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.
Keywords
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Article info
Publication history
Published online: May 18, 2017
Accepted:
May 8,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
