Safety of the Breast Cancer Adjuvant Radiotherapy in Ataxia–Telangiectasia Mutated Variant Carriers
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. ATM Variants Identification and Classification
2.3. Radiation Therapy Treatment Characteristics and Follow-Up
2.4. Statistical Analysis
3. Results
3.1. Population Characteristics
3.2. Characteristics of Genetic Variants
3.3. Treatment Details
3.4. Acute Toxicities
3.5. Late Toxicities
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total Number n = 50 | Rare ATM Variant Carriers * n = 9 | Noncarriers n = 41 | p-Value |
---|---|---|---|---|
Median age at diagnosis (years, [median, range]) | 53 (35–77) | 52 (36–77) | 53 (35–75) | 0.48 |
Mean follow up (years, range) | 13.1 (1.6–21.9) | 14.3 (7–18.2) | 12.9 (1.6–21.9) | 0.53 |
BMI (kg/m2, [median, range]) | 24.6 (18.2–34.9) | 23.4 (18.2–28.9) | 22.9 (18.2–34.9) | 0.48 |
Smoking status | ||||
Ever (30%) | 15 | 2 | 13 | |
Never (70%) | 35 | 7 | 28 | 0.87 |
Histopathology (WHO classification) | ||||
In situ carcinoma (4%) | 2 | 0 | 4 | |
Invasive ductal carcinoma (82%) | 41 | 9 | 32 | |
Invasive lobular carcinoma (14%) | 7 | 0 | 7 | 0.29 |
Immunochemistry | ||||
Grade | ||||
1 (26%) | 13 | 1 | 12 | |
2 (44%) | 22 | 5 | 17 | |
3 (26%) | 13 | 3 | 10 | |
Unknown (4%) | 2 | 0 | 2 | 0.58 |
Mitotic index (%) | ||||
<4 (20%) | 10 | 2 | 8 | |
4–12 (44%) | 22 | 5 | 17 | |
>12 (30%) | 15 | 2 | 13 | |
Unknown (6%) | 3 | 0 | 3 | 0.65 |
Embolus | ||||
Yes (26%) | 13 | 4 | 9 | |
No (68%) | 34 | 5 | 29 | |
Unknown (6%) | 3 | 0 | 3 | 0.30 |
ER expression | ||||
Positive (80%) | 40 | 8 | 32 | |
Negative (16%) | 8 | 1 | 7 | |
Unknown (4%) | 2 | 0 | 2 | 0.70 |
HER 2 expression | ||||
0 (40%) | 20 | 3 | 17 | |
+ (18%) | 9 | 2 | 7 | |
++ and FISH negative (6%) | 3 | 1 | 2 | |
+++ (12%) | 6 | 1 | 5 | |
Unknown (24%) | 12 | 2 | 10 | 0.70 |
Clinical stage (AJCC 2017 v8) | ||||
0 (4%) | 2 | 0 | 2 | |
I (40%) | 20 | 4 | 16 | |
IIA (24%) | 12 | 1 | 11 | |
IIB (20%) | 10 | 3 | 7 | |
IIIA (6%) | 3 | 0 | 3 | |
IIIB (2%) | 1 | 1 | 0 | |
Unknown (4%) | 2 | 0 | 2 | 0.16 |
Patient | Study | ATM Rare Variant | MAF in GnomAD a | In Silico Predictions | Our Classification for This Study | ClinVar Classification | Genotype for rs1801516 (c.5557G>A; p.Asp1853Asn) d | |
---|---|---|---|---|---|---|---|---|
CADD Phred Score b | Align-GVGD c | |||||||
Pt 1 | GENESIS | c.8494C>T; p.Arg2832Cys | 0.0004 | 32 | C45 | PV | PV | GG |
Pt 2 | CoF-AT2 | c.3894dupT; p.Ala1299CysfsX3 | 0.000007 | n/a | n/a | PV | PV | Unknown |
Pt 3 | CoF-AT2 | c.5644C>T; p.Arg1882X | Not reported | 36 | n/a | PV | PV | Unknown |
Pt 4 | GENESIS | c.4709T>C; p.Val1570Ala | 0.0007 | 17.66 | C0 | PPV | VUS | GG |
Pt 5 | GENESIS | c.2T>G; p.Met1Arg (START loss) | Not reported | 23.4 | C65 | PPV | VUS | GG |
Pt 6 | GENESIS | c.6059G>T; p.Gly2020Val | Not reported | 27.3 | C65 | PPV | VUS | GG |
Pt 7 | GENESIS | c.4853G>A; p.Arg1618Gln | 0.00003 | 22.6 | C0 | PPV | VUS | GA |
Pt 8 | GENESIS | c.6067G>A; p.Gly2023Arg | 0.0024 | 28.9 | C25 | PPV | VUS | GG |
Pt 9 | GENESIS | c.1073A>G; p.Asn358Ser | 0.00001 | 14.04 | C0 | PPV | Benign | Unknown |
Pt 10 | GENESIS | - | - | - | - | - | - | GA |
Pt 11 | GENESIS | - | - | - | - | - | - | GA |
Pt 12 | GENESIS | - | - | - | - | - | - | GA |
Pt 13 | GENESIS | - | - | - | - | - | - | GA |
Pt 14 | GENESIS | - | - | - | - | - | - | GA |
Pt 15 | GENESIS | - | - | - | - | - | - | GA |
