Annual Meeting Proceedings Part 1 - American Society of Clinical ...

74s Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
1101 General Poster Session (Board #31B), Sat, 8:00 AM-12:00 PM
Patterns of regional node irradiation therapy following breast-conserving
surgery: Report from the National Cancer Data Base 2003-2007. Presenting
Author: Ningqi Hou, University of Chicago, Chicago, IL
Background: A recent randomized trial (MA.20) showed that regional nodal
irradiation (RNI) in addition to breast irradiation in high risk node negative
and 1-3 node positive patients undergoing breast-conserving therapy (BCT)
reduced the risk of recurrence and improved disease-free survival. We
investigated the trends of RNI use in the United States and related factors
for the use of RNI using the National Cancer Data Base. Methods: This study
includes 292,598 stage I-III breast cancer patients without neoadjuvant
therapy who underwent BCT from 2003-2007. We investigated pathological,
patient, and facility factors related to RNI use, by multivariable logistic
regression, with odds ratio (OR) estimations. Results: The proportion of
radiotherapy use after BCT slightly declined from 78.6% in 2003 to 75.6%
in 2007. The use of breast irradiation plus RNI decreased from 10.8% in
2003 to 8.3% in 2007 (p�0.0001). The number of tumor positive lymph
nodes strongly determined the use of additional RNI: 4.4% patients with
negative nodes, 22.8% patients with 1-3 nodes, and 39.7% patients with
4 or more nodes received breast irradiation plus RNI after undergoing BCT
(p�0.0001). The proportion of patients undergoing RNI significantly
decreased over the study period from 43.3% to 37.2% in the 4� node
positive group, and from 23.6% to 22.0% in the 1-3 node positive group.
At comprehensive community cancer centers, 25.5% patients with 1-3
positive nodes were treated with breast irradiation plus RNI (vs. 23.2% in
community cancer centers and 21.1% in academic/research cancer
centers). Among node negative patients, 11.5% of those with tumor size
greater than 5 cm received additional RNI, compared to 4.3% in patients
with tumors less than 5cm (p�0.0001). Other significant factors related to
RNI use included higher tumor grade, younger age, facility location, and
facility volume. Conclusions: The use of RNI varies by number of tumor
positive nodes and facility factors. Only 22.8% of patients with 1-3 positive
nodes underwent RNI. Future studies are needed to determine if the use of
RNI will increase after publication of the MA.20 trial especially for the 1-3
node positive group.
1103 General Poster Session (Board #31D), Sat, 8:00 AM-12:00 PM
SPIO-enhanced MR imaging for axillary staging to avoid sentinel node
biopsy in patients with breast cancer. Presenting Author: Kazuyoshi
Motomura, Department of Breast and Endocrine Surgery, Osaka Medical
Center for Cancer and Cardiovascular Diseases, Osaka, Japan
Background: We previously demonstrated the usefulness of SPIO-enhanced
MR imaging for the detection of metastases in sentinel nodes localized by
computed tomography (CT) lymphography (CT-LG) in patients with breast
cancer (Ann Surg Oncol, 2011). These techniques have evolved and we
report our most recent results of axillary staging using them. Methods:
Previously unreported 87 consecutive patients with breast cancer and
clinically negative nodes were enrolled in this study. Sentinel nodes
identified by CT-LG were evaluated prospectively using SPIO-enhanced MR
imaging. A node was considered non-metastatic if it showed a homogenous
low signal intensity and metastatic if the entire node or a focal area did not
show a low signal intensity on MR imaging. Sentinel nodes located by
CT-LG were removed, and imaging results and histopathological findings
were compared. Results: The mean patient age was 54.9 years (range,
34-77). Sentinel nodes were identified by CT-LG and removed successfully
in all patients. The mean number of sentinel nodes identified by CT-LG was
1.16 (range, 1-2). Twenty of 22 patients with positive sentinel nodes
definitively diagnosed by pathology demonstrated metastases on SPIOenhanced
MR imaging. Fifty-eight of 65 patients with negative sentinel
nodes definitively diagnosed by pathology were non-metastatic on imaging
studies. The sensitivity, specificity and accuracy of MR imaging for the
diagnosis of sentinel node metastases were 91%, 89%, and 90%,
respectively. Two patients whose metastases were not detected had
micrometastases. No adverse events were associated with either CT or MR
imaging. Conclusions: SPIO-enhanced MR imaging provided accurate
axillary staging, and therefore sentinel node biopsy may not be necessary
for most patients with breast cancer.
