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Daniel F Hayes - One of the best experts on this subject based on the ideXlab platform.
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review of preoperative magnetic resonance imaging mri in breast cancer should mri be performed on all women with newly diagnosed early stage breast cancer
CA: A Cancer Journal for Clinicians, 2009Co-Authors: Nehmat Houssami, Daniel F HayesAbstract:Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with Breast-Conservation Therapy (local excision and radioTherapy) or mastectomy. Decades of experience have demonstrated that Breast-Conservation Therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer.
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review of preoperative magnetic resonance imaging mri in breast cancer should mri be performed on all women with newly diagnosed early stage breast cancer
CA: A Cancer Journal for Clinicians, 2009Co-Authors: Nehmat Houssami, Daniel F HayesAbstract:Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with Breast-Conservation Therapy (local excision and radioTherapy) or mastectomy. Decades of experience have demonstrated that Breast-Conservation Therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer. CA Cancer J Clin 2009;59:290–302. © 2009 American Cancer Society, Inc.
Nehmat Houssami - One of the best experts on this subject based on the ideXlab platform.
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review of preoperative magnetic resonance imaging mri in breast cancer should mri be performed on all women with newly diagnosed early stage breast cancer
CA: A Cancer Journal for Clinicians, 2009Co-Authors: Nehmat Houssami, Daniel F HayesAbstract:Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with Breast-Conservation Therapy (local excision and radioTherapy) or mastectomy. Decades of experience have demonstrated that Breast-Conservation Therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer.
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review of preoperative magnetic resonance imaging mri in breast cancer should mri be performed on all women with newly diagnosed early stage breast cancer
CA: A Cancer Journal for Clinicians, 2009Co-Authors: Nehmat Houssami, Daniel F HayesAbstract:Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with Breast-Conservation Therapy (local excision and radioTherapy) or mastectomy. Decades of experience have demonstrated that Breast-Conservation Therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer. CA Cancer J Clin 2009;59:290–302. © 2009 American Cancer Society, Inc.
Albert Losken - One of the best experts on this subject based on the ideXlab platform.
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how to optimize aesthetics for the partial mastectomy patient
Aesthetic Surgery Journal, 2020Co-Authors: Albert Losken, Ciara A BrownAbstract:Aesthetic concern is one of the main driving forces behind the popularity of the oncoplastic approach to breast conservation Therapy. Oncoplastic options at the time of lumpectomy include volume replacement techniques such as flaps and volume displacement techniques such as the oncoplastic reduction. These techniques can be employed to ensure preservation of breast shape and contour, size and symmetry, inframammary fold position, and position of the nipple-areola complex. The importance of aesthetic outcomes is not only to improve overall patient satisfaction but also to minimize the need for revisional surgeries for shape and symmetry. The purpose of this review is to discuss ways to optimize the aesthetic result and to review the evidence behind aesthetic outcomes.
