Reform and Prospect of Systemic Therapy on HER2-positive Early-stage Breast Cancer / 肿瘤防治研究

In the past two decades, the survival of HER2-positive early-stage breast cancer patients has significantly improved with the development of HER2-targeted therapies. The focus has been placed on maximizing the clinical benefit of HER2-positive early-stage breast cancer by optimizing the treatment frameworks and therapeutic strategies in this field. In this paper, several important clinical studies of HER2-positive early-stage breast cancer in the neoadjuvant or adjuvant settings will be summarized and analyzed to provide clues for the development of personalized treatment strategies in the future.

Research progress of breast conserving surgery combined with intraoperative radiotherapy for early stage breast cancer / 中华内分泌外科杂志

Currendy,the incidence of breast cancer ranks first at home and abroad of female cancer and the age of onset tends to be younger.Due to the local changes of the tumor residual cavity after the breast conserving surgery,we can't accurately delineate the irradiation range using traditional breast conserving surgery combined with external irradiation of whole breast and tumor bed plus the amount,and the course of treatment is longer.Intra-operative radiation therapy(IORT) can avoid the impact of respiratory motion and postural changes.Meanwhile,it can immediately irradiate the tumor bed during operation accurately.For patients,IORT can shorten the cycle of radiotherapy and reduce irradiation on the skin and subcutaneous tissue.So IORT is convenient,easy to be accepted,and has relatively few complications,good cosmetic results and so on.In recent years,more and more Cancer Center choose breast conserving surgery combined with IORT for treatment of early stage breast cancer and make relative researches in terms of the indications,methods,dosage,efficacy and prognosis of IORT.

Radiotherapy-induced secondary primary cancer risks for early breast cancer: flattening filter versus flattening filter free IMRT radiotherapy / 中华放射医学与防护杂志

Objective To evaluate the secondary cancer risk to various organs due to radiation treatment for early left-sided breast cancer using 6 MV X-ray flattening filter free (FFF) and flattening filter (FF) modes.Methods Two techniques,6 MV FFF and 6 MV FF X-rays modes,were used to develop the two tangential fields d-IMRT plans for 20 early left-sided breast cancer patients respectively.For all the patients,the dose to surrounding tissues was minimized as low as possible,the 95％ volume of the planning target volume (PTV) and clinical target volume (CTV) was consistent with the prescribed dose.The beam parameters and the plan optimization parameters of FFF modes were in consonance with FF modes.The radiation doses and volumes of the planning target volumes,organs at risk and normal tissue were detected by dose-volume histogram.And then,the excess absolute risk(EAR) of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver were calculated using the radiotherapy-induced secondary primary cancer risks models.Results The treatment plans of two groups met the requirements of clinical.The FFF d-IMRT techniques resulted in a systematic reduction of the organ equivalent dose (OED) (t =2.18-9.72,P ＜ 0.05),and the EAR (t =2.11-9.99,P ＜ 0.05) of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver was compared to the FF IMRT techniques,especially for the contralateral breast.Conclusions Both FFF and FF d-IMRT plans can achieve comparable target dose coverage in patients with early left-sided breast cancer,while the FFF d-IMRT techniques could reduce the excess absolute risk of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver.These results are of clinical importance,especially for the early-stage patients with an overall good prognosis.

The progress of breast conserving surgery combined with intraoperative radiotherapy for early stage breast cancer / 中华内分泌外科杂志

Currently,the incidence of breast cancer ranks first at home and abroad of female cancer and the age of onset tends to be younger.Due to the local changes of the tumor residual cavity after the breast conserving surgery,we can't accurately delineate the irradiation range using traditional breast conserving surgery combined with external irradiation of whole breast and tumor bed plus the amount,and the course of treatment is longer.Intra-operative radiation therapy (IORT) can avoid the impact of respiratory motion and postural changes.Meanwhile,it can immediately irradiate the tumor bed intraoperative accurately.For patients,IORT can shorten the cycle of radiotherapy and reduce irradiation on the skin and subcutaneous tissue.So IORT is convenient,easy to be accepted,and it has relatively few complications,good cosmetic results and so on.In recent years,more and more Cancer Center choose breast conserving surgery combined with IORT for the treatment of early stage breast cancer and do researches to the indications,methods,dosage,efficacy and prognosis of IORT.

