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Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant-Associated Anaplastic
Mark W Clemens1, L Jeffrey Medeiros1, Charles E Butler1
1Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO.
Purpose:
Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach.
Patients And Methods:
In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention.
Results:
The median and mean follow-up times were 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomy with breast implant removal had better OS (P = .022) and EFS (P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy.
Conclusion:
Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.
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