scholarly journals Cardiac Sparing with Personalized Treatment Planning for Early-stage Left Breast Cancer

Cureus ◽  
2020 ◽  
Author(s):  
Dominique Mathieu ◽  
Stéphane Bedwani ◽  
Julia Mascolo-Fortin ◽  
Nicolas Côté ◽  
Andrée-Anne Bernard ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Planning ◽  
Early Stage ◽  
Left Breast ◽  
Personalized Treatment ◽  
Cardiac Sparing

Case series: Paclitaxel (P) and pegfigrastim (PF)-induced hypersensitivity pneumonitis (HSP) in breast cancer patients (pts)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11631-e11631
Author(s):  
L. Cream ◽  
A. C. Barochia ◽  
J. Sivik ◽  
R. Kass
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Case Series ◽  
Ground Glass Opacity ◽  
Left Breast ◽  
Nodal Metastasis ◽  
Breast Cancer Patients ◽  
Duct Carcinoma ◽  
Normal Limits ◽  
Long Acting

e11631 Background: P, a chemotherapeutic agent, extensively used in management of solid tumors. Although hypersensitivity reactions from P are common; HSP is rarely reported. We report 3 pts with early stage, high risk breast cancer, who developed HSP while receiving dose dense (DD) P with PF support. Methods: C#1 51 yr old woman (W) was diagnosed (Di) with triple negative (TN), infiltrating duct carcinoma (ca) with nodal metastasis. Neoadjuvant chemo (NC) with DD adriamycin 60 mg/m2 (A) and Cyclophosphamide 600 mg/m2 (C) was started. She completed 4 cycles of AC with PF 6 mg SQ given day 2 of each cycle without complications. Several days after her first dose of P with PF, she experienced dyspnea on exertion (DOE) and a non productive cough (NPC). CT of chest (CC) revealed ground glass opacity more in upper lungs, suggestive of HSP, and echocardiogram (echo) was within normal limits (WNL). She rapidly improved with steroid (S). C#2 46 yr w was Di with hormone positive, her 2 negative, infiltrating duct ca with nodal involvement. NC with DD AC followed by P was started. She completed 4 cycles of AC with minimal toxicity followed by DDP. After the third P infusion, she developed NPC with DOE. CC revealed diffuse interstitial prominence and echo was WNL. She rapidly improved with S. C#3 63 yr W was Di with 2.3 cm, TN, invasive duct carcinoma of left breast. NC with DD AC followed by P was started. After 2nd infusion of P, she developed hypoxia and cough; CC revealed diffuse groundglass opacities throughout lungs bilaterally, suggestive of HSP. She rapidly improved with S. Results: All 3 cases occurred in non-smoking pts without known lung/cardiac disease, treated with PF on day 2 of each cycle. Pts had abnormal CCs, were afebrile and responded quickly to steroids. Published DD experience (Citron et al) uses daily filgrastim (F), not the pegylated form which our pts received. We believe that HSP in these pts may be related to long acting growth factor stimulation of white cells and causing reversible HSP. Conclusions: Future prospective studies on taxanes using DD regimens should include a randomized design where pts given PF are compared to pts who receive F. No significant financial relationships to disclose.

Recurrence Score across the age spectrum: Is there an age discrimination?

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 27-27
Author(s):  
Franz Omar Smith ◽  
Marie Catherine Lee ◽  
Geza Acs ◽  
William J. Fulp ◽  
Ji-Hyun Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Treatment Planning ◽  
Tumor Size ◽  
Predictive Power ◽  
Early Stage ◽  
Recurrence Score ◽  
Positive Lymph Node ◽  
Node Negative

27 Background: Treatment planning for early-stage estrogen receptor (ER) positive, lymph node negative breast cancer was based on prognostic factors with limited predictive power such as age. The Recurrence Score (RS) from the Oncotype DX assay (ODX) provides predictive power transcending age but is rarely applied to the elderly or young patients (pts). We examined our experience with RS along the age continuum. Methods: Retrospective review was conducted of prospectively gathered breast cancer pts having a RS obtained as part of their cancer care. Eligibility for performance of the ODX was based on NCCN guidelines or physician discretion. Comparisons on RS were made by age groups (young: <45yrs; middle: >45yrs -<70yrs: elderly: >70yrs) using general linear regression model and the exact Wilcoxon Rank Sum Test. Results: 677pts had 681 tumors with RS available (89 young, 476 middle and 112 elderly pts). Median RS for the study pts was 17 (range 0-85) and 16, 17, and 15 for the young, middle, and elderly respectively. Median age was 58yrs (range: 27-95); young, middle, and elderly was 42, 58, and 74yrs respectively. Age as a continuous or categorical variable was not predictive of RS (p value = 0.38, 0.58 respectively). No significant differences were seen between age cohorts for histology, mitotic rate, lymphovascular invasion (LVI), grade, nodal status, stage, or strength of ER positivity. Mastectomy rates were higher in the young (57.5%), compared to the middle (42.5%) and elderly (39.6%) (p=0.02). Median invasive tumor size was 1.6, 1.5, and 1.5cm for young, middle, and elderly. Larger tumor size, as a continuous variable, equaled higher RS (p=0.046). Other significant factors predicting higher RS were increased mitosis (p<0.001), LVI (p=0.013), high grade (p<0.001), and weak (<10%) ER positivity (p<0.001). Nodal status, stage, and histology did not affect RS. Conclusions: Age has limited predictive power for treatment planning for breast cancer. Age alone should not preclude recommendations for performance of ODX in estrogen receptor positive lymph node negative early stage breast cancer as the RS distribution across the spectrum of age is well matched.

