Search Results (103)

Breast-conserving surgery followed by external beam Radiotherapy (RT) is a standard approach for early-stage Breast Cancer (BC). This retrospective study aims to determine the risk of RT-induced lung cancer for both standard and hypofractionated treatments. Fifty-eight Sicilian women treated at Humanitas Istituto Clinico Catanese (Misterbianco, Italy) between 2015 and 2021 with standard fractionated 3D-CRT (50 Gy in 2 Gy/fraction) were included. All treatment plans were designed using a hypofractionated schedule (42.56 Gy in 2.66 Gy/fraction). An Eclipse™ plug-in script was developed using the Eclipse Scripting Application Programming Interface (ESAPI) to extract patient and treatment data from the Treatment Planning System and compute Organ At Risk (OAR) volume, Organ Equivalent Dose (OED), Excess Absolute Risk (EAR), and Lifetime Attributable Risk (LAR) using the Schneider Mechanistic Model and reference data from regional populations, A-bomb survivors, and patients with Hodgkin’s Disease (HD). The OED distributions exhibited a statistically significant shift toward higher values in standard fractionated plans (p < 0.01, one-tailed paired Student’s t-test), leading to increased EAR and LAR. These results indicate that hypofractionated treatment may lower the risk of radiation-induced lung cancer. The feasibility of a priori risk estimation was evaluated by integrating the script into the TPS, allowing rapid comparison of SF and HF plans during planning. Full article

Purpose: Neoadjuvant endocrine therapy (NET) represents a valuable treatment option for hormone receptor-positive (HR+)/HER2-negative breast cancer, particularly in postmenopausal women. This study aimed to evaluate the clinical and histopathological efficacy of NET and to explore early and late changes in Ki-67 and progesterone receptor (PgR) expression as indicators of endocrine response. Methods: A prospective cohort of 127 postmenopausal patients with stage cT1–4N0–3M0 HR+/HER2− breast cancer was enrolled between 2019 and 2021. Patients received NET (mostly letrozole) for a mean of 7.7 months. In 80 cases, a second core biopsy was performed after four weeks. Tumor size, histological grade, and biomarkers (Ki-67, PgR) were assessed pre- and post-treatment. Results: NET led to a significant reduction in tumor size, with median shrinkage of 47.0% (from 32.0 mm to 17.0 mm, p < 0.0001). Breast-conserving surgery (BCS) was performed in 52.2% of patients and lymph node negativity (pN0) was observed in 50.4%. Median Ki-67 decreased from 20.0% at baseline to 5.0% after four weeks (p < 0.0001) and remained low in surgical specimens (median 5.0%, p < 0.0001). In 33.3% of patients, Ki-67 dropped below 2.7%, and 67.0% showed a concordant decrease in both Ki-67 and PgR. PgR expression declined significantly during treatment (p < 0.0001). HER2 status conversion was noted in 6.4% of patients during treatment. Pathological complete response (pCR) occurred in 3.5%, while minimal or moderate residual disease (RCB I–II) was identified in 71.3% of cases. Conclusions: NET effectively reduced tumor burden and histological aggressiveness, enabling higher rates of BCS. Early reduction in Ki-67 and PgR may serve as surrogate markers of endocrine responsiveness, supporting their use for treatment stratification and monitoring during NET in HR+/HER2− breast cancer. Full article

Oncoplastic breast-conserving surgery (OBCS), or oncoplastic surgery, has revolutionized the surgical management of breast cancer by integrating oncologic principles with reconstructive techniques to optimize both cancer control and aesthetic outcomes following breast-conserving surgery (BCS). Since its inception in the 1980s, the field has evolved significantly, incorporating a range of volume displacement and volume replacement strategies to restore breast contour after partial mastectomy. This review explores the current practices and key surgical considerations of OBCS. It highlights the role of preoperative multidisciplinary planning, patient selection, anatomical and vascular knowledge, and intraoperative technique in optimizing results. Barriers to access—including disparities in training, insurance, and geographic availability—are addressed, alongside efforts by professional societies like the American Society of Breast Surgeons (ASBS) to standardize definitions and practices. The review also outlines strategies for minimizing complications and enhancing oncologic, reconstructive, and patient-reported outcomes. By offering a comprehensive framework for clinical decision-making, this paper aims to support broader adoption and refinement of OBCS as a standard component of breast cancer care. Full article

