Complete surgical excision of the breast implant and surrounding capsule is the most effective treatment for breast implant-associated anaplastic large-cell lymphoma (BI-ALCL), according to a new study.
The current study, published in the Journal of Clinical Oncology, is the most comprehensive study of BI-ALCL to date, including 30 investigators from 14 institutions across five continents.
The surgical approach as a primary modality for BI-ALCL treatment is a significantly different recommendation than standard therapy for most other lymphomas, which usually involve chemotherapy alone.
Approximately 450,000 breast implants are placed annually in the US, and an estimated 10 million women worldwide have breast implants. The annual incidence of BI-ALCL is estimated to be 0.1 to 0.3 per 100,000 women with breast implants. The disease manifests as a large fluid collection around the implant more than a year after implantation, usually taking an average of 8 years to develop.
“Although this disease is rare, it appears to be amenable to treatment and, in the vast majority of patients, the outcome is very good,” says lead study author Mark Clemens, MD, assistant professor of plastic surgery at 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.”
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 front-line therapy for BI-ALCL.
“We determined that complete surgical excision was essential for the management of this disease. 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,” Clemens says in a news release.
Although patients in this study had received a wide variety of multimodality therapies, patients with complete surgical excision had recurrence rates of only 4% at 5 years, compared to 28% for radiation therapy and 32% for chemotherapy. Surgery also significantly improved overall survival compared to nonsurgically resected patients receiving chemotherapy or radiation therapy, the study showed.
The surgical approach as a primary modality for BI-ALCL treatment is a significantly different recommendation than standard therapy for most other lymphomas, which usually involve chemotherapy alone.
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 authors are 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. They are also studying animal models to further assess the role of breast implants in the pathogenesis of this lymphoma.
I would add that it is important to remove any silicone laden (from the texturing) axillary lymph nodes as well. This is a chemically based problem, so those chemicals are still in the textured silicone we find in almost all cases in the axillary lymph nodes.
Also, this lymphoma was the most common cause of death in my practice until I started removing these nodes. To date, since 2005, I have no reports of lymphoma deaths in my extensive explant population. We know that chemicals predispose to many lymphomas so it is most likely a chemical used in the texturing that is the cause that is not used in the smooth shell.
Great insight.. I would love you to write about your experience for the magazine. Would you be interested?