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the use of reduction mammaplasty with breast conservation Therapy an analysis of timing and outcomes
Plastic and Reconstructive Surgery, 2015Co-Authors: Francesco Maria Egro, Ximena Pinellwhite, Alexandra M Hart, Albert LoskenAbstract:Background:Oncoplastic reduction mammaplasty is often used to prevent or correct breast conservation Therapy deformities. The purpose of this review was to evaluate surgical outcomes, patient satisfaction, and aesthetic outcomes of this procedure when performed before or after radiation Therapy.Meth
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the use of oncoplastic reduction techniques to reconstruct partial mastectomy defects in women with ductal carcinoma in situ
Breast Journal, 2010Co-Authors: Hanjoon Mike Song, Toncred M Styblo, Grant W Carlson, Albert LoskenAbstract:: The application of oncoplastic techniques to breast conservation Therapy (BCT) is thought to improve cosmetic results with some documented oncologic advantages in certain patients. Although present data highlight the oncologic safety of this approach, the role of oncoplastic surgery specific to ductal carcinoma in situ (DCIS) has not been elucidated. In this study, all women in the Emory Healthcare system between January 1991 and June 2006 with biopsy-proven DCIS who underwent lumpectomies combined with simultaneous reduction mammaplasties or mastopexies were identified. Medical records, including office notes, operative and pathology reports were analyzed. Parameters included age, BMI, histologic grade (low, intermediate, high) and type (comedo versus non-comedo) of DCIS, margin status, locoregional recurrence, specimen weight, postoperative complications, and overall outcomes. Pedicle design and contralateral breast pathology were also analyzed. Twenty-eight women were included in the study with an average age of 47. Therapeutic mammaplasty was the definitive procedure for 18 (64%) of these patients. Ten patients (36%) required reoperations: nine for positive margins and one for residual microcalcifications (stereo biopsy DCIS). Overall, seven patients (25%) required completion mastectomy with reconstruction (transverse rectus abdominus myocutaneous flap: n = 3, latissimus flap: n = 4), whereas three patients (11%) underwent re-excisions with confirmation of negative margins. All ten women who required completion mastectomy or re-excisions exhibited either intermediate or high-grade, comedo DCIS. Overall, 50% (6/12) of women diagnosed with high-grade comedo DCIS required completion mastectomy with reconstruction after initial therapeutic mammaplasty. The final positive-margin rate for women diagnosed with intermediate-grade, comedo necrosis was 43% (3/7). The women in this failed group that required reoperations were overall younger (mean: 45.6; median: 43) than those in which oncoplastic surgery was the definitive procedure (mean: 57.8; median: 57). There were no significant differences between the failed and successful groups in terms of biopsy weight (failed: 253 g, successful: 237 g), type of excision (e.g., wire-localized), location of tumor, reduction type (e.g., superior medial), or postoperative complications. There was one case of locoregional recurrence of DCIS 7 months after the initial operation. All 28 patients had no evidence of disease at an average follow-up of 2.7 years. This study suggests that although oncoplastic reduction techniques are a reasonable approach for women with DCIS, stricter patient selection and improved confirmation of negative margins will minimize the need for either re-excisions or completion mastectomy and reconstruction.
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the impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance
Plastic and Reconstructive Surgery, 2009Co-Authors: Albert Losken, Timothy G Schaefer, Mary S Newell, Toncred M StybloAbstract:Background:Partial breast reconstruction using reduction techniques has recently increased in popularity. Some fear that combining breast conservation Therapy with partial breast reconstruction alters the architecture and will affect patterns of local recurrence and make postoperative cancer surveil
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immediate endoscopic latissimus dorsi flap risk or benefit in reconstructing partial mastectomy defects
Annals of Plastic Surgery, 2004Co-Authors: Albert Losken, Grant W Carlson, Toncred M Styblo, Glyn E Jones, Timothy G Schaefer, John BostwickAbstract:Management of the partial mastectomy defect has become a common entity as a result of the improved popularity and equivalent survival associated with breast conservation Therapy (BCT). Numerous reconstructive options have been proposed in select patients following BCT in an attempt to maintain esthetic results. Thirty-nine women underwent simultaneous endoscope-assisted latissimus muscle transfer at the time of resection and were included in this review. The average follow-up was 3.7 years. Patient demographics and tumor characteristics were discussed. Donor site morbidity was acceptable. Tumor recurrence was experienced in 6 patients (15%) following lumpectomy and latissimus reconstruction. Two patients had local recurrence, and 4 had distant recurrence. Thirty-three patients (85%) had no evidence of disease at long-term follow-up. Lumpectomy and latissimus flap transfer was the definitive reconstructive procedure in 33 of the 39 patients (85%). Patients who subsequently required completion mastectomy were easily reconstructed with a TRAM flap or implants. As the management of partial mastectomy defects continues to challenge the plastic surgeon, we are noticing a shift away from immediate simultaneous reconstructions based on arguments regarding the appropriateness from an oncological and reconstructive perspective. Stringent patient selection, confirmation of negative margins, and possibly delaying the latissimus flap transfer will maximize the benefits of this reconstructive modality while limiting the risk.
