Breast1 Flashcards
(94 cards)
1
Q
What was the 15-year breast cancer mortality (BCM) for lumpectomy with radiation therapy (RT)?
A
1.74%
The data is from Giannakeas et al, JAMA, 2018.
2
Q
What is the number needed to treat (NNT) for lumpectomy with RT to reduce BCM?
A
170
3
Q
Which tumor grades showed a clear benefit in BCM with lumpectomy and RT according to the subanalysis?
A
Grade 3
HR 0.59 indicates a significant benefit.
4
Q
What was the 10-year BCM for patients who received RT compared to those who did not in the Sagara et al. study?
A
1.8% with RT vs. 2.1% without RT
5
Q
What factors were associated with improved overall survival (OS) at 10 years in Sagara et al.’s study?
A
- High nuclear grade
- Young age
- Large tumor size
6
Q
What were the 10-year invasive ipsilateral breast tumor recurrence (IBTR) rates for observation vs. RT in the RTOG 9804 trial?
A
4.3% vs. 0.4%
7
Q
True or False: Observation can be an appropriate option for low-risk DCIS.
A
True
8
Q
In the IBIS-II DCIS trial, what was compared with anastrozole?
A
Tamoxifen (TAM) x 5 years
9
Q
What were the findings regarding overall recurrences or death between anastrozole and TAM in the IBIS-II DCIS trial?
A
No difference
10
Q
What was the 10-year breast cancer-free interval (BCFI) for anastrozole compared to TAM in the NSABP B-35 trial?
A
93.1% vs. 89.1%
11
Q
What is the effect of tamoxifen on ipsilateral or contralateral tumor recurrence when RT is given, according to the UKCCCR trial?
A
Tamoxifen had no benefit on ipsilateral or contralateral tumors
12
Q
What was the 5-year invasive breast cancer recurrence reduction with TAM added to RT?
A
Reduced invasive breast cancer recurrence
13
Q
What were the 5-year IBTR rates for observation, tamoxifen, RT, and RT + TAM in the UKCCCR trial?
A
- 22% observation
- 18% TAM
- 8% RT
- 6% RT + TAM
14
Q
What was the primary endpoint of the BIG 3-07 TROG 07.01 trial?
A
Local recurrence (LR)
15
Q
What was the significant finding regarding boost therapy in the BIG 3-07 TROG 07.01 trial?
A
Boost improves LR in all types of DCIS
16
Q
What were the 9-year local recurrence rates for hypofractionation (hypofx) compared to conventional RT in the DBCG HYPO trial?
A
3% both arms
17
Q
What is the recommended standard of care for DCIS according to the BIG 3-07 TROG 07.01 trial?
A
Hypofractionation should become standard of care
18
Q
What is the difference in side effects between anastrozole and tamoxifen?
A
- Tamoxifen: more muscle spasms, gynecologic cancers, DVTs
- Anastrozole: more fractures, musculoskeletal events
19
Q
What was the conclusion regarding the efficacy of RT compared to TAM for DCIS?
A
RT is more effective than TAM
20
Q
What percentage of patients intended to use tamoxifen in the RTOG 9804 trial?
A
70%
21
Q
What is the significance of the term ‘hypofractionation’ in the context of DCIS treatment?
A
Hypofractionation refers to delivering higher doses of radiation in fewer sessions.
22
Q
What does the acronym SEER stand for?
A
Surveillance, Epidemiology, and End Results
23
Q
What is the primary endpoint used in the DCIS studies mentioned?
A
Breast cancer mortality (BCM)
24
Q
What is the typical treatment option for low-risk DCIS according to NCCN guidelines?
A
Radiotherapy (RT)
25
What was the treatment comparison in the study involving invasive N0 or DCIS patients aged >40?
40 Gy/15 fx vs. 50 Gy/25 fx
## Footnote
Boost allowed in both treatment arms.
26
What was the 9-year local recurrence rate (LRR) for both treatment arms?
3% for both arms
27
What were the findings regarding induration rates between the two radiation doses?
3-year induration rates were 9.0% vs. 11.8% with no worsening in large breasts for 40 Gy vs. 50 Gy.
28
What were the overall survival rates after 9 years for the treatment arms?
93% for both arms
29
True or False: Hypofractionation led to more induration than conventional RT.
False
30
What percentage of patients in the study were T1c?
About 50%
31
What was the boost dose given in the study, and what percentage of patients received it?
Boost of 10 Gy given to 23% of patients
32
What was the finding regarding heart and lung toxicity in the studied patients?
Heart and lung toxicity were rare
33
What was the effect of smoking and large breast size on induration risk?
Increased risk overall, but no worsening with 40 Gy vs. 50 Gy
34
What was the purpose of the DCIS study involving 16 Gy boost vs. no boost?
To compare 5-year invasive breast tumor recurrence (IBTR) rates
35
What were the 5-year IBTR rates for boost vs. no boost?
3% vs. 7%
36
What was the finding regarding regional recurrence and distant metastasis in both arms?
≤1% in both arms
37
What were the grade ≥2 adverse effects for boost vs. no boost?
