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Unveiling the Potential of Drain Tip Cultures: Impact on Surgical Site Infections in Implant-Based Breast Reconstruction. 揭示引流管尖端培养的潜力:基于植入物的乳房再造术中手术部位感染的影响。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-29 DOI: 10.4048/jbc.2024.0045
Ji-Young Kim, I Zhen Ma, Ki Yong Hong

Purpose: Surgical site infections (SSIs) remain a concern after implant-based breast reconstruction, despite preventive measures. These infections can have serious consequences. This study evaluated the correlation between drain tip culture results and SSIs in this patient population.

Methods: We analyzed data from patients who underwent implant-based breast reconstruction between July 2021 and May 2023. Drain tip cultures were collected, and any SSIs occurring within one month of surgery were documented. We then compared clinical data with the culture results.

Results: A total of 263 drain tip cultures were included. Notably, none of the 61 patients who underwent tissue expander removal and implant insertion had positive cultures. However, among the 202 patients who received tissue expanders or direct-to-implant procedures, 11 (5.45%) had positive cultures, with a total of 12 SSIs identified. Importantly, five of the 11 culture-positive wounds developed SSIs. Multivariate analysis revealed a significant two-way association between infection and positive drain tip cultures. For Staphylococcus aureus specifically, drain tip cultures showed excellent predictive value: sensitivity (33.33%), specificity (100%), positive predictive value (100%), and negative predictive value (95.96%).

Conclusion: Drain tip cultures from immediate implant-based breast reconstructions significantly correlated with SSIs. Close monitoring is crucial, especially when S. aureus is identified in the culture.

目的:尽管采取了预防措施,但手术部位感染(SSI)仍然是假体乳房重建后的一个令人担忧的问题。这些感染可造成严重后果。本研究评估了该患者群体中引流管尖端培养结果与 SSI 之间的相关性:我们分析了 2021 年 7 月至 2023 年 5 月期间接受植入物乳房重建术的患者数据。我们收集了引流管尖端培养结果,并记录了手术后一个月内发生的任何 SSI。然后,我们将临床数据与培养结果进行了比较:结果:共纳入了 263 份引流管尖端培养结果。值得注意的是,在61名接受组织扩张器移除和植入手术的患者中,没有一人的培养结果呈阳性。然而,在接受组织扩张器或直接植入手术的202名患者中,有11人(5.45%)的培养结果呈阳性,共发现12例SSI。重要的是,11 个培养阳性伤口中有 5 个出现了 SSI。多变量分析显示,感染与引流管尖端培养阳性之间存在显著的双向关联。特别是对于金黄色葡萄球菌(S. aureus),引流管尖端培养显示出极好的预测价值:敏感性(33.33%)、特异性(100%)、阳性预测值(100%)和阴性预测值(95.96%):结论:立即植入假体的乳房再造术中的引流管尖端培养与 SSIs 有显著相关性。密切监测至关重要,尤其是在培养物中发现金黄色葡萄球菌时。
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引用次数: 0
Is Adjuvant Chemotherapy Preceding Cyclin-Dependent Kinase 4/6 Inhibitor Therapy Beneficial? 细胞周期蛋白依赖性激酶4/6抑制剂治疗前的辅助化疗是否有益?
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-08 DOI: 10.4048/jbc.2024.0136
Steven Sorscher
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引用次数: 0
Neoadjuvant Chemotherapy Is Effective in Those Infected With SARS-CoV-2: The Real-World Experience of a Large Chinese Breast Cancer Center. 新辅助化疗对SARS-CoV-2感染者有效:一家大型中国乳腺癌中心的实际经验
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-02 DOI: 10.4048/jbc.2023.0299
Teng Ma, Tianyi Ma, Lulu Wang, Haibo Wang

Purpose: During the major shift in China's policies on coronavirus disease 2019 (COVID-19), many residents will be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over a short period, including a few patients with breast cancer undergoing neoadjuvant chemotherapy (NAC). Moreover, it is unknown whether this comorbidity affects the efficacy of NAC for breast cancer and the patient's psychological state and quality of life (QOL). This study aims to answer these questions.

