Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Johnson, L.; O'Donoghue, J.M.; McLean, N.; Turton, P.; Khan, A.A.; Turner, S.D.; Lennard, A.; Collis, N.; Butterworth, M.; Gui, G.; Bristol, J.; Hurren, J.; Smith, S.; Grover, K.; Spyrou, G.; Krupa, K.; Azmy, I.A.; Young, I.E.; Staiano, J.J.; Khalil, H.; MacNeill, F.A.
• Is Part Of: European journal of surgical oncology. Volume 43:Issue 8(2017:Aug.)
• Page Start: 1393
• Page End: 1401
• Publication Date: 2017-08
• Subjects: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) -- Breast implant effusion; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2017.05.004
• Languages: English
• ISSNs: 0748-7983

Abstract

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.