National Cancer Institute®
Last Modified: June 1, 2002
UI - 11932224
AU - Amin R; Hamilton-Wood C; Silver D
TI - Subcutaneous calcification following chest wall and breast irradiation: a late complication.
SO - Br J Radiol 2002 Mar;75(891):279-82
AD - Department of Radiation Oncology, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
Subcutaneous calcification as a complication of chest wall irradiation has only been described once before in the literature. Six patients who developed heavy calcification of soft tissue following chest wall and breast irradiation are described here, and relevant literature is reviewed.
UI - 12013281
AU - Proulx GM; Loree T; Edge S; Hurd T; Stomper P
TI - Outcome with postmastectomy radiation with transverse rectus abdominis musculocutaneous flap breast reconstruction.
SO - Am Surg 2002 May;68(5):410-3
AD - Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
The effects of radiation on the outcome of patients undergoing transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction have not been extensively studied. Concern still exists of a possible negative impact secondary to irradiation as related to control of disease, cosmetic outcome, and flap viability. Thirty-six patients underwent both a modified radical mastectomy (MRM) with TRAM flap reconstruction and irradiation to the chest wall to include the TRAM flap and/or regional nodes either before reconstruction or after TRAM flap reconstruction. Fifteen patients had all of their treatment and follow-up at our institution and were retrospectively reviewed to assess treatment and outcome. During a median follow-up of 36 months there were no local-regional failures. One patient at Stage IIIA failed with distant metastases 3 years after treatment. One patient had a flap loss from a nonhealing wound after reconstruction performed 2 years after MRM and radiotherapy. Only one patient expressed dissatisfaction with the cosmetic outcome. Patients undergoing MRM with TRAM flap reconstruction and irradiation before or after reconstruction can achieve excellent local-regional control and satisfactory cosmesis. Risk of flap loss is low. Further follow-up is needed for assessing longer-term outomes in this patient group. Larger prospective studies are necessary for more definitive conclusions.
UI - 11992392
AU - Neuschatz AC; DiPetrillo T; Safaii H; Lowther D; Landa M; Wazer DE
TI - Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast.
SO - Int J Cancer 2001;96 Suppl():97-104
AD - Department of Radiation Oncology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
In order to assess the utility of margin width in relation to other histopathologic features as a determinant of local control in ductal carcinoma in situ (DCIS) of the breast, we retrospectively examined the treatment of 109 breasts treated with (n = 54) or without adjuvant radiotherapy (n = 55). Median follow-up was 49 and 54 months for patients treated with excision alone (E) or excision plus adjuvant radiotherapy (E+XRT), respectively. Cases treated with E+XRT were significantly larger and had a trend towards closer surgical margins than those treated with E alone. For all cases, margin width < or = 1 mm and lesion diameter >15 mm were significantly associated with increased local recurrence. Lesion size < or = 15 mm was associated with no cases of local failure regardless of treatment arm. For lesions >15 mm in diameter, there was a significant decrease in 5-year local failure with E+XRT compared to E alone (21% vs. 36%, P = 0.03). Tumor margin >1 mm was associated with a low rate of 5-year local failure for either E alone or E+XRT (10.9% vs. 4.6%, P = NS). Tumor margin < = 1 mm had a high rate of local failure that was not significantly decreased by the addition of adjuvant radiotherapy. These results show that large diameter (>15 mm) and close surgical margins (< or = 1 mm) are the dominant risk factors for local recurrence in DCIS. E+XRT significantly decreased local failure risk compared to E alone for large lesions but not for those with close margins. Copyright 2002 Wiley-Liss, Inc.
UI - 12039934
AU - Lee JH; Glick HA; Hayman JA; Solin LJ
TI - Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients.
