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1. Management and outcomes for older women with early breast cancer treated with primary endocrine therapy (PET)

Author

Thomas Hubbard, Georgia Wright, Jenna Morgan, Charlene Martin, Stephen Walters, Kwok-Leung Cheung, Riccardo Audisio, Malcolm Reed, and Lynda Wyld

Subjects
Breast neoplasms, Endocrine therapy, Older adult, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: This study reports the detailed management and outcomes of women treated with Primary Endocrine Therapy (PET) in a large prospective UK cohort of older women (≥70) with breast cancer. Methods: This was an unplanned secondary analysis of a prospective, multicentre, observational study (The Age Gap study). Data were collected at baseline and regular intervals on patient, tumour and treatment characteristics with tumour RECIST response category recorded. Direct study follow-up was 24 months with longer-term survival data obtained from the UK cancer registry. Results: The Age Gap study recruited 3316 women across 56 breast units. Primary endocrine therapy (PET) was initiated for 505/3316 (15 %) women; median age was 84 (IQR 79–88) with median follow-up 41.9 months (IQR 27–60). Death occurred in 205/505(40.6 %) patients, 160/205; 78 % non- Breast Cancer related, 45/205; 21.9 % Breast Cancer related. Multivariate analysis identified older age (HR-1.055(95 % Confidence Interval: 1.029–1.084); P 0.05). Conclusion: Early disease response and change of endocrine therapy are not significantly associated with overall survival, conversion to surgery is linked to improved outcome. Prognosis is largely determined by age and comorbidity in older women treated with PET.

Published
2024
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2. Cancer treatment data available in European cancer registries: Where are we and where are we going?

Author

Francesco Giusti, Carmen Martos, Annalisa Trama, Manola Bettio, Arantza Sanvisens, Riccardo Audisio, Volker Arndt, Silvia Francisci, Carine Dochez, Josepa Ribes, Laura Pareja Fernández, Anna Gavin, Gemma Gatta, Rafael Marcos-Gragera, Yolande Lievens, Claudia Allemani, Roberta De Angelis, Otto Visser, Liesbet Van Eycken, and the ENCR Working Group on Treatment Data Harmonisation

Subjects
cancer registry, data harmonisation, questionnaire, big data, Europe, cancer registry data, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literature review shows that there is an increase in published data on cancer treatment by population-based cancer registries over the years. In addition, the review indicates that treatment data are most often collected for breast cancer, the most frequent cancer in women in Europe, followed by colorectal, prostate and lung cancers, which are also more common. Treatment data are increasingly being reported by cancer registries, though further improvements are required to ensure their complete and harmonised collection. Sufficient financial and human resources are needed to collect and analyse treatment data. Clear registration guidelines are to be made available to increase the availability of real-world treatment data in a harmonised way across Europe.

Published
2023
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3. Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT

Author

Lynda Wyld, Malcolm WR Reed, Karen Collins, Sue Ward, Geoff Holmes, Jenna Morgan, Mike Bradburn, Stephen Walters, Maria Burton, Kate Lifford, Adrian Edwards, Kate Brain, Alistair Ring, Esther Herbert, Thompson G Robinson, Charlene Martin, Tim Chater, Kirsty Pemberton, Anne Shrestha, Anthony Nettleship, Paul Richards, Alan Brennan, Kwok Leung Cheung, Annaliza Todd, Helena Harder, Riccardo Audisio, Nicolo Matteo Luca Battisti, Juliet Wright, Richard Simcock, Christopher Murray, Alastair M Thompson, Margot Gosney, Matthew Hatton, Fiona Armitage, Julietta Patnick, Tracy Green, Deirdre Revill, Jacqui Gath, Kieran Horgan, Chris Holcombe, Matt Winter, Jay Naik, and Rishi Parmeshwar

Subjects
breast cancer, older women, surgery, primary endocrine therapy, chemotherapy, survival, quality of life, shared decision-making, decision support tool, cluster randomised trial, cohort study, Public aspects of medicine, RA1-1270
Abstract

