Breast Cancer Research and Treatment

, Volume 160, Issue 2, pp 211–221 | Cite as

The 2016 Assisi Think Tank Meeting on breast cancer: white paper

  • Cynthia Aristei
  • Orit Kaidar-Person
  • Meritxell Arenas
  • Charlotte Coles
  • Birgitte V. Offersen
  • Celine Bourgier
  • Giovanni Frezza
  • Maria Cristina Leonardi
  • Vincenzo Valentini
  • Philip M. P. Poortmans
Review

Abstract

Purpose

To identify weak points in daily routine use of radiation therapy (RT) for non-metastatic breast cancer patients, particularly when data are lacking or equivocal, a “think tank” of experts met in Assisi.

Methods

Before the meeting, controversial issues on non-metastatic breast cancer were identified and reviewed, and clinical practice investigated by means of an online questionnaire. During the 3-day meeting, topics were discussed in-depth with attendees and potential sponsors that are involved in breast cancer treatment.

Results

Three issues were identified as needing further investigation: (1) Regional lymph node treatment in early-stage breast cancer; (2) Combined post-mastectomy RT and breast reconstruction; (3) RT in patients treated with primary systemic therapy. Future research proposals included the following: (1) Participating in appropriately selected on-going clinical trials; (2) Designing new randomized controlled clinical trials and prospective population cohort studies; (3) Setting-up large database(s) to generate predictive response models and detect biomarkers for tailored loco-regional treatments.

Conclusions

It is hoped that the ATTM findings, as described in the present white paper, will stimulate a new generation of radiation oncologists to focus on research in these areas, and that the white paper will become a tool for multidisciplinary groups to help them design research proposals and strategies.

Keywords

Breast cancer Radiation therapy Regional lymph node treatment Post-mastectomy radiation therapy Breast reconstruction Primary systemic therapy 

Abbreviations

ATTM

Assisi Think Tank Meeting

ESTRO

European Society for RadioTherapy & Oncology

RT

Radiation therapy

PMRT

Post-mastectomy radiation therapy

PST

Primary systemic therapy

ALND

Axillary lymph node dissection

IBCSG

International Breast Cancer Study Group

SLN

Sentinel lymph node

ACOSOG

American College of Surgeons Oncology Group

EORTC

European Organisation for Research and Treatment of Cancer

DBCG-IMN

Danish breast cancer cooperative group—internal mammary nodes

EBCTCG

Early Breast Cancer Trialists’ Collaborative Group

IMRT

Intensity-modulated radiation therapy

pCR

Pathological complete response

CTNeoBC

Collaborative Trials in Neoadjuvant Breast Cancer

HER2

Human Epidermal Growth Factor Receptor 2

FNR

False-negative rate

SENTINA

Sentinel-Lymph-Node Biopsy in Patients with Breast Cancer Before and After Neoadjuvant Chemotherapy

MARI

Marking axillary’s lymph node with radioactive iodine seed

NSABP

National Surgical Adjuvant Breast Project

NCDB

National Cancer Database

ER

Estrogen receptor

PR

Progesterone receptor

AI

Aromatase inhibitors

FNA

Fine-needle aspiration

CNB

Core needle biopsy

Notes

Acknowledgments

The authors thank all the other ATTM Expert European Board members: Bruno Cutuli, Pierfrancesco Franco, Domenico Genovesi, Vladislav Grinberg, Diclehan Kilic, Vassilis Kouloulias, Lorenzo Livi, Stefano Maria Magrini, Fabio Marazzi, Icro Meattini, Angel Montero Luis, Isabella Palumbo, Elisabetta Perrucci, Luigi Pirtoli, Ugur Selek, Daniela Smaniotto, Fabrizio Stracci, Vincenzo Tombolini, Lurdes Trigo, Cristiana Vidali.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. Dr. Charlotte Coles is supported by the Cambridge National Institute of Health Research Biomedical Research Centre.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10549_2016_3998_MOESM1_ESM.docx (32 kb)
Supplementary material 1 (DOCX 31 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Cynthia Aristei
    • 1
  • Orit Kaidar-Person
    • 2
    • 3
  • Meritxell Arenas
    • 4
  • Charlotte Coles
    • 5
  • Birgitte V. Offersen
    • 6
  • Celine Bourgier
    • 7
  • Giovanni Frezza
    • 8
  • Maria Cristina Leonardi
    • 9
  • Vincenzo Valentini
    • 10
  • Philip M. P. Poortmans
    • 11
  1. 1.Radiation Oncology Section, Department of Surgical and Biomedical SciencesUniversity of Perugia and Perugia General HospitalPerugiaItaly
  2. 2.Department of Radiation OncologyUniversity of North CarolinaChapel HillUSA
  3. 3.Oncology InstituteRambam Medical CenterHaifaIsrael
  4. 4.Department of Radiation OncologyHospital Universitari Sant Joan de ReusTarragonaSpain
  5. 5.Oncology CentreCambridge University Hospitals NHS TrustCambridgeUK
  6. 6.Department of OncologyAarhus University HospitalAarhusDenmark
  7. 7.Département de radiothérapie oncologique/Inserm U1194, Institut du Cancer de Montpellier (ICM-Val d’Aurelle)Université de MontpellierMontpellierFrance
  8. 8.Dipartimento di OncologiaAzienda Sanitaria di BolognaBolognaItaly
  9. 9.Radiotherapy DivisionEuropean Institute of OncologyMilanItaly
  10. 10.Radiation Oncology DepartmentUniversità Cattolica del Sacro CuoreRomeItaly
  11. 11.Radboud university medical centerNijmegenThe Netherlands

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