Thomas A Buchholz - One of the best experts on this subject based on the ideXlab platform.
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classification of ipsilateral breast tumor recurrences after breast conservation Therapy can predict patient prognosis and facilitate treatment planning
Annals of Surgery, 2011Co-Authors: Min Yi, Thomas A Buchholz, Henry Mark Kuerer, Funda Mericbernstam, Isabelle Bedrosian, Rosa F Hwang, Merrick I Ross, Ana M Gonzalezangulo, Aman U Buzdar, Fraser W SymmansAbstract:methods and compared sensitivities and specificities between them. Our goal was to determine whether distinguishing NP from TR had prognostic value. Background: After Breast-Conservation Therapy, IBTR may be classified into 2 distinct types (NP and TR). Studies have attempted to classify IBTR by using tumor location, histologic subtype, DNA flow cytometry data, or geneexpression profiling data. Methods: A total of 447 (7.9%) of 5660 patients undergoing breastconservation Therapy from 1970 to 2005 experienced IBTR. Clinical data from 397 patients were available for review. We classified IBTRs as NP or TR on the basis of either tumor location and histologic subtype (method 1) or tumor location, histologic subtype, estrogen receptor status and human epidermal growth factor receptor 2 status (method 2). Kaplan-Meier curves and log-rank tests were used to evaluate overall and disease-specific survival differences between the 2 groups. Classification methods were validated by calculating sensitivity and specificity values using a Bayesian method. Results: Of 397 patients, 196 (49.4%) were classified as NP by method 1 and 212 (53.4%) were classified as NP by method 2. The sensitivity and specificity values were 0.812 and 0.867 for method 1 and 0.870 and 0.800 for method 2, respectively. Regardless of method used, patients classified as NP developed contralateral breast carcinoma more often but had better 10-year overall and disease-specific survival rates than those classified as TR. Patients with TR were more likely to develop metastatic disease after IBTR. Conclusion: Ipsilateral breast tumor recurrences classified as TR and NP had clinically different features, suggesting that classifying IBTR may provide clinically significant data for the management of IBTR.
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a management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects
Plastic and Reconstructive Surgery, 2008Co-Authors: Steven J Kronowitz, Thomas A Buchholz, Henry Mark Kuerer, Vicente Valero, Kelly K HuntAbstract:Background: In patients undergoing a partial mastectomy, choosing the best method with which to repair the defect is essential to optimizing outcomes and minimizing the potential for postoperative complications. Methods: The authors present a management algorithm for repairing partial mastectomy defects based on clinically relevant parameters to allow clinicians to better select the most appropriate indications for the various reparative oncoplastic procedures. The clinicopathologic factors considered in surgical decision-making for reconstruction after partial mastectomy include timing of reconstruction in relation to radiation Therapy, status of the tumor margin, extent of breast skin resection, breast size, and whether the cosmetic outcome would be better after a total mastectomy with immediate breast reconstruction, thereby avoiding the need for radiation Therapy. Results: Most patients with medium or large breasts will likely benefit from immediate repair, whereas some with small breasts may not. Immediate repair of partial mastectomy defects is preferred with the use of local breast tissue (local tissue rearrangement or breast reduction techniques) because of the simplicity of these approaches and because techniques using local tissue maintain the color and texture of the breast. Waiting to repair a large deformity until after whole-breast radiation Therapy usually necessitates a complex transfer of a large volume of autologous tissue, which many patients who undergo breast conservation Therapy are not willing to pursue. Use of lower abdominal flaps to repair partial breast defects is generally discouraged. Conclusion: Although the authors' management algorithm and practical oncoplastic techniques should prove useful, it is up to the multidisciplinary breast team and the patient to determine the best approach.