Background: In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to base treatment recommendations. Aim: We aimed to optimise treatment choice and outcomes for older women (aged ≥ 70 years) with operable breast cancer. Objectives: Our objectives were to (1) determine the age, comorbidity, frailty, disease stage and biology thresholds for endocrine therapy alone versus surgery plus adjuvant endocrine therapy, or adjuvant chemotherapy versus no chemotherapy, for older women with breast cancer; (2) optimise survival outcomes for older women by improving the quality of treatment decision-making; (3) develop and evaluate a decision support intervention to enhance shared decision-making; and (4) determine the degree and causes of treatment variation between UK breast units. Design: A prospective cohort study was used to determine age and fitness thresholds for treatment allocation. Mixed-methods research was used to determine the information needs of older women to develop a decision support intervention. A cluster-randomised trial was used to evaluate the impact of this decision support intervention on treatment choices and outcomes. Health economic analysis was used to evaluate the cost–benefit ratio of different treatment strategies according to age and fitness criteria. A mixed-methods study was used to determine the degree and causes of variation in treatment allocation. Main outcome measures: The main outcome measures were enhanced age- and fitness-specific decision support leading to improved quality-of-life outcomes in older women (aged ≥ 70 years) with early breast cancer. Results: (1) Cohort study: the study recruited 3416 UK women aged ≥ 70 years (median age 77 years). Follow-up was 52 months. (a) The surgery plus adjuvant endocrine therapy versus endocrine therapy alone comparison: 2854 out of 3416 (88%) women had oestrogen-receptor-positive breast cancer, 2354 of whom received surgery plus adjuvant endocrine therapy and 500 received endocrine therapy alone. Patients treated with endocrine therapy alone were older and frailer than patients treated with surgery plus adjuvant endocrine therapy. Unmatched overall survival and breast-cancer-specific survival were higher in the surgery plus adjuvant endocrine therapy group (overall survival: hazard ratio 0.27, 95% confidence interval 0.23 to 0.33; p 25]. In this high-risk population, there were no differences according to adjuvant chemotherapy use in overall survival or breast-cancer-specific survival after propensity matching. Adjuvant chemotherapy was associated with a lower risk of metastatic recurrence than no chemotherapy in the unmatched (adjusted hazard ratio 0.36, 95% confidence interval 0.19 to 0.68; p = 0.002) and propensity-matched patients (adjusted hazard ratio 0.43, 95% confidence interval 0.20 to 0.92; p = 0.03). Adjuvant chemotherapy improved the overall survival and breast-cancer-specific survival of patients with oestrogen-receptor-negative disease. (2) Mixed-methods research to develop a decision support intervention: an iterative process was used to develop two decision support interventions (each comprising a brief decision aid, a booklet and an online tool) specifically for older women facing treatment choices (endocrine therapy alone or surgery plus adjuvant endocrine therapy, and adjuvant chemotherapy or no chemotherapy) using several evidence sources (expert opinion, literature and patient interviews). The online tool was based on models developed using registry data from 23,842 patients and validated on an external data set of 14,526 patients. Mortality rates at 2 and 5 years differed by 90 years, surgery plus adjuvant endocrine therapy was no longer cost-effective and generated fewer quality-adjusted life-years than endocrine therapy alone. The incremental benefit of surgery plus adjuvant endocrine therapy reduced with age and comorbidities. (5) Variation in practice: analysis of rates of surgery plus adjuvant endocrine therapy or endocrine therapy alone between the 56 breast units in the cohort study demonstrated significant variation in rates of endocrine therapy alone that persisted after adjustment for age, fitness and stage. Clinician preference was an important determinant of treatment choice. Conclusions: This study demonstrates that, for older women with oestrogen-receptor-positive breast cancer, there is a cohort of women with a life expectancy of

Published
2022
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6. The ESSO core curriculum committee update on surgical oncology