Hot issues in surgical treatment of early stage breast cancer patients in the era of preci-sion medicine / 中国肿瘤临床

Breast cancer is the most common malignant tumor in women. For early stage breast cancer patients, surgical treatment is still the foundation of local treatment. With background from precision medicine, this article reviews recent hot issues in surgical treat-ment for early stage breast cancer patients. We summarized strategies in surgical treatment, selection of resection range, manage-ment of local lymph nodes, timing of breast reconstruction, and the application of minimally invasive surgery.

The Long-term Efficacy Observation of Whole-breast External Beam Radiation Therapy after Breast Conserving Surgery Coupled with Brachytherapy or Local Electronic Boost Radiation / 昆明医科大学学报

Objective To summarize the long term effect of the whole-breast external beam radiation therapy after breast conserving surgery coupled with brachytherapy or local electronic boost radiation. Methods The survival rate and cosmetic results were retrospectively analyzed for 96 patients with early stage breast cancer received breast conserving surgery and hormone therapy from January 1995 to December 2003 in Yunnan Tumor Hospital. The enrolled conditions included single lesion, tumor maximum diameter ≤ 3cm, microscopically negative surgical margin, negative axillary lymph node dissection, and pathological type of invasive ductal carcinoma. 53 cases with comprehensive follow-up data were selected. Among them, 23 cases were treated with whole breast tangent conventional fractionated irradiation: 46-50 G/23-25 fractions, local tumor bedarea with high dose-rate brachytherapy: 8-10 Gy/1-2 fractions in postoperative,and 30 cases in control group were treated with electron beam irradiation of 10 Gy/5 fractions. The efficacy and cosmetic results were observed in every three months within two years,in every six months from three to five years, and in every year five years later. Results All the patients were followed up for 217 months (average follow-up 165 months), of which 2 patients died of distant metastasis 62 months and 158 months later after treatment. The excellent cosmetic result was more than 78%, and no local recurrence was observed in the group. The 3-,5-,10-and 15-years survival rates were 100%,100%,95.7%and 88.3%,respectively. In control group,3 patients were died of distant metastasis 46 months,97 months and 87 months later after treatment,also with excellent cosmetic results. There was only one case of local recurrence,and the local control rate was 97.0%. The 3-,5-,10-and 15-years survival rates were 100%,96.7%,93.6%and 82.3%, respectively. There was no significant difference in local recurrence and survival rates between the two groups ( >0.05) . Conclusion Both radiation brachytherapy and electronic boost have the same effect and good cosmetic results. The radiation brachytherapy shows a high quality of life and a short treatment time.

Review: Predictive and Prognostic Features and Their Impact on Outcome for Early-stage Breast Cancer in Mid-Western Ireland.

Aims: Predictive and prognostic features have served to allow prognostication for patients with early stage breast cancer. We sought to document our own outcomes for these features to see if our cohort corresponded to published reports. Study Design: Retrospective pilot cohort study. Place and Duration of Study: Department of Medical Oncology, Mid-Western Cancer Centre (MWCC), Mid-Western Regional Hospital (MWRH), Limerick, Ireland, between 1st January 2002 and 31st December 2002. Methodology: A retrospective analysis was designed to include with early stage breast cancer seen at our institution for the aforementioned period, information was derived from the patients’ records and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and χ2 or Fisher’s exact test. Results: Seventy-seven (77) patients were found, with a median age of 52.2 years. Median overall survival of 84 months for the 10-year period of follow-up. The majority presented with moderately differentiated oestrogen receptor positive invasive ductal carcinoma and lymph node involvement (60%). 64% of patients underwent mastectomy as opposed to breast conservation. Adjuvant cytotoxic chemotherapy uptake was 61%, which was comparable to proportion of node positive disease. The predictive and prognostic features including axillary nodal status, tumour size, tumour grade, age at presentation and oestrogen receptor status were all significant indicators for outcome, but particularly within patients under 50 years of age. Conclusions: This report underscores that these predictive and prognostic factors were more significant within for patients under the age of 50 years.

Câncer de mama: alcance do tratamento local / Breast cancer: extent of local treatment

O câncer de mama é a segunda neoplasia mais frequente no mundo e a mais comum entre as mulheres. Apesar de ser considerado um câncer de bom prognóstico se diagnosticado e tratado oportunamente, as taxas de mortalidade continuam elevadas no Brasil; muito provavelmente porque a doença ainda é diagnosticada em estádios avançados. No presente artigo, os autores apresentam definições acerca do câncer de mama e discutem o seu tratamento locorregional.