Methods: The clinical data of 2,793 patients with breast cancer who received NAC at The Affiliated Hospital of Qingdao University were retrospectively collected. The infected and non-infected groups were divided according to whether they were infected with COVID-19 during NAC. Propensity score matching was used to reduce patient selection bias. The effectiveness, psychological well-being, and QOL of the two groups were compared.

Results: No discernible differences were observed in the pathological complete response rates (p = 0.307) and major histological responses rate (p = 0.398) between the infected and non-infected groups. Following the full course of NAC, the Functional Assessment of Cancer Treatment General (p < 0.001) and Functional Assessment of Cancer Therapy for Breast Cancer (p < 0.001) were lower in the infected group than the non-infected group, the Hospital Anxiety and Depression Scale (HADS) anxiety scale (p < 0.001) and HADS depression scale (p < 0.001) were considerably higher in the infected group than the non-infected group.

Conclusion: With timely treatment and effective medical management, SARS-CoV-2 does not appear to affect the efficacy of NAC; however, it can significantly affect the QOL of patients and increase their psychological distress. Therefore, in addition to a timely assessment of the efficacy of NAC, it is necessary to dynamically understand the patient's psychological state and QOL.

目的:在2019年中国冠状病毒病(COVID-19)政策大调整期间,许多居民将在短期内感染严重急性呼吸系统综合征冠状病毒2(SARS-CoV-2),其中包括少数接受新辅助化疗(NAC)的乳腺癌患者。此外,这种并发症是否会影响乳腺癌新辅助化疗的疗效以及患者的心理状态和生活质量(QOL),目前尚不得而知。本研究旨在回答这些问题:方法:回顾性收集在青岛大学附属医院接受 NAC 治疗的 2,793 例乳腺癌患者的临床资料。根据患者在接受新农合治疗期间是否感染 COVID-19,将其分为感染组和非感染组。采用倾向得分匹配法减少患者选择偏差。比较了两组患者的疗效、心理健康和 QOL:感染组和非感染组的病理完全反应率(p = 0.307)和主要组织学反应率(p = 0.398)没有明显差异。在接受整个疗程的新农合治疗后,感染组的癌症治疗一般功能评估(p < 0.001)和乳腺癌治疗功能评估(p < 0.001)低于非感染组,感染组的医院焦虑和抑郁量表(HADS)焦虑量表(p < 0.001)和HADS抑郁量表(p < 0.001)显著高于非感染组:结论:通过及时治疗和有效的医疗管理,SARS-CoV-2 似乎不会影响新农合的疗效,但会严重影响患者的生活质量,增加他们的心理压力。因此,除了及时评估 NAC 的疗效外,还需要动态了解患者的心理状态和 QOL。
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引用次数: 0
The 21-Gene Recurrence Score Assay Improved Multidisciplinary Treatment Compliance in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: An Analysis of 2,323 Patients. 21基因复发评分检测提高了激素受体阳性、人表皮生长因子受体2阴性乳腺癌患者的多学科治疗依从性:对 2323 名患者的分析。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-11 DOI: 10.4048/jbc.2023.0248
Liangqiang Li, Jing Yu, Kunwei Shen, Xiaosong Chen

Purpose: The 21-gene recurrence score (RS) can guide adjuvant chemotherapy decisions in the multidisciplinary treatment (MDT) of patients with early breast cancer. This study aimed to evaluate the influence of the 21-gene RS assay on patient' compliance with MDT and its association with disease outcomes.

Methods: Patients diagnosed with pN0-1, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer between January 2013 and June 2019 were enrolled. A logistic regression model was used to identify parameters associated with treatment adherence. Prognostic indicators were evaluated using the Cox proportional hazard models.

Results: After the assay, patients were less likely to violate the treatment plan (14.9% vs. 23.1%, p < 0.001), and higher compliance rates were observed for chemotherapy (p = 0.042), radiotherapy (p = 0.012), and endocrine therapy (p < 0.001). Multivariable analysis demonstrated that the 21-gene RS assay (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.09-1.88; p = 0.009) was independently associated with MDT compliance. Moreover, compliance with MDT was independently associated with better disease-free survival (hazard ratio, 0.43; 95% CI, 0.29-0.64; p < 0.001), regardless of the 21-gene RS assay (interaction p = 0.842).

