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Background:. Acellular dermal matrices (ADMs) entered the market in the early 2000s and their use has increased thereafter. Several retrospective cohort studies and single surgeon series reported benefits with the use of ADMs. However, robust evidence supporting these advantages is lacking. There is the need to define the role for ADMs in implant-based breast reconstruction (IBBR) after mastectomy. Methods:. A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints, and establish recommendation for the use of ADMs for subpectoral one-/two-stage IBBR (compared with no ADM use) for adult women undergoing mastectomy for breast cancer treatment or risk reduction using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results:. Based on the voting outcome, the following recommendation emerged as a consensus statement: the panel members suggest subpectoral one- or two-stage IBBR either with ADMs or without ADMs for adult women undergoing mastectomy for breast cancer treatment or risk reduction (with very low certainty of evidence). Conclusions:. The systematic review has revealed a very low certainty of evidence for most of the important outcomes in ADM-assisted IBBR and the absence of standard tools for evaluating clinical outcomes. Forty-five percent of panel members expressed a conditional recommendation either in favor of or against the use of ADMs in subpectoral one- or two-stages IBBR for adult women undergoing mastectomy for breast cancer treatment or risk reduction. Future subgroup analyses could help identify relevant clinical and pathological factors to select patients for whom one technique could be preferable to another.

Background: Adjuvant breast radiotherapy practice standard is 40 Gray in 15 fractions. 10 patients with early breast cancer were treated after primary surgery, with ultra-hypofractionated 5 fractions in one week schedule WBI regimen of 26 Gray (Gy), based on the FAST FORWARD trial results, and 0,6Gy/fraction of simultaneous integrated boost (SIB) for a total dose of 29Gy/5,8Gy delivered in 5 fractions. This study attempts to identify the safety, low toxicity profile and patient convenience compared to other hypofractionated schemes. Methods: In the present study, 10 cases of patients, aged 40-70 with invasive carcinoma of the breast T1–2, pN0, M0 who underwent radiotherapy after breast conservation surgery are presented. Concurrent trastuzumab and/or endocrine therapies were allowed. For patient participation, all the inclusion criteria of the FAST FORWARD trial were met. 26 Gy in five fractions to the whole breast, with SIB of 29Gy to the tumor bed over one week, was delivered. At the breast conservation surgery, two pairs of titanium clips were implanted into the walls of the tumour excision cavity (tumor bed) to assist target delineation. Planning Target Volumes PTVwb and PTVTB were created by adding a 3d uniform expansion of 10mm to the CTVwb and 5mm to the CTVboost containing the tumour bed (clips), respectively. For dose-volume histogram assessment, lungs, heart, contralateral breast, and ipsilateral ribs were contoured. VMAT treatment plans using 6MV beams were used for the patient treatment. Daily pretreatment imaging verification was performed (CBCT), and all corrections were applied (6dCouch). Ultrasound examination and photographs were taken as baseline before the treatment. Follow-up assessment performed in week 1, week 4 and then every 3 months. Results: All patients completed the 5 fractions schedule. The titanium clips proved to be necessary for the accuracy of the tumor bed delineation. The prescription dose was uniformly delivered to the whole breast and the tumor bed (V95%(PD)>95%). All dose constraints for OARs described by Fast-Forward trial were met. During the first year follow up, no changes in breast appearance or shape were observed, while the skin reaction was grade 2 or less. Conclusions: WBI regimen of 26 Gy in 5fx with SIB is a well-tolerated and safe hypofractionated radiotherapy scheme. It is also time efficient as it reduces the overall treatment time of EBRT to 1 week, with no differences in normal tissue toxicity or changes in breast appearance versus other radiotherapy schemes. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant systemic anticancer therapy (neoSACT) is increasingly used in the treatment of early breast cancer. Response to therapy is prognostic and allows locoregional and adjuvant systemic treatments to be tailored to minimise morbidity and optimise oncological outcomes and quality of life. Accurate information about locoregional treatments following neoSACT is vital to allow the translation of downstaging benefits into practice and facilitate meaningful interpretation of oncological outcomes, particularly locoregional recurrence. Reporting of locoregional treatments in neoSACT studies, however, is currently poor. The development of a core outcome set (COS) and reporting guidelines is one strategy by which this may be improved., Methods and Analysis: A COS for reporting locoregional treatment (surgery and radiotherapy) in neoSACT trials will be developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) and Core Outcome Set-Standards for Development guidelines. Reporting guidance will be developed concurrently.The project will have three phases: (1) generation of a long list of relevant outcome domains and reporting items from a systematic review of published neoSACT studies and interviews with key stakeholders. Identified items and domains will be categorised and formatted into Delphi consensus questionnaire items. (2) At least two rounds of an international online Delphi survey in which at least 250 key stakeholders (surgeons/oncologists/radiologists/pathologists/trialists/methodologists) will score the importance of reporting each outcome. (3) A consensus meeting with key stakeholders to discuss and agree the final COS and reporting guidance., Ethics and Dissemination: Ethical approval for the consensus process will be obtained from the Queen's University Belfast Faculty Ethics Committee. The COS/reporting guidelines will be presented at international meetings and published in peer-reviewed journals. Dissemination materials will be produced in collaboration with our steering group and patient advocates so the results can be shared widely., Registration: The study has been prospectively registered on the COMET website (https://www.comet-initiative.org/Studies/Details/2854)., Competing Interests: Competing interests: SM reports speaker honoraria from MSD, Roche, BD and Astra Zeneca; advisory boards for Lilly, Novartis, MSD, Roche and Astra Zeneca; conference travel and support from Roche, Lilly and MSD; and institutional research funding from Novartis. HI reports consulting fees from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer and Gilead; honoraria from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer, Taiho and Kyowa Kirin; and institutional research funding from Chugai, Daiichi Sankyo and Astra Zeneca. PD reports institutional research funding from Cepheid and Roche; consulting fees from Roche, and honoraria from Astra Zeneca and Oncoviews; and conference and travel support from Roche. H-BL reports research funding from Devicor Medical Product Inc. and is a co-founder and director of DCGen Co. Ltd. ALR reports consulting fees from Astra Zeneca and royalties from Myriad Genetics. GW reports consulting fees from Astra Zeneca, MSD, Novartis, Daiichi Sankyo and Roche; honoraria from Astra Zeneca, MSD, Novartis, Roche, Pfizer and Daiichi-Sankyo; and institutional research funding from Astra Zeneca/Medimmune, Roche/Genentech, GlaxoSmithKline, Novartis, Pfizer, Roche, MSD, Merck, Bayer, Janssen, Astellas Pharma, Libbs and Takeda. NZ reports consulting fees from Lilly, Eisai, Astra Zeneca, MSD, Novartis and Gilead; honoraria from Roche, Pfizer, Eisai, Amgen, Gilead, Novartis, Lilly and Astra Zeneca; and conference travel and support from Novartis, Astra Zeneca and Lilly. The remaining authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)