Anyone here who could help me out with accessing an article on Pubmed?
Its pmid 17855006
If anyone could get me the article, it would be greatly appreciated.
Printable View
Anyone here who could help me out with accessing an article on Pubmed?
Its pmid 17855006
If anyone could get me the article, it would be greatly appreciated.
Is this the one you want?
Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation for stage II-III breast cancer: treatment intervals and clinical outcomes.
Wright JL, Cordeiro PG, Ben-Porat L, Van Zee KJ, Hudis C, Beal K, McCormick B (2008) Int J Radiat Oncol Biol Phys. 70 (1), 43-50.
PURPOSE: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. METHODS AND MATERIALS: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. RESULTS: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5,040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. CONCLUSIONS: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.
I hope that was the one you wanted.
SS
I was wondering where you have been lately.
Only one that I knew of that had access was AJ from nexus
Hes long gone
Yes, that's the abstract of the article. I would like to find the whole article so that I can see what chemo and radiation techniques they used to get such good results.
Sorry bigben that's all that I have access to.
SS
Bigben...I grabbed it for you....gimme ur email and I will send the PDF.Quote:
Originally Posted by bigben
MASTECTOMY WITH IMMEDIATE EXPANDER-IMPLANT RECONSTRUCTION,
ADJUVANT CHEMOTHERAPY, AND RADIATION FOR STAGE II–III BREAST CANCER:
TREATMENT INTERVALS AND CLINICAL OUTCOMES
JEAN L. WRIGHT, M.D.,* PETER G. CORDEIRO, M.D.,y LEAH BEN-PORAT, M.S.,z KIMBERLY J. VAN
ZEE, M.S., M.D.,x CLIFFORD HUDIS, M.D.,k KATHRYN BEAL, M.D.,* AND BERYL MCCORMICK, M.D.*
* Department of Radiation Oncology, y Department of Surgery, Plastic and Reconstructive Service, z Department of Epidemiology
and Biostatistics, x Department of Surgery, and k Department of Medicine, Solid Tumor Division,
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY
Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated
with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant con-
trol and overall survival in these patients.
Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II–III breast cancer were
routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph
node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange
of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical
outcomes were retrospectively evaluated.
Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received
adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy.
Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose
was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy
to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy
to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for
locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%.
Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radia-
tion results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to
be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall sur-
vival. Ó 2008 Elsevier Inc.
Breast cancer, Postmastectomy radiation, Immediate reconstruction, Survival, Recurrence.
INTRODUCTION definitive surgery, and the decision to proceed with immedi-
ate reconstruction may therefore be made before this informa-
Postmastectomy radiation (PMRT) is indicated in selected
tion is available. The integration of PMRT into the overall
breast cancer patients. Traditional indications for PMRT
management of patients who proceed with immediate recon-
have included tumors >5 cm and four or more involved axil- struction poses a treatment dilemma and is not well studied.
lary lymph nodes (1, 2). However, the number of patients In the mid-1990s, an empiric algorithm was developed at
receiving this treatment is growing as newer data suggest Memorial Sloan-Kettering Cancer Center to manage patients
both a local control and survival advantage in patients with who were determined to need PMRT after having undergone
even one positive axillary lymph node (3). At the same immediate breast reconstruction with an expander-implant
time, many women wish to pursue breast reconstruction, (E-I) technique. Figure 1 depicts the algorithm. The treatment
whether or not they will undergo PMRT. Because the need begins with definitive surgery, consisting of mastectomy,
for PMRT is determined by the pathologic stage of disease, axillary lymph node dissection (ALND), and placement of
a subpectoral tissue expander (TE). Tissue expansion then
its role in a patient’s management is often not known before
Radiology and Oncology (ASTRO), November 5–9, 2006, Phila-
Reprint requests to: Beryl McCormick, M.D., Department of Ra-
delphia, PA.
diation Oncology, Memorial Sloan-Kettering Cancer Center, 1275
Conflict of interest: none.
York Ave., New York, NY 10021. Tel: (212) 639-2950; Fax:
Received March 27, 2007, and in revised form May 21, 2007.
(212) 639-2417; E-mail: mccormib@mskcc.org
Accepted for publication May 24, 2007.
Presented in abstract form and as an oral presentation at the
48th Annual Meeting of the American Society for Therapeutic
43
I. J. Radiation Oncology d Biology d Physics
44 Volume 70, Number 1, 2008
All patients underwent total mastectomy (TM) of the affected
Mastectomy, ALND, placement of tissue expander breast and ipsilateral ALND. In some cases patients underwent
one or more lumpectomies before TM, and some had ALND at
the time of a prior lumpectomy. In all patients, at the time of TM,
Start adjuvant chemotherapy, tissue expansion
a subpectoral TE was placed by a plastic surgeon. One to two weeks
after surgery, tissue expansion was begun under the care of the plas-
tic surgeon, and 4–6 weeks after the surgery, adjuvant chemotherapy
was initiated under the care of the medical oncologist. The length
Completion of chemotherapy
of this period depended on the chemotherapy regimen selected.