Author

Jos van der Hage, Sergio Sandrucci, Riccardo Audisio, Lynda Wyld, Kjetil Søreide, Teresa Amaral, Viren Bahadoer, Geerard Beets, Kim Benstead, Elisabeth Berge Nilsen, Kalijn Bol, Andreas Brandl, Jerry Braun, Tanja Cufer, Cristina Dopazo, Ibrahim Edhemovic, Jesper Grau Eriksen, Marco Fiore, Tessa van Ginhoven, Santiago Gonzalez-Moreno, Merlijn Hutteman, Yazan Masannat, Elisa Concetta Onesti, Beate Rau, Theo De Reijke, Isabel Rubio, Jelle Ruurda, Kjetil Soreide, Stefan Stattner, Dario Trapani, Domenico D'Ugo, Menno Vriens, Ane Gerda Zahl Eriksson, Institut Català de la Salut, [van der Hage J] Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, the Netherlands. [Sandrucci S] Surgical Oncology Unit, City of Health and Science, University of Turin, Turin, Italy. [Audisio R] Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden. [Wyld L] Department of Oncology and Metabolism, Sheffield University, Sheffield, United Kingdom. [Søreide K] Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Stavanger, Norway. Department of Clinical Medicine, University of Bergen, Bergen, Norway. [Amaral T] Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany. [Dopazo C] Servei de Cirurgia Hepatobiliopancreàtica i Trasplantaments, Vall d'Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Educació sanitària, Oncologia, Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2], education, Specialty, Translational research, Core curriculum, SDG 3 - Good Health and Well-being, Surgical oncology, Humans, media_common.cataloged_instance, Medicine, Càncer - Cirurgia, European union, Curriculum, Core Knowledge, media_common, Health Occupations::Medicine::Internal Medicine::Medical Oncology::Surgical Oncology [DISCIPLINES AND OCCUPATIONS], Medical education, Evidence-Based Medicine, business.industry, Otros calificadores::Otros calificadores::/educación [Otros calificadores], General Medicine, Europe, Clinical trial, Surgical Oncology, Oncology, profesiones sanitarias::medicina::medicina interna::oncología médica::oncología quirúrgica [DISCIPLINAS Y OCUPACIONES], Education, Medical, Graduate, Surgery, Other subheadings::Other subheadings::/education [Other subheadings], business, Specialization
Abstract

Cancer care; Curriculum; Surgical oncology Cuidado del cancer; Plan de estudios; Oncología quirúrgica Cura del càncer; Pla d'estudis; Oncologia quirúrgica Introduction Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. Material and methods The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. Results The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. Conclusions As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients.

Published
2021
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7. Comparing radiotherapy patient flows in England and Italy

Author

Riccardo Audisio, Alberto Franci, Rob Gandy, Caterina Gurrieri, and Francesca Maurizi

Subjects
Service (business), Leadership and Management, business.industry, Health Policy, 05 social sciences, International comparisons, 0506 political science, Patient flow, 03 medical and health sciences, Health services, 0302 clinical medicine, Geography, 030220 oncology & carcinogenesis, 050602 political science & public administration, Demographic economics, Operations management, business, RA, Self-sufficiency
Abstract

Research into radiotherapy patient flows in England and Italy investigated the degree of self-sufficiency in related service areas across each country. The respective results showed very different patterns, with there apparently being greater patient flow and less self-sufficiency for services in Italy, compared to England. However, close inspection suggested the results were not strictly comparable, despite the data, methodology and analyses being similar and entirely fitting in both cases. The respective studies were consequently compared for a range of criteria: how radiotherapy services are commissioned and provided; cultural expectations; base area definitions; data used; analyses undertaken; and research results. It was found that direct comparisons could not necessarily be drawn because cultural, conceptual, organisational and systemic factors in the delivery of services within each country influenced the results. Therefore, such factors should be taken into account when comparing health services in different countries, particularly in respect of patient flows and service self-sufficiency.

Published
2017
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8. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Author

