Treatment of Primary Breast Lymphoma in Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), Stage IIA
This protocol covers primary breast lymphoma presenting as BIA-ALCL at stage IIA — the subset in which the lymphoma has extended beyond the periprosthetic fibrous capsule into the surrounding soft tissue, typically in patients with macrotextured breast implants.
Clinical Scenario
Macrotextured breast implants are present. Lymphoma cells have infiltrated beyond the fibrous capsule and invaded the surrounding soft tissue, defining stage IIA disease. This extracapsular extension places the patient in a higher-risk subgroup that requires a more intensive, multimodal approach than confined (stage I) BIA-ALCL.
Treatment Approach — Partial Overview
Management of stage IIA BIA-ALCL centers on a surgical intervention — full capsulectomy — used in combination with additional oncological treatment modalities. In specific circumstances, a targeted systemic agent may be considered before proceeding to surgery.
Complete regimen, sequencing criteria, and decision points are available in the full structured protocol below.
References
DOI: 10.1016/j.jpra.2022.01.004
- In some cases, the lymphoma cells infiltrate beyond the fibrous capsule and invade the surrounding soft tissue (stage IIA; as shown in Figure 8A, B).
- For patients with invasion beyond the fibrous capsule (stage IIA), successful treatment outcomes have been achieved with full capsulectomy in combination with radiotherapy or chemotherapy and radiotherapy.
- The successful use of BV has been reported when a patient progressed through chemotherapy and prior to capsulectomy, in order to avoid more complicated and risky surgery involving the sub-pectoral muscles and ribs.
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