CI: 1.3-7.6%), with only 1 (of 102) new benign proliferative event at year 5. The event rate in both arms was much lower than projected, making treatment arm comparisons less informative. A normal endometrium prior to tamoxifen may provide reassurance regarding future endometrial events. However, validation in a larger trial is needed before changing practice in asymptomatic, postmenopausal women.

Published
2016

26. Defect Repair After Breast Cancer Surgery

Author

Qi, Fazhi, Fan, Peizhi, Wang, Wei, Ouyang, Lizhi, Zhou, Bo, Austen, William G., Jr, Tang, Rong, Oren, Tessler, Smith, Barbara L., Wang, Wei, Series editor, Zhang, Zhiyuan, Series editor, Gao, Jingheng, Series editor, Ai, Yufeng, Series editor, Wu, Sufan, Series editor, Zhou, Xiao, editor, and Cao, Yilin, editor

Published
2018
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41. Intraoperative Fluorescence Guidance for Breast Cancer Lumpectomy Surgery

Author

Smith, Barbara L., primary, Hunt, Kelly K., additional, Carr, David, additional, Blumencranz, Peter W., additional, Hwang, E. Shelley, additional, Gadd, Michele A., additional, Stone, Kimberly, additional, Dyess, Donna L., additional, Dodge, Daleela, additional, Valente, Stephanie, additional, Dekhne, Nayana, additional, Clark, Patricia, additional, Lee, Marie Catherine, additional, Samiian, Laila, additional, Lesnikoski, Beth-Anne, additional, Clark, Lynne, additional, Smith, Kate Porta, additional, Chang, Manna, additional, Harris, Daniel K., additional, Schlossberg, Brian, additional, Ferrer, Jorge, additional, and Wapnir, Irene L., additional

Published
2023
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43. Abstract CT043: Feasibility study to evaluate performance of the LUM Imaging System for intraoperative detection of residual tumor in breast cancer patients receiving and not receiving neoadjuvant therapy

Author

Ferrer, Jorge M., primary, Wapnir, Irene, additional, Blumencranz, Peter, additional, Hunt, Kelly, additional, Hwang, Shelley, additional, Carr, David, additional, Smith, Kate, additional, Cruz, Heidi Santa, additional, Shanno, Julia, additional, Pogrebinsky, Alexander, additional, Chang, Manna, additional, and Smith, Barbara L., additional

Published
2023
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47. Supplementary Data from Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis

Author

Spring, Laura M., primary, Fell, Geoffrey, primary, Arfe, Andrea, primary, Sharma, Chandni, primary, Greenup, Rachel, primary, Reynolds, Kerry L., primary, Smith, Barbara L., primary, Alexander, Brian, primary, Moy, Beverly, primary, Isakoff, Steven J., primary, Parmigiani, Giovanni, primary, Trippa, Lorenzo, primary, and Bardia, Aditya, primary

Published
2023
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48. Abstract OT2-07-01: Feasibility study to evaluate performance of the LUM Imaging System for intraoperative detection of residual tumor in breast cancer patients receiving and not receiving neoadjuvant therapy

Author

Wapnir, Irene L., primary, Hunt, Kelly K., additional, Hwang, E Shelley, additional, Smith, Kate, additional, Blumencranz, Peter, additional, Carr, David, additional, Ferrer, Jorge, additional, Cruz, Heidi Santa, additional, Webster, Alexandra, additional, Shanno, Julia, additional, Pogrebinsky, Alexander, additional, Chang, Manna, additional, and Smith, Barbara L., additional

Published
2023
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50. Using machine learning to parse breast pathology reports

Author

Yala, Adam, Barzilay, Regina, Salama, Laura, Griffin, Molly, Sollender, Grace, Bardia, Aditya, Lehman, Constance, Buckley, Julliette M., Coopey, Suzanne B., Polubriaginof, Fernanda, Garber, Judy E., Smith, Barbara L., Gadd, Michele A., Specht, Michelle C., Gudewicz, Thomas M., Guidi, Anthony J., Taghian, Alphonse, and Hughes, Kevin S.

Published
2017
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