Conclusion: The 21-gene RS assay improved the MDT compliance rate in patients with early breast cancer. Adherence to MDT is associated with a better prognosis.

目的:21基因复发评分(RS)可指导早期乳腺癌患者多学科治疗(MDT)中的辅助化疗决策。本研究旨在评估 21 基因 RS 检测对患者遵从 MDT 治疗的影响及其与疾病预后的关系:研究招募了2013年1月至2019年6月期间被诊断为pN0-1、激素受体阳性、人表皮生长因子受体-2阴性的乳腺癌患者。采用逻辑回归模型确定与治疗依从性相关的参数。使用Cox比例危险模型评估了预后指标:检测后,患者违反治疗计划的可能性较低(14.9% vs. 23.1%,p < 0.001),化疗(p = 0.042)、放疗(p = 0.012)和内分泌治疗(p < 0.001)的依从率较高。多变量分析表明,21 基因 RS 检测(几率比 [OR],1.43;95% 置信区间 [CI],1.09-1.88;p = 0.009)与 MDT 依从性独立相关。此外,无论采用哪种 21 基因 RS 检测方法,MDT 的依从性都与较好的无病生存率独立相关(危险比为 0.43;95% 置信区间为 0.29-0.64;p < 0.001)(交互作用 p = 0.842):21基因RS检测提高了早期乳腺癌患者的MDT依从率。坚持MDT与更好的预后有关。
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引用次数: 0
Prediction of Oncotype DX Recurrence Score Based on Systematic Evaluation of Ki-67 Scores in Hormone Receptor-Positive Early Breast Cancer. 基于对激素受体阳性早期乳腺癌 Ki-67 评分的系统评估预测 Oncotype DX 复发评分
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 DOI: 10.4048/jbc.2024.0065
Ji Min Kim, Eun Yoon Cho

Purpose: Oncotype DX (ODX) predicts the risk of recurrence and benefits of adding chemotherapy for patients with estrogen receptor positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) early-stage breast cancer. We aimed to develop a simplified scoring system using readily available clinicopathological parameters to predict a high-risk ODX recurrence score (RS) while minimizing reproducibility issues regarding Ki-67 index evaluation methods.

Methods: We enrolled 300 patients with ER+/HER2- early breast cancer, for whom ODX RS data were available in the test set. Using the QuPath image analysis platform, we systematically evaluated the average, hotspot, and hottest spot Ki-67 scores in the test set. Logistic regression analyses were conducted to establish a predictive scoring system for high-risk ODX RS. An independent validation set comprising 117 patients over different periods was established.

Results: Factors such as age ≤ 50 years, invasive ductal carcinoma tumor type, histologic grade 2 or 3, tumor necrosis, progesterone receptor negativity, and a high Roche-analyzed Ki-67 score (> 20) were associated with high-risk ODX RS. These variables were incorporated into our scoring system. The area under the curve of the scoring system was 0.8057. When applied to both the test and validation sets with a cutoff value of 3, the sensitivity of our scoring system was 92%.

Conclusion: We successfully developed a scoring system based on the systematic evaluation of Ki-67 scoring methods. We believe that our user-friendly predictive scoring system for high risk ODX RS could help clinicians in identifying patients who may or may require additional ODX testing.

