Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases

Purpose
There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines.

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The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis.

Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy

Pediatric low-grade gliomas encompass a heterogeneous set of tumors of different histologies. Cerebellar pilocytic astrocytomas occur most frequently followed by supratentorial diffuse fibrillary astrocytomas. Recent research has implicated activation of the RAS/RAF/MEK pathway in tumorigenesis of these tumors. Surgery is the mainstay of therapy. Overall survival rates for patients whose tumors are completely resected are 90% or greater, 10 years from diagnosis. Conversely, most optic pathway/hypothalamic, deep midline, and brain stem gliomas have minimal potential for resection; these tumors can be difficult to treat and deserve special attention. Combination chemotherapy is currently recommended as front-line adjuvant treatment for progressive or recurrent tumors. Second-line radiotherapy can also improve overall survival but is associated with more frequent and significant neurocognitive, endocrine, and other long-term toxicities.

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Pediatric Low-Grade Gliomas

Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship

Purpose: To document the incidence of tumor progression in pediatric patients with low-grade gliomas (LGGs), with particular emphasis on those patients who did not receive postoperative chemotherapy or radiotherapy (RT). Methods and Materials: A database of 128 patients with histologically confirmed LGGs (World Health Organization Grade I–II), age ≤18 years, who had been referred to the London Regional Cancer Center and Dalhousie University between 1979 and 1995, was compiled. Results: The median follow-up for the 128 patients was 7.3 years. Of the 128 patients, 63 were male and 65 female. The median age was 7.0 years (range 0–18). Twenty-five patients underwent gross complete resection, 63 subtotal resection, and 40 patients biopsy. Ninety-one percent (n = 117) of the tumors were astrocytomas, of which 22 were pilocytic, 3 were oligodendrogliomas, 7 were mixed gliomas, and 1 was a ganglioglioma. Of the 103 subtotally resected patients, 48 received postoperative RT (median dose 59 Gy in 25 fractions) and 10 patients were irradiated at the time of tumor progression. The 5-year overall survival was 86%, cause-specific survival 88%, and 5-year progression-free survival 79%. The results of the univariate analysis of the overall survival by the Wilcoxon model were statistically significant for Karnofsky performance status (p = 0.03), RT timing (i.e., postoperative vs. deferred; p = 0.05), and tumor location (p = 0.02). The analysis of progression-free survival confirmed the statistical significance of the extent of surgical resection (i.e., complete vs. subtotal resection; p = 0.02). None of the patients who underwent gross complete resections received postoperative RT and none developed tumor recurrence. Of the 103 patients who had subtotal resections, 33 had progression, with a median postprogression survival of 39 months. The rate of tumor progression among the subtotally resected LGG patients who did not receive immediate postoperative RT was 42%. The timing of RT and tumor location lost statistical significance for overall survival when the completely resected patients were excluded from the analysis. Conclusions: The extent of surgical resection was prognostically significant for progression-free survival but lost significance as a prognostic factor once the complete resection patients were excluded from the analysis. At a median survival of 7.3 years, 42% of the subtotally resected LGG patients who did not receive immediate postoperative RT had tumor progression. No statistically significant difference in survival was seen between the postoperative and deferred RT groups, even though the postoperative RT group was a group with poorer prognostic features (bulky residual tumor postoperatively, Karnofsky performance status

Results of a policy of surveillance alone after surgical management of pediatric low grade gliomas.