Pt 16 | GENESIS | - | - | - | - | - | - | GA |
Treatment Characteristics | Number of Treated Patients | % of Total | Rare ATM Variant Carriers | Noncarriers | p-Value |
---|---|---|---|---|---|
Type of surgery before RT | |||||
Breast conserving | 40 | 80 | 6 | 34 | |
Mastectomy | 10 | 20 | 3 | 7 | |
Sentinel lymph node | 12 | 24 | 2 | 10 | |
ALND | 34 | 68 | 6 | 28 | 0.51 |
Chemotherapy | |||||
NAC | 9 | 18 | 3 | 6 | 0.39 |
Adjuvant chemotherapy | 18 | 36 | 4 | 14 | 0.84 |
Targeted adjuvant therapy | 4 | 8 | 0 | 4 | 0.76 |
Hormonotherapy | |||||
AI | 10 | 20 | 0 | 10 | |
Tamoxifen | 22 | 44 | 5 | 17 | 0.37 |
Median duration of HT (years, range) | 5 (1–11) | NA | 5 (4–11) | 5 (1–10) | |
Technique of radiation therapy | |||||
3D-CRT | 35 | 70 | 5 | 30 | |
ILD | 15 | 30 | 4 | 11 | 0.52 |
Mean dose of radiation therapy (Gy, range) | 56 (45–71) | NA | 57 (45–66) | 56 (45–71) | 0.64 |
Mean RT duration (days, range) | 42.7 (28–81) | NA | 42 (32–52) | 43 (28–81) | 0.73 |
Irradiated volume | |||||
Only breast | 22 | 44 | 3 | 19 | |
Breast and lymph nodes | 28 | 56 | 6 | 22 | |
Associated boost | 22 | 44 | 4 | 18 | 0.73 |
Number of Patients with Toxicities (%) | p-Value | |||||
---|---|---|---|---|---|---|
Acute toxicities | ||||||
Grade 0 | Grade 1 | Grade 2 | Grade 3 | |||
Dermatitis | Noncarriers | 7 (14%) | 21(42%) | 9 (18%) | 4 (8%) | |
Carriers | 1 (2%) | 5 (10%) | 2 (4%) | 1 (2%) | ||
Total | 8 (16%) | 26 (52%) | 11 (22%) | 5 (10%) | 0.98 (Chi 2) | |
Dysphagia | Noncarriers | 37 (74%) | 4 (8%) | 0 | 0 | |
Carriers | 9 (18%) | 0 | 0 | 0 | ||
Total | 46 (92%) | 4 (8%) | 0 | 0 | 1 (Chi 2) | |
Lymphoedema | Noncarriers | 39 (78%) | 2 (4%) | 0 | 0 | |
Carriers | 9 (18%) | 0 | 0 | 0 | ||
Total | 48 (96%) | 2 (4%) | 0 | 0 | 1 (Chi 2) | |
Late toxicities | ||||||
Grade 0 | Grade 1 | Grade 2 | Grade 3 | |||
Subcutaneous fibrosis | Noncarriers | 23 (46%) | 16 (32%) | 2 (4%) | ||
Carriers | 7 (14%) | 2 (4%) | 0 | |||
Total | 30 (60%) | 18 (36%) | 2 (4%) | 0.16 (Gray) | ||
Telangiectasia | Noncarriers | 37 (74%) | 4 (8%) | 0 | ||
Carriers | 9 (18%) | 0 | 0 | |||
Total | 46 (92%) | 4 (8%) | 0 | 0.33 (Gray) | ||
Lymphoedema | Noncarriers | 38 (76%) | 0 | 3 (6%) | ||
Carriers | 8 (16%) | 1 (2%) | 0 | |||
Total | 46 (92%) | 1 (2%) | 3 (6%) | 0.72 (Gray) | ||
Heart disease | Noncarriers | 40 (80%) | 1 (2%) | 0 | ||
Carriers | 9 (18%) | 0 | 0 | |||
Total | 49 (98%) | 1 (2%) | 0 | 1 (Gray) |
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Bensenane, R.; Beddok, A.; Lesueur, F.; Fourquet, A.; Warcoin, M.; Le Mentec, M.; Cavaciuti, E.; Le Gal, D.; Eon-Marchais, S.; Andrieu, N.; et al. Safety of the Breast Cancer Adjuvant Radiotherapy in Ataxia–Telangiectasia Mutated Variant Carriers. Cancers 2024, 16, 1417. https://doi.org/10.3390/cancers16071417
Bensenane R, Beddok A, Lesueur F, Fourquet A, Warcoin M, Le Mentec M, Cavaciuti E, Le Gal D, Eon-Marchais S, Andrieu N, et al. Safety of the Breast Cancer Adjuvant Radiotherapy in Ataxia–Telangiectasia Mutated Variant Carriers. Cancers. 2024; 16(7):1417. https://doi.org/10.3390/cancers16071417
Chicago/Turabian StyleBensenane, Rayan, Arnaud Beddok, Fabienne Lesueur, Alain Fourquet, Mathilde Warcoin, Marine Le Mentec, Eve Cavaciuti, Dorothée Le Gal, Séverine Eon-Marchais, Nadine Andrieu, and et al. 2024. "Safety of the Breast Cancer Adjuvant Radiotherapy in Ataxia–Telangiectasia Mutated Variant Carriers" Cancers 16, no. 7: 1417. https://doi.org/10.3390/cancers16071417