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Monica Morrow, Kimberly J Van Zee, Lawrence J Solin, Nehmat Houssami, Mariana Chavez-MacGregor, Jay R Harris, Janet Horton, Shelley Hwang, Peggy L Johnson, M Luke Marinovich, Stuart J Schnitt, Irene Wapnir, Meena S Moran
BACKGROUND: Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation (WBRT). METHODS: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus. RESULTS: Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS...
August 15, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Rahul D Tendulkar, Shree Agrawal, Tianming Gao, Jason A Efstathiou, Thomas M Pisansky, Jeff M Michalski, Bridget F Koontz, Daniel A Hamstra, Felix Y Feng, Stanley L Liauw, Matthew C Abramowitz, Alan Pollack, Mitchell S Anscher, Drew Moghanaki, Robert B Den, Kevin L Stephans, Anthony L Zietman, W Robert Lee, Michael W Kattan, Andrew J Stephenson
PURPOSE: We aimed to update a previously published, multi-institutional nomogram of outcomes for salvage radiotherapy (SRT) following radical prostatectomy (RP) for prostate cancer, including patients treated in the contemporary era. METHODS: Individual data from node-negative patients with a detectable post-RP prostate-specific antigen (PSA) treated with SRT with or without concurrent androgen-deprivation therapy (ADT) were obtained from 10 academic institutions...
August 15, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Vincenzo Valentini, Maria Antonietta Gambacorta, Brunella Barbaro, Giuditta Chiloiro, Claudio Coco, Prajnan Das, Francesco Fanfani, Ines Joye, Lisa Kachnic, Philippe Maingon, Corrie Marijnen, Samuel Ngan, Karin Haustermans
INTRODUCTION: The delineation of Clinical Target Volume (CTV) is a critical step in radiotherapy. Several guidelines suggest different subvolumes and anatomical boundaries in rectal cancer (RC), potentially leading to a misunderstanding in the CTV definition. International consensus guidelines (CG) are needed to improve uniformity in RC CTV delineation. MATERIAL AND METHODS: The 7 radiation oncologist experts defined a roadmap to produce RC CG. Step 1: revision of the published guidelines...
August 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Armando E Giuliano, Karla Ballman, Linda McCall, Peter Beitsch, Pat W Whitworth, Peter Blumencranz, A Marilyn Leitch, Sukamal Saha, Monica Morrow, Kelly K Hunt
BACKGROUND AND OBJECTIVE: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. METHODS: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment...
September 2016: Annals of Surgery
Brian C Baumann, Walter R Bosch, Amit Bahl, Alison J Birtle, Rodney H Breau, Amarnath Challapalli, Albert J Chang, Ananya Choudhury, Sia Daneshmand, Ali El-Gayed, Adam Feldman, Steven E Finkelstein, Thomas J Guzzo, Serena Hilman, Ashesh Jani, S Bruce Malkowicz, Constantine A Mantz, Viraj Master, Anita V Mitra, Vedang Murthy, Sima P Porten, Pierre M Richaud, Paul Sargos, Jason A Efstathiou, Libni J Eapen, John P Christodouleas
PURPOSE: To develop multi-institutional consensus clinical target volumes (CTVs) and organs at risk (OARs) for male and female bladder cancer patients undergoing adjuvant radiation therapy (RT) in clinical trials. METHODS AND MATERIALS: We convened a multidisciplinary group of bladder cancer specialists from 15 centers and 5 countries. Six radiation oncologists and 7 urologists participated in the development of the initial contours. The group proposed initial language for the CTVs and OARs, and each radiation oncologist contoured them on computed tomography scans of a male and female cystectomy patient with input from ≥1 urologist...
