51
|
Bernier J. Radiotherapy in early breast disease: current status and perspectives. Curr Probl Cancer 2003; 27:17-23. [PMID: 12569345 DOI: 10.1067/mcn.2003.120002a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jacques Bernier
- Radio-Oncology Department, San Giovanni Hospital, Bellinzona, Switzerland
| |
Collapse
|
52
|
|
53
|
Affiliation(s)
- J Kurtz
- Radiation Oncology Division, Hopitaux universitaires de Genève, CH-1211 Geneva 14, Switzerland.
| |
Collapse
|
54
|
Athow AC, Gattuso JM, Perry N, Wells C, Dutt N, Bahsir GM, Mair G, Carpenter R. Is radiotherapy needed after breast conservation for small invasive breast cancers? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:379-82. [PMID: 12099645 DOI: 10.1053/ejso.2002.1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The purpose of this study was to determine the rate of local recurrence in patients with small invasive breast cancers (<1 cm) who had been treated with breast-conserving surgery either with (group 1) or without (group 2) adjuvant radiotherapy. METHODS This is a retrospective study of 110 patients with an invasive breast cancer less than 1 cm in size, treated in our centre by breast-conserving surgery. Parameters examined included age at and mode of presentation, histopathological features, adjuvant therapy, length of follow-up and outcome in terms of local recurrence rate and death. RESULTS In group 1 there were 59 women of median age 57 (38-80) years. The median tumour size was 9 (1-10) mm and median follow-up was 74 (15-110) months. There were no local recurrences. In group 2 the median age at presentation was 59 (48-81) years. The median tumour size was 7 (2-10) mm and median follow-up was 47 (14-93) months. There were three non-breast-cancer related deaths and three local recurrences (6%). CONCLUSIONS A local recurrence rate of 6% at almost 4 years median follow-up suggests that it may be possible to avoid adjuvant radiotherapy in a subgroup of largely screen-detected, node-negative patients with invasive tumours less than 1 cm, in whom adequate local excision is performed. Further follow-up is required to substantiate this.
Collapse
MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Case-Control Studies
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Incidence
- Mammography
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Factors
- Treatment Outcome
- Unnecessary Procedures
Collapse
Affiliation(s)
- A C Athow
- St Bartholomew's Hospital, West Smithfield, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
55
|
Abstract
Breast cancer is a heterogenous disease with significant variations in biologic potential, ranging from small, low-grade, DCIS discovered mammographically with essentially no impact on patient survival to rapidly growing, palpable, locally advanced invasive breast cancer with clinically palpable nodal metastasis. The current challenge is to identify the clinical, pathologic, and molecular factors that determine the biologic potential of a particular breast cancer. Although size, nodal status, histologic grade, age, surgical margin, and hormone receptor status of breast cancer are the most important prognostic factors, the focus of research must be beyond these factors to other nonspecific prognostic information. Bone marrow micrometastasis may be an important factor to help predict outcome (7a) and the complement of sentinel node biopsy, bone marrow analysis, and primary tumor features may allow physicians to better select therapy. With increased understanding of the individual molecular events that control the invasive potential of a particular cancer, practitioners should be better able to predict more accurately which patients have little risk of recurrent disease or metastasis and would be best served by surgery alone versus patients who have a high risk of recurrent and metastatic disease and who should receive multimodality care.
Collapse
Affiliation(s)
- Maureen A Chung
- The Breast Health Center, Women and Infants Hospital, Providence, RI 02905, USA.
| | | | | |
Collapse
|
56
|
Buchholz TA, Singletary SE. Radiotherapy for early stage favourable breast cancers. Br J Cancer 2002; 86:309-11. [PMID: 11870524 PMCID: PMC2375196 DOI: 10.1038/sj.bjc.6600004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
British Journal of Cancer (2002) 86, 309–310. DOI: 10.1038/sj/bjc/6600004www.bjcancer.com © 2002 The Cancer Research Campaign
Collapse
|
57
|
Hanna WM, Kahn HJ, Chapman JAW, Fish EB, Lickley HLA, McCready DR. Pathologic Characteristics of Breast Cancer that Predict for Local Recurrence After Lumpectomy Alone. Breast J 2002; 5:105-111. [PMID: 11348268 DOI: 10.1046/j.1524-4741.1999.00133.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast conservation surgery (BCS) plus irradiation has been shown to be equivalent to mastectomy in controlling ipsilateral breast cancer recurrence. The purpose of this study is to evaluate the factors that determine the rate of local recurrence in a group of patients treated with partial mastectomy without postoperative radiation, adjuvant hormonal therapy, or chemotherapy. We also assess the role of standard pathologic features, specifically lymphovascular invasion (LVI) in identifying high- and low-risk subsets of patients. We have a cohort of 293 patients treated with partial mastectomy followed prospectively for a median of 8 years. Data collected included patient's age, tumor size, tumor morphology, tumor grade, the extent of ductal carcinoma in situ (DCIS), the presence of LVI, lymph node status, and hormone receptors. Statistical analyses carried out were Kaplan-Meier plots with Wilcoxon (Peto-Prentice) test statistics for univariate analysis and Cox stepwise regression for multivariate analysis; the end point was local recurrence. The relapse rate in this cohort was 26%. In univariate analysis the significant factors associated with prolonged disease-free survival included older age, negative nodes, positive estrogen receptor (ER) status, and absence of LVI. Small tumor size was significant only in the univariate analysis. In the multivariate analysis, absence of comedocarcinoma entered the model in addition to the other variables. If the variables are stratified, a group of 66 patients with 6% local recurrence rate was identified. These were node-negative women >/=50 years of age with no LVI, no comedo DCIS, and ER-positive tumors. This study clearly indicates the important role of pathologic parameters in assessing the risk of recurrence.
