Clinical breast cancer最新文献_第9页

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。

{"title":"Staging Invasive Lobular Carcinoma: A Prospective Study on the Efficacy of 18F-Fluoroestradiol (FES)-PET/CT","authors":"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","doi":"10.1016/j.clbc.2025.11.003","DOIUrl":"10.1016/j.clbc.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Patients and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 36-46"},"PeriodicalIF":2.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621861","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

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。

{"title":"Quality of Life and Fear of Recurrence or Progression in Women With DCIS Who Did and Did Not Receive Radiotherapy.","authors":"Michelle Sinclair, G Bruce Mann, Christina Kozul, Allan Park, Lesley Stafford","doi":"10.1016/j.clbc.2025.11.001","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.11.001","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630357","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

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。

{"title":"Intra-Operative Radiotherapy with Photons – Update of a Single Institution Registry Trial","authors":"Caroline Oska , Eleni Kohilakis , Sheldon Feldman , Wolfgang Tome , Ying Jin , Ryung Kim , Keyur Mehta , Maureen McEvoy , Jana Fox","doi":"10.1016/j.clbc.2025.11.002","DOIUrl":"10.1016/j.clbc.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 28-35"},"PeriodicalIF":2.5,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621862","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

Immunohistochemical Changes After Neoadjuvant Chemotherapy and Their Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis. 新辅助化疗后免疫组织化学变化及其对乳腺癌生存的影响：系统回顾和荟萃分析。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-01 DOI: 10.1016/j.clbc.2025.10.017

Marcelo Antonini, André Mattar, Gil Facina, Francisco Pimentel Cavalcante, Felipe Zerwes, Fabricio Palermo Brenelli, Antônio Luis Frasson, Eduardo Camargo Millen, Rodrigo Caires Campos, Letícia Xavier Félix, Juliana Calado Vieira, Marina Diógenes Teixeira, Marcelo Madeira, Rogério Fenile, Henrique Lima Couto, Leonardo Ribeiro Soares, Ruffo de Freitas Junior, Renata Arakelian, Renata Montarroyos Leite, Vitoria Rassi Mahamed Rocha, Luiz Henrique Gebrim

Changes in immunohistochemical (IHC) profiles following neoadjuvant chemotherapy (NAC) may impact therapeutic decisions and prognosis in breast cancer patients. However, the clinical significance of these biomarker conversions remains uncertain. To evaluate the frequency of IHC marker conversion (estrogen receptor [ER], progesterone receptor [PR], and HER2) after NAC and its association with pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS). We conducted a systematic review and meta-analysis of cohort studies reporting pre- and post-NAC IHC profiles in breast cancer. A comprehensive search was performed in PubMed, Embase, Scopus, and Web of Science. The ROBINS-I tool was used to assess risk of bias. Random-effects models were applied to calculate pooled conversion rates and assess the prognostic impact of IHC changes. Twenty-four studies (n = 5891 patients) were included. The pooled conversion rates were 9.2% for ER, 15.1% for PR, 8.6% for HER2. Loss of hormone receptor positivity was associated with a lower pCR rate and worse DFS (HR 1.42; 95% CI, 1.11-1.81). HER2 gain correlated with improved pCR. High heterogeneity was observed, and sensitivity analyses confirmed the robustness of the results. IHC profile changes after NAC are frequent and clinically relevant. Loss of hormone receptor expression may indicate poorer prognosis, while HER2 gain suggests improved treatment sensitivity. Reassessment of IHC markers post-NAC should be considered to optimize adjuvant therapy decisions.

新辅助化疗（NAC）后免疫组化（IHC）谱的变化可能影响乳腺癌患者的治疗决策和预后。然而，这些生物标志物转化的临床意义仍然不确定。评价NAC后IHC标志物（雌激素受体[ER]、孕激素受体[PR]、HER2）转换频率及其与病理完全缓解（pCR）、总生存期（OS）、无病生存期（DFS）的关系。我们对报告nac前后乳腺癌IHC概况的队列研究进行了系统回顾和荟萃分析。在PubMed， Embase， Scopus和Web of Science中进行了全面的搜索。使用ROBINS-I工具评估偏倚风险。应用随机效应模型计算合并转换率并评估IHC变化对预后的影响。纳入24项研究（n = 5891例患者）。ER的总转化率为9.2%，PR为15.1%，HER2为8.6%。激素受体阳性的丧失与较低的pCR率和较差的DFS相关（HR 1.42; 95% CI, 1.11-1.81）。HER2增益与pCR改进相关。观察到高度异质性，敏感性分析证实了结果的稳健性。NAC后免疫组化谱变化频繁且具有临床相关性。激素受体表达缺失可能提示预后较差，而HER2表达增加提示治疗敏感性提高。nac后应考虑重新评估免疫组化标志物，以优化辅助治疗决策。

