Treatment of older breast cancer patients:de-escalation in oncology

De prognose van borstkankerpatiënten is in de afgelopen decennia sterk verbeterd. Innovaties in beeldvormende technieken en pathologisch onderzoek, geoptimaliseerde chirurgische en radiotherapeutische technieken hebben daaraan bijgedragen. Een groot deel van de verbetering komt door de uitbreiding van het scala aan effectieve systemische middelen en de gestage uitbreiding van de indicatie hiervoor. Verruiming van de richtlijnen met betrekking tot aanvullende behandelingen maakt echter dat de absolute winst steeds kleiner wordt. De balans tussen effectiviteit en bijwerkingen kan hierdoor in het gedrang komen. Dat is een stimulans om te zoeken naar mogelijkheden om bepaalde aanvullende behandelingen achterwege te laten, ter preventie van de potentiële schade van die behandelingen, zonder het individuele risico op terugkeer van ziekte onnodig te vergroten. Een patiëntengroep bij wie dit momenteel onderzocht wordt in Nederland zijn oudere vrouwen met borstkanker.The prognosis of breast cancer patients has greatly improved in recent decades. Innovations in imaging techniques, pathological assessment, optimized surgical and radiotherapy techniques have contributed to this. Much of the improvement is due to the increase of the range of effective systemic treatment and the continual expansion of the indication for this purpose. However, broadening the guidelines for adjuvant systemic treatments, results in a smaller absolute gain. The balance between effectiveness and side-effects could therefore be compromised, which is an incentive to search for possibilities for de-escalation to prevent potential damage, without unnecessarily increasing the risk of recurrence. Currently, in The Netherlands this is being investigated in older breast cancer patients.</p

De behandeling van oudere vrouwen met borstkanker

De prognose van borstkankerpatiënten is in de afgelopen decennia sterk verbeterd. Innovaties in beeldvormende technieken en pathologisch onderzoek, geoptimaliseerde chirurgische en radiotherapeutische technieken hebben daaraan bijgedragen. Een groot deel van de verbetering komt door de uitbreiding van het scala aan effectieve systemische middelen en de gestage uitbreiding van de indicatie hiervoor. Verruiming van de richtlijnen met betrekking tot aanvullende behandelingen maakt echter dat de absolute winst steeds kleiner wordt. De balans tussen effectiviteit en bijwerkingen kan hierdoor in het gedrang komen. Dat is een stimulans om te zoeken naar mogelijkheden om bepaalde aanvullende behandelingen achterwege te laten, ter preventie van de potentiële schade van die behandelingen, zonder het individuele risico op terugkeer van ziekte onnodig te vergroten. Een patiëntengroep bij wie dit momenteel onderzocht wordt in Nederland zijn oudere vrouwen met borstkanker

The feasibility of manual parameter tuning for deformable breast MR image registration from a multi-objective optimization perspective

textabstractDeformable image registration is typically formulated as an optimization problem involving a linearly weighted combination of terms that correspond to objectives of interest (e.g. similarity, deformation magnitude). The weights, along with multiple other parameters, need to be manually tuned for each application, a task currently addressed mainly via trial-and-error approaches. Such approaches can only be successful if there is a sensible interplay between parameters, objectives, and desired registration outcome. This, however, is not well established. To study this interplay, we use multi-objective optimization, where multiple solutions exist that represent the optimal trade-offs between the objectives, forming a so-called Pareto front. Here, we focus on weight tuning. To study the space a user has to navigate during manual weight tuning, we randomly sample multiple linear combinations. To understand how these combinations relate to desirability of registration outcome, we associate with each outcome a mean target registration error (TRE) based on expert-defined anatomical landmarks. Further, we employ a multi-objective evolutionary algorithm that optimizes the weight combinations, yielding a Pareto front of solutions, which can be directly navigated by the user. To study how the complexity of manual weight tuning changes depending on the registration problem, we consider an easy problem, prone-to-prone breast MR image registration, and a hard problem, prone-to-supine breast MR image registration. Lastly, we investigate how guidance information as an additional objective influences the prone-to-supine registration outcome. Results show that the interplay between weights, objectives, and registration outcome makes manual weight tuning feasible for the prone-to-prone problem, but very challenging for the harder prone-to-supine problem. Here, patient-specific, multi-objective weight optimization is needed, obtaining a mean TRE of 13.6 mm without guidance information reduced to 7.3 mm with guidance information, but also providing a Pareto front that exhibits an intuitively sensible interplay between weights, objectives, and registration outcome, allowing outcome selection

Reducing interobserver variation of boost-CTV delineation in breast conserving radiation therapy using a pre-operative CT and delineation guidelines

Clinical Oncolog

Corrigendum to "Local control and postponement of systemic therapy after modest dose radiotherapy in oligometastatic myxoid liposarcomas" [Radiother. Oncol. 158 (2021) 33-39]

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Effect of local therapy on locoregional recurrence in postmenopausal women with breast cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial

Development and application of statistical models for medical scientific researc

Effect of local therapy on locoregional recurrence in postmenopausal women with breast cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial

Background and purpose: The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of either exemestane or the sequence of tamoxifen followed by exemestane in postmenopausal hormone-sensitive breast cancer. The present analyses explored the association between locoregional therapy and recurrence (LRR) in this population. Material and methods: Between 2001 and 2006, 9779 patients were randomized. Local treatment was breast conserving surgery plus radiotherapy (BCS + RT), mastectomy without radiotherapy (MST-only), or mastectomy plus radiotherapy (MST + RT). Patients with unknown data on surgery, radiotherapy, tumor or nodal stage (n = 199), and patients treated by lumpectomy without radiotherapy (n = 349) were excluded. Results: After a median follow-up of 5.2 years, 270 LRRs occurred (2.9%) among 9231 patients. The 5-years actuarial incidence of LRR was 4.2% (95% CI 3.3-4.9%) for MST-only, 3.4% (95% CI 2.4-4.2%) for MST + RT and 1.9% (95% CI 1.5-2.3%) for BCS + RT. After adjustment for prognostic factors, the hazard ratio (HR, reference BCS + RT) for LRR remained significantly higher for MST-only (HR 1.53; 95% CI 1.10-2.11), not for MST + RT (HR 0.78; 95% Cl 0.50-1.22). Conclusion: This explorative analysis showed a higher LRR risk after MST-only than after BCS + RT, even after adjustment for prognostic factors. As this effect was not seen for MST + RT versus BCS + RT, it might be explained by the beneficial effects of radiation treatment. (C) 2013 Elsevier Ireland Ltd. All rights reserved