Bruce G. Haffty, MD | Authors

ACR Appropriateness Criteria® Ductal Carcinoma in Situ

June 15, 2015

Management of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.

Significance of Tumor Biology on Local Control in Breast Cancer

November 15, 2014

The incorporation of molecular subtypes into the locoregional management of breast cancer has lagged behind its use in systemic therapy. Omission or dose-intensification of RT based on subtypes should be investigated in future trials.

ACR Appropriateness Criteria® Local-Regional Recurrence (LRR) and Salvage Surgery-Breast Cancer

February 15, 2014

Management recommendations for breast cancer local-regional recurrence (LRR), including patient scenarios, are reviewed, and represent evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on LRR.

Key Points in Repeat Breast-Conservation Therapy

October 13, 2009

Chadha et al are to be commended for their excellent review of repeat breast-conservation therapy after isolated in-breast local failures. We will briefly review several important points already made by the study authors.

Local Therapy Matters

July 14, 2009

As breast cancer remains the most commonly diagnosed cancer among women in the United States, there has been a decline in breast cancer–related mortality for the past 2 decades; this is likely related to diagnosis at an earlier stage and the availability of more effective treatment regimens.

Current Application and Research Directions for Partial-Breast Irradiation

April 01, 2007

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

End Results of Salvage Therapy After Failure of Breast-Conservation Surgery

March 01, 2004

About 10% to 15% of patients who undergo breast-conservation surgeryand radiation therapy will subsequently develop ipsilateral breasttumor recurrence (IBTR). This paper reviews the biology, clinical management,and outcome of this entity. Risk factors for IBTR includeyoung age, positive microscopic margins, gross multifocality, an extensiveintraductal component, and lymphatic vessel invasion. The standardtherapy following IBTR has been mastectomy, but interest in furtherbreast-conservation approaches has recently arisen. Although theoutcome following salvage therapy is quite good, the risk of distantmetastases for patients with IBTR is three to five times greater than forthose without recurrence. The reason for this association has been controversial,but it now appears that IBTR is both a marker of the underlyingbiologic aggressiveness of the tumor and a source for furthertumor metastasis. Monitoring of patients following lumpectomy andradiation therapy, and aggressive therapy for IBTR when diagnosed,are clearly warranted. Prognostic factors at the time of IBTR and implicationsfor local and systemic therapy are discussed.

Local Recurrence After Mastectomy or Breast-Conserving Surgery and Radiation

November 01, 2000

Approximately 10% to 15% of patients with stage I/II invasive breast cancer will develop a clinically isolated local recurrence. The standard management of an ipsilateral breast tumor recurrence following breast-

Expert Consultations in Breast Cancer: Critical Pathways and Clinical Decision Making

August 01, 2000

This book is the 17th volume in the Basic and Clinical Oncology series edited by Bruce D. Cheson, MD. Like other volumes in this series, Expert Consultations in Breast Cancer follows a unique format and seeks to integrate advances in the basic understanding of breast cancer with promising new therapies and changing health- care economics. The integration of these different perspectives provides both a conceptual and pragmatic framework for clinical decision-making.

Mounting Evidence for Postmastectomy Locoregional Radiation Therapy

August 01, 1999

Marks, Hardenbergh, and Prosnitz provide an excellentoverview of the role of postmastectomy radiation therapy for node-positive breast cancer patients. Their review not only summarizes the most recent literature supporting the clearly established