Grade ≥2 breast pain: 14% vs. 10%; Induration: 14% vs. 6%
38
What was the conclusion regarding hypofractionation in the DCIS study?
Hypofx should become standard of care in DCIS, maintaining local control.
39
What was the 10-year risk of invasive breast event (IBE) for low, intermediate, and high-risk DCIS patients?
* Low risk: 11%
* Intermediate risk: 27%
* High risk: 26%
40
How many countries participated in the DCIS study?
11 countries
41
What was the outcome for patients receiving endocrine therapy in the DCIS study?
Only 13% received endocrine therapy
42
What is the significance of the DCIS score?
Quantifies recurrence risk and provides a tool for individualized treatment.
43
What are the long-term outcomes of RT compared to observation in breast-conserving surgery (BCS)?
RT halves rates of any recurrence and reduces mortality by about 1/6.
44
What did the Swedish database analysis reveal about OS and BCSS in BCS+RT compared to mastectomy?
BCS+RT had better OS and BCSS than mastectomy and mastectomy with PMRT.
45
True or False: The NSABP B-06 trial showed significant differences in OS between mastectomy and BCT.
False
46
What was the finding regarding the long-term outcomes in Milan I study?
No difference in OS or cancer-specific survival between radical mastectomy and quadrantectomy with RT.
47
What was the IBTR rate at 20 years for lumpectomy with RT vs. lumpectomy alone in the NSABP B-06 trial?
14% vs. 39%
48
What was the conclusion regarding the benefit of RT in the context of breast cancer subtypes?
Subtype was not predictive of response to radiation.
49
What were the overall IBTR results in the Swedish Breast Cancer Group 91 study?
6% vs. 20% for RT vs. observation
50
What was the focus of the study by Veronesi et al, NEJM, 2002 regarding early-stage breast cancer?
Comparison of radical mastectomy vs. quadrantectomy with ALND and radiotherapy.
## Footnote
At 20 years, no difference in overall survival (OS) or cancer-specific survival (CSS) was observed.
51
What were the results of NSABP B-21 regarding RT+TAM vs. RT alone vs. TAM alone?
8-year IBTR: 17% TAM vs. 3% TAM RT vs. 9% RT; 14-year IBTR: 29% TAM vs. 10% TAM RT vs. 11% RT; 14-year OS: 78-82%, not different.
## Footnote
RT and TAM improve IBTR in tumors ≤1 cm.
52
What does hypofractionated RT combined with TAM show according to Fyles et al, NEJM, 2004?
5-year local recurrence (LR): 0.6% vs. 7.7% with TAM alone.
## Footnote
Benefit also observed in subgroup of T1, ER+ tumors.
53
What were the findings of CALGB C9343 about elderly patients receiving RT+TAM vs. TAM alone?
RT improves local recurrence rate (LRR) but does not change OS or distant metastasis (DM).
## Footnote
5-year LRR: 4% without RT vs. 1% with RT.
54
What was the conclusion of PRIME II regarding RT in elderly patients with low-risk tumors?
RT improves IBTR but shows no benefit in OS or DM.
## Footnote
Treatment should be individualized based on goals and patient discussion.
55
What did the study by Whelan et al, NEJM 2023 conclude about luminal A subtype breast cancer?
Low risk of recurrence at 5 years with endocrine therapy alone, without RT.
## Footnote
Median age of participants was 67.
56
What did BASO II reveal about the effectiveness of observation in good prognosis patients?
Observation leads to excess local recurrence (LR) compared to RT or TAM.
## Footnote
TAM alone or RT alone may be reasonable therapy for some patients.
57
What were the results of the EUROPA study regarding elderly patients with luminal A breast cancer?
RT improved quality of life (QOL) and had fewer adverse effects compared to endocrine therapy.
## Footnote
Primary endpoints included EORTC QLQ-C30 global health.
58
What did the IDEA trial find regarding patients with low Oncotype scores?
Omission of radiation therapy leads to low rates of local recurrence at 5 years.
## Footnote
Oncotype score required was ≤18.
59
What is the primary endpoint of the ongoing DEBRA trial?
Invasive breast tumor recurrence (IBTR).
## Footnote
Oncotype score required is ≤18.
60
What did EORTC 22881 study about the impact of a boost in radiotherapy?
5-year LR was reduced with boost: 7.3% vs. 4.3%.
## Footnote
Mastectomies increased by 41% with boost therapy.
61
True or False: The study by Hughes et al. reported that RT improves overall survival in elderly breast cancer patients.
False.
## Footnote
No change in OS was observed despite improved local recurrence rates.
62
Fill in the blank: The study by Bartelink et al. found a significant reduction in 10-year LR with a _______ boost.
16 Gy
## Footnote
The study compared 50 Gy WBRT with and without a boost.
63
What is the 20-year local recurrence (LR) rate for patients with adjacent DCIS and age ≤50?
31% vs. 15%
## Footnote
This indicates a significant increase in the risk of local recurrence in younger patients with adjacent DCIS.
64
What percentage increase in mastectomies was observed?
41%
## Footnote
This reflects a notable trend in surgical management for breast cancer.