September 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Claudio Fiorino, Sara Broggi, Nicola Fossati, Cesare Cozzarini, Gregor Goldner, Thomas Wiegel, Wolfgang Hinkelbein, R Jeffrey Karnes, Stephen A Boorjian, Karin Haustermans, Steven Joniau, Federica Palorini, Shahrokh Shariat, Francesco Montorsi, Hein Van Poppel, Nadia Di Muzio, Riccardo Calandrino, Alberto Briganti
PURPOSE: To fit the individual biochemical recurrence-free survival (bRFS) data from patients treated with postprostatectomy radiation therapy (RT) with a comprehensive tumor control probability (TCP) model. METHODS AND MATERIALS: Considering pre-RT prostate-specific antigen (PSA) as a surrogate of the number of clonogens, bRFS may be expressed as a function of dose-per-fraction-dependent radiosensitivity (αeff), the number of clonogens for pre-RT PSA = 1 ng/mL (C), and the fraction of patients who relapse because of clonogens outside the treated volume (K), assumed to depend (linearly or exponentially) on pre-RT PSA and Gleason score (GS)...
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Renaud Mazeron, Sébastien Gouy, Cyrus Chargari, Eleonor Rivin Del Campo, Isabelle Dumas, Augustin Mervoyer, Catherine Genestie, Enrica Bentivegna, Corinne Balleyguier, Patricia Pautier, Philippe Morice, Christine Haie-Meder
PURPOSES: Firstly, to evaluate the impact of completion hysterectomy after chemoradiation and image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Secondly, to assess a potential differential dose-effect relationship for the rectum and bladder according to the realization of hysterectomy. MATERIAL AND METHODS: Two cohorts of patients were identified, differing by the realization of completion hysterectomy. Inclusions were limited to FIGO stage I-II, with no para-aortic involvement...
September 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Nicola Fossati, R Jeffrey Karnes, Stephen A Boorjian, Marco Moschini, Alessandro Morlacco, Alberto Bossi, Thomas Seisen, Cesare Cozzarini, Claudio Fiorino, Barbara Noris Chiorda, Giorgio Gandaglia, Paolo Dell'Oglio, Steven Joniau, Lorenzo Tosco, Shahrokh Shariat, Gregor Goldner, Wolfgang Hinkelbein, Detlef Bartkowiak, Karin Haustermans, Bertrand Tombal, Francesco Montorsi, Hein Van Poppel, Thomas Wiegel, Alberto Briganti
BACKGROUND: Three prospective randomised trials reported discordant findings regarding the impact of adjuvant radiation therapy (aRT) versus observation for metastasis-free survival (MFS) and overall survival (OS) among patients with pT3N0 prostate cancer treated with radical prostatectomy (RP). None of these trials systematically included patients who underwent early salvage radiation therapy (esRT). OBJECTIVE: To test the hypothesis that aRT was associated with better cancer control and survival compared with observation followed by esRT...
July 30, 2016: European Urology
Emily C Daugherty, Michael R Daugherty, Jeffrey A Bogart, Anna Shapiro
PURPOSE: Published prospective trials have questioned the role of post-lumpectomy radiotherapy in older women with early-stage, estrogen receptor-positive (ER(+)) breast cancer. As the population with ER(-) tumors may be at greater risk for relapse, particularly given that endocrine therapy is not effective, we hypothesize the addition of radiation would be of benefit in patients age ≥ 70. METHODS AND MATERIALS: The Surveillance, Epidemiology, and End Results database was queried from 1998 to 2011 for patients age ≥ 70 years receiving breast-conserving surgery for T1, ER(-) invasive ductal carcinoma...
June 23, 2016: Clinical Breast Cancer
Nils D Arvold, Eudocia Q Lee, Minesh P Mehta, Kim Margolin, Brian M Alexander, Nancy U Lin, Carey K Anders, Riccardo Soffietti, D Ross Camidge, Michael A Vogelbaum, Ian F Dunn, Patrick Y Wen
The clinical management/understanding of brain metastases (BM) has changed substantially in the last 5 years, with key advances and clinical trials highlighted in this review. Several of these changes stem from improvements in systemic therapy, which have led to better systemic control and longer overall patient survival, associated with increased time at risk for developing BM. Development of systemic therapies capable of preventing BM and controlling both intracranial and extracranial disease once BM are diagnosed is paramount...
