Clinical breast cancer最新文献_第6页

The Influence of Socioeconomic Status on Stage at Diagnosis and Survival in Young Breast Cancer Patients 社会经济地位对年轻乳腺癌患者诊断分期及生存的影响。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-24 DOI: 10.1016/j.clbc.2025.11.008

Alexandra Harris , Ryan Conrardy , Aniko Szabo , Lubna N. Chaudhary

Background

Breast cancer is the most common cancer in women. Women of low socioeconomic status (SES) are at increased risk for being diagnosed with later stage breast cancer and experience poorer survival. However, younger women, especially women under 40, are underrepresented in breast cancer research given screening mammography is not recommended until age 40. How SES impacts stage at diagnosis and survival rates in women under 40 diagnosed with breast cancer has not been addressed.

Methods

Data was obtained from the national Surveillance, Epidemiology, and End Results (SEER)*Stat Research Plus Census Tract Attributes Specialty Database, including 27 unique variables representing patient, tumor, and treatment characteristics. Proportional odds logistic regression models were used to assess the relationship between SES and stage at diagnosis and Kaplan–Meier curves along with Cox-proportional hazards models were used to assess the relationship between SES and survival months.

Results

In both women of all ages and in women under 40, lower SES was significantly associated with later stage at breast cancer diagnosis (P < .001), poorer five-year (P < .001), and ten-year (P < .001) overall and breast-cancer specific survival rates in an incremental fashion.

Conclusion

SES significantly impacts breast cancer stage at diagnosis and survival rates in a graded fashion, with lowering SES corresponding with later stage at breast cancer diagnosis and poorer five-year and ten-year survival rates across all age groups, including women under 40. Improving screening rates in low SES populations and initiating high risk screening strategies at an earlier age in women with low SES may help ameliorate these disparities.

背景：乳腺癌是女性中最常见的癌症。社会经济地位较低的妇女被诊断为晚期乳腺癌的风险增加，生存期也较差。然而，年轻女性，尤其是40岁以下的女性，在乳腺癌研究中的代表性不足，因为乳房x光检查在40岁之前是不推荐的。SES如何影响40岁以下诊断为乳腺癌的女性的诊断阶段和生存率尚未得到解决。方法：数据来自国家监测、流行病学和最终结果(SEER)*Stat Research +普查区属性专业数据库，包括27个代表患者、肿瘤和治疗特征的唯一变量。采用比例odds logistic回归模型评估SES与诊断阶段之间的关系，采用Kaplan-Meier曲线和cox比例风险模型评估SES与生存月之间的关系。结果：在所有年龄段的女性和40岁以下的女性中，较低的社会经济地位与乳腺癌诊断晚期（P < 0.001）、较差的5年（P < 0.001）和10年（P < 0.001）总体生存率和乳腺癌特异性生存率呈递增趋势显著相关。结论：社会经济地位对乳腺癌诊断分期和生存率有显著影响，社会经济地位越低，乳腺癌诊断阶段越晚，5年和10年生存率越低，包括40岁以下妇女。提高低社会经济地位人群的筛查率，并在低社会经济地位妇女早期启动高风险筛查策略，可能有助于改善这些差异。

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引用次数: 0

Operating Point Optimization for Efficient Mammogram Triage Using Only Highly Elevated Probability scores 仅使用高概率评分进行有效乳房x线检查分诊的操作点优化

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-21 DOI: 10.1016/j.clbc.2025.11.007

Mark Traill , Jensen Jantz , Blair Richards , Shokoufeh Khalatbari , Jeffrey Hoffmeister , Julie Shisler , Crystal Snyder

Backgroud

Using AI breast cancer detection scores to triage screening mammogram patients has been described in several studies. This type of triage could expedite a cancer diagnosis and significantly shorten the time from screening mammogram to treatment. However, the optimal operating point, or score value, above which patients should be triaged, has not been well defined. Identifying practical operating points is important because the Positive Predictive Value (PPV), sensitivity, specificity, and false-negative (FN) rate at different operating points can vary greatly.

Materials and Methond

Using patient datasets constructed from a clinical practice, the performance metrics of various AI scoring models were calculated at different operating point levels.

Results

Mathematical analysis of the very highest cancer detection case scores revealed that they are highly specific for the presence of breast cancer with few false positives. Therefore, if only the few highest case scores are used for clinical triage, the expectation is that most patients triaged will have cancer.