S Potter, A Trickey, T Rattay, R L O'Connell, R Dave, E Baker, L Whisker, J Skillman, M D Gardiner, R D Macmillan, C Holcombe, Nicola L P Barnes, Jane Blazeby, Elizabeth Conroy, Rajiv V Dave, Matthew D Gardiner, Adrian Harnett, Chris Holcombe, Shelley Potter, Tim Rattay, Joanna Skillman, Paula Williamson, Rajgopal Achuthan, Shweta Aggarwal, Elizabeth Baker, Naren Basu, Lisa Brock, Patricia Fairbrother, Charlotte Ives, Abhilash Jain, Baek Kim, R Douglas Macmillan, John Murphy, Dennis Remoundos, Richard Sutton, Adam Trickey, Philip Turton, Kathryn Williams, Alain Curnier, Amir Tadros, Ivan Depasquale, Mairi Fuller, Roger Bourne, Steven Heys, Ishrak Hamo, Fatima Aloraifi, Laura Fopp, Radhika Bali, Sarah Bache, Sarah L Benyon, Michael S Irwin, Amit Agrawal, Charles M Malata, Claire Murphy, Adam Misky, Dennis Wayne Chicken, Nassreen Abdullah, Arnold D K Hill, Carolyn Cullinane, Gareth Irwin, Stuart A McIntosh, Sigi Refsum, Samantha Sloan, Peter Mallon, Chiara Sirianni, Ilyas Khattak, Geerthan Nagachandra, Pasupathy Kiruparan, Debasish Debanth, Simon Davey, Terry-Ann Curran, Matilda Svenning, Sasirekha Govindarajulu, Zenon Rayter, Rachel Ainsworth, Simon Cawthorn, Ajay Sahu, Sherif Wilson, Elena Prousskaia, Antonello Accurso, Nicola Rocco, Rosa Di Micco, Gennaro Limite, Raffaele Ceccarino, Raffaele Liccardo, Guido Coco, Metin Nizamoglu, Mary Morgan, Venkat Ramakrishnan, Giuseppe Catanuto, Alex Wilkins, Penelope McManus, Peter Kneeshaw, Kartikae Grover, Tapan Mahapatra, Brendan Wooler, Bilal Elahi, Naila Ihsan, Alexandra Bucknor, Dimitris Reissis, Judith Hunter, Simon Wood, Navid Jallali, Francis P Henry, Liaquat S Verjee, Jason Lee, Shazia M Khan, Iman Azmy, Julia Massey, Ciaran Hollywood, Michael Oluwajana, Sonia Bathla, Joanna Seward, Claudia Harding-MacKean, Risha Lane, Kothandaraman Murali, Bashishta Biswas, Pawel Trapszo, Seema Seetharam, Katy Kennedy, Louise Alder, Tomasz Graja, Khalid Amin, Jalal Kokan, Chandeena Roshanlall, Emma Gill, Dhananjay Kulkarni, J M Dixon, Oliver Young, Talha Saleem, M Biddle, Marie Kearns, Eva Weiler-Mithoff, Ben Chew, Andy Malyon, John Scott, David McGill, Iain Mackay, Salena Bains, Sara Barrows, Simon Pilgrim, Sheila Shokuhi, Kelly Lambert, Frances Kenny, Kalliope Valassiadou, Monika Kaushik, Jaroslaw Krupa, Dimitris Dragoumis, Pavlos Lampropoulos, Sarah Moss, Haitham Khalil, Anwar Haq, Balapathiran Balasubramanian, Petros Charalampoudis, Hisham Hamed, Ashutosh Kothari, Tibor Kovacs, Michael Douek, Iftikhar Mehmood, Biswajit Ray, Matthew Adelekan, Laura Humphreys, Salim Tayeh, Christina Choy, Laila Parvanta, Silvia Michieletto, Tania Saibene, James O'Brien, Sue Down, Sarah Downey, Jerome Pereira, A S Sami, Anzors Gvaramadze, Jibril A Jibril, Dinesh Thekkinkattil, S Udayasankar, Saira Khawaja, Yousef Shariaha, Simon Holt, Ruth James, Hirah Rizki, Katharine Kirkpatrick, Duraisamy Ravichandran, Deepak Shrestha, Ellora Barua, Deepika Akolekar, Ahmed Hamad, Eleftheria Kleidi, Susan Hignett, Vanessa Pope, Salma Naseem, Jennifer Isherwood, Rachel Soulsby, Amanda Taylor, Kian Chin, Dai Nguyen, Francesca Guest, Amanda Thorne, Valentina Lefemine, Chris Kirchhoff, Declan C Murphy, Michelle Lo, Ruth Harcourt, Simon J Pain, Maged I Hussien, Katalin Zechmeister, E M Sassoon, Andrea Figus, Richard M Haywood, Rozina Ali, Susanna Alexander, Konstantinos Geropantas, Daniel Epurescu, Rebecca Lewis, Oladapo Fafemi, Jasdeep Gahir, Tasha Gandamihardja, Jennett Kelsall, Nazli Muhibullah, Charlene Otieno, Fayyaz Mazari, Marta Dauria, Lisa Whisker, Douglas Macmillan, Eleanor Gutteridge, Tuabin Rasheed, Hazem Khout, Kristjan Asgeirsson, Stephen McCulley, Maria Donatella Mariniello, Manuela Roncella, Matteo Ghilli, Livio Colizzi, Elena Rossetti, Lo Russo Marzia, Loredana Fustaino, Alessandro Quattrini Li, Kate L Harvey, Rebecca Windle, Dionysios Dennis Remoundos, Pankaj Roy, Gael MacLean, Asha Adwani, Elena Popa, Steven Goh, Geeta Shetty, Sarah Clark, Lorenzo Bernaudo, Avi Agrawal, Lucy Mansfield, Sally Tebbal, Ashraf Patel, Veronica Grassi, Ojas Pujji, Kathryn Hamnett, Emily Granger, Michael Durbar, Panagiotis Pikoulas, Clare Garnsey, Philip Walker, Angela