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barbara fowble

Barbara Fowble, Abhishek Keshav Jairam, Frederick Wang, Anne Peled, Michael Alvarado, Cheryl Ewing, Laura Esserman, Catherine Park, Ann Lazar
INTRODUCTION: Downstaging with neoadjuvant chemotherapy (NAC) might obscure indications for postmastectomy radiation (PMRT). The degree of downstaging that results in local-regional recurrence (LRR) rates low enough to omit PMRT remains controversial. We examined the rate of LRR in women who received NAC who underwent mastectomy without PMRT. PATIENTS AND METHODS: Between 2004 and 2013, 81 women with stage I to IIIA breast cancer had NAC and mastectomy; 48 patients (59%) were clinical N0 and 33 patients (41%) were clinical N1; median age was 45 years; 33 patients (41%) had hormone receptor-positive (HR+ )HER2- , 21 patients (26%) HR+ HER2+ , 19 patients (23%) HR-  HER2- , and 7 patients (9%) HR- HER2+ disease...
February 2018: Clinical Breast Cancer
Anne Warren Peled, Marie Sears, Frederick Wang, Robert D Foster, Michael Alvarado, Jasmine Wong, Cheryl A Ewing, Hani Sbitany, Laura J Esserman, Barbara Fowble
BACKGROUND: Many patients undergoing total-skin sparing mastectomy (TSSM) and 2-staged expander-implant (TE-I) reconstruction require postmastectomy radiation therapy (PMRT). Additionally, many patients undergoing TSSM for recurrent cancer have a history of lumpectomy and radiation therapy (XRT). Few studies have looked at the impact of XRT on the stages of TE-I reconstruction. METHODS: Patients undergoing TSSM and immediate TE-I reconstruction between 2006 and 2013 were identified from a prospectively maintained database...
January 2018: Annals of Plastic Surgery
Merisa L Piper, Maristella Evangelista, Dominic Amara, David Daar, Robert D Foster, Barbara Fowble, Hani Sbitany
INTRODUCTION: Postmastectomy radiation therapy (PMRT) has known deleterious side effects in immediate autologous breast reconstruction. However, plastic surgeons are rarely involved in PMRT planning. Our institution has adopted a custom bolus approach for all patients receiving PMRT. This offers uniform distribution of standard radiation doses, thereby minimizing radiation-induced changes while maintaining oncologic safety. We present our 8-year experience with the custom bolus approach for PMRT delivery in immediate autologous breast reconstruction...
April 2017: Plastic and Reconstructive Surgery. Global Open
Jennifer S Chang, Josephine Chen, Vivian K Weinberg, Barbara Fowble, Rajni A Sethi
INTRODUCTION/BACKGROUND: We evaluated heart dose from left breast radiotherapy with 2-dimensional (2D) versus 3-dimensional (3D) plans. PATIENTS AND METHODS: Treatment plans from patients treated with standard fractionation for left breast cancer from 2003 to 2013 were reviewed, with patients grouped into 3 cohorts: 2003 to 2004 ("2D", with computed tomography scans for dose calculation but fields defined using simulation films; n = 29), 2005 to 2006 ("2D-post," after several influential articles on heart dose were published; n = 31), and 2007 to 2013 ("3D"; n = 256)...
October 2016: Clinical Breast Cancer
Hope S Rugo, R Bryan Rumble, Erin Macrae, Debra L Barton, Hannah Klein Connolly, Maura N Dickler, Lesley Fallowfield, Barbara Fowble, James N Ingle, Mohammad Jahanzeb, Stephen R D Johnston, Larissa A Korde, James L Khatcheressian, Rita S Mehta, Hyman B Muss, Harold J Burstein
PURPOSE: To develop recommendations about endocrine therapy for women with hormone receptor (HR) -positive metastatic breast cancer (MBC). METHODS: The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women...
September 1, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Julian Johnson, Laura Esserman, Cheryl Ewing, Michael Alvarado, Catherine Park, Barbara Fowble
BACKGROUND AND OBJECTIVES: Invasive chest wall recurrences (CWR) following mastectomy are typically treated with surgical excision, radiation therapy (RT) to the chest wall and supraclavicular (SCV) region, and appropriate systemic therapy. Repeat axillary surgery is not routinely performed if the axilla is clinically negative. We evaluated sentinel node biopsy (SNB) in patients with an isolated invasive CWR, for identification and biopsy rates, non-axillary drainage, and clinical implications for radiation fields and outcome...