1102 General Poster Session (Board #31C), Sat, 8:00 AM-12:00 PM
Primary tumor resection to improve survival and local disease control in
stage IV inflammatory breast cancer. Presenting Author: Catherine Akay,
University of Texas M. D. Anderson Cancer Center, Houston, TX
Background: Inflammatory breast cancer (IBC) is a rare and aggressive form
of breast cancer typically presenting with early metastasis. Optimal
outcomes are achieved with multimodality treatment strategies in the
non-metastatic setting. Data is limited, however, on the benefit of surgery
in patients with metastatic IBC. We evaluated the effect of primary tumor
resection on outcomes in patients with newly diagnosed stage IV IBC.
Methods: We reviewed records of 172 patients with metastatic IBC treated
at our institution from 1994 - 2009. All patients received systemic therapy
with or without locoregional therapy (LRT). Patient demographics, receptor
(ER) and HER2-neu status, grade, histology, presence of lymphovascular
invasion, margin status, number of distant disease sites, pathologic
response of primary tumor and clinical response to systemic therapy (CRS)
at distant disease sites were recorded. Overall survival (OS), distant
progression-free survival (DPFS), and chest/skin involvement at last follow-up
were evaluated. Kaplan-Meier survival analyses, univariate (UV) and
multivariate (MV) logistic regression models were used. Chest/skin involvement
was compared between groups using Kruskal-Wallis test. Results:
Seventy-nine (45%) patients underwent primary tumor resection. Average
age was 51 (22-78). Median live-patient follow-up was 33 months. OS and
DPFS were significantly better for patients who underwent LRT versus none
(p�0.0001). Factors associated significantly for improved DPFS on MV
analysis were ER and HER2-neu status (HR 0.61,0.60 p�0.02,0.05
,respectively), LRT (HR .38, p�0.002) and CRS (HR 0.62, p�0.03). ER
status (HR .45, p�0.001), LRT (HR .30, p�0.001) and CRS (HR 0.54,
p�0.02) were significant predictors for higher OS on MV analysis. At last
follow up, chest/skin involvement was moderate/severe in 11% of patients
in LRT group versus 35% of patients in no LRT group (p�0.0001).
Conclusions: This latest retrospective study demonstrates metastatic IBC
patients who undergo LRT in addition to systemic therapy may have
improved survival and local control outcomes. CRS may be used to guide
LRT. A prospective randomized trial is needed to validate these findings.
1104 General Poster Session (Board #31E), Sat, 8:00 AM-12:00 PM
Breast cancer multifocality-multicentricity and survival outcomes. Presenting
Author: Siobhan P. Lynch, University of Texas M. D. Anderson Cancer
Center, Houston, TX
Background: Studies have consistently shown a correlation between multifocal
(MF) and multicentric (MC) breast cancers and the rate and extent of
lymph node metastases, but the literature is divided on whether there is a
corresponding impact on survival outcomes. In the absence of compelling
evidence to dictate otherwise, the convention according to current TNM
staging guidelines has been to stage and treat MF and MC cancers
according to the diameter of the largest lesions, without taking other foci of
disease into consideration. We evaluated a large single institution cohort of
MF and MC breast cancers to determine their frequency, clinicopathological
characteristics and effect on survival outcomes. Methods: MF
and MC were defined pathologically as more than one lesion in the same
quadrant and more than one lesion in separate quadrants, respectively.
Patients were categorized by presence or absence of MF or MC disease.
Kaplan-Meier product limit method was used to calculate relapse-free
survival (RFS), breast cancer-specific survival (BCSS) and overall survival
(OS). Cox proportional hazards models were fit to determine independent
associations of MF/MC disease with survival outcomes. Results: Out of
3924 patients, 942 (24%) had MF (n�695) or MC (n�247) disease. MF
and MC disease was associated with higher T-stages (T2 26% vs. 21.6%;
T3 7.4% vs. 2.3%, P�0.001), higher nuclear grade (grade 3 44% vs.
38.2%, P�0.001), lymphovascular invasion (26.2% vs. 19.3%, P�0.001)
and lymph node metastases (43.1% vs. 27.3%, P�0.001). After a median
follow up of 51 months, MC but not MF breast cancers were associated with
significantly worse 5-year RFS (90% vs. 95%, P�0.02) and BCSS (95%
vs. 97%, P�0.01), and a trend towards worse 5-year OS (92% vs. 93%,
P�0.08). After controlling for other risk factors, multifocality and multicentricity
did not have an independent impact on RFS, BCSS or OS. This was
true for the subset of T1N0 breast cancers as well. Conclusions: MF and MC
breast cancers occurred in 24% of the cases and were associated with poor
prognostic factors, but they were not independent predictors of worse
survival outcomes. Our findings support the current TNM staging system of
using the diameter of the largest lesion to assign T-stage.
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