9 results on '"Julian, Thomas B"'
Search Results
2. Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO)
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Smith, Benjamin D., Arthur, Douglas W., Buchholz, Thomas A., Haffty, Bruce G., Hahn, Carol A., Hardenbergh, Patricia H., Julian, Thomas B., Marks, Lawrence B., Todor, Dorin A., Vicini, Frank A., Whelan, Timothy J., White, Julia, Wo, Jennifer Y., and Harris, Jay R.
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BREAST cancer treatment , *CANCER radiotherapy , *RANDOMIZED controlled trials , *ONCOLOGY - Abstract
Purpose: To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine''s PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein. Results: The Task Force proposed three patient groups: (1) a “suitable” group, for whom APBI outside of a clinical trial is acceptable, (2) a “cautionary” group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an “unsuitable” group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety. Conclusion: Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer. [Copyright &y& Elsevier]
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- 2009
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3. Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy.
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Armer JM, Ballman KV, McCall L, Armer NC, Sun Y, Udmuangpia T, Hunt KK, Mittendorf EA, Byrd DR, Julian TB, and Boughey JC
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- Adult, Aged, Breast Neoplasms pathology, Female, Humans, Lymphedema pathology, Middle Aged, Prospective Studies, Surgeons, United States, Young Adult, Axilla physiopathology, Breast Neoplasms etiology, Breast Neoplasms therapy, Cancer Survivors psychology, Extremities growth & development, Lymph Node Excision methods, Lymphedema etiology, Lymphedema therapy, Neoadjuvant Therapy adverse effects
- Abstract
Purpose: Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema., Methods: Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1-2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire., Results: In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0-66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8-80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7-31.1%) and 30.9% (95% CI 26.3-36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05-0.09)., Conclusions: Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care., Trial Registration: NCT00881361.
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- 2019
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4. Landmark clinical trials influencing surgical management of non-invasive and invasive breast cancer.
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Julian TB, Venditti CA, and Duggal S
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- Breast Neoplasms pathology, Breast Neoplasms surgery, Europe, Female, History, 20th Century, History, 21st Century, Humans, Mastectomy standards, United States, Breast Neoplasms history, Clinical Trials as Topic history, Mastectomy history
- Abstract
The surgical management of breast cancer has changed considerably since the use of the Halstedian radical mastectomy early in the 20th century. Over the last 50 years, several landmark clinical trials from the USA and Europe have resulted in a paradigm shift in the management of breast cancer toward less radical forms of surgery with the combined use of multi-modality treatments including systemic chemotherapy, endocrine therapy, and radiotherapy. Advances in such research have established a new worldwide standard of care for breast cancer surgical management and treatment, which has become more patient centric and which places a higher emphasis on cosmesis and improved patient quality of life. In this chapter, we review the landmark clinical trials that have influenced surgical management for non-invasive and invasive breast cancer and that serve to guide current clinical practices to date., (© 2014 Wiley Periodicals, Inc.)
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- 2015
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5. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24.
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Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, Mamounas EP, Julian TB, Geyer CE Jr, Costantino JP, Land SR, and Wolmark N
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- Adult, Age Factors, Aged, Antineoplastic Agents, Hormonal administration & dosage, Antineoplastic Agents, Hormonal adverse effects, Breast Neoplasms mortality, Breast Neoplasms pathology, Breast Neoplasms surgery, Carcinoma in Situ mortality, Carcinoma in Situ pathology, Carcinoma in Situ surgery, Carcinoma, Intraductal, Noninfiltrating mortality, Carcinoma, Intraductal, Noninfiltrating pathology, Carcinoma, Intraductal, Noninfiltrating surgery, Chemotherapy, Adjuvant, Disease-Free Survival, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Mastectomy, Segmental methods, Middle Aged, Neoplasm Invasiveness pathology, Neoplasm Recurrence, Local mortality, Neoplasm Staging, Receptors, Estrogen analysis, Receptors, Progesterone analysis, Receptors, Progesterone drug effects, Risk Assessment, Survival Analysis, Tamoxifen adverse effects, United States, Breast Neoplasms drug therapy, Carcinoma in Situ drug therapy, Carcinoma, Intraductal, Noninfiltrating drug therapy, Neoplasm Recurrence, Local prevention & control, Receptors, Estrogen drug effects, Tamoxifen administration & dosage
- Abstract
Purpose: The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen., Patients and Methods: Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n = 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n = 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years)., Results: ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P < .001) and overall follow-up (HR, 0.60; P = .003), which remained significant in multivariable analysis (overall HR, 0.64; P = .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone., Conclusion: Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.
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- 2012
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6. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial.