Background and Objectives: Lymphedema is one of the most important morbid complications of modified radical mastectomy (MRM) surgery. It can cause limb movement restriction and psychosocial deformities in some patients. This study aimed to determine and compare the physiological and pathological changes that develop in the axillary venous structures in patients who underwent axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Materials and Methods: Patients diagnosed with breast cancer who underwent MRM and breast-conserving surgery (BCS) plus SLNB between 2017 and 2022 were retrospectively examined. The patients’ operation side and contralateral axillary vein diameter and the difference between them, axillary vein flow rate and the difference between them, axillary vein wall thickness and the difference between them, severity of lymphedema, extremity joint restriction examination, and the Nottingham Health Profile (NHP) data were recorded. The relationship of these parameters with the lymph node dissection width and radiotherapy was analyzed. Results: Fifty-eight patients in total were included in the study. In the distribution of lymphedema and lymphedema severity according to ALND groups, there is a statistically significant difference (p < 0.001). A statistically significant difference was determined in the distribution of the difference in the axillary vein blood flow rate and axillary vein diameter difference between the two arms according to the lymph node dissection groups. In the distribution of physical therapy and rehabilitation scales according to the lymph node dissection groups, a significant difference was found in the disabilities of the arm, shoulder, and hand (DASH), shoulder flexion restriction variables, and NHP sleep variables (all p < 0.001). Conclusions: This study demonstrated that ALND leads to more pronounced physiological and pathological changes in axillary venous structures—including increased vein wall thickness, altered flow rates, and diameter differences—compared to SLNB combined with breast-conserving surgery. These changes may be attributed to lymphovenous disruption and postoperative edema. Furthermore, radiotherapy appears to contribute to these changes, though to a lesser extent than ALND. Therefore, SLNB followed by radiotherapy may be preferable in eligible patients to reduce postoperative complications such as lymphedema, joint restriction, and sleep disturbances. Full article

Background: Intercostal artery perforator (ICAP) flaps are a reliable option for volume replacement in breast-conserving surgery (BCS), particularly for lower pole defects. However, limited flap volume may reduce their applicability in selected patients. Autologous fat grafting has been proposed to enhance both volume and aesthetic outcomes. Methods: This retrospective study evaluated 10 patients undergoing BCS with immediate reconstruction using fat-graft-augmented ICAP flaps. Nine anterior ICAP (AICAP) flaps and one lateral ICAP (LICAP) flap were employed. The outcomes included flap viability, complications, and aesthetic results over a 6-month follow-up. Results: Partial flap resorption occurred in 2 patients (20%), both of whom were active smokers. No cases of skin necrosis were observed. Fat grafting volumes ranged from 20 to 60 cc. Aesthetic outcomes were satisfactory, with good restoration of the breast contour and stable integration of the flap and grafted fat. Conclusions: The combined use of ICAP flaps and autologous fat grafting is a feasible and effective technique for immediate reconstruction after BCS. It allows volume enhancement, maintains natural contour, and shows low complication rates in properly selected patients. Smoking remains a significant risk factor. Full article

Background/objectives: Pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer (BC) is a solid indicator of favourable prognosis, potentially also being useful for more conservative patient management. We aim to explore the potential of [¹⁸F]FDG PET/CT as a non-invasive method to predict response to NAC. Methods: In this prospective, observational cohort study, we enrolled BC patient candidates for NAC who underwent baseline and preoperative [¹⁸F]FDG PET/CT. NAC response was determined using final histopathology. PET images were assessed qualitatively and semi-quantitatively, and the findings correlated with NAC response. Results: In total, 133 BC patients were included. The visual analysis of preoperative PET/CT detected residual disease (RD) with high specificity (>93%) and moderate sensitivity, based on pCR/RD classification and RCB index. Semiquantitative measures (SUVmax, TBR) were significantly higher in non-responders across the classification methods (p < 0.001 for all). Conclusions: These findings highlight the potential of preoperative [¹⁸F]FDG PET/CT as a complementary tool for identifying excellent responders to NAC across BC subtypes or response criteria. This could inform personalised treatment and potentially allow for surgery to be omitted in selected patients. Full article