Objective To assess the impact of radiation management on male breast cancer (MBC) at London Regional Cancer Program (LRCP). Methods and Materials Men with a diagnosis of breast cancer referred to LRCP were reviewed. The seventh American Joint Committee on Cancer staging system was used. Patients treated with and without post-mastectomy radiation therapy (PMRT) were analyzed. Disease-free survival (DFS) was defined as time duration from diagnosis to first recurrence. Overall survival (OS) was defined as time duration from pathologic diagnosis to death or last follow-up with any death defined as an event. Survival estimates were obtained using Kaplan-Meier methodology. Results From January 1977 to December 2006, 81 men had invasive ductal carcinoma. The median age was 65 (range, 35–87 years). There were 15 Stage I, 40 Stage II, 20 Stage III, and 6 Stage IV patients. Median follow-up time was 46 months (range, 1–225 months). Of the 75 patients treated with curative intent, 29 did not receive PMRT and 46 completed PMRT. Patients who received PMRT demonstrated no benefit in overall survival ( p  = 0.872) but significantly better local recurrence free survival ( p Conclusion The experience at LRCP suggests that high-risk MBC patients should consider PMRT to improve their chance of local recurrence-free survival.

The impact of post-mastectomy radiation therapy on male breast cancer patients--a case series.

Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after conservative breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy, between January 1, 1985 and December 31, 1992 at the London Regional Cancer Centre. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0 to 8 weeks (201 patients), greater than 8 to 12 weeks (235 patients), greater than 12 to 16 weeks (91 patients), and greater than 16 weeks (41 patients). Kaplan-Meier estimates of time to local-recurrence and disease-free survival rates were calculated. Results: Median follow-up was 11.2 years. Patients in all 4 time intervals were similar in terms of age and pathologic features. No statistically significant difference was seen between the 4 groups in local recurrence or disease-free survival with surgery radiotherapy interval (p = 0.521 and p = 0.222, respectively). The overall local-recurrence rate at 5 and 10 years was 4.6% and 11.3%, respectively. The overall disease-free survival at 5 and 10 years was 79.6% and 67.0%, respectively. Conclusion: This retrospective study suggests that delay in the start of breast irradiation of up to 16 weeks from definitive surgery does not increase the risk of recurrence in node-negative breast cancer patients. The certainty of these results is limited by the retrospective nature of this analysis.

Eleven-year follow-up results in the delay of breast irradiation after conservative breast surgery in node-negative breast cancer patients.

A rare occurrence of solitary intracranial plasmacytoma arising from the meninges over the left hemisphere is reported. Clinical features and management of the case are described with review of literature.

Solitary intracranial plasmacytoma: case report and review of management.

Purpose: The aim of this study was to determine the effect of timing of radiotherapy after conservative breast surgery on local recurrence in women with positive resection margins and young age, treated without systemic therapy. Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, between January 1, 1985, and December 31, 1992, at the London Regional Cancer Centre. 63 patients (11.1%) had positive/close resection margins ( 8 to 12 weeks and >12 weeks. For patients ≤40 years, the intervals used for analysis were 0 to 8 weeks and >8 weeks. Results: Median follow up was 11.2 years. For patients ≤40 years, local recurrence rate at 5 and 10 years was 17.2% and 19.8% respectively. Four patients (17.4%) treated in the 0-week to 8-week interval and 7 patients (28.0%) treated in the >8 week interval had local recurrences. For patients ≤40 years with positive resection margins, the local recurrence rate was 25.0%. For patients with positive resection margins, 5-year and 10-year local recurrence rates were as follows: 0 to 8 weeks, 0% and 10.5% respectively; >8 to 12 weeks, 10.3% and 10.3% respectively; and >12 weeks, 13.3% and 20.0% respectively. Conclusion: Patients ≤40 years have an increased local recurrence rate which occurs early. Patients with positive resection margins have higher local recurrence rates that become apparent when breast irradiation is delayed.

The effect of timing of radiotherapy after breast-conserving surgery in patients with positive or close resection margins, young age, and node-negative disease, with long term follow-up

O. Vujovic

Papers

Results of a policy of surveillance alone after surgical management of pediatric low grade gliomas.

The impact of post-mastectomy radiation therapy on male breast cancer patients--a case series.

Eleven-year follow-up results in the delay of breast irradiation after conservative breast surgery in node-negative breast cancer patients.

Solitary intracranial plasmacytoma: case report and review of management.

The effect of timing of radiotherapy after breast-conserving surgery in patients with positive or close resection margins, young age, and node-negative disease, with long term follow-up