The breast cancer is the second most frequent tumor in the world and the most common among women. Although it is considered a good prognostic cancer if diagnosed and treated in time, the rates of mortality keep high in Brazil, probably because the disease is still diagnosed in advanced stage. In this article, the authors present definitions about breast cancer and discuss the local treatment.

Analysis of breast conserving operation in 38 patients with early stage breast cancer / 中华内分泌外科杂志

Objective To study the effects of breast conserving surgery for early stage breast cancer. Methods The record of 38 patients with 0-IIa-stage breast cancer who received breast conserving surgery from Jan. 2005 to Feb.2010 was reviewed. The short-term effect was analyzed and the cosmetic effect was evaluated according to Rose standard. Results All patients recovered well and they were all satisfied with the shape of their breasts. No complication occurred. During the follow-up, no local recurrence and distant metastasis occurred. Conclusion Satisfactory clinical and cosmetic effect can be achieved by breast-conserving surgery in patients with early stage breast cancer.

Advances in radiation therapy for early stage breast cancer / 中国癌症杂志

Radiation therapy plays an important role in the multidisciplinary treatment of early stage breast cancer. While breast conservative treatment has become an established strategy, recent clinical investigations focus mainly on the possibility of modification to the standard practice, including the significance of tumor bed boost after whole breast irradiation, the criteria for low-risk patients not to receive adjuvant radiotherapy after breast conservative surgery and the feasibility of partial breast irradiation. Post-mastectomy radiotherapy to the chest wall and regional lymph nodes in high-risk patients has been proved to reduce the local-regional recurrence by 2/3. However, only a few trials support the improvement of survival, and significant controversy exists concerning the role of post-mastectomy radiotherapy in intermediate-risk patients. Current review summarizes the advances and controversies stated above for the treatment of early stage breast cancer.

Localized Biopsy of Nonpalpable Breast Lesions and It’s Role in Early Diagnosis and Treatment of Breast Cancer / 中国普外基础与临床杂志

Objective To evaluate the localized biopsy of nonpalpable breast lesions (NPBLs) and its role in the early diagnosis and treatment of breast cancer. Methods One hundred and fifty-eight NPBLs from a series of 141 women detected by mammography were resected with wire localization technique. Results Forty-two lesions (26.6%, 42/158) in 42 patients were diagnosed with malignant result, including 12(28.6%) patients with stage 0 breast cancer, 24(57.1%) with stageⅠ, 2(4.8%) with stage Ⅱ and 4(9.5%) with stage Ⅲ disease according to American Joint Committee on Cancer (AJCC) staging system(the 6th edition). The contralateral axillary lymph nodes metastasis were found in only one (2.4%) patient with stage Ⅲ disease and the other forty-one patients remained free of recurrent disease at a median follow-up of 31 months.Conclusion The results showed that the most nonpalpable breast cancers detected by mammography were early-stage breast cancers and had good prognosis. The NPBLs should get a localized biopsy in order to facilitate the early diagnosis and treatment of nonpalpable breast cancers.

Application of Keishi-bukuryo-gan for the Diagnosis of Breast Cancer in Diagnostic Hormonal Therapy / 日本東洋医学雑誌

Mortality rates for breast cancer in Japan have been increasing sharply. Earlier detection leading to early treatment is highly desirable. Despite improvement in imaging techniques for breast cancer, many cases with latent microcarcinoma go undetected each year. In Western medicine, diagnostic hormonal therapy with antiestrogens for mastopathy in order to induce latent carcinoma has been used successfully for diagnosis of such difficult cases. Antiestrogens, however, may cause intolerable side effects for some patients, and sometimes their administration must be stopped. Thus excisional biopsy is required for definitive diagnosis of malignancy. In oriental medicine, Keishi-bukuryo-gan has been shown to be effective for mastopathy and is considered quite safe. We examined it as an alternative to antiestrogens. Keishi-bukuryo-gan was administered to 116 patients out of 218 with mastopathy. In response, four were suspected to have breast cancer. All four were definitively diagnosed with breast cancer: two by fine-needle aspiration cytology, and two by excisional biopsy. Keishi-bukuryo-gan proved to be useful in diagnostic hormonal evaluation of mastopathy and diagnosis of breast cancer.

