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Salvage Mastectomy for Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy
Abstracts / The Breast 20 (2011) S12–S55
Conclusion: In this study we showed that triple negative is more aggressive form of inflammatory breast cancer than HER2+ IBC, with lower response rate to iCT, shorter time to disease progression and higher mortality. Interestingly, patients with HER2+ IBC have higher chance to develop CNS metastases. Although the number of patients analyzed in this paper is relatively small and follow up is quite short, we are strongly convinced that this analysis can contribute to the knowledge about IBC at least in the term of its metastatic potential.
PO80 ADVANCED BREAST CANCER WITH OLIGOMETASTASIS. QUALITY OF LIFE IN LONG TERM SURVIVORS FOLLOWING AGGRESSIVE TREATMENTS. SINGLE CLINICIAN'S EXPERIENCE Thomas Varughese Lakeshore Hospital, Cochin, Kerala, India Background: Management of advanced breast cancer is challenging for treating clinicians. The spectrum varies from oligometastasis (non life threatening) to multiple metastasis (life threatening). Modern treatment protocols give better disease control hence quality of life issues is of prime importance for long term survivors. Patients and methods: Data of metastatic breast cancer patients presented to single clinician from March 1996 to Dec 2010 were collected. Mode of presentation, sites of metastasis, performance status, pathology and prognostic variables, tools for metastatic work up, details of different modes of treatments (surgical, medical, radiation, hormonal or supportive care) were evaluated. Quality of life evaluation was done using linear analogue self-assessment (LASA) in all patients. Results: Total number of patients -165. Age group 29-75. Skin ulceration/ fungation, were present in 64 and larger than 5 cms size tumor in the rest. Oligometastasis in the form of isolated lung lesions (8), liver (5), bones (18), brain (11), visceral (10). Remaining 114 had multiple metastasis. 158 had IDCA, 4 medullary and 3 lobular cancer. 60 were triple negative, 21 were HER2+ve, 84 ER and PR +ve. All received Docetaxel / epirbicin / xeloda combination regimen. Of the 21, HER2+ve cases 10 had Herceptin, 5 Tykerb, 6 could not afford. All together 21 had brain metastasis and received RT to brain. Pleural tapping was required for 25,2 required ventilator support. Ascitic tapping was done in 35.40 /165 based on the extent of disease were treated with palliative intent only. Surgical salvages were attempted in those with oligometastasis in bones. Chest wall resections in 4, excision of sternum in 5, clavicle in 2, spine decompression and stabilization in 2, hip replacement in 3 and humerus conservative resection in 2. 25 patients with bone metastasis as a part of multiple metastasis also received spine decompressions.. Local surgeries were done in 130 cases. Flap cover in 80, BCT in 40 and mastectomy in 10. Isolated lung lesions were controlled with 2nd or 3rd line chemotherapies. Premenopausal ER/PR +ve patients received tamoxifen and post menopausal Letrazole. Radiation was offered to all those who had local surgeries or for symptomatic bony lesions. Disease control (risk group), 18 (10.9%)patients survived more than 5 years -very good, 64 (38.7%) patients more than 36 months-good, 71 (43%) patients more than 12 months-average and 15 (9%) succumbed within 12months- was rated as poor-risk group. Conclusions: Therapeutic refinements, technological advancements in surgery, radiation, understanding of tumor biology and modern targeted treatments have resulted in advanced breast cancer patients surviving for more number of years than in the past. Patients with oligometastasis confined to chest wall, manubrium, single bones or isolated lung lesions having salvage surgery performed better. Hence aggressive approach in selected metastatic cases and personalized treatment plans respecting tumor biology may be ideal offering best quality of life, in the current scenario.
S39
PO81 SALVAGE MASTECTOMY FOR IPSILATERAL BREAST RECURRENCE AFTER BREAST CONSERVING THERAPY
TUMOR
Abdel Hamid Ezzat, Ashraf Ibrahim, Reda Tabashy National Cancer Institute-Cairo University, Cairo, Egypt Introduction: Ipsilateral breast tumor recurrence (IBTR) is one of the complications following breast conserving therapy that is conventionally treated with simple mastectomy. There is limited data evaluating the outcome after mastectomy for IBTR. Patients and methods: A retrospective review was conducted evaluating 176 patients operated for breast conservation during the period from January 2002 till December 2006 at the surgical oncology department National Cancer Institute - Cairo University. Thirty three patients (18.8%) experienced IBTR after breast conservation therapy (BCT).Patients with repeated lumpectomy and / or metastatic disease where excluded from the study. Results: The pathologic presentation was IDC (92.6%), ILL (3.4%), Medullary carcinoma (3.4%), Mixed duct and lobular carcinoma (0.6%).The mean IBTR size was 5.02 0.91 cm. mean follow up after mastectomy was 61.03 12.23 months. Seven patients (21.2%) had post mastectomy recurrence (PMR) which decreased overall survival. Ninety percent of post mastectomy recurrence occurred within the first 24 months following mastectomy. Conclusion: Mastectomy for IBTR remains an effective treatment for most patients with risk of PMR. Strict follow up should be routine during the first 24 months.