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Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, Ashikaga T, Weaver DL, Mamounas EP, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, and Wolmark N
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- Axilla, Breast Neoplasms mortality, Breast Neoplasms pathology, Canada, Chemotherapy, Adjuvant, Coloring Agents, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Lymph Node Excision adverse effects, Lymph Node Excision mortality, Lymphatic Metastasis, Middle Aged, Neoplasm Recurrence, Local, Proportional Hazards Models, Radiopharmaceuticals, Radiotherapy, Adjuvant, Risk Assessment, Risk Factors, Rosaniline Dyes, Technetium Tc 99m Sulfur Colloid, Time Factors, Treatment Outcome, United States, Breast Neoplasms surgery, Lymph Node Excision methods, Mastectomy, Modified Radical adverse effects, Mastectomy, Modified Radical mortality, Mastectomy, Segmental adverse effects, Mastectomy, Segmental mortality, Sentinel Lymph Node Biopsy adverse effects, Sentinel Lymph Node Biopsy mortality
- Abstract
Background: Sentinel-lymph-node (SLN) surgery was designed to minimise the side-effects of lymph-node surgery but still offer outcomes equivalent to axillary-lymph-node dissection (ALND). The aims of National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 were to establish whether SLN resection in patients with breast cancer achieves the same survival and regional control as ALND, but with fewer side-effects., Methods: NSABP B-32 was a randomised controlled phase 3 trial done at 80 centres in Canada and the USA between May 1, 1999, and Feb 29, 2004. Women with invasive breast cancer were randomly assigned to either SLN resection plus ALND (group 1) or to SLN resection alone with ALND only if the SLNs were positive (group 2). Random assignment was done at the NSABP Biostatistical Center (Pittsburgh, PA, USA) with a biased coin minimisation approach in an allocation ratio of 1:1. Stratification variables were age at entry (≤ 49 years, ≥ 50 years), clinical tumour size (≤ 2·0 cm, 2·1-4·0 cm, ≥ 4·1 cm), and surgical plan (lumpectomy, mastectomy). SLN resection was done with a blue dye and radioactive tracer. Outcome analyses were done in patients who were assessed as having pathologically negative sentinel nodes and for whom follow-up data were available. The primary endpoint was overall survival. Analyses were done on an intention-to-treat basis. All deaths, irrespective of cause, were included. The mean time on study for the SLN-negative patients with follow-up information was 95·6 months (range 70·1-126·7). This study is registered with ClinicalTrials.gov, number NCT00003830., Findings: 5611 women were randomly assigned to the treatment groups, 3989 had pathologically negative SLN. 309 deaths were reported in the 3986 SLN-negative patients with follow-up information: 140 of 1975 patients in group 1 and 169 of 2011 in group 2. Log-rank comparison of overall survival in groups 1 and 2 yielded an unadjusted hazard ratio (HR) of 1·20 (95% CI 0·96-1·50; p=0·12). 8-year Kaplan-Meier estimates for overall survival were 91·8% (95% CI 90·4-93·3) in group 1 and 90·3% (88·8-91·8) in group 2. Treatment comparisons for disease-free survival yielded an unadjusted HR of 1·05 (95% CI 0·90-1·22; p=0·54). 8-year Kaplan-Meier estimates for disease-free survival were 82·4% (80·5-84·4) in group 1 and 81·5% (79·6-83·4) in group 2. There were eight regional-node recurrences as first events in group 1 and 14 in group 2 (p=0·22). Patients are continuing follow-up for longer-term assessment of survival and regional control. The most common adverse events were allergic reactions, mostly related to the administration of the blue dye., Interpretation: Overall survival, disease-free survival, and regional control were statistically equivalent between groups. When the SLN is negative, SLN surgery alone with no further ALND is an appropriate, safe, and effective therapy for breast cancer patients with clinically negative lymph nodes., Funding: US Public Health Service, National Cancer Institute, and Department of Health and Human Services., (Copyright © 2010 Elsevier Ltd. All rights reserved.)
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- 2010
- Full Text
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7. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).
- Author
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Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, Julian TB, Marks LB, Todor DA, Vicini FA, Whelan TJ, White J, Wo JY, and Harris JR
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- Advisory Committees, Age Factors, Breast Neoplasms surgery, Female, Humans, Informed Consent standards, Mastectomy, Segmental, Radiotherapy Dosage, Societies, Medical standards, United States, Breast Neoplasms radiotherapy, Consensus, Patient Selection, Radiation Oncology standards
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- 2009
- Full Text
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8. Mammographic density and breast cancer after ductal carcinoma in situ.
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Habel LA, Dignam JJ, Land SR, Salane M, Capra AM, and Julian TB
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- Adult, Aged, Breast Neoplasms epidemiology, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Carcinoma, Intraductal, Noninfiltrating epidemiology, Carcinoma, Intraductal, Noninfiltrating radiotherapy, Carcinoma, Intraductal, Noninfiltrating surgery, Confounding Factors, Epidemiologic, Female, Humans, Incidence, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local prevention & control, Proportional Hazards Models, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Single-Blind Method, United States epidemiology, Breast pathology, Breast Neoplasms diagnostic imaging, Carcinoma, Intraductal, Noninfiltrating diagnostic imaging, Mammography, Neoplasm Recurrence, Local diagnostic imaging
- Abstract
Women with ductal carcinoma in situ (DCIS) are at substantially increased risk for a second breast cancer, but few strong predictors for these subsequent tumors have been identified. We used Cox regression modeling to examine the association between mammographic density at diagnosis of DCIS of 504 women from the National Surgical Adjuvant Breast and Bowel Project B-17 trial and risk of subsequent breast cancer events. In this group of patients, mostly 50 years old or older, approximately 6.6% had breasts categorized as highly dense (i.e., > or =75% of the breast occupied by dense tissue). After adjusting for treatment with radiotherapy, age, and body mass index, women with highly dense breasts had 2.8 (95% confidence interval [CI] = 1.3 to 6.1) times the risk of subsequent breast cancer (DCIS or invasive), 3.2 (95% CI = 1.2 to 8.5) times the risk of invasive breast cancer, and 3.0 (95% CI = 1.2 to 7.5) times the risk of any ipsilateral breast cancer, compared with women with less than 25% of the breast occupied by dense tissue. Our results provide initial evidence that the risk of second breast cancers may be increased among DCIS patients with highly dense breasts.
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- 2004
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9. Report of the Working Groups on Breast MRI: report of the Breast Cancer Staging Group.
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Harms SE, Rabinovitch R, Julian TB, Rafferty E, Masood S, and Weatherall P
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- Clinical Trials as Topic instrumentation, Female, Humans, Neoplasm Staging, Reproducibility of Results, United States, Breast Neoplasms pathology, Magnetic Resonance Imaging
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- 2004
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