Conclusion

In clinical practice, this approach could be used to identify patients who would benefit from immediate diagnostic workup without overwhelming the clinic logistics with false-positive cases.

一些研究已经描述了使用人工智能乳腺癌检测评分来筛选乳房x光检查患者。这种类型的分诊可以加快癌症的诊断，并显著缩短从乳房x光检查到治疗的时间。然而，最佳手术点，或分值，在此之上的患者应该进行分类，并没有很好的定义。确定实际操作点很重要，因为不同操作点的阳性预测值（PPV）、灵敏度、特异性和假阴性（FN）率可能会有很大差异。材料和方法利用从临床实践中构建的患者数据集，在不同的操作点水平上计算各种AI评分模型的性能指标。结果对最高的癌症检测病例分数的数学分析表明，它们对乳腺癌的存在具有高度特异性，几乎没有假阳性。因此，如果只有少数得分最高的病例被用于临床分诊，预计大多数分诊的患者将患有癌症。结论在临床实践中，该方法可用于识别从即时诊断检查中获益的患者，而不会因假阳性病例而使临床后勤不堪重负。

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引用次数: 0

National Breast Cancer Surgery Snapshot Study: Breast Cancer Surgery after Neoadjuvant Systemic Therapy in Primary Breast Cancer (MANS Study) 全国乳腺癌手术快照研究：原发性乳腺癌新辅助全身治疗后的乳腺癌手术（MANS研究）

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-16 DOI: 10.1016/j.clbc.2025.10.019

Gaelle Kramer , José Volders , Femke den Haring , Roza Opperman , Pauline Spronk , Petrousjka van den Tol , Marie-Jeanne Vrancken Peeters

Introduction

The use of neoadjuvant systemic therapy (NST) in primary breast cancer has increased worldwide. This study provides real-time data of the reasons and variation in NST, conversion rate of mastectomy to BCS and conversion rate of ALND to radiation or omission of axillary treatment.

Methods

This is a Breast Cancer Surgery Snapshot study, multicenter prospective cross-sectional study in 70 breast cancer hospitals in the Netherlands. For 2 months the reason for NST is registered with patient- and tumor characteristics. The expectation of the surgical procedure in breast and axilla before and after NST is noted and the actual surgical outcome after NST is registered.

Results

Four hundred sixty seven patients receiving NST were registered. The 3 main reasons for NST were in 26% axillary down-staging, 25% a triple negative (TN) tumor and 25% HER2+. Before NST, 219 patients (47%) were eligible for BCS. In 210 patients (45%) initially assigned to receive a mastectomy, 99 patients (47%) underwent BCS. Triple negativity had the highest conversion rate with 68%. Of all mastectomy patients, 30% showed a pCR of the breast. Axillary conversion from ALND to axillary sparing surgery was achieved in 87% cN+ patients.

Conclusion

In the Netherlands the main reasons for NST were subtype (triple negative, HER2+) and axillary down staging. Additional reasons for NST focused more on down staging to convert to BCS and improve cosmetic outcomes. Real time data showed that NST lead to very high conversion rates from mastectomy to BCS as well as high rates of omission of ALND after NST.

新辅助全身治疗（NST）在原发性乳腺癌中的应用在世界范围内有所增加。本研究提供了NST的原因和变化、乳房切除术到BCS的转换率和ALND到放疗或遗漏腋窝治疗的转换率的实时数据。方法：这是一项针对荷兰70家乳腺癌医院的乳腺癌手术快照研究，多中心前瞻性横断面研究。2个月来，NST的原因与患者和肿瘤的特征有关。记录NST前后对乳房和腋窝手术的预期，记录NST后的实际手术结果。结果467例患者接受了NST治疗。发生NST的3个主要原因是腋窝分期下降26%，三阴性（TN）肿瘤25%，HER2+ 25%。在NST之前，219例患者（47%）符合BCS的条件。210名患者（45%）最初接受乳房切除术，99名患者（47%）接受了BCS。三重否定的转化率最高，达到68%。在所有乳房切除术患者中，30%的患者显示乳房的pCR。87%的cN+患者实现了腋窝从ALND到腋窝保留手术的转换。结论荷兰NST发生的主要原因是亚型（三阴性、HER2+）和腋窝下分期。NST的其他原因更多地关注于低分期转化为BCS和改善美容效果。实时数据显示，NST导致从乳房切除术到BCS的转换率非常高，并且NST后ALND的遗漏率也很高。