Approximately 4 weeks after completion of chemotherapy, patients
Exchange for permanent implant were taken back to the operating room for exchange of the TE for
a permanent silicone or saline implant. Approximately 4 weeks after
this exchange, patients initiated radiation.
Start radiation
We gathered information by chart review on patient treatment, in-
cluding surgery, chemotherapy, and radiation regimens. We exam-
Fig. 1. Memorial Sloan-Kettering algorithm for integration of post- ined the time intervals between the components of treatment. We
mastectomy radiation with immediate expander-implant reconstruc- examined clinical outcomes, including local, regional, and distant
tion. ALND = axillary lymph node dissection.
disease control, as well as survival. Clinical outcomes were evalu-
ated by physical examination as well as imaging. Posttreatment im-
aging included CT scan and contralateral mammogram if applicable.
occurs during a period of adjuvant chemotherapy. After com-
Tumor markers were followed at the discretion of the medical oncol-
pletion of chemotherapy, the patient is taken back to the op-
ogist. All failures were documented by tissue biopsy.
erating room for exchange of the TE for a permanent implant.
We performed univariate analysis of the following factors with
Finally, radiation is delivered to the chest wall and supracla- the outcomes of distant metastasis and survival: age (#45 years
vicular fossa. vs. >45 years), T stage, N stage, extranodal extension, tumor histol-
Radiotherapy to the immediately reconstructed breast, in ogy (invasive ductal vs. other), right-sided vs. left-sided disease,
particular using an E-I technique, remains highly controver- presence of vascular invasion, presence of perineural invasion, mar-
sial. Criticism of the technique has focused on three major gin status, chest wall involvement, estrogen receptor (ER) status,
progesterone receptor (PR) status, chemotherapy regimen (adjuvant
concerns: potential for inferior cosmetic outcomes and in-
chemotherapy–based vs. other), use of hormone therapy, and inter-
creased complication rates, compromised radiation design,
val between chemotherapy and radiation (#8 weeks vs. >8 weeks).
and the risk of inferior disease control due to delay in initiation
Survival time was defined as the time from mastectomy to the date of
of radiation. The first two of these concerns have been previ-
death or last follow-up. Local control was defined as the time from
ously examined (4–6). However, the issue of the timing of ra-
mastectomy to the date of local failure or last follow-up. Distant me-
diation in reconstructive algorithms, and the resultant disease tastasis-free survival time was defined as the time from mastectomy
control, is poorly studied and is the focus of this article. to the date of distant metastasis or last follow-up. The survival
The Memorial Sloan-Kettering Cancer Center treatment curves were estimated using Kaplan-Meier survival methodology.
algorithm incorporates a delay between the completion of Kaplan-Meier estimates of survival time in various groups were
chemotherapy and the initiation of radiation to allow for ex- compared using the log–rank test.
change of the TE for the permanent implant. The first aim of
our study was to determine the actual intervals between the
components of treatment in patients treated under our algo- RESULTS
rithm, to assess the actual length of the incorporated delay
Between May 1996 and December 2003, 3578 mastecto-
in our clinical practice. The second aim was to evaluate local,
mies were performed at Memorial Sloan-Kettering Cancer
regional, and distant disease control, as well as overall sur-
Center. Of these, 1506 included immediate reconstruction:
vival, in patients who were treated under the algorithm, to
1346 with TE placement, 112 with transverse rectus abdom-
assess whether clinical outcomes seemed to be acceptable
inus myocutaneous (TRAM) flaps, and 48 with latissimus
in this group of patients.
dorsi flaps. A total of 192 patients who had undergone imme-
diate TE placement were deemed to require PMRT and initi-
METHODS AND MATERIALS
ated treatment according to the algorithm described in Fig. 1.
After obtaining institutional review board approval for the study, Eighty-eight patients underwent definitive surgery at our in-
we retrospectively reviewed the charts of all patients who initiated stitution but received either the chemotherapy or radiother-
treatment at Memorial Sloan-Kettering Cancer Center according apy component of their treatment at an outside institution.
to the algorithm depicted in Fig. 1. Patients who underwent defini- The remaining 104 patients received all components of their
tive surgery between May 1996 and December 2003 were included
treatment at our institution and constitute our study group; all
in the initial review. Only patients who received all components of
finished treatment by March 2004. Patients were selected for
their treatment at our institution and who completed the entire treat-
treatment under the algorithm by their team of treating phy-
ment algorithm were included in the analysis. Data were collected
sicians; there were no specific inclusion or exclusion criteria
regarding patient characteristics, disease characteristics, treatment
for the algorithm, other than being deemed suitable for the
details, and treatment outcomes. Patients were staged according to
treatment procedures.
the American Joint Committee on Cancer (6th edition) categories.
http://rapidshare.de/files/41314879/sdarticle.pdf.html
there you go. pm me if you need anything.
How are you guys grabbing it without paying?
Please PM me.
SS
If you still need things, you can PM me about it. You shouldn't post the articles out in the open though.
Thanks very much. My wife has had the surgery, and the study was very good to read to see what chemo and rads were employed after.