Implications of short-term follow-up tomosynthesis mammography on downstream workup after breast conservation therapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 311-311
Author(s):  
Kevin Weinberger ◽  
Brittany Colosimo ◽  
Shaakir Hasan ◽  
Steven Gresswell ◽  
Sidney Anderson ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Screening Mammography ◽  
Post Treatment ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Time Interval ◽  
Breast Cancer Patients

311 Background: We previously reported that premature (less than 6 months) follow-up screening mammography after radiotherapy in breast conservation therapy was associated with an increased rate of unnecessary downstream workup. We now present the results of a similar study conducted with follow-up tomosynthesis mammogram (TS). Methods: Between the years 2015-2017, 143 consecutive breast cancer patients between ages 33 – 82 were treated with lumpectomy and adjuvant radiotherapy with follow-up TS and reviewed in this IRB-approved study. Cases were stratified by time interval until the first post-radiation TS, and secondarily by radiation technique: conventional fractionation (n = 84), hypofractionation (n = 59), boost (n = 116), no boost (n = 27), and accelerated partial breast irradiation (n = 10). The primary endpoint was the rate of further imaging/workup following TS, correlated with clinical, treatment, and post-treatment timing related variables using multivariable binomial regression analysis. Results: The patient cohort included the following clinical characteristics: 6 patients with ductal carcinoma in-situ (the remaining demonstrated either invasive ductal or invasive lobular histology), Ninety-seven patients had stage T1 lesions, 34 had T2, and 4 had T3/T4 lesions. Eighteen patients were node+, 95 ER+/ Her2-, 13 were triple negative, and 13 triple positive. No patients had clinical suspicion of recurrence before their first follow-up TS. Conclusions: Unlike with post-treatment screening two-dimensional mammography, there was no association with post-treatment tomosynthesis timing and downstream workup. Further study should be considered to confirm these preliminary findings.

Followup mammography after breast conservation therapy: Is 3D Tomosynthesis(3DT) worth it?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6628-6628
Author(s):  
Shaakir Hasan ◽  
Steven Gresswell ◽  
Brittany Colosimo ◽  
Kevin Weinberger ◽  
Sidney Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Short Interval ◽  
Multivariable Analysis ◽  
Breast Conservation ◽  
Cost Effective ◽  
Breast Conservation Therapy ◽  
Post Treatment ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation

6628 Background: Screening three-dimensional tomosynthesis mammography (3DT) is more cost-effective than two-dimensional mammography (2DM) for detecting breast cancer, however cost-effectiveness as a follow-up for treated breast cancer is unknown. We retrospectively analyzed the downstream workup and costs associated with 3DT compared to 2DM when employed as initial follow-up imaging in breast conservation therapy (BCT). Methods: Between the years 2015-2017, 450 consecutive BCT patients ages 32 – 89 with a follow-up 3DT (n = 162) or 2DM (n = 288) were reviewed in this IRB-approved study. The primary endpoint was further workup after follow-up mammogram and associated healthcare costs at 1 year. Downstream workup was secondarily tested for correlation with clinical and treatment-related variables. A single 3DT cost an estimated $149 compared to $111 for a 2DM, based on Centers for Medicare claims data Oncology Care Model. Results: Patient clinical characteristics were : 6% DCIS, 10% T1a, 29% T1b, 35% T1c, 19% T2, 88% N0, 9% N1, 3% N2, 76% ER+/PR+/HerNeu2-, 12% TNBC, and 14% Her2Neu+. Whole breast radiation was given with conventional (59%) and hypo (39%) fractionation (81% with a boost), and 10% received accelerated partial breast irradiation. First post-treatment mammogram was received within 3 months (20%), 3-6 months (32%), and after 6 months (48%) following RT. There were no differences in breast density, patient age, T/N stage, receptor status, type of RT, or mammogram timing between those in the 2DM and 3DT groups. The following downstream workup ensued for 3DT compared to 2D imaging: 18% vs 29% short-interval (6-month) mammogram (OR = 1.83, P = 0.01), 6% vs 11% breast MRI (OR = 1.90, P = 0.08), 4% ultrasound for each, and 3% biopsy for each (1 positive in the 2D group). Including downstream workup, the estimated cost per patient in the 3DT group = $249.00 compared to $253.64 in the 2D group. With multivariable analysis the independent predictors for reduced downstream workup was the use of 3DT and follow-up mammogram at least 6 months after radiation (P < 0.05). Conclusions: Excess workup was reduced with 3DT compared to 2DM in the post-treatment setting. A single 3DT costs approximately 34% more than 2DM, however in this study the associated reduction in downstream workup with 3DT actually made it more cost-effective.