J Vollermere, Ioannis Michalakis, Robin Jones, Mina Youssef, Mohammad Masood, Julie Dunn, Sisse Olsen, Douglas Ferguson, Rachel Tillett, Anna Allan, Alex Woollard, Rebecca Canny, Alexander Woollard, Afshin Mosahebi, Stephen Hamilton, Jagdeep Chana, Nilesh Sojitra, Ibby Younis, Dick Rainsbury, Natalie Chand, Vasileios Kalles, Anne Stebbing, Kevin Harris, Siobhan Laws, Anne Tansley, Geraldine Mitchell, Emma de Sousa, Julia Henderson, Mysore Chandrashekar, Bernadette Pereira, Chloe Constantinou, Dalia Elfadl, Foivos Irakleidis, Izaro Hernan, Miriam Byrne, Rachel O'Connell, Jennifer Rusby, Peter Barry, Katerine Krupa, William Allum, Fiona MacNeill, Nicola Roche, Gerald Gui, Kelvin Ramsey, Paul Harris, Stuart James, Jamie McIntosh, Nicola Laurence, Louise MacLennan, Robert Milligan, Henry Cain, Adam Critchley, Joe O'Donoghue, Loraine Kalra, Nick Collis, Gina Weston-Petrides, Roanne Fiddes, Victoria Brown, Anna Aertssen, Diana Slade-Sharman, Mansoor Khan, Caroline McGuiness, Vittoria Amorosi, Santanelli di Pompeo Fabio, Georgios Exarchos, Natasha Jiwa, Jennifer Hu, Serena Ledwidge, Laura Johnson, Anthony Peel, Naseem Dhooma, Eric Farrell, Liam Devane, Ruth Tevlin, Enda McDermott, Ruth Prichard, Denis Evoy, Jane Rothwell, James Geraghty, Colin Morrison, Catriona Lawlor, Fiona Langlands, Lauren Taylor, Raj Achuthan, Kieran Horgan, Shireen Mckenzie, Brian Hogan, Mark Lansdown, Channegowda Navin, Liz Sherwin, Caroline Mortimer, Neeraj Garg, Rahma Adam, Tahera Arif, Zbigniew Kryjak, Deedar Ali, Ravi Sowdi, Elena Fage, Senthurun Mylvaganam, Pilar Matey, Raghavan Vidya, Tapan Sircar, Oubida Asaad, Pud Bhaskar, Matei Dordea, Ada Chrysafi, Damian McCartan, Rajiv Dave, Rachel Foster, Rebecca Wilson, Sylvia Okwemba, Yousef Majeed, Ciara O'Brien, Vinod Mathen, Nicola Barnes, Ashu Gandhi, James Harvey, Cliona C Kirwan, Richard Johnson, Krupali Patel, Maria Dalmau Ribas, Natali Vigneswaran, Tom Challoner, Alan Park, Maged Rizkalla, Abigail Tomlins, Kat McEvoy, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan, Robert Kirby, Sladana Bajrusevic, Joseph Maalo, Michalis Charalambous, Lee Min Lai, Kelvin Chong, Simon Thomson, Sherif Monib, Leena Chagla, Riccardo Audisio, Rieka Taghizadeh, Azhar Iqbal, Karen James, Maria Callaghan, Shabbir Poonawala, Jonathan Lund, Raman Vinayagam, Steven Thrush, Rachel Bright Thomas, Michelle Mullan, Jevan Taylor, Ryo Yoshimura, Tom Mathew, Ben Mancey Jones, Kailas Munot, Rana Nasr, Jenny Piper, Deena El-Sharief, Mohammed Mustafa, Caitlin MacLeod, Elizabeth Smyth, Nina Saeed, Yazan Masannat, Amir Tan Mohd-Amin, Sam Sloan, Stuart McIntosh, Abdulla Ibrahim, Rathi Rathinaezhil, Eiman Khalifa, Penny McManus, Alexander Leeper, Jennifer McIlhenny, James Mansell, Keith Ogsto, Laszlo Romics, Shelia Shokuhi, Xiang Wei Jonathan Lee, Asmaa Al-Allak, Clare Fowler, Eleanore Massey, Fiona Court, Richard Hunt, Sarah Vestey, Mohsen Elgammal, Arish Noshirwani, Tehera Arif, Farah H Syed, Gazalla Safdar, Mohammed El-Abbar, Fiona Hogg, Pauline McGee, Vassilis Pitsinis, Jenny Smith, Sundus Makkiyah, Syed Mustafa, Dana Photiou, Ellie Gutteridge, Georgette Oni, Kelly Hallam, Kristjan Asgeirron, Marta D'Auria, Samim Al-zubaidi, James Bailey, Alexandra Tenovici, Dionysios-Dennis Remoundos, Nikos Chaidos, Oana Predescu, Jan Rezulski, Tholkifl Abdullah, Sujatha Udayasankar, Adam Talbot, Jagdeep Singh, Amy Smith, Angela Volleamere, Sarah Dean, Lashan Peiris, Olivia Sjokvist, Emma De Sousa, Aikaterini Micha, Amy Godden, Katherine Krupa, John Henton, Ruth Bennett, Stewart Nicholson, Guido Paolini, Luca Francesco Renzi, Santanelli Di Pompeo, Vitto Ria, Rebecca S Lewis, Sirwan Hadad, Anup Sharma, Delia Toomey, Dibyesh Banerjee, Sarah Shuk Kay Tang, Shireen McKenzie, Tanvir Ahmad, Kate Williams, Mohammed Absar, Nabila Nasir, Igor Jerzy Rychlik, Lynn Darragh, Ruth Johnston, Stephen Kirk, Jacqueline Rees-Lee, Michael Green, Abhishek Sharma, Jia Choong, Zaker Ullah, Ommen Koshy, Tamara Kiernan, Ajay Ashok Bhojwani, Rachel Bright-Thomas, Ged Byrne, Ibrahim Ibrahim, Lyndsey Highton, Owen Morris, Sumohan Chatterjee, Cliona Kirwan, Ben Mancey-Jones, Denna El Sharief, and Richard Frame

