Radiotherapy-induced malignancies in breast cancer patients with TP53 pathogenic germline variants (Li –Fraumeni syndrome)
AbstractThe risk of radiotherapy-induced malignancies (RIMs) is a concern when treating Li –Fraumeni syndrome (LFS) or Li–Fraumeni Like (LFL) patients. However, the type ofTP53 pathogenic germline variant may possibly influence this risk.TP53 p.R337H mutation is particularly prevalent in Brazil. We aimed to evaluate the outcomes of patients with pathogenicTP53 variants treated for localized breast cancer in a Brazilian cohort. We evaluated retrospectively a cohort of patients with germlineTP53 pathogenic variants treated for localized breast cancer between December 1999 and October 2017. All patients were followed by the Hereditary Cancer Group of an academic cancer center. Our primary objective was to evaluate the occurrence of RIMs after adjuvant radiotherapy. Sixteen patients were evaluated; 10 (62.5%) had a germlineTP53 p.R337H pathogenic variant. Median age was 39.8 years. Thirteen patients had invasive ductal carcinoma: 8 (61.5%) were hormone receptor-positive; 6 (46.1%), human epithelial growth factor receptor 2 (HER2)-amplified. Three patients had ductal carcinoma in situ. Most patients (N = 12/16, 75%) received adjuvant radiotherapy. After a median fo llow-up of 52.5 months, 2 patients (2/12, 16.6%) had RIMs. One had a fibrosarcoma and the other, a low-grade leiomyosarcoma. In the group treated with radiotherapy, one distant recurrence was diagnosed (1/12), and no loco-regional recurrence occurred. Among 4 patients who did not rec...
Authors: Deer T, Hagedorn JM PMID: 31935126 [PubMed - as supplied by publisher]
CONCLUSION: Although local treatment already has a place in many guidelines on the basis of the findings of a small number of prospective and retrospective studies, a option of local treatment should be considered by an interdisciplinary tumor board individually for suitable patients. PMID: 31931952 [PubMed - in process]
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DEATHS from prostate cancer have hit a record high – exceeding 12,000 in a year for the first time.
Noorbakhsh-Sabet et al.1 published an excellent review in The American Journal of Medicine summarizing the potential of artificial intelligence (AI) in medicine. They describe wide utility (e.g. in dermatology and stroke), but do not consider surgery and urology, which embrace cutting-edge technology, including fusion-biopsy and robotics,2 and will be early AI adopters. Indeed, prostate cancer creates a huge health care burden, thus being ideal for AI transformation.
We agree with the comments in the letter to the editor from Norris and Raza. The areas where artificial intelligence (AI) can be transformative is beyond what we summarized.1 It is important to mention that the field of AI has been especially transformative in areas where clinical imaging is well integrated into the clinical practice, areas such as radiology, pathology, cancer, and surgery.
Trainee oncologists at a major cancer centre covered clinics and made “critical” decisions without senior supervision, including for cancers they were not trained for, HSJ can reveal.