SO - J Clin Oncol 2002 Jun 1;20(11):2713-25
AD - Department of Radiation Oncology, Division of General Internal Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA. firstname.lastname@example.org
PURPOSE: To present a decision model that describes the clinical and economic outcomes of node-positive breast cancer with and without postmastectomy radiation therapy (PMRT). METHODS: A Markov process was constructed to project the natural history of breast cancer following mastectomy in premenopausal node-positive women. Biannual hazards of local and distant recurrence without PMRT were derived from a large meta-analysis of adjuvant systemic therapy trials for breast cancer. The addition of PMRT reduced the risk of disease relapse by an odds ratio of 0.69. Costs of PMRT ($11,600) and recurrent breast cancer ($4,250 to 16,200/year) were estimated from available literature. The model projected number of recurrences, relapse-free and overall survival, and costs to 15 years, using a discount rate of 3%. Cost-effectiveness ratios were calculated per incremental year of life and quality-adjusted year of life gained. One- and two-way sensitivity analyses were performed to determine the sensitivity of results to clinical and economic assumptions. RESULTS: The model projected 15-year relapse-free survival of 52% and 43% with and without PMRT, respectively. Overall survival was increased from 48% to 55% with PMRT, resulting in an incremental 0.29 years of life gained per subject. PMRT increased 15-year costs from $40,800 to $48,100. Cost per year of life gained was $24,900, or $22,600 when survival was adjusted for quality of life. Results of the model were relatively sensitive to radiation therapy cost and breast cancer relapse risk. CONCLUSION: This analysis suggests that PMRT offers substantial clinical benefits achieved in a cost-effective manner, with an average cost per year of life gained of $24,900. Results of the model were robust under a wide range of clinical and economic parameters.
UI - 11773304
AU - Pierce LJ
TI - Treatment guidelines and techniques in delivery of postmastectomy radiotherapy in management of operable breast cancer.
SO - J Natl Cancer Inst Monogr 2001;(30):117-24
AD - Department of Radiation Oncology, University of Michigan School of Medicine UHB2C490, Box 0010, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA. email@example.com
Radiation therapy has been shown to statistically significantly reduce the risk of locoregional recurrence in high-risk patients with operable breast cancer following mastectomy and systemic therapy. Recent trials have also demonstrated a significant survival benefit following radiotherapy in high-risk patients. Therefore, it is important to identify the patients who could potentially derive that survival benefit and to not offer treatment to those patients who are not at increased risk for failure. Established risk factors that predict for increased rates of locoregional recurrence include axillary lymph node involvement and T3 (or T4) disease. While treatment-related factors, such as the extent of the axillary dissection and extent of lymph nodal positivity, also undoubtedly affect locoregional recurrence, additional studies are needed to define the magnitude of their risk. Locoregional patterns of failure have identified the chest wall and supraclavicular/infraclavicular regions to be the most common sites of locoregional failure following mastectomy, which justifies treatment to these regions. While long-term complications are uncommon following locoregional radiotherapy, careful treatment planning is critical to minimize cardiac (and pulmonary) toxicity.
UI - 12040281
AU - Schwarz RE; Hillebrand G; Peralta EA; Chu DZ; Weiss LM
TI - Long-term survival after radical operations for cancer treatment-induced sarcomas: how two survivors invite reflection on oncologic treatment concepts.
SO - Am J Clin Oncol 2002 Jun;25(3):244-7
AD - Department of General Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA.
Extent and radicality of surgical oncologic treatment has changed in the past 30 years. Two patients with node-positive breast cancer are presented, who underwent (total or radical) mastectomy with lymphadenectomy and postoperative radiation 24 and 40 years ago. A radiation-associated sarcoma of the parascapular soft tissue developed in one patient 9 years after treatment; the other one sought treatment for a lymphedema-associated Stewart-Treves lymphangiosarcoma 16 years after initial therapy. Both patients underwent a forequarter amputation for their treatment-associated high-grade sarcoma. Both are currently alive and cancer-free 15 and 24 years after amputation. These reports remind us that radical locoregional treatment can cure some solid cancers in the absence of systemic therapy; that such extensive treatment may induce significant disability or secondary malignancies long-term; that even advanced treatment-associated sarcomas can be cured with aggressive resection; that today's multimodality therapy approaches and appropriate patient selection have rendered such extensive locoregional treatment for many tumors obsolete or unnecessary; and that if no effective alternative treatment exists and organ or limb preservation is not feasible, an aggressive resection approach for high-grade cancer should not be discounted unless systemic failure is certain or imminent.
UI - 12057080
AU - Taylor ME
TI - Breast cancer: chest wall recurrences.