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practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation Therapy
Plastic and Reconstructive Surgery, 2008Co-Authors: Steven J Kronowitz, Thomas A Buchholz, Eric A Strom, Kelly K Hunt, Henry Mark Kuerer, Joe Ensor, Cindy Koutz, Geoffrey L RobbAbstract:Background The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing partial mastectomy defects and showed the benefits of breast reduction. Methods In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a partial mastectomy defect using breast reduction. Results Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months. Conclusion The authors provide practical guidelines for repairing a partial mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.
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placement of radiopaque clips for tumor localization in patients undergoing neoadjuvant chemoTherapy and breast conservation Therapy
Cancer, 2007Co-Authors: Giang Nguyen, Eric A Strom, Kelly K Hunt, Gary J Whitman, Wendy A Woodward, Welela Tereffe, George H Perkins, Thomas A BuchholzAbstract:Neoadjuvant chemoTherapy is the standard of care for patients with inoperable and locally advanced breast cancer, and its use is increasing in patients with earlier stage, operable breast cancer. From 80% to 90% of patients have a significant clinical response rate of the primary tumor to neoadjuvant chemoTherapy. Although the dramatic response is desirable, and it has been demonstrated that a pathologic complete response (pCR) is prognostic, clinical and radiologic complete tumor response complicates the surgical excision because it is difficult to verify accurate localization of the site of the previous tumor. The use of a radiopaque marker placed in the tumor bed has been reported as a safe and inexpensive technique that allows for subsequent localization of the tumor bed before surgical resection in patients who are receiving neoadjuvant chemoTherapy.1–6 A report on 28 patients who underwent clip placement and preoperative chemoTherapy indicated that preoperative wire localization of the tumor bed would have been impossible in 35.7% of patients and difficult in 21.4% of patients without the aid of the clip. Dash et al. concluded that the clip placement was valuable in 57% of patients at the time of preoperative needle localization.4 Edeiken and colleagues reported a similar experience with ultrasound-guided implantation of metallic markers in 49 patients to mark the tumor bed in anticipation of complete or near complete response to neoadjuvant chemoTherapy. The markers reportedly were the only remaining evidence of the original tumor site in 23 of 49 patients (47%), and the authors concluded that this technique effectively addresses the problem of preoperative localization of the tumor bed in patients who are expected to achieve a complete or near complete response to neoadjuvant chemoTherapy.5 Although the studies described above support the utility of clip placement in approximately 50% of individuals for preoperative tumor bed localization in patients who are receiving neoadjuvant chemoTherapy, the potential impact on locoregional control currently is unknown. The objective of this study was to determine whether patients who were treated with breast conservation after neoadjuvant chemoTherapy had improved local control if radiopaque coils/clips were placed to mark the primary tumor.
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the use of radiation as a component of breast conservation Therapy in national comprehensive cancer network centers
Journal of Clinical Oncology, 2006Co-Authors: Thomas A Buchholz, Joyce C Niland, Richard L Theriault, Melissa E Hughes, Rebecca A Ottesen, Stephen B Edge, Michael A Bookman, Jane C WeeksAbstract:Purpose Benchmark data regarding quality measures of breast cancer management are needed. We investigated rates of radiation use after breast conservation Therapy (BCT) for patients treated for ductal carcinoma-in-situ (DCIS) or invasive breast cancer at National Comprehensive Cancer Network (NCCN) centers. Patients and Methods We studied 3,333 consecutive patients treated between 1997 and 2002 with BCT for DCIS (n = 587) or for stage I or II breast cancer (n = 2,746) in eight NCCN centers. Results The overall rate of radiation Therapy use was 91%, with a lower frequency of radiation use in DCIS versus invasive breast cancers (82% v 94%; odds ratio [OR] = 0.31; P < .0001). In a multivariable analysis of the patients with DCIS, the only factor significantly associated with lower rates of radiation use was low/intermediate grade (OR = 0.19; P = .0003). For patients with invasive breast cancer, significant factors were presence of comorbidity (OR = 0.53; P = .0005), tubular histology (OR = 0.39; P = .02), ty...