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引用次数: 0

Do Not Rush to Omit Sentinel Lymph Node Biopsy for Early Breast Cancer Patients 早期乳腺癌患者不要急于忽略前哨淋巴结活检。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-14 DOI: 10.1016/j.clbc.2025.11.006

Níamh M. Smyth , Alexandra M. Zaborowski , Bukola V. Bolarinwa , Sandra Hembrecht , Rose Joyce Culhane , Abhi Narsiman , Clodagh T. Canavan , Jan Sørensen , Eithne Downey , Michael Allen , Abeeda Butt , Colm Power , Orla McArdle , Patrick G. Morris , Nuala Healy , Laura McKenna , Arnold D.K. Hill

Introduction

Recent data suggest that sentinel lymph node biopsy (SLNB) can be omitted in select patients with early breast cancer. The aim of this study was to determine the utility of SLNB for patients with early breast cancer.

Methods

A retrospective analysis of patients diagnosed with breast cancer in a Level IV hospital in Dublin, Ireland, between December 2013 and March 2024 was conducted. Inclusion criteria included: female patients ≥ 18 years, with cT1 disease and a negative preoperative axillary ultrasound, who underwent breast conserving surgery and a SLNB.

Results

In total, 334 patients were included. The median age was 59 years (26-91 years). The majority had invasive ductal carcinoma (261 patients, 78.1%) and were hormone receptor-postive and human epidermal growth factor receptor 2-negative (274 patients, 82%). Final N stage was N0 in 282 (84%) of patients. Fifty-two patients (16%) had a positive-SLNB, despite a negative preoperative axilla. Twenty-four patients underwent an axillary clearance, of which 7 (14%) were positive, with only 3 patients (12.5%) upstaged following axillary clearance. Eighty-four patients (25%) received chemotherapy due to positive-SLNB. In line with contemporary data, 9 patients (2.7%) were eligible for CDK4/6 inhibitors, 48 patients (14%) for escalation to nodal radiation, or 275 patients (82%) for de-escalation to partial breast radiation.

Conclusion

While SLNB may be safely omitted in specific contexts, its omission carries the risk of under- and over-treatment. Our findings demonstrate that SLNB continues to guide adjuvant therapy for breast cancer patients, and thus, support the ongoing use of SLNB.

简介：最近的数据表明，前哨淋巴结活检（SLNB）可以在选择早期乳腺癌患者中省略。本研究的目的是确定SLNB对早期乳腺癌患者的效用。方法：回顾性分析2013年12月至2024年3月在爱尔兰都柏林一家四级医院诊断为乳腺癌的患者。纳入标准：女性患者≥18岁，cT1病变，术前腋窝超声阴性，行保乳手术和SLNB。结果：共纳入334例患者。中位年龄为59岁（26-91岁）。大多数为浸润性导管癌（261例，78.1%），激素受体阳性，人表皮生长因子受体2阴性（274例，82%）。282例（84%）患者最终N期为0。52例（16%）患者的slnb阳性，尽管术前腋窝阴性。24例患者接受了腋窝清除率，其中7例（14%）阳性，只有3例（12.5%）患者在腋窝清除率后被抢镜。84例（25%）患者因slnb阳性接受化疗。与当代数据一致，9名患者（2.7%）符合CDK4/6抑制剂，48名患者（14%）符合升级到淋巴结放疗，275名患者（82%）符合降级到部分乳房放疗。结论：虽然在特定情况下可以安全地省略SLNB，但省略会带来治疗不足和过度治疗的风险。我们的研究结果表明，SLNB继续指导乳腺癌患者的辅助治疗，因此，支持SLNB的持续使用。

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引用次数: 0

Beyond BMI: Metabolic and Inflammatory Determinants of Recurrence After Neoadjuvant Therapy in Breast Cancer 超越BMI：乳腺癌新辅助治疗后复发的代谢和炎症决定因素。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-10 DOI: 10.1016/j.clbc.2025.11.004

Asim Armagan Aydin , Erkan Kayikcioglu

引用次数: 0

Response to “Cryotherapy in Taxane-Induced Peripheral Neuropathy: The Need for Objective Validation” 对“紫杉烷诱导的周围神经病变的冷冻治疗：需要客观验证”的反应。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-10 DOI: 10.1016/j.clbc.2025.11.005