Accelerated partial-breast irradiation using strut-based brachytherapy in ductal carcinoma in situ patients: A report on 321 patients with median 25-month follow-up.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 92-92
Author(s):  
John Paul Einck ◽  
Steven E. Finkelstein ◽  
Ben Han ◽  
Robert Hong ◽  
Lydia T. Komarnicky ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Late Toxicity ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Skin Dose ◽  
Breast Irradiation ◽  
Median Maximum

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as “cautionary”. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy. Methods: The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed. Results: From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for >3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing ≤ 5mm and 20 with skin spacing ≤ 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade ≥ 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%. Conclusions: APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.

Decisional preferences and satisfaction with short-course radiation for breast cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 193-193
Author(s):  
Matthew Culbert ◽  
Gregory Bidermann ◽  
Audrey S. Wallace
Keyword(s):  
Decision Making ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Second Primary ◽  
Treatment Choices ◽  
Short Course ◽  
Patient Reported ◽  
Decisional Satisfaction

193 Background: Limited literature exists regarding preferences and decisional satisfaction for women who choose accelerated partial breast irradiation (APBI) in lieu of 6-7 weeks of radiation. This analysis provides long-term patient reported outcomes in women treated with APBI at one institution. Methods: Records of women treated primarily with balloon-based APBI (2005-2013) were reviewed after IRB approval. Women with recurrent disease or poor prognosis second primary cancer were excluded. Assessment of decisional factors important to the patient, as well as satisfaction and regret with treatment choices (Decisional Regret and Satisfaction Scales) were captured via mail or telephone. Results: In 141 women who met inclusion criteria, 83 participated. Median age at diagnosis was 62 years (SD = 9), and median time from RT to survey completion was 102 months (SD = 8). Histology was pre-invasive, (25%), invasive (52%), and combined invasive/pre-invasive (23%). The majority had estrogen/progesterone receptor positive disease. Factors that were important in decision making included convenience, physician recommendation, financial considerations, novelty of treatment, desire to avoid mastectomy, and recovery time. The majority (48%) reported convenience to be the single most important factor. Provider recommendation was the primary factor in decision making for 20% of women. Most women agreed that their choice was the right decision (96%) and most felt adequately informed (90%). The majority (92% and 90% respectively) of women agreed that their decision was consistent with their personal values and was the best decision for them personally. Decisional satisfaction was high (95%). Overall satisfaction with treatment choices was high: 84% and 10% reported being totally and somewhat satisfied respectively. The majority (90%) of women stated they would make the same treatment choice again. Conclusions: Decisional satisfaction remains high almost a decade after completion of short course radiation. Practitioners should consider patient values and preferences as part of shared decision making when determining type and duration of radiation as part of breast conservation therapy.

scholarly journals The Radiologist’s Role in a Breast Multidisciplinary Tumor Board

2020 ◽  
Vol 2 (4) ◽  
pp. 372-381
Author(s):  
Steven J Rockoff ◽  
Meghan R Flanagan ◽  
Janice N Kim ◽  
Kalyan Banda ◽  
Kristine E Calhoun ◽  
...  
Keyword(s):  
Breast Conservation ◽  
Staging System ◽  
Breast Conservation Therapy ◽  
Cancer Staging ◽  
Response To Treatment ◽  
Accelerated Partial Breast Irradiation ◽  
Tumor Board ◽  
Partial Breast Irradiation ◽  
Tumor Boards ◽  
Multidisciplinary Tumor Board