Lawrence J Solin - One of the best experts on this subject based on the ideXlab platform.
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long term risk of second malignancies in women after breast conservation Therapy for ductal carcinoma in situ or early stage breast cancer
Breast Cancer Research and Treatment, 2018Co-Authors: Carolyn J Kushner, Lawrence J Solin, Weiting Hwang, Shiyu Wang, Neha VapiwalaAbstract:Women with ductal carcinoma in situ (DCIS) or early-stage breast cancer have an excellent prognosis, but their risk of developing second malignant neoplasms (SMNs) is not well established. We analyzed SMNs in a large cohort with long follow-up after breast conservation Therapy. The study population comprised 755 women with DCIS (n = 135) or stage I-II breast carcinoma (n = 620). Subjects were aged 25-89 (median 55) years when they underwent breast-conserving surgery followed by radioTherapy to the entire breast (60-68Gray) between 1992 and 2001. Additional treatment included hormonal Therapy and/or chemoTherapy based on clinical characteristics. SMNs were grouped by site. The rate of SMNs over time was determined using the Kaplan–Meier method. To compare the probability of developing SMNs overall and for specific organs or sites, probability estimates were obtained for a 55-year-old female from the Surveillance, Epidemiology, and End Results Program (SEER). Median follow-up from radioTherapy was 13.8 years. The 15-year age-adjusted probability of developing any SMN was 12.0%, close to the SEER rate of 12.1% for a non-breast malignancy. Systemic Therapy and higher-dose radioTherapy (> 63 Gray) were not associated with significantly increased risks of SMNs. Compared to SEER, significantly increased risk was noted for gynecologic cancers and melanoma. Most SMNs were unrelated to treatment, and the 15-year incidence was similar to that of cancer in the SEER control group—findings that should be reassuring to patients. Further risk reduction is expected from prophylactic gynecologic surgery. Continued investigations into genetic links with melanoma are warranted.
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no impact of breast magnetic resonance imaging on 15 year outcomes in patients with ductal carcinoma in situ or early stage invasive breast cancer managed with breast conservation Therapy
Cancer, 2017Co-Authors: Neha Vapiwala, Carolyn J Kushner, Weiting Hwang, Mitchell D Schnall, Gary M Freedman, Lawrence J SolinAbstract:BACKGROUND For women undergoing breast conservation Therapy (BCT), the added value of breast magnetic resonance imaging (MRI) at the time of initial diagnosis remains controversial. The current study was performed to determine long-term outcomes after BCT for women with and without pretreatment breast MRI. METHODS Between 1992 and 2001, a total of 755 women with ductal carcinoma in situ or early-stage invasive breast cancer underwent breast-conserving surgery (with axillary lymph node staging for invasive carcinoma) followed by definitive breast radioTherapy. Evaluation at the time of the initial diagnosis included conventional mammography in all subjects and breast MRI in 215 women (28%). Clinical, pathologic, and treatment characteristics were comparable for patients with and without breast MRI. Outcomes were determined using the Kaplan-Meier method and compared using the log-rank method. RESULTS At a median follow-up of 13.8 years, there were 49 local failures (15 women with and 34 women without breast MRI, respectively). The 15-year local failure rates were 8% for women with and 8% for women without MRI (P = .59). There also were no differences noted between women with and without breast MRI with regard to 15-year rates of overall survival (77% vs 71%; P = .24), freedom from distant metastases (86% vs 90%; P = .08), and contralateral breast cancer (10% vs 8%; P = .10). Multivariate analysis demonstrated no significant impact of breast MRI on local failure (P = .96). CONCLUSIONS Breast MRI during the initial evaluation for BCT appears to have no significant impact on 15-year rates for local control, overall survival, freedom from distant metastases, or contralateral breast cancer. The routine use of pretreatment breast MRI is not indicated for patients undergoing BCT. Cancer 2017;123:1324–1332. © 2016 American Cancer Society.
