According to the results of an international study led by researchers at The University of Texas MD Anderson Cancer Center, the optimal treatment for most women with breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is complete surgical excision of the implant and its surrounding capsule.
The study, titled “Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant–Associated Anaplastic Large-Cell Lymphoma,” was published in the Journal of Clinical Oncology. It represents the most comprehensive study of BI-ALCL to date, involving 30 researchers from 14 institutions across five continents.
BI-ALCL is a rare type of T-cell lymphoma found in the scar tissue or fluid around breast implants. Around 450,000 breast implants are placed for cosmetic or reconstructive purposes each year in the United States and, worldwide, some 10 million women are thought to have had a breast implant.
The disease is rare, with estimates of BI-ALCL just 0.1 to 0.3 per 100,000 women, and treatable. “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, assistant professor of plastic surgery and lead author of the study, in a news release. “The disease can be reliably diagnosed, and when treated appropriately it has a good prognosis.”
This study, which expanded upon previous BI-ALCL research conducted at MD Anderson, aimed to evaluate the efficacy of different therapies used to determine an optimal treatment approach. Researchers applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, 50 of whom were previously reported in the literature and 37 unreported.
The results showed that timely diagnosis and complete surgical excision of lymphoma, implants, and the surrounding fibrous capsule is the optimal approach in BI-ALCL patients. “We determined that complete surgical excision was essential for the management of this disease,” said Dr. Clemens. “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 who underwent a complete surgical excision had recurrence rates of 4% at five years, compared to 32% in those treated with systemic chemotherapy and 28% for radiation therapy. Surgical excision was also found to significantly improve overall survival rates.
The surgical approach to treating this disease is a significantly different from standard treatment for most lymphomas, that of chemotherapy alone. “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, a professor of Hematopathology and senior study author. “We have demonstrated that this is a predominantly localized disease where surgical excision has a primary role.”
The authors mention that patients who receive breast implants need to be advised of the risk, albeit low, of developing BI-ALCL, as well as common presenting symptoms, such as a mass or delayed onset of effusion.
The team is now gathering tissue from this cohort of patients to evaluate underlying disease progression mechanisms. Further research is ongoing to optimize treatments using genetic profiling, while defining the role of chemotherapy and radiation therapy. The team is also investigating animal models of the disease to better understand the role played by the implants.