August 2016: Neuro-oncology
Luca Incrocci, Ruud C Wortel, Wendimagegn Ghidey Alemayehu, Shafak Aluwini, Erik Schimmel, Stijn Krol, Peter-Paul van der Toorn, Hanja de Jager, Wilma Heemsbergen, Ben Heijmen, Floris Pos
BACKGROUND: Studies have reported a low α/β ratio for prostate cancer, suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity. In the multicentre phase 3, HYpofractionated irradiation for PROstate cancer (HYPRO) trial, hypofractionated radiotherapy was compared with conventionally fractionated radiotherapy for treatment of prostate cancer. We have previously reported acute and late incidence of genitourinary and gastrointestinal toxicity; here we report protocol-defined 5-year relapse-free survival outcomes...
August 2016: Lancet Oncology
S Vincent Rajkumar
Multiple myeloma accounts for approximately 10% of hematologic malignancies.The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging...
July 2016: American Journal of Hematology
Andrea L Merrill, Rong Tang, Jennifer K Plichta, Upahvan Rai, Suzanne B Coopey, Maureen P McEvoy, Kevin S Hughes, Michelle C Specht, Michele A Gadd, Barbara L Smith
BACKGROUND: No consensus exists for clear margins for breast-conserving surgery for pure ductal carcinoma in situ (DCIS). We examined the implications of applying a "no ink on tumor" standard for pure DCIS by correlating clear margin width with rates of residual disease. METHODS: Lumpectomies with complete shaved cavity margins (SCMs) for pure DCIS at our institution from 2004 to 2007 were reviewed and patients with microinvasive cancer or multifocal disease requiring multiple wires excluded...
October 2016: Annals of Surgical Oncology
Stephanie A Valente, Rahul D Tendulkar, Sheen Cherian, Colin O'Rourke, Jon M Greif, Lisa Bailey, Valery Uhl, Kevin P Bethke, Eric D Donnelly, Ray Rudolph, Aaron Pederson, Thomas Summer, S Chace Lottich, Darrel L Ross, Christine Laronga, Loretta Loftus, Andrea M Abbott, Pond Kelemen, Ulrich Hermanto, Neil B Friedman, Gauri C Bedi, Jennifer E Joh, William A Thompson, Richard A Hoefer, Jason P Wilson, Song K Kang, Barry Rosen, James Ruffer, Luis Bravo, Alice Police, Jamie M Escallon, Anthony W Fyles, David R McCready, Gregory M Graves, Nitin Rohatgi, Joyce A Eaker, Jannine Graves, Shawna C Willey, Eleni A Tousimis, Brian T Collins, Christina M Shaw, Lee Riley, Nimisha Deb, Tricia Kelly, David L Andolino, Marc E Boisvert, Joanne Lyons, William Small, Stephen R Grobmyer
BACKGROUND: Single-dose intraoperative radiotherapy (IORT) is an emerging treatment for women with early stage breast cancer. The objective of this study was to define the frequency of IORT use, patient selection, and outcomes of patients treated in North America. METHODS: A multi-institutional retrospective registry was created, and 19 institutions using low-kilovoltage IORT for the treatment of breast cancer entered data on patients treated at their institution before July 31, 2013...
September 2016: Annals of Surgical Oncology
Hannah Headon, Umar Wazir, Abdul Kasem, Kefah Mokbel
Traditionally, stage IV metastatic breast cancer has been treated with systemic therapy and/or radiotherapy in order to decrease cancer-associated symptoms, maintain quality of life and control disease burden. Previous research suggests that surgical treatment of the primary tumour may prolong survival, as well achieve local control of disease. Using the PubMed and Ovid SP databases, a literature review and meta-analysis was performed in order to assess whether surgical resection of the primary tumour in metastatic breast cancer prolongs survival...