Purpose: The aim of the present study is to analyze, for the first time, the results of a large prospective academic multicenter trial of partial breast irradiation (PBI) with exclusive photon intraoperative radiation therapy (ph-IORT) in early breast cancer patients, focusing on ipsilateral breast tumor recurrence. The secondary endpoints were (a) incidence of regional/distant recurrence, (b) survival, and (c) toxicity. Methods: From January 2013 to December 2022, patients with low-risk TARGIT-A criteria invasive breast cancer were included in a prospective academic multicenter study of exclusive PBI with ph-IORT during breast-conserving surgery, conducted in three university hospitals in Las Palmas (Hospital Universitario Insular, Hospital Universitario Materno-Infantil, and Hospital Universitario de Gran Canaria Dr. Negrín). Results: Three hundred and twelve patients were included in the study. The mean age at diagnosis was 62 years (46–88). All tumors were classified as luminal molecular profile. No patient received supplementary external beam radiotherapy. Four patients developed ipsilateral breast tumor recurrence (IBTR) at 19, 29, 43, and 62 months of follow-up. Seventeen patients died of intercurrent diseases, and there were only 2 breast cancer-related deaths at 68 and 95 months, respectively. With a median follow-up of 78 months (7–140), actuarial 5-year freedom from local relapse and cancer survival rates were 98.9% and 100%, respectively. No patient developed early or late grade-3 toxicity. Conclusions: Partial breast irradiation with ph-IORT is a feasible, safe, and useful treatment in early breast cancer patients after BCS. A longer follow-up is needed to confirm the present results. Full article

Introduction: In breast conserving surgery (BCS), 15–40% of patients must undergo a second surgery (re-operation) due to post-surgical cancer-positive margins. Efficient intraoperative assessment of lumpectomy margins can reduce this rate. Classical methods like specimen radiography and ultrasound have limitations. The SHIELD study was conducted to prospectively quantify the reduction of the re-operation rate when the Histolog^® Scanner (HLS) confocal microscope is intraoperatively used by surgeons for the margin assessment. Methods: 50 patients undergoing BCS were enrolled and analyzed. Lumpectomy margins were intraoperatively assessed by surgeons with the HLS in addition to standard-of-care techniques. Detected positive margins triggered the excision of additional recuts during the same surgery. Subsequent re-operation and detection rates were compared to historical data and pathology gold standards, respectively. Results: The study population included 32% of patients with pure invasive cancer(s), 18% with pure DCIS and 50% with invasive cancer(s) mixed with DCIS. The overall mean age was 63.56. All population features were statistically similar to the historical control (p > 0.1). Notably, 80.95% sensitivity and 99.53% specificity for breast cancer detection at the margin were intraoperatively achieved by the surgeons using the HLS. The re-operation rate in SHIELD was 10% (5/50) while the historical control was 30% (12/40) corresponding to a 67% reduction (p = 0.016). Notably, 17/21 positive margins were intraoperatively identified with the HLS while 4/21 were detected with standard-of-care techniques. Conclusions: The intraoperative use of the Histolog Scanner confocal microscope provides a significant increase in detection rates of lumpectomy positive margins resulting in a substantial reduction in the re-operation rate, while preserving specimen integrity without impact on histopathology assessment. Full article

In triple-negative (TNBC) and human epidermal growth factor receptor 2-positive (HER2+) breast cancer patients, neoadjuvant systemic therapy is the standard recommendation for tumors larger than 2 cm. Monitoring the response to primary systemic therapy allows for the assessment of treatment effects, the need for breast-conserving surgery (BCS), and the achievement of pathological complete responses (pCRs). In estrogen receptor-positive/HER2-negative (ER+/HER2-) breast cancer, the benefit of neoadjuvant strategies is controversial, as they have shown lower tumor downstaging and pCR rates compared to other breast cancers. In recent decades, several gene expression assays have been developed to tailor adjuvant treatments in ER+/HER2- early breast cancer (EBC) to identify the patients that will benefit the most from adjuvant chemotherapy (CT) and those at low risk who could be spared from undergoing CT. It is still a challenge to identify patients who will benefit from neoadjuvant systemic treatment (CT or endocrine therapy (ET)). Here, we review the published data on the most common gene expression signatures (MammaPrint (MP), BluePrint (BP), Oncotype Dx, PAM50, the Breast Cancer Index (BCI), and EndoPredict (EP)) and their ability to predict the response to neoadjuvant treatment, as well as the possibility of using them on core needle biopsies. Additionally, we review the changes in the gene expression signatures after neoadjuvant treatment, and the ongoing clinical trials related to the utility of gene expression signatures in the neoadjuvant setting. Full article

