Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent.
Embargo End Date
ICR Authors
Authors
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
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
Document Type
Journal Article
Date
2017-08-01
Date Accepted
2017-05-08
Abstract
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.
Citation
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2017, 43 (8), pp. 1393 - 1401
Source Title
Publisher
ELSEVIER SCI LTD
ISSN
0748-7983
eISSN
1532-2157
Collections
Research Team
Targeted Therapy