May 2016: Molecular and Clinical Oncology
Rong Tang, Suzanne B Coopey, Andrea L Merrill, Upahvan Rai, Michelle C Specht, Michele A Gadd, Amy S Colwell, William G Austen, Elena F Brachtel, Barbara L Smith
BACKGROUND: When a nipple margin of a nipple-sparing mastectomy (NSM) contains malignancy, current practice includes removal of the nipple or nipple areola complex (NAC). We evaluated rates and trends of positive nipple margins, subsequent management, and oncologic outcomes. STUDY DESIGN: A retrospective chart review of all NSM at our institution from 2007 to 2014 was performed. A descriptive analysis was performed of patients with positive nipple/subareolar margins...
June 2016: Journal of the American College of Surgeons
Olivia Pagani, Meredith M Regan, Prudence A Francis
Optimal adjuvant endocrine therapy for premenopausal women with hormone-receptor positive breast cancer has long been debated. In particular, the role of ovarian function suppression in addition to standard tamoxifen divided oncologists worldwide, and more recently, the role of aromatase inhibitors as an alternative to tamoxifen in the setting of ovarian suppression became a key question. In 2014, the long awaited results of the International Breast Cancer Study Group (IBCSG) led randomized, phase 3 trials, Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT), provided additional evidence to inform the discussion...
June 2016: Breast: Official Journal of the European Society of Mastology
Jan C Buckner, Edward G Shaw, Stephanie L Pugh, Arnab Chakravarti, Mark R Gilbert, Geoffrey R Barger, Stephen Coons, Peter Ricci, Dennis Bullard, Paul D Brown, Keith Stelzer, David Brachman, John H Suh, Christopher J Schultz, Jean-Paul Bahary, Barbara J Fisher, Harold Kim, Albert D Murtha, Erica H Bell, Minhee Won, Minesh P Mehta, Walter J Curran
BACKGROUND: Grade 2 gliomas occur most commonly in young adults and cause progressive neurologic deterioration and premature death. Early results of this trial showed that treatment with procarbazine, lomustine (also called CCNU), and vincristine after radiation therapy at the time of initial diagnosis resulted in longer progression-free survival, but not overall survival, than radiation therapy alone. We now report the long-term results. METHODS: We included patients with grade 2 astrocytoma, oligoastrocytoma, or oligodendroglioma who were younger than 40 years of age and had undergone subtotal resection or biopsy or who were 40 years of age or older and had undergone biopsy or resection of any of the tumor...
April 7, 2016: New England Journal of Medicine
Meredith M Regan, Prudence A Francis, Olivia Pagani, Gini F Fleming, Barbara A Walley, Giuseppe Viale, Marco Colleoni, István Láng, Henry L Gómez, Carlo Tondini, Graziella Pinotti, Karen N Price, Alan S Coates, Aron Goldhirsch, Richard D Gelber
PURPOSE: Risk of recurrence is the primary consideration in breast cancer adjuvant therapy recommendations. The TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials investigated adjuvant endocrine therapies for premenopausal women with hormone receptor-positive breast cancer, testing exemestane plus ovarian function suppression (OFS), tamoxifen plus OFS, and tamoxifen alone. We examined absolute treatment effect across a continuum of recurrence risk to individualize endocrine therapy decision making for premenopausal women with human epidermal growth factor receptor 2 (HER2) -negative disease...
July 1, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Stephanie M Wong, Rachel A Freedman, Yasuaki Sagara, Fatih Aydogan, William T Barry, Mehra Golshan
OBJECTIVE: To update and examine national temporal trends in contralateral prophylactic mastectomy (CPM) and determine whether survival differed for invasive breast cancer patients based on hormone receptor (HR) status and age. METHODS: We identified women diagnosed with unilateral stage I to III breast cancer between 1998 and 2012 within the Surveillance, Epidemiology, and End Results registry. We compared characteristics and temporal trends between patients undergoing breast-conserving surgery, unilateral mastectomy, and CPM...
March 8, 2016: Annals of Surgery
2016-09-18 08:02:28
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