{"title":"Immunohistochemical Changes After Neoadjuvant Chemotherapy and Their Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis.","authors":"Marcelo Antonini, André Mattar, Gil Facina, Francisco Pimentel Cavalcante, Felipe Zerwes, Fabricio Palermo Brenelli, Antônio Luis Frasson, Eduardo Camargo Millen, Rodrigo Caires Campos, Letícia Xavier Félix, Juliana Calado Vieira, Marina Diógenes Teixeira, Marcelo Madeira, Rogério Fenile, Henrique Lima Couto, Leonardo Ribeiro Soares, Ruffo de Freitas Junior, Renata Arakelian, Renata Montarroyos Leite, Vitoria Rassi Mahamed Rocha, Luiz Henrique Gebrim","doi":"10.1016/j.clbc.2025.10.017","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.10.017","url":null,"abstract":"<p><p>Changes in immunohistochemical (IHC) profiles following neoadjuvant chemotherapy (NAC) may impact therapeutic decisions and prognosis in breast cancer patients. However, the clinical significance of these biomarker conversions remains uncertain. To evaluate the frequency of IHC marker conversion (estrogen receptor [ER], progesterone receptor [PR], and HER2) after NAC and its association with pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS). We conducted a systematic review and meta-analysis of cohort studies reporting pre- and post-NAC IHC profiles in breast cancer. A comprehensive search was performed in PubMed, Embase, Scopus, and Web of Science. The ROBINS-I tool was used to assess risk of bias. Random-effects models were applied to calculate pooled conversion rates and assess the prognostic impact of IHC changes. Twenty-four studies (n = 5891 patients) were included. The pooled conversion rates were 9.2% for ER, 15.1% for PR, 8.6% for HER2. Loss of hormone receptor positivity was associated with a lower pCR rate and worse DFS (HR 1.42; 95% CI, 1.11-1.81). HER2 gain correlated with improved pCR. High heterogeneity was observed, and sensitivity analyses confirmed the robustness of the results. IHC profile changes after NAC are frequent and clinically relevant. Loss of hormone receptor expression may indicate poorer prognosis, while HER2 gain suggests improved treatment sensitivity. Reassessment of IHC markers post-NAC should be considered to optimize adjuvant therapy decisions.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630313","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

Effect of HER2-Low Expression on the Efficacy of CDK4/6 Inhibitors in Breast Cancer: A Meta-Analysis. her2低表达对CDK4/6抑制剂治疗乳腺癌疗效的影响：一项荟萃分析

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-10-30 DOI: 10.1016/j.clbc.2025.10.018

Lingling Ye, Yan Dai, Liushan Chen, Yuqi Liang, Jiafa He, Shenying Chen, Xue Song, Rui Xu, Qianjun Chen

CDK4/6 inhibitors combined with endocrine therapy have become the standard first-line and second-line therapy for advanced HR+/HER2- breast cancer. This study aimed to evaluate the impact of HER2 low expression on the efficacy of breast cancer patients treated with CDK4/6 inhibitors. We systematically searched 4 major databases and important conference proceedings up to May 2025, and screened out studies that reported the progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) in HR+/HER2-low breast cancer patients and HR+/HER2-zero breast cancer patients treated with CDK4/6 inhibitors. We calculated the pooled hazard ratio (HR) and its 95% confidence interval (CI). A total of 18 studies involving 8461 patients were finally included. Among them, HER2-low breast cancer patients accounted for 41.25% of the sample, and HER2-zero breast cancer patients accounted for 57.98% of the sample. The results showed that the progression-free survival (PFS) of HR+/HER2-low breast cancer patients treated with the combination of CDK4/6 inhibitors and endocrine therapy was significantly lower than that of HR+/HER2-zero breast cancer patients (HR = 1.19, 95% CI, 1.10-1.28, P < .0001). Further subgroup analysis indicated that among HER2-low patients, whether they received first-line treatment, subsequent treatment, or were treated with Ribociclib, their prognosis was worse. Analysis of OS showed no statistically significant difference between groups (HR = 1.00, 95% CI, 0.93-1.07, P = .93). Similarly, no significant differences were observed in ORR. In addition, no significant differences in the PFS were observed in HR+/HER2-low breast cancer patients, regardless of whether the HER2 status changed due to treatment, the presence of visceral metastases. In conclusion, among patients receiving CDK4/6 inhibitor combined with endocrine therapy, HER2-low status was associated with significantly shorter PFS but not with significant differences in OS or ORR. However, it is worth noting that most of these studies are retrospective and real-world studies, with limited adjustments for confounding factors, and the statistical power of testing may be insufficient.

