Breast Implant Associated Anaplastic Large Cell Lymphoma: An Updated Systematic Review and Analysis of Treatment Strategies.
BACKGROUND: Although guidelines have been published on BIA-ALCL treatment, there has been no comprehensive analysis of BIA-ALCL treatment variation based on the available literature. The authors sought to assess current treatment strategies of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) relative to current guidelines. METHODS: Database searches were conducted in June 2020. Included articles were case reports and case series with patient-level data. Collected variables included clinicopathological features, implant characteristics, diagnostic tests, ALCL characteristics, treatment, and details of follow-up and outcome. Treatment data before and after 2017 was compared with National Cancer Center Network guidelines. RESULTS: 89 publications were included, and a total of 178 cases of BIA-ALCL were identified. Most patients presented with seroma (N=114, 70.4%), followed by a mass (N=14, 8.6%), or both (N=23, 14.2%). Treatment included en-bloc capsulectomy of the affected implant in 122 out of 126 cases with treatment details provided (96.8%). Radiation therapy was given in 38 cases (30.2%), and chemotherapy was given in 71 cases (56.3%). Practitioners used less chemotherapy for local disease after treatment guideline publication in 2017 (p<0.001), while treatment for advanced disease remained unchanged (p=0.3). There were 10 recurrences and 8 fatalities due to BIA-ALCL, which were associated with advanced presentation (29% vs. 2.1%, OR = 19.4 [3.9 - 96.3], p<0.001). CONCLUSION: BIA-ALCL remains a morbid but treatable condition. Current guidelines focused treatment for local disease and reduced non-surgical interventions with radiation or chemotherapy. Patients presenting with advanced BIA-ALCL experience higher rates of recurrence and mortality.
Naga, HI; Mellia, JA; Basta, MN; Morris, MP; Christopher, AN; Campbell, FM; Sommers, K; Levinson, H; Nelson, JA; Fischer, JP
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