65
What is the 10-year fibrosis rate for patients receiving a boost of 16 Gy?
1.6% vs. 4.4%
## Footnote
Indicates that the 16 Gy boost has a lower rate of fibrosis compared to other treatments.
66
What is the 20-year severe fibrosis rate for those receiving a 16 Gy boost?
1.8% vs. 5.2%
## Footnote
Highlights the increased risk of severe fibrosis over time.
67
What are the risk factors for ipsilateral breast tumor recurrence (IBTR) identified in the initial subanalysis?
Age <50 and grade 3
## Footnote
These factors significantly impact the risk of recurrence.
68
What does the EORTC study indicate about the risks associated with 16 Gy boost?
5% vs. 2% severe risk at 20 years; 15% vs. 30% moderate-severe risk
## Footnote
This study provides evidence for the long-term risks of fibrosis related to radiation boosts.
69
True or False: The overall survival (OS) rates are different between treatment groups with a 16 Gy boost.
False
## Footnote
Despite differences in local control and fibrosis, OS remains unchanged.
70
What is the primary benefit of using a 16 Gy boost in radiation therapy?
Improves local control after whole breast radiation for lumpectomy
## Footnote
This treatment strategy aims to enhance cancer control post-surgery.
71
In the Lyon study, what was the 5-year local control (LC) rate for 10 Gy boost?
4.5% vs. 3.6% (p=0.044)
## Footnote
Suggests a statistically significant improvement in local control with the boost.
72
What does the UK IMPORT HIGH trial conclude about the 48 Gy SIB boost?
Noninferior to sequential hypofractionation plus boost
## Footnote
Indicates the effectiveness of SIB boost in comparison to traditional methods.
73
What was the 5-year induration/hardness rate with the 48 Gy SIB boost?
Less with 48 Gy
## Footnote
Suggests improved cosmetic outcomes compared to other treatment regimens.
74
What is the treatment duration benefit of hypofractionation with SIB boost?
Reduced treatment duration
## Footnote
This is a significant advantage for patient convenience and compliance.
75
What were the 9-year local recurrence rates for both arms in the DBCG HYPO trial?
3% both arms
## Footnote
Demonstrates the effectiveness of both treatment regimens in preventing recurrence.
76
What is the relationship between boost and induration in large breast patients?
No worsening of induration with 40 Gy vs. 50 Gy
## Footnote
Indicates that hypofractionated regimens can maintain favorable outcomes in larger breasts.
77
Fill in the blank: The 5-year IBTR rates in the UK FAST FORWARD study were ______.
2.3% vs. 2.0% vs. 1.5%
## Footnote
Reflects the low rates of local recurrence across different treatment doses.
78
What was the significant outcome of the UK FAST FORWARD study regarding 26 Gy treatment?
Noninferior to 40 Gy in 15 fractions
## Footnote
This highlights the potential for shorter treatment regimens without compromising efficacy.
79
What is the significance of the p-values for DCIS in the MVA analysis?
p=0.001 for DCIS; p=<0.001 for age
## Footnote
Indicates strong statistical significance for these variables as risk factors.
80
What was the induration outcome with 40 Gy?
Worse induration
## Footnote
Patients generally at medium risk; lowest risk enrolled in a Danish PBI trial
81
What percentage of patients were T1c?
About 50%
## Footnote
Smoking and large breast increased risk of induration overall
82
Did the boost lead to worse induration?
No
## Footnote
Patients with boost tended to have more chemo, providing more time to heal after surgery
83
What percentage of patients had DCIS?
13%
## Footnote
Boost was given in 23% of cases, with ~85% having 10 Gy
84
What therapies were used in DCIS and invasive cases?
* Endocrine therapy in 35% of DCIS
* Chemo in ~35-40% of invasive
85
What are the heart dose volume constraints?
* V35 <5%
* V17 <10%
86
What were the dose protocols compared in the START trial?
* 50 Gy/25 fx
* 39 Gy/13 fx
* 41.6 Gy/13 fx
* 40 Gy/15 fx
87
What was the 10-year local recurrence rate (LRR) observed?
4-6%, not different
## Footnote
Less cosmetic changes in 39 Gy and 40 Gy group (HR 0.77)
88
What was the outcome for arm and shoulder toxicity in patients receiving RT to LNs?
No difference
## Footnote
No difference in lung or heart toxicity at 10 years
89
What does hypofractionation result in regarding outcomes and toxicity?
Favorable outcomes and low toxicity
## Footnote
Late cosmetic effects are reduced
90
What were the findings regarding grade 3 outcomes in the Ontario trial?
Favored conventional RT
## Footnote
This finding was not replicated in START A/B
91
What was the treatment comparison in the Ontario trial?
* 42.5 Gy / 16 fx
* 50 Gy / 25 fx
92
What was the 5-year local recurrence rate for both arms in the Ontario trial?
3%
## Footnote
10-year LR ~6%
93
How did cosmetic outcomes compare between treatment arms in the Ontario trial?
Not different
94
What was the conclusion about hypofractionation in the Ontario trial?
Hypofractionation is noninferior to conventional RT