Abstract Breast multidisciplinary tumor boards (MTBs) play an important role in determining treatment. This article serves as a guide for the radiologist participating in a breast MTB, as the information presented at MTB can significantly influence treatment plans and dictate future steps for further patient work-up. Multidisciplinary tumor board preparation involves a careful review of the patient’s history while gathering all relevant imaging studies, and reinterpreting them when appropriate. Presented images should be carefully selected, annotated, and displayed clearly before providing final recommendations for localization and incompletely assessed findings. Anatomic staging factors from the AJCC Breast Cancer Staging System, such as tumor size and degree of suspected skin involvement, should be described. In addition, there are many other types of information that the treatment specialists want to know. The surgeon is interested in anatomic information that will help them decide whether breast conservation therapy is feasible or if local structures, such as the nipple, can be spared. The radiation oncologist may need to know whether accelerated partial breast irradiation is feasible or if postmastectomy radiation therapy is indicated. The medical oncologist is looking for factors that may provide an indication for neoadjuvant therapy and ensuring there is a reliable follow-up method for evaluating the response to treatment, such as comparative MRI. Additionally, all specialists need to know the extent of suspected nodal involvement. By clearly and comprehensively presenting this information to the rest of the MTB team, the radiologist provides a vital contribution that guides treatment and ensures adherence to clinical guidelines.

External accelerated partial breast irradiation for ductal carcinoma in situ: long-term follow-up from a phase 3 randomized trial

2018 ◽  
Vol 105 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Carlotta Becherini ◽  
Icro Meattini ◽  
Lorenzo Livi ◽  
Pietro Garlatti ◽  
Isacco Desideri ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Efficacy And Safety ◽  
Breast Irradiation ◽  
Phase 3

Introduction: For a long time, accelerated partial breast irradiation (APBI) effectiveness for ductal carcinoma in situ (DCIS) has been debated, due to conflicting published results. Recent encouraging data from phase 3 trials reopened new perspectives for this radiation approach. The aim of the present study was to analyze the long-term efficacy and safety results of the series of patients with DCIS enrolled in the APBI arm of the APBI-IMRT-Florence phase 3 trial (NCT02104895). Methods: Patients were treated in a phase 3 randomized trial comparing whole breast irradiation (50 Gy in 25 fractions to the whole breast, plus 10 Gy in 5 fractions to the tumor bed) to APBI (30 Gy in 5 nonconsecutive fractions) using the intensity-modulated radiotherapy technique. Results: Overall, 22 patients were treated in the APBI arm. Median age was 62 years (mean 59; range 42–75 years). At a median follow-up of 9.2 years (mean 8.8; range 3.8–12.1 years), no contralateral invasive/DCIS occurrence, distant metastasis, or breast cancer–related death were recorded. The 5- and 10-year local recurrence, distant metastasis–free survival, and breast cancer–specific survival were 100%. The 10-year overall survival rate was 90.9%. No late toxicity at 5 and 10 years was recorded. Conclusions: Waiting for pending studies and mature follow-up, we confirmed the efficacy and safety of APBI for low-risk DCIS.

Outcomes for APBI with strut-based brachytherapy: First 100 accrued patients (5-year median follow-up).

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 114-114
Author(s):  
Robert R. Kuske ◽  
Coral Quiet ◽  
Margaret B. Snyder ◽  
Maureen Lyden ◽  
Deanna J. Attai ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ductal Carcinoma ◽  
Target Volume ◽  
Invasive Disease ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Serious Adverse Events ◽  
Conventional Dose ◽  
Estrogen Receptor Positive