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the effects of sequence and type of chemoTherapy and radiation Therapy on cosmesis and complications after breast conservation Therapy
International Journal of Radiation Oncology Biology Physics, 1996Co-Authors: Deborah A Markiewicz, Delray Schultz, Jonathan A Haas, Eleanor E R Harris, Kevin Fox, John H Glick, Lawrence J SolinAbstract:Abstract Purpose|: ChemoTherapy plays an increasingly important role in the treatment of both node-negative and node-positive positive breast cancer partients, but the optimal sequencing of chemoTherapy and radiation Therapy is not well established. The purpose of this study is to evaluate the interaction of sequence and type of chemoTherapy and hormonal Therapy given with radiation Therapy on the cosmetic outcome and the incidence of complications of Stage I and II breast cancer patients treated with breast-conserving Therapy. Methods and Materials: The records of 1053 Stage I and II breast cancer patients treated with curative intent with breast-conserving surgery, axillary dissection, and radiation Therapy between 1977–1991 were reviewed. Median follow-up after treatment was 6.7 years. Two hundred fourteen patients received chemoTherapy alone, 141 patients received hormonal Therapy alone, 86 patients received both, and 612 patients received no adjuvant Therapy. Patients who received chemoTherapy ± hormonal Therapy were grouped according to sequence of chemoTherapy: (a) concurrent=concurrent chemoTherapy with radiation Therapy followed by chemoTherapy; (b) sequential=radiation followed by chemoTherapy or chemoTherapy followed by radiation; and (c) sandwich=chemoTherapy followed by concurrent chemoTherapy and radiation followed by chemoTherapy. Compared to node negative patients, node-positive patients more commonly received chemoTherapy (77 vs. 9%, p p Results: The use of chemoTherapy had an adverse effect on cosmetic outcome compared to no chemoTherapy, which was of borderline significance at 3 years (92% excellent or good cosmetic outcome vs. 96% respectively, p = 0.057); however, cosmesis was not different at 5 years (91 vs. 93% respectively, p = 0.67). Cosmesis was not significantly different between patients treated sequentially and those treated concurrently (3 year: 87 vs. 93% respectively, p = 0.33), nor was it different between patients who received CMF vs. CAF (3 year: 92 vs. 93% respectively, p = 0.89). Hormonal Therapy did not influence cosmetic outcome ( p = 0.78). The incidence of Grade 4 or 5 arm edema (≥ 2 cm difference in arm circumference) was 2% without chemoTherapy vs. 8% with chemoTherapy ( p = 0.00002). However, the incidence of arm edema was not affected by sequencing or type of chemoTherapy (all p ≥ 0.52). Patients treated sequentially had a 10% incidence of Grade 4 to 5 arm edema vs. 7% in the patients treated concurrently ( p = 0.52). The incidence was 7 vs. 9% in patients treated with CMF vs. CAF ( p = 0.73. The incidence of clinical pneumonitis and rib fracture was not influenced by use of chemoTherapy, sequence of chemoTherapy or use of hormonal Therapy (all p ≥ 0.06). Conclusions: ChemoTherapy can be given concurrently with radiation Therapy in the treatment of Stage I and II breast cancer with breast-conserving Therapy without seriously compromising cosmetic outcome or incidence of complications compared to patients receiving other sequences of chemoTherapy. Hormonal Therapy did not affect cosmesis or complications. The chemotherapeutic regimen of cytoxan and 5-FU concurrent with radiation Therapy followed by more chemoTherapy is one reasonable option for breast conservation Therapy in patients requiring chemoTherapy.