目的:Oncotype DX(ODX)可预测雌激素受体阳性(ER+)/人表皮生长因子受体2阴性(HER2-)早期乳腺癌患者的复发风险和增加化疗的益处。我们旨在开发一种简化的评分系统,利用现成的临床病理参数预测高风险 ODX 复发评分 (RS),同时尽量减少 Ki-67 指数评估方法的可重复性问题:我们招募了300名ER+/HER2-早期乳腺癌患者,测试集中有这些患者的ODX RS数据。利用 QuPath 图像分析平台,我们对测试集中的平均、热点和最热点 Ki-67 分数进行了系统评估。我们进行了逻辑回归分析,以建立高风险 ODX RS 的预测评分系统。结果:年龄小于50岁、浸润性导管癌肿瘤类型、组织学分级2级或3级、肿瘤坏死、孕酮受体阴性、罗氏分析Ki-67高分(> 20)等因素与高风险ODX RS相关。这些变量被纳入了我们的评分系统。评分系统的曲线下面积为 0.8057。当应用于截止值为 3 的测试集和验证集时,我们的评分系统的灵敏度为 92%:我们在对 Ki-67 评分方法进行系统评估的基础上,成功开发了一套评分系统。我们相信,我们的用户友好型高风险 ODX RS 预测评分系统可以帮助临床医生识别可能或可能需要进行额外 ODX 检测的患者。
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引用次数: 0
Undifferentiated Pleomorphic Sarcoma Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma. 模仿乳房植入物相关性非典型大细胞淋巴瘤的未分化多形性肉瘤
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-07 DOI: 10.4048/jbc.2024.0054
Nayana Chandrasiri, Oluwatosin Taiwo, Muneer Ahmed, Anmol Malhotra, Soha El-Sheikh

Breast implant augmentation is a low-risk procedure with few life-threatening complications, most commonly rupture or leakage and contraction of the capsule. Breast implant-associated (BIA) malignancies are rare. Anaplastic large cell lymphoma (ALCL) is the most well-known neoplastic condition associated with breast augmentation. Carcinomas arising in association with implants have been reported but are rarer than ALCL. BIA-mesenchymal tumors are extremely rare and most are locally aggressive fibromatosis. To date, only eight cases of BIA sarcomas have been reported. Herein, we describe a case of silicone BIA-undifferentiated pleomorphic sarcoma (UPS) that was initially mistaken for ALCL because of a significant clinical and radiological overlap in presentation and imaging. Here, we present the morphological and molecular features of this rare neoplasm. We reviewed the existing literature related to BIA sarcomas to highlight the importance of considering this diagnosis in cases of recurrent ALCL-negative BIA effusions.

假体隆胸是一种低风险手术,很少出现危及生命的并发症,最常见的是破裂或渗漏以及囊收缩。乳房植入物相关恶性肿瘤(BIA)很少见。无性大细胞淋巴瘤(ALCL)是与隆胸相关的最著名的肿瘤性疾病。与假体相关的癌也有报道,但比无性大细胞淋巴瘤更罕见。BIA-间质瘤极为罕见,大多数是局部侵袭性纤维瘤病。迄今为止,仅有七例 BIA 肉瘤的报道。在此,我们描述了一例硅质BIA-未分化多形性肉瘤(UPS)病例,该病例最初被误认为是ALCL,因为其临床表现和影像学表现明显重叠。在此,我们介绍了这种罕见肿瘤的形态学和分子特征。我们回顾了与BIA肉瘤相关的现有文献,以强调在复发性ALCL阴性BIA积液病例中考虑这一诊断的重要性。
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引用次数: 0
Dosimetric Correlation of Acute Radiation Dermatitis in Patients With Breast Cancer Undergoing Hypofractionated Proton Beam Therapy Using Pencil Beam Scanning. 使用铅笔束扫描对接受超微分质子束治疗的乳腺癌患者的急性放射性皮炎进行剂量学相关性分析
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-15 DOI: 10.4048/jbc.2024.0012
Eng-Yen Huang, Meng Wei Ho, Yu-Ming Wang

Purpose: Pencil-beam scanning (PBS) is a modern delivery technique used in proton beam therapy (PBT) to reduce normal tissue reactions. No dosimetric correlation between dermatitis and PBS has been reported for breast cancer. The current study aimed to investigate the factors associated with grade 2 or higher dermatitis in patients with breast cancer undergoing PBT using PBS.

Methods: The medical data of 42 patients with breast cancer who underwent adjuvant radiotherapy between December 2019 and September 2023 were reviewed. All patients received hypofractionated radiotherapy (HFRT), either 26 Gy (relative biological effectiveness [RBE])/five fractions or 40.05 or 43.5 Gy (RBE)/15 fractions, for the whole breast/chest wall with or without nodal irradiation. The duration of acute radiation dermatitis was defined as within 90 days from the start of radiotherapy. The Kaplan-Meier method and Cox proportional hazards model were used for univariate and multivariate analyses of the actuarial rates of grade 2-3 dermatitis.