PO82 CHRONOLOGY OF HER2 DISEASE Junichiro Watanabe 1, Noriko Nishikawa 2, Akiko Ogiya 2, Yukiko Tadokoro 2, Kumiko Tanaka 2, Kaoru Takahashi 2, Seiji Yamasaki 2, Masako Kasami 3, Takayoshi Uematsu 4 1 Department of Breast Oncology, Shizuoka Cancer Centre, Shizuoka, Japan 2 Department of Breast Surgery, Shizuoka Cancer Centre, Shizuoka, Japan 3 Department of Pathology, Shizuoka Cancer Centre, Shizuoka, Japan 4 Department of Breast Imaging, Shizuoka Cancer Centre, Shizuoka, Japan Background: It is still unclear that lapatinib have a potential to change the clinical course of HER2-positive metastatic breast cancer (HER2+MBC) patients. Patients and Methods: From October 2002 to February 2011, 122 female patients were diagnosed as HER2+MBC in our institute. Most of them (99.2%) showed IHC-positive for HER2 and 42.6% was found estrogen receptor positive. Trastuzumab-based chemotherapy was planned for managing MBC. In addition, after an approval of lapatinib for trastuzumabresistant HER2+MBC, lapatinib-based regimen was considered. Results: All of the patients received trastuzumab-based chemotherapies and 39 patients (32.0%) were treated with lapatinib plus capecitabine or lapatinib alone who showed progression after trastuzumab therapy. Median overall survival (OS) for all patients was 1553 days (95% confidence intervals form 1268 to 1838). Major causes of death were respiratory failure (32.9%), cachexia (20.3%) and central nervous system (CNS) disease (20.3%). Patients who received lapatinib within their lifetime showed remarkable improvement of survival compared to patients who were not treated with lapatinib. (Median OS; 2905 vs. 1279 days, p¼0.0001) CNS involvement, one of the major causes of death, was found in 49.2% of patients and shortened their OS. (2123 days for without CNS lesion, 1213 days for with CNS lesion, p¼0.0001) Interestingly, it was markedly extended from 955 to 2231 days for patients' survival having CNS disease by the appearance of lapatinib. (p¼0.0004) Conclusions: According to our clinical observation, 1) lapatinib maintains patients' survival significantly, and 2) lapatinib may delay development of CNS disease and improve survival after CNS involvement in HER2+MBC
Conclusion: In this study we showed that triple negative is more aggressive form of inflammatory breast cancer than HER2+ IBC, with lower response rate to iCT, shorter time to disease progression and higher mortality. Interestingly, patients with HER2+ IBC have higher chance to develop CNS metastases. Although the number of patients analyzed in this paper is relatively small and follow up is quite short, we are strongly convinced that this analysis can contribute to the knowledge about IBC at least in the term of its metastatic potential.
PO80 ADVANCED BREAST CANCER WITH OLIGOMETASTASIS. QUALITY OF LIFE IN LONG TERM SURVIVORS FOLLOWING AGGRESSIVE TREATMENTS. SINGLE CLINICIAN'S EXPERIENCE Thomas Varughese Lakeshore Hospital, Cochin, Kerala, India Background: Management of advanced breast cancer is challenging for treating clinicians. The spectrum varies from oligometastasis (non life threatening) to multiple metastasis (life threatening). Modern treatment protocols give better disease control hence quality of life issues is of prime importance for long term survivors. Patients and methods: Data of metastatic breast cancer patients presented to single clinician from March 1996 to Dec 2010 were collected. Mode of presentation, sites of metastasis, performance status, pathology and prognostic variables, tools for metastatic work up, details of different modes of treatments (surgical, medical, radiation, hormonal or supportive care) were evaluated. Quality of life evaluation was done using linear analogue self-assessment (LASA) in all patients. Results: Total number of patients -165. Age group 29-75. Skin ulceration/ fungation, were present in 64 and larger than 5 cms size tumor in the rest. Oligometastasis in the form of isolated lung lesions (8), liver (5), bones (18), brain (11), visceral (10). Remaining 114 had multiple metastasis. 158 had IDCA, 4 medullary and 3 lobular cancer. 60 were triple negative, 21 were HER2+ve, 84 ER and PR +ve. All received Docetaxel / epirbicin / xeloda combination regimen. Of the 21, HER2+ve cases 10 had Herceptin, 5 Tykerb, 6 could not afford. All together 21 had brain metastasis and received RT to brain. Pleural tapping was required for 25,2 required ventilator support. Ascitic tapping was done in 35.40 /165 based on the extent of disease were treated with palliative intent only. Surgical salvages were attempted in those with oligometastasis in bones. Chest wall resections in 4, excision of sternum in 5, clavicle in 2, spine decompression and stabilization in 2, hip replacement in 3 and humerus conservative resection in 2. 25 patients with bone metastasis as a part of multiple metastasis also received spine decompressions.. Local surgeries were done in 130 cases. Flap cover in 80, BCT in 40 and mastectomy in 10. Isolated lung lesions were controlled with 2nd or 3rd line chemotherapies. Premenopausal ER/PR +ve patients received tamoxifen and post menopausal Letrazole. Radiation was offered to all those who had local surgeries or for symptomatic bony lesions. Disease control (risk group), 18 (10.9%)patients survived more than 5 years -very good, 64 (38.7%) patients more than 36 months-good, 71 (43%) patients more than 12 months-average and 15 (9%) succumbed within 12months- was rated as poor-risk group. Conclusions: Therapeutic refinements, technological advancements in surgery, radiation, understanding of tumor biology and modern targeted treatments have resulted in advanced breast cancer patients surviving for more number of years than in the past. Patients with oligometastasis confined to chest wall, manubrium, single bones or isolated lung lesions having salvage surgery performed better. Hence aggressive approach in selected metastatic cases and personalized treatment plans respecting tumor biology may be ideal offering best quality of life, in the current scenario.