Subjects
Adult, therapeutic mammaplasty, medicine.medical_specialty, Mammaplasty, medicine.medical_treatment, Kaplan-Meier Estimate, 030230 surgery, Young Adult, 03 medical and health sciences, Postoperative Complications, breast cancer, 0302 clinical medicine, Breast cancer, cohort study, medicine, Adjuvant therapy, Humans, breast reconstruction, Young adult, Mastectomy, collaborative, Aged, Proportional Hazards Models, Aged, 80 and over, Proportional hazards model, business.industry, Immediate breast reconstruction, oncological safety, conservative treatment, mastectomy, Middle Aged, medicine.disease, Surgery, Logistic Models, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Breast reconstruction, business, Cohort study
Abstract

Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment.TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante.Se incluyeron en el análisis 2.916 pacientes (TM n = 376; mastectomía n = 1.532; IBR n = 1.008). La TM era más frecuente en pacientes obesas o en las sometidas a cirugía bilateral en comparación con las pacientes con IBR. Sin embargo, las pacientes sometidas a una mastectomía +/- IBR tenían más probabilidades de desarrollar complicaciones que las del grupo TM (TM n = 79, 21,0%; mastectomía n = 570, 37,2%; mastectomía y IBR n = 359, 35,6%; P 0,001). La conservación de la mama fue posible en el 87% de las pacientes con TM y el procedimiento no retrasó el inicio del tratamiento adyuvante. CONCLUSIÓN: La TM puede permitir que pacientes de alto riesgo que no serían candidatas a IBR eviten la mastectomía de una forma segura. Se necesitan más trabajos para comparar los resultados percibidos por las pacientes y los estéticos de las diferentes estrategias terapéuticas y establecer la seguridad oncológica a largo plazo.

Published
2020
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