Results: Twenty-two (52.4%) and 20 (47.6%) patients were diagnosed with grade 1 and 2 dermatitis, respectively. Multivariate analysis revealed a clinical target volume (CTV) ≥ of 320 cc (p = 0.035) and a skin dose of D10cc ≥ 38.3 Gy (RBE) (p = 0.009) as independent factors of grade 2 dermatitis. The 10-week cumulative grade 2 dermatitis rates were 88.2%, 39.4%, and 8.3% (p < 0.001) for patients with both high, either high, and neither high CTV and D10cc, respectively.

Conclusion: To the best of our knowledge, this is the first study on dosimetric correlations for dermatitis in patients with breast cancer who underwent hypofractionated PBT using PBS. In the era of HFRT, skin dose modulation using PBS may reduce the incidence of dermatitis.

目的:铅笔束扫描(PBS)是质子束治疗(PBT)中使用的一种现代传输技术,可减少正常组织的反应。目前还没有关于乳腺癌皮炎与铅笔束扫描之间剂量学相关性的报道。本研究旨在调查使用 PBS 进行 PBT 的乳腺癌患者发生 2 级或以上皮炎的相关因素:回顾性分析了在 2019 年 12 月至 2023 年 9 月期间接受辅助放疗的 42 名乳腺癌患者的医疗数据。所有患者均接受了低分次放疗(HFRT),26 Gy(相对生物效应[RBE])/5次分次或40.05或43.5 Gy(RBE)/15次分次,用于整个乳房/胸壁,伴或不伴结节照射。急性放射性皮炎的持续时间定义为放疗开始后 90 天内。采用 Kaplan-Meier 法和 Cox 比例危险模型对 2-3 级皮炎的精算率进行单变量和多变量分析:分别有22名(52.4%)和20名(47.6%)患者被诊断为1级和2级皮炎。多变量分析显示,临床靶体积 (CTV) ≥ 320 cc (p = 0.035) 和皮肤剂量 D10cc ≥ 38.3 Gy (RBE) (p = 0.009) 是导致 2 级皮炎的独立因素。CTV和D10cc均高、高或不高的患者10周累计2级皮炎发生率分别为88.2%、39.4%和8.3%(p < 0.001):据我们所知,这是第一项关于使用 PBS 进行低分量 PBT 的乳腺癌患者皮炎剂量相关性的研究。在 HFRT 时代,使用 PBS 调节皮肤剂量可能会降低皮炎的发病率。
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引用次数: 0
Breast Cancer and Therapy-Related Cardiovascular Toxicity. 乳腺癌与治疗相关的心血管毒性
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-29 DOI: 10.4048/jbc.2024.0085
Hui-Jeong Hwang, Sang-Ah Han, Il Suk Sohn

The global incidence of breast cancer is on the rise, a trend also observed in South Korea. However, thanks to the rapid advancements in anticancer therapies, survival rates are improving. Consequently, post-treatment health and quality of life for breast cancer survivors are emerging as significant concerns, particularly regarding treatment-related cardiotoxicity. In this review, we delve into the cardiovascular complications associated with breast cancer treatment, explore surveillance protocols for early detection and diagnosis of late complications, and discuss protective strategies against cardiotoxicity in breast cancer patients undergoing anticancer therapy, drawing from multiple guidelines.

全球乳腺癌发病率呈上升趋势,韩国也是如此。然而,由于抗癌疗法的快速发展,生存率正在提高。因此,乳腺癌幸存者的治疗后健康和生活质量成为人们关注的焦点,尤其是与治疗相关的心脏毒性。在这篇综述中,我们将深入探讨与乳腺癌治疗相关的心血管并发症,探讨早期发现和诊断晚期并发症的监测方案,并借鉴多种指南,讨论针对接受抗癌治疗的乳腺癌患者心脏毒性的保护策略。
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引用次数: 0
Selective Avoidance of Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Human Epidermal Growth Factor 2-Positive/Triple-Negative Breast Cancer Patients With Excellent Response. 人类表皮生长因子 2 阳性/三阴性乳腺癌患者在新辅助化疗后选择性避免前哨淋巴结活组织检查
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2024-04-01 DOI: 10.4048/jbc.2023.0264
Jai Min Ryu, Hyunjun Lee, Wonshik Han, Han-Byoel Lee, Sung Gwe Ahn, Hee Jeong Kim, Hyung Seok Park, Ji Soo Choi, Haeyoung Kim, Won Kyung Cho, Jeong Eon Lee