Collapse
Affiliation(s)
- Wedad M. Hanna
- Women's College Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
58
|
Formenti SC, Rosenstein B, Skinner KA, Jozsef G. T1 stage breast cancer: adjuvant hypofractionated conformal radiation therapy to tumor bed in selected postmenopausal breast cancer patients--pilot feasibility study. Radiology 2002; 222:171-8. [PMID: 11756722 DOI: 10.1148/radiol.2221010769] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore the feasibility of a short course of hypofractionated conformal radiation therapy to the tumor bed as part of a breast preservation protocol in postmenopausal patients with nonpalpable pT1N0 stage breast cancer. MATERIALS AND METHODS The tumor bed was imaged at computed tomography (CT) in the prone position on a dedicated table. The same table and position were used for treatment with a 4-MV linear accelerator. The planning target volume was the tumor bed plus a 1-2-cm margin defined at postmastectomy CT. A regimen of five fractions was tested in this pilot dose study. Cosmesis was assessed by patients and physicians before treatment and 36 months after treatment. RESULTS Ten consecutive patients who were eligible for the study were assigned to one of three dose-per-fraction regimens; nine were treatable with the proposed technique on the basis of CT findings. Patients received five fractions over 10 days (total dose range, 25-30 Gy): Three received 5.0 Gy per fraction; four, 5.5 Gy; and two, 6.0 Gy. At minimum follow-up of 36 months (range, 36-53 months), all patients were alive and disease free with good to excellent cosmesis. CONCLUSION Hypofractionated conformal breast radiation therapy is feasible. Further studies are warranted.
Collapse
Affiliation(s)
- Silvia C Formenti
- Department of Radiation Oncology, New York University School of Medicine, 566 First Ave, New York, NY 10016, USA
| | | | | | | |
Collapse
|
59
|
Kunkler IH, King CC, Williams IJ, Prescott RJ, Jack W. What is the evidence for a reduced risk of local recurrence with age among older patients treated by breast conserving therapy? Breast 2001; 10:464-9. [PMID: 14965625 DOI: 10.1054/brst.2001.0300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2001] [Accepted: 01/25/2001] [Indexed: 11/18/2022] Open
Abstract
With the rising age of the population and the proposed extension of the breast screening programme to older women, increasing numbers of older patients are becoming eligible for breast conserving surgery and post-operative breast irradiation. Women over the age of 70 have traditionally been omitted from randomized controlled trials for assessing the role of breast radiotherapy after local surgery. The majority of trials suggest that local recurrence rates do decline with age. Similar conclusions are suggested by many non-randomized studies. Comparison of randomized and non-randomized studies is limited by differing extent of classifying tumour margins, nodal status, use of adjuvant systemic therapy, sample size, analytical approaches and duration of follow-up. Large randomized trials in older women are needed to assess whether, with careful attention to obtaining clear tumour margins, radiotherapy is required in low risk, ER positive, node negative breast cancer patients following wide excision and adjuvant tamoxifen. Within both randomized and non-randomized studies, only a few studies have failed to demonstrate an impact of age on recurrence rates following breast conserving treatment, with the majority finding a reduction in local recurrence rates with increasing age. Importantly for interpretation, no studies suggest that recurrence rates increase with age. The variation in analytical approaches and sample sizes are such that the variety of conclusions is not surprising. The results are compatible with a tendency for local recurrence rates to fall with age, but the variability is such that one cannot quantify this change with any precision.