March 2016: Annals of Surgical Oncology
Frederick Wang, Anne Warren Peled, Robin Chin, Barbara Fowble, Michael Alvarado, Cheryl Ewing, Laura Esserman, Robert Foster, Hani Sbitany
BACKGROUND: Total skin-sparing mastectomy, with preservation of the nipple-areola complex, must account for adjuvant medical and surgical treatments for cancer. The authors assessed risk factors for complications after second-stage tissue expander-implant exchange. METHODS: The authors reviewed all institutional total skin-sparing mastectomy cases that had completed tissue expander-implant exchange with at least 3 months of follow-up. They developed multivariate generalized estimating equation models to obtain adjusted relative risks of radiation therapy, type of lymph node dissection, and hormonal therapy in relation to postoperative complications...
January 2016: Plastic and Reconstructive Surgery
Barbara Fowble, Catherine Park, Frederick Wang, Anne Peled, Michael Alvarado, Cheryl Ewing, Laura Esserman, Robert Foster, Hani Sbitany, Alex Hanlon
OBJECTIVES: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). METHODS AND MATERIALS: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer...
July 1, 2015: International Journal of Radiation Oncology, Biology, Physics
Jyoti Mayadev, John Einck, Sarah Elson, Hope Rugo, Shelley Hwang, Richard Bold, Parima Daroui, Susan McCloskey, Catheryn Yashar, Danny Kim, Barbara Fowble
BACKGROUND: Practice patterns vary with the planning and delivery of PMRT. In our investigation we examined practice patterns in the use of chest wall bolus and a boost among the Athena Breast Health Network (Athena). MATERIALS AND METHODS: Athena is a collaboration among the 5 University of California Medical Centers that aims to integrate clinical care and research. From February 2011 to June 2011, all physicians specializing in the multidisciplinary treatment of breast cancer were invited to take a Web-based practice patterns survey...
February 2015: Clinical Breast Cancer
Hani Sbitany, Frederick Wang, Anne W Peled, Rachel Lentz, Michael Alvarado, Cheryl A Ewing, Laura J Esserman, Barbara Fowble, Robert D Foster
BACKGROUND: Radiation therapy is increasingly used in breast cancer therapy. With total skin-sparing mastectomy and nipple/areola complex preservation, defining the risks of various treatment regimens for morbidity is important, in the setting of immediate prosthetic reconstruction. The authors assessed the effects of premastectomy and postmastectomy radiation therapy on outcomes in total skin-sparing mastectomy and immediate prosthetic reconstruction. METHODS: All patients undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction at the authors' institution between 2006 and 2012 were identified...
September 2014: Plastic and Reconstructive Surgery
Gary M Freedman, Barbara L Fowble, Tianyu Li, E Shelley Hwang, Naomi Schechter, Karthik Devarajan, Penny R Anderson, Elin R Sigurdson, Lori J Goldstein, Richard J Bleicher
We examine risk of positive nonsentinel axillary nodes (NSN) and ≥4 positive nodes in patients with 1-2 positive sentinel nodes (SN) by age and tumor subtype approximated by ER, PR, and Her2 receptor status. Review of two institutional databases demonstrated 284 women undergoing breast conservation between 1997 and 2008 for T1-2 tumors and 1 (229) or 2 (55) positive SN followed by completion dissection. The median number of SN and total axillary nodes removed were 2 (range 1-10) and 14 (range 6-37), respectively...
July 2014: Breast Journal
Anne Warren Peled, Robert D Foster, Cassandra Ligh, Laura J Esserman, Barbara Fowble, Hani Sbitany
BACKGROUND: Postoperative complications after total skin-sparing mastectomy and expander-implant reconstruction can negatively impact outcomes, particularly in the setting of postmastectomy radiation therapy. The authors studied whether rates of ischemic complications after postmastectomy radiation therapy are impacted by the total skin-sparing mastectomy incision. METHODS: The authors queried a prospectively collected database of patients undergoing total skin-sparing mastectomy and immediate two-stage expander-implant reconstruction...
August 2014: Plastic and Reconstructive Surgery
Lanea M M Keller, Randi Cohen, Dennis M Sopka, Tianyu Li, Linna Li, Penny R Anderson, Barbara L Fowble, Gary M Freedman
PURPOSE: Large breast size presents special problems during radiation simulation, planning, and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiation therapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry. METHODS AND MATERIALS: From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥38 or ≥D cup) were treated with BCT using either 3-dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT)...