Background: This study compared the change in pre- and postoperative health-related quality of life (HRQoL) among breast cancer patients undergoing breast-conserving surgery (BCS), total mastectomy no reconstruction (TMNR), and total mastectomy immediate breast reconstruction (MIBR). Patient factors associated with postoperative anxiety and depression were also identified. Methods: This prospective cohort study enrolled breast cancer patients between September 2017 and August 2020. HRQoL changes from preoperative to six months postoperative were compared using patient-reported outcome tools assessing anxiety, depression, pain, perceived health, breast satisfaction, psychosocial, physical, and sexual well-being and analyzed with ANOVA and linear regression. Results: A total of 471 patients completed preoperative and postoperative surveys (BCS: 313, TMNR: 60, MIBR: 98). Postoperative anxiety decreased across all modalities, with MIBR showing the greatest reduction (p = 0.03), though still exhibiting the highest postoperative anxiety (p = 0.05). Depression and perceived health scores showed no significant difference in change across modalities (p = 0.15, p = 0.48). MIBR patients showed the greatest increase in pain (p = 0.05) and the highest postoperative pain scores (p = 0.04). All three modalities showed a clinically significant decline in physical and sexual well-being. TMNR and MIBR had additional reductions in breast satisfaction, with TMNR also showing a decline in psychosocial well-being. Absolute postoperative scores for breast satisfaction, psychosocial, physical, and sexual well-being remained highest in BCS compared to TMNR and MIBR (p < 0.01, for each domain). In multivariable regression analysis, postoperative depression and anxiety scores did not differ between surgical modalities, but younger age was significantly associated with higher postoperative depression, pain and anxiety (p < 0.01), and adjuvant chemotherapy with higher postoperative depression (p < 0.01). Conclusions: BCS may have better overall HRQoL outcomes, specifically in breast satisfaction, psychosocial, physical, and sexual well-being, compared to TMNR and MIBR. Additionally, younger age, rather than surgical modality, was found to be associated with higher postoperative depression, pain, and anxiety scores. Full article

Background: Breast-conserving surgery (BCS) is one of the major surgical advances in breast cancer treatment. This study evaluated the oncological outcomes of BCS in patients with non-metastatic breast cancer at a referral cancer center in a medium-resource country between 2013 and 2019. Methods: An observational, analytical, retrospective cohort study was conducted on patients with stage I–IIIC breast cancer treated at the Instituto Nacional de Cancerología (Bogotá, Colombia) from September 2013 to March 2019. Demographic data, tumor characteristics, treatment types, and survival outcomes were retrospectively collected. Results: A total of 409 patients were included. In 64.1% of cases, BCS was performed as the initial treatment and in 35.9%, after neoadjuvant chemotherapy (NACT). With a median follow-up of 85.2 months, tumor recurrence was documented in 9.04% of patients, local recurrence in 2.9%, regional in 2.2%, and distant in 5.6%. The identified risk factors for mortality were a locally advanced clinical stage (HR 5.13; p = 0.01), triple-negative subtype (HR 8.02; p < 0.01), and nodal involvement of more than four lymph nodes in the surgical specimen (HR 4.00; p < 0.01). Conclusions: Breast-conserving surgery is an oncologically safe procedure for patients with early and locally advanced breast cancer who respond to NACT. The time to recurrence and overall survival are determined by the clinical stage, axillary tumor burden, and biological subtype of the disease. Full article

Background: Ductal carcinoma in situ (DCIS) is a precursor of invasive breast cancer and its early diagnosis and treatment are essential to prevent progression and recurrences. Risk stratification guidelines, such as the Van Nuys Prognostic Index (VNPI) and those by the National Comprehensive Cancer Network (NCCN), help guide appropriate treatment. This study compares VNPI recommendations for DCIS patients treated at Hospital do Servidor Público Estadual de São Paulo (HSPE) with NCCN guidelines, focusing on treatment conducted and recurrence rates. Methods: This retrospective, cross-sectional study reviewed medical records of 145 patients treated for DCIS at HSPE between January 1996 and June 2022, with a mean follow-up of 60.3 months. Results: Based on VNPI, 38.8% were low risk, 53.2% intermediate risk, and 7.8% high risk. NCCN guidelines classified only 12.9% as low risk and 87.1% as high risk. Treatment included breast-conserving surgery (BCS) with radiotherapy (43.1%), BCS alone (38.8%), and mastectomy (18.1%). There were 18 recurrences (15.5%): 5.2% as DCIS and 10.3% as invasive cancer. Of these recurrences, 5.6% occurred in patients who, according to NCCN, would have received BCS with radiotherapy or mastectomy. Conclusion: By integrating the VNPI with NCCN treatment guidelines, the NCCN’s recommendations could potentially reduce local recurrence rates by 5.6%. However, further studies are necessary to evaluate the long-term impact of these guidelines on overall survival outcomes. Full article