Purpose: The Avoid Axillary Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy (ASLAN) trial aims to demonstrate the oncologic safety of omitting axillary surgery in patients with excellent response after neoadjuvant chemotherapy (NACT) for early human epidermal growth factor 2 (HER2)-positive (+)/triple-negative breast cancer (TNBC) who have undergone breast-conserving surgery (BCS) and adjuvant radiotherapy. The ASLAN trial will provide crucial information that could change the procedure in highly selected patients undergoing axillary surgery after NACT.

Methods: ASLAN is a prospective, multicenter, and single-arm surgical trial. The recruitment will be conducted among five tertiary care hospitals in the Republic of Korea. The total number of patients to be recruited will be 178, and we plan to complete patient enrollment by December 2023. The enrollment is considered among patients with HER2+ breast cancer (BC) or TNBC at clinical stage T1-3N0-1M0 who are expected to achieve breast pathological complete response (BpCR) based on a combination of radiologic imaging and physical examination after NACT. BCS was performed on eligible patients. After BCS, patients who showed BpCR were enrolled with the omission of sentinel lymph node biopsy (SLNB). The primary study endpoint upon completion of this trial is 5-year recurrence-free survival, and the secondary endpoints include the 5-year ipsilateral breast tumor recurrence interval, 5-year ipsilateral axillary recurrence interval, 5-year distant metastasis-free survival, 5-year BC-specific survival, 5-year overall survival, 5-year contralateral BC-free survival, re-operation rate according to breast biopsy after NACT, adverse events within 5 years, and quality of life.

Discussion: Several clinical trials are currently underway to determine whether SLNB can be omitted after NACT in patients with HER2+ BC or TNBC that are expected to achieve pathologic complete response. The ASLAN trial is expected to provide valuable clues regarding the feasibility of omitting axillary surgery in highly selected patients.

Trial registration: ClinicalTrials.gov Identifier: NCT04993625. Registered on August 6, 2021. Clinical Research Information Service Identifier: KCT0006371. Registered on July 22, 2021.

目的:"新辅助化疗后避免腋窝前哨淋巴结活检"(ASLAN)试验旨在证明,对于接受了保乳手术(BCS)和辅助放疗的早期人类表皮生长因子2(HER2)阳性(+)/三阴性乳腺癌(TNBC)新辅助化疗(NACT)后反应良好的患者,省略腋窝手术具有肿瘤学安全性。ASLAN 试验将提供重要信息,从而改变在 NACT 后接受腋窝手术的高选择性患者的手术方法:ASLAN是一项前瞻性、多中心、单臂手术试验。方法:ASLAN 是一项前瞻性、多中心、单臂手术试验,将在大韩民国的五家三级医院进行招募。招募的患者总数为 178 人,我们计划在 2023 年 12 月前完成患者招募。招募对象为临床分期为T1-3N0-1M0的HER2+乳腺癌(BC)或TNBC患者,这些患者在接受NACT治疗后,根据放射影像学检查和体格检查的综合结果,有望获得乳腺病理完全反应(BpCR)。对符合条件的患者进行 BCS。BCS 后,显示出 BpCR 的患者入组,但不进行前哨淋巴结活检 (SLNB)。该试验完成后的主要研究终点是5年无复发生存率,次要终点包括5年同侧乳腺肿瘤复发间隔、5年同侧腋窝复发间隔、5年无远处转移生存率、5年BC特异性生存率、5年总生存率、5年对侧BC无复发生存率、NACT后乳腺活检的再次手术率、5年内的不良事件以及生活质量:目前有几项临床试验正在进行中,目的是确定预计会获得病理完全反应的 HER2+ BC 或 TNBC 患者在接受 NACT 后是否可以省略 SLNB。ASLAN试验有望为高选择性患者省略腋窝手术的可行性提供有价值的线索:试验注册:ClinicalTrials.gov Identifier:NCT04993625。注册日期:2021 年 8 月 6 日。临床研究信息服务标识符:KCT0006371:KCT0006371.注册日期:2021 年 7 月 22 日。
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引用次数: 0
Hypofractionated Partial Breast Irradiation With Intensity-Modulated Radiotherapy in Early Breast Cancer or Carcinoma In Situ: An Investigational Short-Term Analysis. 早期乳腺癌或原位癌的部分乳腺低分次放射治疗与调强放疗:一项研究性短期分析。
IF 2.4 4区 医学 Q3 ONCOLOGY Pub Date : 2024-04-01 Epub Date: 2024-03-26 DOI: 10.4048/jbc.2023.0296
Nam Kyu Kang, Soo-Yoon Sung, Sung Hwan Kim, Ye Won Jeon, Young Jin Suh, Jong Hoon Lee

