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The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.
The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.
BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.
An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.
“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.
“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”
Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.
The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.
“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”
Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.
In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.
“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.
“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”
The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.
Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma. 
Photo courtesy of the FDA
The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.
The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.
BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.
An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.
“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.
“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”
Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.
The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.
“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”
Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.
In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.
“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.
“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”
The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.
Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.
Photo courtesy of the FDA
The optimal treatment approach for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and surrounding capsule, a new study suggests.
The study, published in the Journal of Clinical Oncology, represents the most comprehensive study of BI-ALCL to date, including 87 patients and 30 investigators from 14 institutions across 5 continents.
BI-ALCL is a rare T-cell lymphoma that forms in the scar tissue or in the fluid surrounding a breast implant. The disease manifests as a large fluid collection around the implant over a year after implantation, usually taking an average of 8 years to develop.
An estimated 10 million women worldwide have breast implants, and the annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants.
“Although this disease is rare, it appears to be amenable to treatment, and, in the vast majority of patients, the outcome is very good,” said Mark Clemens, MD, of The University of Texas MD Anderson Cancer Center in Houston.
“The disease can be reliably diagnosed, and, when treated appropriately, it has a good prognosis.”
Still, the optimal management for BI-ALCL hasn’t been clear. So with this study, Dr Clemens and his colleagues sought to evaluate treatment efficacy on disease outcomes and determine the best treatment approach. The study expands on previous research published in the Journal of Clinical Oncology in 2014.
The researchers gathered detailed treatment and outcome information from a total of 87 BI-ALCL patients, including 37 whose information had not previously been published. A review of treatment approaches in relation to event-free survival and overall survival revealed that surgery was the optimal frontline therapy for BI-ALCL.
“We determined that complete surgical excision was essential for the management of this disease,” Dr Clemens said. “Patients did not do as well unless they were treated with full removal of the breast implant and complete excision of the capsule around the implant.”
Patients with complete surgical excision had a recurrence rate of 4% at 5 years, compared to 28% for patients who received radiation therapy and 32% for chemotherapy.
In addition, patients who underwent a complete surgical excision had better overall survival (P=0.022) and event-free survival (P=0.014) than patients who received a partial capsulectomy, systemic chemotherapy, or radiation.
“This lymphoma represents a different paradigm from systemic anaplastic large-cell lymphoma, in particular because of its strong association with breast implants,” said Roberto N. Miranda, MD, of The University of Texas MD Anderson Cancer Center.
“We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”
The researchers emphasized that, despite the overall good prognosis, some rare cases of BI-ALCL exhibit more aggressive behavior with systemic dissemination. As a part of this study, the team is gathering tissue from these patients to assess underlying mechanisms for progression of disease.
Additional research is ongoing to optimize therapy for these cases through genetic profiling and defining the role of chemotherapy and radiation. The researchers are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.