Helya Kargar , Seyed Alireza Javadinia

引用次数: 0

Enhancing Breast Cancer Research Through Snapshot Studies: Benefits and Challenges 通过快照研究加强乳腺癌研究：益处和挑战

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-09 DOI: 10.1016/j.clbc.2025.10.011

Gabrielle Maria Kramer MD , Eva Heeling MD, PhD , José Henriette Volders MD, PhD , Marie-Jeanne Tertia Francoise Daphne Vrancken Peeters MD, PhD

Introduction

Snapshot studies have emerged as valuable research design in cancer research, offering rapid, multicenter evaluation of clinical practice on an (inter)national scale. Compared to randomized controlled trials, which are time- and resource-intensive, snapshot studies collect large-scale real-world data in reduced timeframe. In breast cancer care, snapshot studies are particularly effective identifying variations in clinical practice, guideline adherence, and surgical outcomes. Through the MANS and DECIDE studies, nationwide snapshot research on real-world surgical outcomes in breast cancer care is taking shape in the Netherlands.

Methods

This article outlines the design and implementation of snapshot studies within breast cancer research as prospective, cross-sectional, multicenter observational design without interventions. Key steps include defining a focused research question, establishing a multidisciplinary steering committee, developing a structured database, and outlining statistical considerations. Participating centers obtain local ethical approval and contribute pseudonymized patient data during a predefined inclusion period. Participation is promoted through coordinated recruitment, and collaborative authorship ensures recognition for all contributors.

Results

Lessons learned:

• Clearly define research questions to prevent data overload and maintain focus.

• Early multidisciplinary involvement improves study design and execution.

• Structured databases prevent data duplication and inconsistencies.

• Common challenges such as workload and data quality can be addressed through standardized templates and proactive communication.

• Experience from the MANS and DECIDE studies underline importance of structured planning, consistent data collection and team engagement.

Conclusion

Snapshot studies provide an efficient design for evaluating breast cancer care, as they generate valuable insights into clinical practice and contribute to evidence-based improvements in breast cancer treatment.

快照研究已经成为癌症研究中有价值的研究设计，在（国际）国家范围内提供快速、多中心的临床实践评估。与时间和资源密集的随机对照试验相比，快照研究可以在更短的时间内收集大规模的真实世界数据。在乳腺癌护理中，快照研究特别有效地识别临床实践、指南依从性和手术结果的变化。通过MANS和DECIDE研究，荷兰正在对乳腺癌护理的实际手术结果进行全国性的快照研究。方法：本文概述了乳腺癌研究中快照研究的设计和实施，作为前瞻性、横断面、无干预的多中心观察设计。关键步骤包括确定一个重点研究问题，建立一个多学科指导委员会，开发一个结构化数据库，概述统计考虑。参与中心获得当地的伦理批准，并在预定的纳入期间提供假名的患者数据。通过协调招聘促进参与，协作作者确保对所有贡献者的认可。•明确定义研究问题，以防止数据过载并保持焦点。•早期多学科参与改善研究设计和执行。•结构化数据库防止数据重复和不一致。•可以通过标准化模板和主动沟通来解决工作量和数据质量等常见挑战。•MANS和DECIDE研究的经验强调了结构化计划、一致的数据收集和团队参与的重要性。结论snapshot研究为评估乳腺癌护理提供了一种有效的设计，因为它们为临床实践提供了有价值的见解，并有助于改善乳腺癌的循证治疗。

