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Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent

Lookup NU author(s): Joseph O'Donoghue, Dr Anne Lennard

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Abstract

© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. Background: Breast 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. Methods: Between 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. Results: The 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. Discussion: BIA-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.

Publication metadata

Author(s): Johnson L, O'Donoghue JM, McLean N, Turton P, Khan AA, Turner SD, Lennard A, Collis N, Butterworth M, Gui G, Bristol J, Hurren J, Smith S, Grover K, Spyrou G, Krupa K, Azmy IA, Young IE, Staiano JJ, Khalil H, MacNeill FA

Publication type: Article

Publication status: Published

Journal: European Journal of Surgical Oncology

Year: 2017

Volume: 43

Issue: 8

Pages: 1393-1401

Print publication date: 01/08/2017

Online publication date: 18/05/2017

Acceptance date: 08/05/2017

ISSN (print): 0748-7983

ISSN (electronic): 1532-2157

Publisher: W.B. Saunders Ltd

URL: https://doi.org/10.1016/j.ejso.2017.05.004

DOI: 10.1016/j.ejso.2017.05.004

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