Value of radiotherapy following breast-conserving surgery in early stage breast cancer / 中国癌症杂志

Purpose:To validate further the importance of r adiotherapy following breast-conserving surgery in early breast cancer. Methods:From 1994.12 to 2001.12,237patients with early stage breast can cer were treated Of these patients,eighty-three received breast-conserving surgery followed by radiotherapy,and one hundred and fifty-four received modified radical mastectom y.All patients with breast-conserving surgery underwent postoperative radiother apy.The range of radiation dose depends on the size,location of tumor,and involv ement of axillaty nodes.Tangential chest wall fields delivered 5000cGy with 8MV -X ray beam in 5 weeks .An additional 1500cGy was delivered in 8 days to tumor bed with electron beam.Among the patients with modified radical mastectomy.only 3 received postoperative radiotherapy.Results:In both the breast-conserving surgery group and modified radical mastectomy gro up,one patient recurred regionally,and one died respectively .In the modified ra dical mastectomy group,there were no regional lymph nodes recurrence,but two of them had distant metastasis.The 5year survival of the two groups were 96.49%and 98.61%,respectively.The breasts are soft and resilient in the breast-conserving surgery group,and breast shape whole after surgery.Conclusions :Breast-conserving surgery plus postoperative radiotherapy in early breast can cer can obtain treatment results similar to modified radical mastectomy,with goo d cosmetic

Experience with 132 Cases of Breast Conservation Surgery

Recently, "Breast Conserving Therapy" (BCT) in the early-stage breast cancer has spread rapidly in Korea, as is in western world. For the evaluation and the standardization of BCT in Korea, a randomized study of 132 patients with breast cancer who received BCT was performed. Of the 401 patients with breast cancer who were admitted to Yongdong Severance Hospital from Feb. 1991 to Jan. 1996, 116 patients with stage I/II breast cancer and 15 patients with ductal carcinoma in situ (DCIS) had BCT and 173 patients with stage I/II breast cancer received modified radical mastectomy (MRM). In order to evaluate the BCT, the clinicopathologic features, locoregional recurrence, distant metastasis, actuarial overall survival rate and disease-free survival rate were analyzed during the follow-up period (a minimum of 1 month, a maximum of 58 months and a mean of 32 months). The results are as follows : 1) Three out of the 116 BCT patients with stage I/II and 5 out of 173 MRM patients with stage I/II had locoregional recurrence. 2) For BCT, the actuarial overall survival rate was 94.9% and disease-free survival rate was 87.6%; however, for MRM, the actuarial overall survival rate was 96.6% and the disease-free survival rate was 83.9%. Hence, there was no statistically significant difference between BCT and MRM. 3) Patient with DCIS who had BCT experienced neither locoregional recurrence nor distant metastasis. 4) All patients were good to excellent in their cosmetic appearance. In conclusion, BCT can be a good alternative surgical treatment modality and can substitute for MRM with the patients with early-stage breast cancer, including DCIS, in Korea. However, further follow up study will be needed to assess the long term results.

Clinical and image features of breast cancer in early stage / 解放军医学杂志

Objective To study the features of mammography,breast ultrasonography(US)and physical examination(PE)on 0-Ⅰstage(early stage)breast cancer,and to approach a diagnostic measure for early stage breast cancer(EBC).Methods Physical examination,ultrasonography and mammography were performed in 28 patients with pathologically proved breast cancer in 0-Ⅰ stage,and the data were analyzed.Results The accuracy of PE for 0-Ⅰstage of EBC was 57.1%(16/28),and the accuracy by US or mammography was 85.7%(24/28)and 89.3%(25/28),respectively.As the main clinical symptom of 0-Ⅰ stage EBC,breast lumps were found in 14 of 16 PE positive cases(87.5%).The main feature of EBC by mammography was the finding of a lump(14/25,56%).The low echo of a solid space occupying lesion was the main US feature of EBC(18/24,75%).The diagnostic accuracy of mammography for 0 stage EBC was 100.0%(8/8),while only 50%(4/8)by both US and PE.Malignant calcification was the main feature of o stage breast cancer in mammography.The diagnostic accuracy of US,mammography and PE for I stage EBC was 100.0%(20/20),and was 85.0%(17/20)and 40%(8/20),respectively.US was advantagious in detecting cancer in young patient with compact breast.Conclusion Early stage breast cancer often displayed atypical features in PE,US and mammography,which are important for the early-diagnosis of breast cancer,and false negative findings are inevitable in examination.Therefore,the diagnosis of early stage breast cancer should be made with.The findings of PE,US and mammography should be analyzed comprehensively,however,when one of examinations gives a positive finding,the diagnosis of breast cancer should be suspected,and further examination should be carried out to make an early diagnosis.