January 2013: Practical Radiation Oncology
Lanea Keller, Randi Cohen, Dennis M Sopka, Tianyu Li, Linna Li, Penny R Anderson, Barbara L Fowble, Gary M Freedman
PURPOSE: Large breast size presents special problems during radiation simulation, planning and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiotherapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry. MATERIALS AND METHODS: From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥ 38 and/or ≥ D cup) were treated with BCT using either 3D conformal (3D-CRT) or Intensity Modulated Radiation (IMRT)...
2013: Practical Radiation Oncology
E Shelley Hwang, Daphne Y Lichtensztajn, Scarlett Lin Gomez, Barbara Fowble, Christina A Clarke
BACKGROUND: Randomized clinical trials (RCT) have demonstrated equivalent survival for breast-conserving therapy with radiation (BCT) and mastectomy for early-stage breast cancer. A large, population-based series of women who underwent BCT or mastectomy was studied to observe whether outcomes of RCT were achieved in the general population, and whether survival differed by surgery type when stratified by age and hormone receptor (HR) status. METHODS: Information was obtained regarding all women diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004, who were treated with either BCT or mastectomy and followed for vital status through December 2009...
April 1, 2013: Cancer
Anne Warren Peled, Robert D Foster, Laura J Esserman, Catherine C Park, E Shelley Hwang, Barbara Fowble
BACKGROUND: Increased rates of complications can occur when postmastectomy radiation therapy is required after immediate expander-implant breast reconstruction. The sequence and timing of tissue expansion and implant exchange with regard to postmastectomy radiation therapy may impact complication rates. METHODS: A prospectively maintained database of patients undergoing mastectomy and immediate reconstruction was queried for patients who underwent postmastectomy radiation therapy...
September 2012: Plastic and Reconstructive Surgery
Barbara L Fowble, John P Einck, Danny N Kim, Susan McCloskey, Jyoti Mayadev, Catheryn Yashar, Steven L Chen, E Shelley Hwang
PURPOSE: To identify a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation therapy (PMRT) may be omitted according to the projected risk of local-regional failure (LRF). METHODS AND MATERIALS: Seven breast cancer physicians from the University of California cancer centers created 14 hypothetical clinical case scenarios, identified, reviewed, and abstracted the available literature (MEDLINE and Cochrane databases), and formulated evidence tables with endpoints of LRF, disease-free survival, and overall survival...
June 1, 2012: International Journal of Radiation Oncology, Biology, Physics
Linda W Chan, Joseph Rabban, E Shelley Hwang, Alison Bevan, Michael Alvarado, Cheryl Ewing, Laura Esserman, Barbara Fowble
PURPOSE: Resection margin status is one of the most significant factors for local recurrence in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery with or without radiation. However, its impact on chest wall recurrence in patients treated with mastectomy is unknown. The purpose of this study was to determine chest wall recurrence rates in women with DCIS and close (<5 mm) or positive mastectomy margins in order to evaluate the potential role of radiation therapy...
May 1, 2011: International Journal of Radiation Oncology, Biology, Physics
Jennifer Zakhireh, Barbara Fowble, Laura J Esserman
A significant number of women choose mastectomy for the treatment of early and locally advanced breast cancer. Advances in reconstruction techniques and greater awareness of options have led to an increased use of immediate breast reconstruction, which has resulted in uncertainty for the management of surveillance for local recurrence. In this article, we review mastectomy and reconstruction trends and how these techniques affect the frequency and location of local recurrence. The data on surveillance imaging of the reconstructed breast are extremely limited...
January 1, 2010: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Martina Descovich, Barbara Fowble, Alison Bevan, Naomi Schechter, Catherine Park, Ping Xia
PURPOSE: To investigate the planning efficiency and dosimetric characteristics of hybrid direct aperture optimized (hDAO) intensity-modulated radiotherapy (IMRT) compared with forward planning (FP)-IMRT for whole breast irradiation with two tangential beams. METHODS AND MATERIALS: A total of 15 patients with left-sided breast cancer, categorized with three different breast volumes, were selected for this study. All patients were treated with FP plans to 50 Gy in 25 fractions...
January 1, 2010: International Journal of Radiation Oncology, Biology, Physics
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