医学
乳腺癌
乳房切除术
BRCA突变
预防性乳房切除术
癌症
肿瘤科
放射治疗
内科学
人口
外科
妇科
环境卫生
作者
Ella Evron,A. Ben-David,Hadassah Goldberg,Georgeta Fried,Bella Kaufman,Raphael Catane,Myer Raphael Pfeffer,David Geffen,P. Chernobelsky,Tamar Karni,Roxolyana Abdah‐Bortnyak,Ora Rosengarten,D. Matceyevsky,Moshe Inbar,Abraham Kuten,Benjamin W. Corn
标识
DOI:10.1093/annonc/mdy515
摘要
BackgroundWomen who carry germ-line mutations in BRCA1/2 are at very high risk of developing breast and ovarian cancer. Breast conserving therapy is associated with a similar risk of ipsilateral cancer recurrence in BRCA carriers compared with non-carriers. However, the risk of subsequent contralateral breast cancer in carriers is markedly increased. Therefore, mastectomy of the diseased breast along with risk reducing mastectomy of the contralateral breast is often advocated for BRCA carriers who are treated for early breast cancer. Yet, many BRCA carriers forgo this option for fear of harmful effects and choose breast conserving treatment and observation instead. In Israel, BRCA-associated breast cancer is relatively common. Accordingly, a national protocol was devised for this enriched population.Patients and methodsIn this Institutional Review Board-approved phase II trial, the option of prophylactic irradiation to the contralateral breast, in addition to standard loco-regional treatment, was offered to BRCA carrier patients treated for early breast cancer who declined contralateral mastectomy. The primary end point was contralateral breast cancer.ResultsBetween May 2007 and October 2017, 162 patients were enrolled. Eighty-one patients opted for standard loco-regional treatment including surgery and radiation to the involved side (control arm) and 81 patients chose additional contralateral breast irradiation (intervention arm). At a median follow-up of 58 months, 10 patients developed contralateral breast cancer in the control arm at a median of 32 months, as compared with 2 patients in the intervention arm who developed contralateral breast cancer 80 and 105 months after bilateral breast irradiation (log-rank P = 0.011).ConclusionsAmong BRCA carrier patients treated for early breast cancer, the addition of contralateral breast irradiation was associated with a significant reduction of subsequent contralateral breast cancers and a delay in their onset.Clinical trialPhase II, comparative two-arm trial (NCT00496288).
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