114 Background: The SAVI Collaborative Research Group (SCRG), was created to study the long-term outcomes of women receiving accelerated partial breast irradiation (APBI) using strut-based applicators. The outcomes for the first 100 accrued patients in the study are reported. Methods: Patients for this subset analysis weretaken as the initial 100 treated across all participating sites. Median follow-up of this cohort was 56.3 months at the time of the abstract. Patients were treated with APBI using the strut-based brachytherapy device with conventional dose and fractionation (3.4 Gy x 10 fx, BID). Treatment planning goals for the planning target volume were a V90>90%, V150<50 cc, and V200<20 cc. Patients were followed regularly by their radiation oncologist and outcomes were graded based on the CTCAE v3.0 (common terminology criteria for adverse events, version 3.0). Recurrence (raw and actuarial) rates were also calculated based on the follow up. Cosmesis was graded using the Harvard Scale. Results: 75 patients had invasive disease and 25 had ductal carcinoma in situ. The median age was 60.5 yrs (range 40-85 yrs), with 84% post-menopausal. Median tumor size was 10.0 mm (range 0.7-35 mm) with 92% being estrogen receptor positive. 65% of patients had at least one round of hormone therapy and 7% had chemotherapy. All patients completed APBI as planned with no serious adverse events. All patients met the dosimetric criteria. Good/excellent cosmesis was seen in >94% of subjects at all times of follow up (6-60 months). The 5-yr actuarial rates for TR/MM were 2.2%, 1.5% and 4.2% for all subjects, invasive and DCIS subgroups, respectively. The 5-yr actuarial rates for IBTR were 3.3%, 3.0% and 4.2% for all subjects, invasive and DCIS subgroups, respectively. Conclusions: For these initially treated 100 patients with a median 5 years of follow up, strut-based brachytherapy appears to be a well-tolerated, effective treatment with low rates of toxicities and local control as good as other brachytherapy APBI methods.

Residual cancer found on re-excision for close and positive margins after breast conservation for early-stage breast cancer: A single-institution review.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 55-55
Author(s):  
Dahlia Michelle Rice ◽  
Karen Beatrice Salud Ching ◽  
Sahil Gambhir ◽  
Edward Woo
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Published Data ◽  
Breast Cancer Patients ◽  
Residual Cancer ◽  
Positive Margins ◽  
Recommended Guidelines

55 Background: The SSO/ASTRO guidelines for margins on breast-conservation therapy (BCT) were recently published, recommending re-excision for positive margins only defined as ink on invasive cancer. The aim of our study is to retrospectively analyze our institution’s re-excision rate and the rate of finding residual cancer in the re-excision specimen when re-excisions were performed for positive and/or close margins. We want to confirm that our institution’s data for re-excision rates and residual cancer rates are comparable to national data from where the SSO/ASTRO guidelines were derived. Methods: A 3-year (2010 to 2012) retrospective review of data from our institution’s prospectively collected breast cancer database was performed for all stage 0, I, and II breast cancer patients who underwent BCT with subsequent re-excision or completion mastectomy for close or positive margins. Close margins were divided into two groups of < 1 mm or 1 to 2 mm margins, and positive margins were defined as tumor cells present on ink of specimen. Results: A total of 688 patients were analyzed. Our population was found to consist mostly of Caucasian females who were postmenopausal and married. 68% (468/688) of patients were found to have invasive ductal carcinoma (IDC), of which 27.8% (130/468) underwent re-excision for positive and/or close margins. Rates of residual cancer found in margins that are positive, < 1 mm, and 1-2 mm were 54.8% (17/31), 56% (14/25), and 6.3% (1/16) respectively. For DCIS, 38.9% (65/167) underwent re-excision. Rates of residual cancer found in margins that are positive, < 1 mm, and 1 to 2 mm were 38.9% (7/18), 28.6 % (4/14), and 20% (2/10) respectively. Conclusions: Our results reveal that in our institution, re-excision rates are comparable to published data. However, in patients with both positive and < 1 mm margins, the rates of finding residual cancer in the re-excision specimen was higher than the national average. Therefore, in our institution, further analysis is necessary prior to adopting the current recommended guidelines by SSO/ASTRO to prevent adverse impact in local recurrence rate.

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