{"title":"Enhancing Breast Cancer Research Through Snapshot Studies: Benefits and Challenges","authors":"Gabrielle Maria Kramer MD , Eva Heeling MD, PhD , José Henriette Volders MD, PhD , Marie-Jeanne Tertia Francoise Daphne Vrancken Peeters MD, PhD","doi":"10.1016/j.clbc.2025.10.011","DOIUrl":"10.1016/j.clbc.2025.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Snapshot studies have emerged as valuable research design in cancer research, offering rapid, multicenter evaluation of clinical practice on an (inter)national scale. Compared to randomized controlled trials, which are time- and resource-intensive, snapshot studies collect large-scale real-world data in reduced timeframe. In breast cancer care, snapshot studies are particularly effective identifying variations in clinical practice, guideline adherence, and surgical outcomes. Through the MANS and DECIDE studies, nationwide snapshot research on real-world surgical outcomes in breast cancer care is taking shape in the Netherlands.</div></div><div><h3>Methods</h3><div>This article outlines the design and implementation of snapshot studies within breast cancer research as prospective, cross-sectional, multicenter observational design without interventions. Key steps include defining a focused research question, establishing a multidisciplinary steering committee, developing a structured database, and outlining statistical considerations. Participating centers obtain local ethical approval and contribute pseudonymized patient data during a predefined inclusion period. Participation is promoted through coordinated recruitment, and collaborative authorship ensures recognition for all contributors.</div></div><div><h3>Results</h3><div>Lessons learned:</div><div>• Clearly define research questions to prevent data overload and maintain focus.</div><div>• Early multidisciplinary involvement improves study design and execution.</div><div>• Structured databases prevent data duplication and inconsistencies.</div><div>• Common challenges such as workload and data quality can be addressed through standardized templates and proactive communication.</div><div>• Experience from the MANS and DECIDE studies underline importance of structured planning, consistent data collection and team engagement.</div></div><div><h3>Conclusion</h3><div>Snapshot studies provide an efficient design for evaluating breast cancer care, as they generate valuable insights into clinical practice and contribute to evidence-based improvements in breast cancer treatment.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 50-57"},"PeriodicalIF":2.5,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Staging Invasive Lobular Carcinoma: A Prospective Study on the Efficacy of 18F-Fluoroestradiol (FES)-PET/CT 侵袭性小叶癌分期：18f -氟雌二醇(FES)-PET/CT疗效的前瞻性研究

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-08 DOI: 10.1016/j.clbc.2025.11.003

Matthew F. Covington , Samantha Salmon , Andrew Kozlov , Zane Archibald , Regan Butterfield , Sophie Stolk , Sam Mitchell , Kenneth Boucher , Regina Rosenthal , Jane Porretta , Kirstyn E. Brownson , Cindy Matsen , Mei Wei , Saundra Buys , Christos Vaklavas , Namita Chittoria , Brandon Buckway , Angela Meite , Jeffrey Yap

Background

Invasive lobular carcinoma (ILC) often presents diagnostic challenges on conventional imaging, necessitating advanced imaging strategies for accurate staging. [18F]Fluoroestradiol (FES), a PET radiopharmaceutical, targets estrogen receptor-positive (ER+) lesions, which are prevalent in ILC. This study evaluates the utility of FES-PET/CT compared to standard-of-care (SOC) imaging for staging ER+ ILC.

Patients and Methods

This IRB-approved prospective trial (October 2022-October 2024) enrolled adults with histologically confirmed ER+ ILC at a National Cancer Institute-designated Comprehensive Cancer Center. Participants underwent FES-PET/CT, with optional [18F]Fluorodeoxyglucose (FDG)-PET/CT. The primary endpoint was the percentage of stage changes post-FES-PET/CT compared to SOC imaging, analyzed using a 1-sided binomial proportions test. Imaging was interpreted by a blinded nuclear and breast radiology specialist, with staging per AJCC eighth edition guidelines.

Results

Of 27 enrolled participants, 25 underwent FES-PET/CT (2 excluded due to synthesis failure). Mean age was 60.3 years. Pre-FES-PET/CT staging was stage I (16%), II (60%), III (20%), and IV (4%). FES-PET/CT altered clinical staging in 32% of cases (P = .036), identifying occult stage IV disease in 12.5% and histologically confirmed axillary lymph node metastases in 8%. However, it missed axillary metastases in 28% compared to surgical staging. FDG-PET/CT, performed in 15 participants, showed 40% discordance with FES-PET/CT.

Conclusion

FES-PET/CT significantly enhances staging accuracy for ER+ ILC, detecting occult metastases that impact clinical management. Its limitations in axillary nodal detection suggest it complements, rather than replaces, surgical staging. Larger trials are needed to validate these findings.