S39
PO81 SALVAGE MASTECTOMY FOR IPSILATERAL BREAST RECURRENCE AFTER BREAST CONSERVING THERAPY
TUMOR
Abdel Hamid Ezzat, Ashraf Ibrahim, Reda Tabashy National Cancer Institute-Cairo University, Cairo, Egypt Introduction: Ipsilateral breast tumor recurrence (IBTR) is one of the complications following breast conserving therapy that is conventionally treated with simple mastectomy. There is limited data evaluating the outcome after mastectomy for IBTR. Patients and methods: A retrospective review was conducted evaluating 176 patients operated for breast conservation during the period from January 2002 till December 2006 at the surgical oncology department National Cancer Institute - Cairo University. Thirty three patients (18.8%) experienced IBTR after breast conservation therapy (BCT).Patients with repeated lumpectomy and / or metastatic disease where excluded from the study. Results: The pathologic presentation was IDC (92.6%), ILL (3.4%), Medullary carcinoma (3.4%), Mixed duct and lobular carcinoma (0.6%).The mean IBTR size was 5.02 0.91 cm. mean follow up after mastectomy was 61.03 12.23 months. Seven patients (21.2%) had post mastectomy recurrence (PMR) which decreased overall survival. Ninety percent of post mastectomy recurrence occurred within the first 24 months following mastectomy. Conclusion: Mastectomy for IBTR remains an effective treatment for most patients with risk of PMR. Strict follow up should be routine during the first 24 months.
PO82 CHRONOLOGY OF HER2 DISEASE Junichiro Watanabe 1, Noriko Nishikawa 2, Akiko Ogiya 2, Yukiko Tadokoro 2, Kumiko Tanaka 2, Kaoru Takahashi 2, Seiji Yamasaki 2, Masako Kasami 3, Takayoshi Uematsu 4 1 Department of Breast Oncology, Shizuoka Cancer Centre, Shizuoka, Japan 2 Department of Breast Surgery, Shizuoka Cancer Centre, Shizuoka, Japan 3 Department of Pathology, Shizuoka Cancer Centre, Shizuoka, Japan 4 Department of Breast Imaging, Shizuoka Cancer Centre, Shizuoka, Japan Background: It is still unclear that lapatinib have a potential to change the clinical course of HER2-positive metastatic breast cancer (HER2+MBC) patients. Patients and Methods: From October 2002 to February 2011, 122 female patients were diagnosed as HER2+MBC in our institute. Most of them (99.2%) showed IHC-positive for HER2 and 42.6% was found estrogen receptor positive. Trastuzumab-based chemotherapy was planned for managing MBC. In addition, after an approval of lapatinib for trastuzumabresistant HER2+MBC, lapatinib-based regimen was considered. Results: All of the patients received trastuzumab-based chemotherapies and 39 patients (32.0%) were treated with lapatinib plus capecitabine or lapatinib alone who showed progression after trastuzumab therapy. Median overall survival (OS) for all patients was 1553 days (95% confidence intervals form 1268 to 1838). Major causes of death were respiratory failure (32.9%), cachexia (20.3%) and central nervous system (CNS) disease (20.3%). Patients who received lapatinib within their lifetime showed remarkable improvement of survival compared to patients who were not treated with lapatinib. (Median OS; 2905 vs. 1279 days, p¼0.0001) CNS involvement, one of the major causes of death, was found in 49.2% of patients and shortened their OS. (2123 days for without CNS lesion, 1213 days for with CNS lesion, p¼0.0001) Interestingly, it was markedly extended from 955 to 2231 days for patients' survival having CNS disease by the appearance of lapatinib. (p¼0.0004) Conclusions: According to our clinical observation, 1) lapatinib maintains patients' survival significantly, and 2) lapatinib may delay development of CNS disease and improve survival after CNS involvement in HER2+MBC