B.M. Rabatic

Is Breast Conserving Therapy a Safe Modality for Early-Stage Male Breast Cancer?

INTRODUCTION Male breast cancer (MBC) is a rare disease and lacks data-based treatment guidelines. Most men are currently treated with modified radical mastectomy (MRM) or simple mastectomy (SM). We compared the oncologic treatment outcomes of early-stage MBC to determine whether breast conservation therapy (BCT) is appropriate. MATERIALS AND METHODS We searched the Surveillance, Epidemiology, and End Results database for MBC cases. That cohort was narrowed to cases of stage I-II, T1-T2N0 MBC with surgical and radiation therapy (RT) data available. The patients had undergone MRM, SM, or breast conservation surgery (BCS) with or without postoperative RT. We calculated the actuarial 5-year cause-specific survival (CSS). RESULTS We identified 6263 MBC cases and included 1777 men with stage I or II, T1-T2, node-negative disease, who had the required treatment information available. MRM without RT was the most common treatment (43%). Only 17% underwent BCS. Of the BCS patients, 46% received adjuvant RT to complete the traditional BCT. No deaths were recorded in the BCT group, regardless of stage, or in the 3 stage I surgical groups if the men had received RT. The actuarial 5-year CSS was 100% in each BCT group. MRM alone resulted in an actuarial 5-year CSS of 97.3% for stage 1% and 91.2% for stage 2. CONCLUSION The results from our study suggest that BCT for early-stage MBC yields comparable survival compared with more invasive treatment modalities (ie, MRM or SM alone). This could shift the treatment paradigm to less-invasive interventions and might have the added benefit of increased functional and psychological outcomes. Further prospective studies are needed to confirm our conclusions.

Rebuttal from Prof. Kong and Dr. Rabatic

We have the fortune of an eloquent consideration to the alternatives of concurrent chemoradiation offered by our esteemed colleague for patients diagnosed with stage III non-small cell lung cancer (NSCLC). Dr. Rodrigues rightfully clarifies the significant challenges of a concurrent treatment regimen in this very heterogeneous patient population. Understandably from his viewpoint, there exists low success of cure in the face of such advanced cancer. We concur that treating patients with significant morbidity may potentially increase treatment-related toxicities, and possibly, death. While toxicity seen with the use of concurrent chemotherapy for stage III NSCLC cancer can be an argument for avoiding a concurrent treatment paradigm, we must recognize that we do not have data which demonstrates mortality is significantly higher in patients treated with concurrent chemoradiation, compared to those treated with sequential chemoradiation or radical radiation therapy alone. Additionally, the negative result of poorer survival in high dose arm of RTOG 0617 cannot support the “Con” for concurrent chemoradiation, as the standard arm of concurrent chemoradiation had outstanding survival (1).

Pros: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with large volume unresectable stage III non-small cell lung cancer

The debate of treating stage III, large volume non-small cell lung cancer (NSCLC) with definitive chemo-radiotherapy continues to be waged. A physically fit patient, having large volume and unresectable disease is the ideal candidate for this treatment approach. The ability of this patient population to successfully complete, and thereby benefit from an aggressive, combined treatment to improve local control and survival, drives the recommendation of treating oncologists for this approach. Until a phase III trial proves otherwise, concurrent chemo-radiotherapy will remain the ideal treatment for fit patients having large volume unresectable stage III NSCLC.

Experimental Therapies in Breast Cancer

Advancement of radiation-based breast cancer therapy is driven by highly strategic approaches to target diseased tissue. As a core premise, radiation therapy is designed to maximize therapeutic potential while minimizing harm to surrounding healthy tissue. Recently, advances in material design, synthesis, and characterization have lead to a surge in the number of approaches intended to shrink or eliminate the tumor burden of breast cancer. These latest advancements serve as the focus of the following chapter. While the topic is broad in nature, this review will emphasize the latest advancements in molecular-based and gene-based targeting, intralesional and intraoperative designs, and, importantly, the expanding sphere of nanomaterials. The topic of nanoscale materials will be developed to include approaches of organic-based systems, inorganic-based systems, and biological hybrid nanomaterials.