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

Johnson, L and O'Donoghue, J M and McLean, N and Turton, P and Khan, A A and Turner, S D and Lennard, A and Collis, N and Butterworth, M and Gui, G and Bristol, J and Hurren, J and Smith, S and Grover, K and Spyrou, G and Krupa, K and Azmy, I A and Young, I E and Staiano, J J and Khalil, Haitham H and MacNeill, F A (2017) Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 43 (8). pp. 1393-1401. ISSN 1532-2157. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://www.ejso.com/article/S0748-7983(17)30481-X/...

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.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WO Surgery
Divisions: Planned IP Care > General Surgery
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 24 Nov 2017 14:35
Last Modified: 24 Nov 2017 14:35
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1517

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