SO - Curr Treat Options Oncol 2002 Apr;3(2):175-7
AD - Department of Radiation Oncology, Washington University School of Medicine, 4939 Children's Place, Suite 5500, Box 8224/21, St. Louis, MO 63110, USA. firstname.lastname@example.org
Irradiation is indicated for patients undergoing mastectomy as surgical management for breast cancer treatment when clinical or pathologic tumor and nodal features predict risk of local/regional recurrence. Such features include: tumor size >/= 5 cm, inadequate surgical margins; skin, facial, or skeletal muscle invasion; dermal lymphatic invasion; poorly differentiated tumor histology; four or more lymph nodes positive; gross extracapsular tumor nodal extension into soft tissues; and matted lymph nodes or enlarged lymph nodes > 2 cm. Patients who were treated with irradiation after mastectomy can develop local/regional recurrences despite such adjuvant therapy. General management for chest wall and nodal recurrences is structured on the extent and volume of local/regional disease, the absence of distant metastases, the general health of the patient, and the extent of prior local/regional therapies, especially irradiation. Management of local/regional recurrence in the setting of no prior irradiation includes tumor debulking by systemic or surgical treatment followed by comprehensive chest wall and regional lymphatic irradiation. Doses are selected by tissue tolerances and volume of remaining disease. The management strategy for the patient with a history of irradiation parallels the nonirradiated patient with respect to systemic and surgical therapies to debulk the tumor to maximal response or no gross clinical disease. Radiation field design is determined by prior therapies. Doses to these fields are adjusted to normal tissue tolerance. Irradiation is given with a sensitizer such as hyperthermia or 5-fluorouracil chemotherapy. Use of radiation sensitizers can allow for a more meaningful biologic tumor effect when normal tissue tolerances prohibit delivery of standard tumor doses. Hyperthermia has been used effectively to promote complete tumor responses with use of irradiation in re-treatment cases.
UI - 11963223
AU - Happle R; Starink TM
TI - [Radiation-induced cutaneous hamartoma in a patient with Cowden syndrome. Clinical evidence for heterozygosity]
SO - Hautarzt 2002 Jan;53(1):47-9
AD - Dermatologische Klinik der Universitat Marburg, Deutschhausstrasse 9, 35033 Marburg. email@example.com
A 56-year-old woman had typical features of Cowden syndrome in the form of hamartomas involving the skin, lips, and oral mucosa. At the age of 48, a mastectomy was performed for adenocarcinoma with a regional metastasis, and X-ray treatment was applied to the left axilla. Subsequently the patient developed approximately 30 skin-colored nodules surrounding the irradiated axillary region within several months. Histopathological examination of one of these lesions showed characteristic features of sclerotic fibroma. The multiple radiation-induced fibrous hamartomas observed may be best explained by multiple events of loss of heterozygosity (LOH), because molecular studies in other patients with Cowden syndrome have shown that both benign and malignant tumors originate from LOH. The X-ray treatment would have induced LOH in many cells, giving rise to either homo- or hemizygosity for the Cowden mutation.
UI - 12043216
AU - Mitsumori M
TI - [Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Breast cancer]
SO - Nippon Igaku Hoshasen Gakkai Zasshi 2002 Mar;62(4):138-43
AD - Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University.
Evidenced-based medicine(EBM) is undergoing rapid acceptance as a principle of decision making in radiation oncology clinics. Adjuvant therapy for breast cancer is one of the most actively researched areas, and there is a great deal of clinical evidence of high-quality treatment of breast cancer. The case of 47-year-old premenopausal woman who underwent consultation for postmastectomy radiotherapy (PMRT) is presented, and the course of practice using EBM is described. Because she had one positive axillary lymph node, she received systemic chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel. She is also receiving trastuzumab and tamoxifen. She underwent immediate reconstruction with a TRAM flap. Existing guidelines point out that PMRT significantly reduces the risk of local recurrence; however, none of them recommend PMRT for a patient with < 4 positive lymph nodes because of the lack of firm evidence for improvement of overall survival. There is also some evidence that PMRT after immediate reconstruction reduces the cosmetic result and that paclitaxel might increase the risk of radiation pneumonitis even in sequential administration. She chose PMRT, although our recommendation was not to do so. Expertise in the area of breast cancer as well as high-level evidence developed in Japan is essential to effectively implement EBM.
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