背景：浸润性小叶癌（ILC）通常对常规影像学诊断提出挑战，需要先进的影像学策略来准确分期。[18F]氟雌二醇（Fluoroestradiol， FES）是一种PET放射性药物，靶向雌激素受体阳性（ER+）病变，这种病变在ILC中普遍存在。本研究评估了FES-PET/CT与标准护理（SOC）成像对ER+ ILC分期的效用。患者和方法：这项经irb批准的前瞻性试验（2022年10月至2024年10月）在国家癌症研究所指定的综合癌症中心招募组织学证实的ER+ ILC成人。参与者接受FES-PET/CT，可选择[18F]氟脱氧葡萄糖(FDG)-PET/CT。主要终点是fes - pet /CT与SOC成像后的分期变化百分比，使用单侧二项比例检验进行分析。成像由盲核和乳腺放射学专家解释，分期按照AJCC第八版指南。结果在27名入组参与者中，25人接受了FES-PET/CT检查（2人因合成失败而被排除）。平均年龄60.3岁。fes - pet /CT前分期为I期（16%）、II期（60%）、III期（20%）和IV期（4%）。FES-PET/CT改变了32%的病例的临床分期（P = 0.036）， 12.5%的病例发现了隐匿的IV期疾病，8%的病例在组织学上证实了腋窝淋巴结转移。然而，与手术分期相比，它错过腋窝转移的比例为28%。对15名参与者进行FDG-PET/CT检查，结果显示与FES-PET/CT有40%的不一致。结论fes - pet /CT可显著提高ER+ ILC的分期准确性，发现影响临床管理的隐匿性转移。它在腋窝淋巴结检测方面的局限性表明它是对手术分期的补充，而不是替代。需要更大规模的试验来验证这些发现。

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引用次数: 0

Quality of Life and Fear of Recurrence or Progression in Women With DCIS Who Did and Did Not Receive Radiotherapy. 接受和未接受放射治疗的DCIS患者的生活质量和对复发或进展的恐惧。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-06 DOI: 10.1016/j.clbc.2025.11.001

Michelle Sinclair, G Bruce Mann, Christina Kozul, Allan Park, Lesley Stafford

Background: Ductal carcinoma in situ (DCIS) is frequently identified during mammographic screening and treated to minimize the risk of development of invasive cancer. Local recurrence is a recognised risk after breast conserving surgery (BCS), and radiotherapy (RT) is frequently used to reduce this, despite having no impact on overall survival. Little is known about the impact of RT on patient-reported outcomes. We conducted a retrospective study to assess differences in health-related quality of life (HRQoL), fear of recurrence or progression (FRP), risk perceptions, and illness beliefs in women with DCIS, based on RT status.

Patients and methods: Women with DCIS diagnosed or treated at a tertiary hospital in Melbourne from 2010 to 2022 who underwent BCS were eligible. HRQoL (QLQ-C30; BR45), FRP (FCRI-SF), illness perceptions (BIPQ) and perceptions of risk of DCIS recurrence or progression were assessed by self-report.

Results: Questionnaires from 160 women (RT n = 80, no RT n = 80) were analysed. Median age was 65 and median time since diagnosis was 7.7 years. Overall impact on HRQoL of treatment was low irrespective of treatment. There was no difference in FRP according to RT status. Women who received RT had larger tumours (P < .001), more breast symptoms (P = .015) and stronger beliefs in the effectiveness of treatment (P = .034). In multivariate analysis, neuroticism, perceived likelihood of DCIS progression to invasive disease and emotional impact of DCIS predicted FRP.

Conclusion: DCIS treatment was associated with minimal long-term HRQoL impact and low FRP, irrespective of RT. Improving understanding of recurrence/progression risk may protect against persistent FRP in these women.

背景：导管原位癌（DCIS）在乳房x线摄影筛查中经常被发现，并进行治疗以降低发展为浸润性癌症的风险。局部复发是保乳手术（BCS）后公认的风险，放疗（RT）经常用于减少这种风险，尽管对总体生存没有影响。RT对患者报告结果的影响知之甚少。我们进行了一项回顾性研究，以评估基于放疗状态的DCIS女性健康相关生活质量（HRQoL）、复发或进展恐惧（FRP）、风险认知和疾病信念的差异。患者和方法：2010年至2022年在墨尔本一家三级医院诊断或治疗的DCIS妇女接受了BCS。采用自我报告的方式评估HRQoL （QLQ-C30; BR45）、FRP （FCRI-SF）、疾病感知（BIPQ）和DCIS复发或进展风险感知。结果：对160名妇女（RT = 80，无RT = 80）的问卷进行分析。中位年龄为65岁，中位诊断时间为7.7年。不论何种治疗方式，对HRQoL的总体影响均较低。不同RT状态的玻璃钢无差异。接受放疗的妇女肿瘤较大（P < 0.001），乳房症状较多（P = 0.015），对治疗效果的信念更强（P = 0.034）。在多变量分析中，神经质、DCIS进展为侵袭性疾病的感知可能性和DCIS的情绪影响预测FRP。结论：DCIS治疗与最小的长期HRQoL影响和较低的FRP相关，而与rt无关。提高对复发/进展风险的了解可以防止这些女性的持续性FRP。