Purpose: This study aimed to analyze the treatment outcomes and adverse effects of moderately hypofractionated partial breast irradiation (PBI) in patients with early breast cancer.

Methods: In total, 473 patients with early breast cancer or carcinoma in situ were diagnosed with Tis or T1N0 disease and underwent PBI following breast-conserving surgery. All histologic tumor types, close surgical margins within 1 mm of the tumor, and multifocal tumors were included in this study. A radiation dose of 50 Gy in 20 fractions was delivered over 4 weeks using intensity-modulated radiotherapy technique. Dosimetric data, recurrence patterns, survival outcomes, and adverse events were retrospectively analyzed.

Results: During a median follow-up of 28.9 months, seven patients (1.5%) experienced ipsilateral breast tumor recurrence (IBTR). Two patients had regional recurrence, four patients developed contralateral breast cancer, and no distant metastases were observed. The locoregional recurrence rate in the ipsilateral breast was 1.8%. Two deaths occurred during the follow-up period, but were not attributed to breast cancer. The 2-year disease-free survival and 2-year overall survival rates were was 94.0% and 99.8%, respectively. Acute adverse events occurred in 131 patients (27.1%), and were distributed among all grades, with only two patients (0.4%) experiencing grade 3 events. Late adverse events were noted in 16 patients (3.4%), and were distributed among all grades, including grade 3 events in four patients (0.8%). No grade 4 or 5 events were observed.

Conclusion: Hypofractionated PBI demonstrated favorable IBTR rates in patients with early breast cancer, with low incidence of acute and late toxicities in the short-term analysis.

目的:本研究旨在分析早期乳腺癌患者接受适度低分次乳腺部分照射(PBI)的治疗效果和不良反应:共有 473 例早期乳腺癌或原位癌患者被诊断为 Tis 或 T1N0 病变,并在保乳手术后接受了 PBI 治疗。所有组织学肿瘤类型、手术切缘在肿瘤周围1毫米以内以及多灶性肿瘤均被纳入本研究。采用调强放疗技术,在4周内分20次给予50 Gy的放射剂量。对剂量数据、复发模式、生存结果和不良事件进行了回顾性分析:在中位 28.9 个月的随访期间,7 名患者(1.5%)出现同侧乳腺肿瘤复发(IBTR)。两名患者出现局部复发,四名患者出现对侧乳腺癌,未发现远处转移。同侧乳腺局部复发率为1.8%。随访期间有两人死亡,但并非死于乳腺癌。2年无病生存率和2年总生存率分别为94.0%和99.8%。131名患者(27.1%)发生了急性不良反应,这些不良反应分布在各个等级,只有2名患者(0.4%)发生了3级不良反应。16名患者(3.4%)出现了晚期不良反应,不良反应分布在各个级别,其中4名患者(0.8%)出现了3级不良反应。没有观察到4级或5级事件:结论:低分量 PBI 在早期乳腺癌患者中表现出良好的 IBTR 率,短期分析中急性和晚期毒性反应发生率较低。
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Journal of Breast Cancer
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