Breast Implant Associated Anaplastic Large Cell Lymphoma: The UK experience. Recommendations on its management and implications for informed consent

Publication date: Available online 18 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): L. Johnson, J.M. O'Donoghue, N. McLean, P. Turton, A.A. Khan, S.D. Turner, A. Lennard, N. Collis, M. Butterworth, G. Gui, J. Bristol, J. Hurren, S. Smith, K. Grover, G. Spyrou, K. Krupa, I.A. Azmy, I.E. Young, J.J. Staiano, H. Khalil, F.A. MacNeill
BackgroundBreast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for anaplastic lymphoma kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment.Methodsmaterials-methodsBetween 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients.ResultsThe mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free.DiscussionBIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.



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