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引用次数: 0

Intra-Operative Radiotherapy with Photons – Update of a Single Institution Registry Trial 术中光子放射治疗-单一机构注册试验的更新

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-03 DOI: 10.1016/j.clbc.2025.11.002

Caroline Oska , Eleni Kohilakis , Sheldon Feldman , Wolfgang Tome , Ying Jin , Ryung Kim , Keyur Mehta , Maureen McEvoy , Jana Fox

Background

Intraoperative radiotherapy (IORT) allows early-stage breast cancer patients to complete adjuvant radiation at the time of breast conserving surgery (BCS). In this study, we provide updated outcomes of women treated with IORT in the Bronx, New York.

Methods

This is a single-centre, prospective, institutional review-board-approved registry trial of patients treated with IORT using the Intrabeam system. Patients included women aged 45 years and older with estrogen-receptor positive, cT1-2N0 invasive carcinoma or grade 1-2, ductal carcinoma in-situ (DCIS). Exclusion criteria included BRCA mutation, neoadjuvant chemotherapy, or multicentric disease. Patients received a single dose of 20 Gy to the lumpectomy surface with 50kVp x-rays. Those with high-risk pathological features were recommended adjuvant whole breast irradiation (WBI). The primary outcome was locoregional recurrence. Secondary outcomes were overall survival and wound-healing complications.

Results

Between January 2018 and January 2024, 257 women were treated with IORT. The median age was 65.7, and most patients (76.7%) did not identify as white. Nine patients were treated bilaterally, yielding 266 treated lumpectomy cavities. Most tumors were pathologically T1 (n =195, 73.3%), followed by Tis (n =38, 14.2%), then T2 (n =31, 11.6%). Forty-three patients (16.6%) were recommended adjuvant WBI. Median follow-up was 3.7 years, during which there were 7 (2.6%) biopsy-proven ipsilateral breast tumor recurrences. Overall survival was 97.3%, and 10 patients (3.9%) had wound-healing complications.

Conclusion

IORT demonstrated a 97.4% locoregional control rate and spared 83.4% of women from the toxicity of WBI. IORT may serve as a safe alternative for women seeking more personalized treatment.

背景手术放疗（IORT）允许早期乳腺癌患者在保乳手术（BCS）时完成辅助放疗。在这项研究中，我们提供了纽约州布朗克斯接受IORT治疗的妇女的最新结果。方法：这是一项使用Intrabeam系统接受IORT治疗的患者的单中心、前瞻性、机构审查委员会批准的注册试验。患者包括45岁及以上的女性，雌激素受体阳性，cT1-2N0浸润性癌或1-2级导管原位癌（DCIS）。排除标准包括BRCA突变、新辅助化疗或多中心疾病。患者接受单剂量20gy乳房肿瘤切除表面50kVp x射线照射。有高危病理特征者推荐全乳辅助照射。主要结果为局部复发。次要结局是总生存和伤口愈合并发症。结果2018年1月至2024年1月，257名妇女接受了IORT治疗。中位年龄为65.7岁，大多数患者（76.7%）不为白人。9例患者接受双侧治疗，产生266个乳房肿瘤切除术腔。病理以T1型肿瘤居多（n =195, 73.3%），其次为Tis型（n =38, 14.2%），其次为T2型（n =31, 11.6%）。43例（16.6%）患者推荐辅助WBI。中位随访时间为3.7年，在此期间有7例（2.6%）活检证实的同侧乳腺肿瘤复发。总生存率97.3%，10例（3.9%）出现创面愈合并发症。结论iort局部控制率为97.4%，使83.4%的妇女免于WBI的毒性。IORT可以作为寻求更个性化治疗的女性的安全选择。

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引用次数: 0