Integration of multi-modality treatment planning for early stage breast cancer (BC) into Watson for Oncology, a Decision Support System: Seeing the forest and the trees.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e12042-e12042 ◽  
Author(s):  
Andrew David Seidman ◽  
Melissa Louise Pilewskie ◽  
Mark E. Robson ◽  
Joanne Frankel Kelvin ◽  
Marjorie Glass Zauderer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Support ◽  
Decision Support System ◽  
Treatment Planning ◽  
Support System ◽  
Early Stage ◽  
Early Stage Breast Cancer

scholarly journals Prone breast forward intensity-modulated radiotherapy for Asian women with early left breast cancer: factors for cardiac sparing and clinical outcomes

2013 ◽  
Vol 54 (5) ◽  
pp. 899-908 ◽  
Author(s):  
Jenny Ling-Yu Chen ◽  
Jason Chia-Hsien Cheng ◽  
Sung-Hsin Kuo ◽  
Hsing-Min Chan ◽  
Yu-Sen Huang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Outcomes ◽  
Intensity Modulated Radiotherapy ◽  
Left Breast ◽  
Asian Women ◽  
Intensity Modulated ◽  
Cardiac Sparing

An IMRT technique to increase therapeutic ratio of breast irradiation in patients with early stage left breast cancer: Limiting second malignancies

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10791-10791 ◽  
Author(s):  
R. S. Ahmed ◽  
J. B. Fiveash ◽  
R. A. Popple ◽  
S. A. Spencer ◽  
J. F. De Los Santos
Keyword(s):  
Breast Cancer ◽  
Low Dose ◽  
Early Stage ◽  
Breast Conservation ◽  
Left Breast ◽  
Breast Conservation Surgery ◽  
Adjuvant Radiation ◽  
Target Coverage ◽  
Second Malignancy ◽  
Dose Levels

10791 Background: The clinical application of IMRT for adjuvant treatment of breast cancer has been the subject of increasing study in recent years. IMRT plans have improved target coverage and reduced dose inhomogeneities observed within the breast in standard plans. IMRT was able to reduce doses delivered to the heart, lungs, and right breast at clinically significant doses, but this has been at the cost of larger volumes of low dose radiation to these structures and thus, increasing the risk for second malignancy. Our goal was to develop an IMRT beam arrangement that did not result in additional low dose spill to risk organs while maintaining equal or better target coverage. Methods: Five patients with early stage left-sided breast cancer, who underwent breast conservation surgery, and adjuvant radiation using standard wedged tangential fields, were chosen for this comparative study. An IMRT plan consisting of 6 tangential beams (3 medial and 3 lateral) was generated by using the gantry, collimator and table angles of the standard plan used for the conventional radiation (CRT), and moving the table +10 and −10 degrees on each side. The prescription dose for both CRT and IMRT plans was 45 Gy, 1.8 Gy/fraction, prescribed to the isocenter which was placed near the center of the breast. Results: IMRT plans provided significantly better coverage of the left breast than CRT plans, (p=0.03). Although dose heterogeneity was greater with the IMRT plans, the difference was not significant (p = 0.68). The mean volumes of the heart, lung, and right breast were lower in patients planned with IMRT at all dose levels from 5% to 100% dose (5% increments). This difference was significant for volumes receiving 2.25 Gy for the heart (p = 0.003), volumes receiving 2.25 Gy, 4.5 Gy, 6.75 Gy, 33.75 Gy, 36 Gy, 38.25 Gy, and 42.75 Gy for the lung (p = 0.014, 0.04, 0.044, 0.05, 0.049, 0.045, 0.05, respectively). Surprisingly, breast IMRT resulted in significantly lower right breast volumes irradiated at all dose levels compared to CRT. Conclusions: A six-tangential field IMRT technique achieved significantly better left breast coverage while maintaining lower doses to risk organs at all dose levels and therefore, reducing the potential for induction of a second malignancy. No significant financial relationships to disclose.

scholarly journals Cardiotoxicity of concomitant radiotherapy and trastuzumab for early breast cancer

2014 ◽  
Vol 48 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Tanja Marinko ◽  
Jure Dolenc ◽  
Cvetka Bilban-Jakopin
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Growth Factor Receptor ◽  
Left Breast ◽  
Thoracic Wall ◽  
Breast Cancer Patients ◽  
Long Term Effects ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

AbstractBackground. Trastuzumab therapy given in combination with one of several chemotherapy regimens is currently considered the standard of care for the treatment of early-stage, human epidermal growth factor receptor-2 (HER2) -positive breast cancer. The treatment with trastuzumab is due to a significant impact on the survival part of the standard adjuvant treatment of patients with HER2-positive breast cancer. Patients treated with postoperative breast or chest wall irradiation receive trastuzumab concomitant with radiotherapy. In a small proportion of patients trastuzumab causes cardiotoxicity. Preclinical findings indicate a radiosensibilizing effect of trastuzumab in breast cancer cells, but it is not yet clear whether it radiosensibilizes cells of healthy tissues too.Conclusions. Special attention is required when left breast or left thoracic wall is irradiated in patient receiving trastuzumab, because long-term effects of the concurrent treatment with trastuzumab and radiotherapy are not yet known. In an era where more patients are surviving a diagnosis of breast cancer, better understanding and earlier detection of therapy-induced cardiac toxicity will be of paramount importance.

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