CDK4/6抑制剂联合内分泌治疗已成为晚期HR+/HER2-乳腺癌的标准一线和二线治疗。本研究旨在评估HER2低表达对CDK4/6抑制剂治疗乳腺癌患者疗效的影响。我们系统地检索了截至2025年5月的4个主要数据库和重要会议记录，筛选出了报告HR+/ her2低乳腺癌患者和HR+/ her2零乳腺癌患者接受CDK4/6抑制剂治疗的无进展生存期（PFS）、总生存期（OS）和客观缓解率（ORR）的研究。我们计算了合并风险比（HR）及其95%置信区间（CI）。最终纳入18项研究，涉及8461例患者。其中her2 -低乳腺癌患者占41.25%，her2 -零乳腺癌患者占57.98%。结果显示，CDK4/6抑制剂联合内分泌治疗的HR+/ her2低乳腺癌患者的无进展生存期（PFS）显著低于HR+/ her2零乳腺癌患者（HR = 1.19, 95% CI, 1.10 ~ 1.28, P < 0.0001）。进一步的亚组分析表明，her2 -低患者无论是接受一线治疗、后续治疗还是接受Ribociclib治疗，其预后都较差。OS分析显示，两组间差异无统计学意义（HR = 1.00, 95% CI: 0.93 ~ 1.07, P = 0.93）。同样，ORR也无显著差异。此外，在HR+/HER2低的乳腺癌患者中，无论HER2状态是否因治疗、是否存在内脏转移而改变，PFS均未观察到显著差异。总之，在接受CDK4/6抑制剂联合内分泌治疗的患者中，her2低状态与PFS显著缩短相关，但与OS或ORR无显著差异。然而，值得注意的是，这些研究大多是回顾性和现实世界的研究，对混杂因素的调整有限，检验的统计能力可能不足。

{"title":"Effect of HER2-Low Expression on the Efficacy of CDK4/6 Inhibitors in Breast Cancer: A Meta-Analysis.","authors":"Lingling Ye, Yan Dai, Liushan Chen, Yuqi Liang, Jiafa He, Shenying Chen, Xue Song, Rui Xu, Qianjun Chen","doi":"10.1016/j.clbc.2025.10.018","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.10.018","url":null,"abstract":"<p><p>CDK4/6 inhibitors combined with endocrine therapy have become the standard first-line and second-line therapy for advanced HR+/HER2- breast cancer. This study aimed to evaluate the impact of HER2 low expression on the efficacy of breast cancer patients treated with CDK4/6 inhibitors. We systematically searched 4 major databases and important conference proceedings up to May 2025, and screened out studies that reported the progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) in HR+/HER2-low breast cancer patients and HR+/HER2-zero breast cancer patients treated with CDK4/6 inhibitors. We calculated the pooled hazard ratio (HR) and its 95% confidence interval (CI). A total of 18 studies involving 8461 patients were finally included. Among them, HER2-low breast cancer patients accounted for 41.25% of the sample, and HER2-zero breast cancer patients accounted for 57.98% of the sample. The results showed that the progression-free survival (PFS) of HR+/HER2-low breast cancer patients treated with the combination of CDK4/6 inhibitors and endocrine therapy was significantly lower than that of HR+/HER2-zero breast cancer patients (HR = 1.19, 95% CI, 1.10-1.28, P < .0001). Further subgroup analysis indicated that among HER2-low patients, whether they received first-line treatment, subsequent treatment, or were treated with Ribociclib, their prognosis was worse. Analysis of OS showed no statistically significant difference between groups (HR = 1.00, 95% CI, 0.93-1.07, P = .93). Similarly, no significant differences were observed in ORR. In addition, no significant differences in the PFS were observed in HR+/HER2-low breast cancer patients, regardless of whether the HER2 status changed due to treatment, the presence of visceral metastases. In conclusion, among patients receiving CDK4/6 inhibitor combined with endocrine therapy, HER2-low status was associated with significantly shorter PFS but not with significant differences in OS or ORR. However, it is worth noting that most of these studies are retrospective and real-world studies, with limited adjustments for confounding factors, and the statistical power of testing may be insufficient.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582023","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

Comment on “The USP8/CEP55/CHMP6 Axis Orchestrates Triple-Negative Breast Cancer Progression by Regulating Ferroptosis and Macrophage M2 Polarization” 评论“USP8/CEP55/CHMP6轴通过调节铁凋亡和巨噬细胞M2极化来协调三阴性乳腺癌的进展”。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-10-28 DOI: 10.1016/j.clbc.2025.10.015

Wenyan Zhang, Zhongzhu Tang

引用次数: 0

Cryotherapy in Taxane-Induced Peripheral Neuropathy: The Need for Objective Validation 冷冻治疗紫杉烷诱导的周围神经病变：需要客观验证。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-10-28 DOI: 10.1016/j.clbc.2025.10.016

Kadri Altundag