Backgrounds: Neoadjuvant therapy (NAT) is a cornerstone in the management of breast cancer (BC), enabling tumor downstaging and improved surgical options. Methods: This study retrospectively analyzed 607 BC patients treated with NAT and surgery at IRCCS Humanitas Research Hospital, Milan, Italy, to compare long-term oncologic outcomes of breast-conserving surgery (BCS) versus mastectomy. Patient demographics, tumor characteristics, and treatment details were analyzed using descriptive statistics, logistic regression, and Cox proportional hazards models. Results: Of the 607 patients, 54.7% underwent BCS, and 45.3% had mastectomy. BCS was associated with significantly superior 10-year outcomes compared to mastectomy, including disease-free survival (DFS, 75.2% vs. 71.1%, p = 0.001), distant DFS (75.2% vs. 71.1%, p = 0.001), overall survival (OS, 82.9% vs. 78.1%, p = 0.002), and BC-specific survival (BCSS, 87.7% vs. 83.1%, p = 0.001). Pathologic complete response (pCR) emerged as a protective factor across all endpoints, while mastectomy was independently associated with worse BCSS (HR: 2.068, 95% CI: 1.016–4.210, p = 0.045). Conclusions: Our findings demonstrate the oncologic safety and potential superiority of BCS over mastectomy in NAT-treated BC patients, highlighting the importance of individualized surgical decision-making to optimize survival outcomes. Full article

Background: Male breast cancer (MaBC) is a rare disease and due to its rarity and the lack of specific protocols for its management, treatment algorithms are extrapolated from female breast cancer (FBC). To optimize MaBC treatment, we conceived an umbrella review with the aim of supplying an evidence-based summary of systematic reviews published about this topic in the last twenty years. Methods: This umbrella review was performed according to a predefined protocol (PROSPERO number CRD42024574299). We performed a literature search of the PubMed and Cochrane Libraries databases and we considered systematic reviews on MaBC treatment published from 2004 to 2024. We evaluated relevant treatments in the management of MaBC, including surgery, radiotherapy, and systemic treatments. We conducted the quality assessment according to A MeaSurement Tool to Assess systematic Reviews version 2 (AMSTAR-2), and the description of the main findings of eligible articles. Results: Seven systematic reviews were selected and the main findings were compiled. Breast-conserving surgery is a reasonable treatment approach and, in selected cases, equivalent in terms of safety and survival outcomes compared to mastectomy. Sentinel lymph node biopsy represents a successful surgical practice with similar accuracy compared to female cases. Adjuvant radiotherapy improves overall survival in MaBC patients following partial mastectomy and after radical mastectomy, in case of involved nodes. Finally, Tamoxifen is associated with an improvement of survival outcomes; aromatase inhibitor and gonadotrophin-releasing hormone should be used only in case of contraindications to tamoxifen. Conclusions: Further research and improved guidelines for MaBC treatment should consider these evidence-based data. Full article

Breast cancer remains the most common malignancy in women, and breast-conserving surgery (BCS) with adjuvant radiotherapy is a standard treatment for early-stage disease. This study assessed the impact of positive surgical margins and secondary surgeries on local recurrence rates and patient outcomes. In this retrospective tumor registry-based study, 24,450 women were eligible for analysis. Of them, 18,082 underwent primary BCS only, 4836 underwent re-excision by BCS, and 1532 underwent re-excision by mastectomy following primary BCS. Our findings indicate that even though re-excision procedures were associated with higher local recurrence rates (HR 1.19; 95% CI 1.08–1.33), they did not significantly affect long-term survival (HR 0.98; 95% CI 0.87–1.10). This underscores the need for meticulous surgical practices to achieve clean margins initially, and suggests that the choice of surgical intervention should consider individual tumor characteristics and patient preferences to optimize oncological and aesthetic outcomes. Full article