Collapse
Affiliation(s)
- I H Kunkler
- Department of Clinical Oncology, Western General Hospital, Edinburgh, UK
| | | | | | | | | |
Collapse
|
60
|
Anan K, Mitsuyama S, Tamae K, Nishihara K, Iwashita T, Abe Y, Ihara T, Nakahara S, Katsumoto F, Toyoshima S. Pathological features of mucinous carcinoma of the breast are favourable for breast-conserving therapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:459-63. [PMID: 11504516 DOI: 10.1053/ejso.2001.1142] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The effectiveness of breast-conserving therapy for mucinous carcinoma has not been well documented. We examined clinical and pathological features of cases to determine whether patients with mucinous carcinoma were suitable candidates for this treatment. METHOD Cases of pure type (n=52) and mixed type (n=24) mucinous carcinomas were reviewed with emphasis on the risk factors associated with local recurrences after breast-conserving therapy. RESULTS Large pure mucinous carcinomas had a low incidence of extensive intraductal spreading (EIS). An inverse correlation existed between the incidence of EIS and tumour size (P<0.05). Comedo type EIS was infrequent (11%) in pure mucinous carcinoma. Incidences of lymphatic vessel invasion (4%) and nodal involvement (4%) were lower in pure mucinous carcinoma than in mixed carcinoma (P<0.05). No nodal involvement occurred in patients with pure mucinous carcinoma less than 3 cm in diameter. CONCLUSIONS Patients with pure mucinous carcinomas, except those invading the local skin, are suitable candidates for breast-conserving therapy. Most pure mucinous carcinomas, including a large tumour up to 5 cm in diameter, can be treated with this therapy.
Collapse
Affiliation(s)
- K Anan
- Department of Surgery, Kitakyushu Municipal Medical Centre, Kitakyushu, Fukuoka 802-0077, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
61
|
Baglan KL, Martinez AA, Frazier RC, Kini VR, Kestin LL, Chen PY, Edmundson G, Mele E, Jaffray D, Vicini FA. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2001; 50:1003-11. [PMID: 11429228 DOI: 10.1016/s0360-3016(01)01547-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We present the preliminary results of our in-house protocol using outpatient high-dose-rate (HDR) brachytherapy as the sole radiation modality following lumpectomy in patients with early-stage breast cancer. METHODS AND MATERIALS Thirty-seven patients with 38 Stage I-II breast cancers received radiation to the lumpectomy cavity alone using an HDR interstitial implant with (192)Ir. A minimum dose of 32 Gy was delivered on an outpatient basis in 8 fractions of 4 Gy to the lumpectomy cavity plus a 1- to 2-cm margin over consecutive 4 days. RESULTS Median follow-up is 31 months. There has been one ipsilateral breast recurrence for a crude failure rate of 2.6% and no regional or distant failures. Wound healing was not impaired in patients undergoing an open-cavity implant. Three minor breast infections occurred, and all resolved with oral antibiotics. The cosmetic outcome was good to excellent in all patients. CONCLUSION In selected patients with early-stage breast cancer, treatment of the lumpectomy cavity alone with outpatient HDR brachytherapy is both technically feasible and well tolerated. Early results are encouraging, however, longer follow-up is necessary before equivalence to standard whole-breast irradiation can be established and to determine the most optimal radiation therapy technique to be employed.
Collapse
Affiliation(s)
- K L Baglan
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
62
|
Vicini FA, Baglan KL, Kestin LL, Mitchell C, Chen PY, Frazier RC, Edmundson G, Goldstein NS, Benitez P, Huang RR, Martinez A. Accelerated treatment of breast cancer. J Clin Oncol 2001; 19:1993-2001. [PMID: 11283132 DOI: 10.1200/jco.2001.19.7.1993] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Radiation therapy (RT) restricted to the tumor bed, by means of an interstitial implant, and lasting 4 to 5 days after lumpectomy was prospectively evaluated in early-stage breast cancer patients treated with breast-conserving therapy (BCT). The goals of the study were to determine whether treatment time can be reduced and whether elective treatment of the entire breast is necessary. MATERIALS AND METHODS Between January 1993 and January 2000, 174 cases of early-stage breast cancer were managed with lumpectomy followed by RT restricted to the tumor bed using an interstitial implant. Each brachytherapy patient was matched with one external-beam RT (ERT) patient derived from a reference group of 1,388 patients treated with standard BCT. Patients were matched for age, tumor size, histology, margins of excision, absence of an extensive intraductal component, nodal status, estrogen receptor status, and tamoxifen use. Median follow-up for both the ERT and brachytherapy groups was 36 months. RESULTS No statistically significant differences were noted in the 5-year actuarial rates of ipsilateral breast treatment failure or locoregional failure between ERT and brachytherapy patients (1% v 0%, P =.31 and 2% v 1%, P =.63, respectively). In addition, there were no statistically significant differences noted in rates of distant metastasis (6% v 3%, P =.24), disease-free survival (87% v 91%, P =.55), overall survival (90% v 93%, P =.66), or cause-specific survival (97% v 99%, P =.28). CONCLUSION Accelerated treatment of breast cancer using an interstitial implant to deliver radiation to the tumor bed alone over 4 to 5 days seems to produce 5-year results equivalent to those achieved with conventional ERT. Extended follow-up will be required to determine the long-term efficacy of this treatment approach.
Collapse
Affiliation(s)
- F A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
63
|
Faverly DR, Hendriks JH, Holland R. Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer 2001; 91:647-59. [PMID: 11241230 DOI: 10.1002/1097-0142(20010215)91:4<647::aid-cncr1053>3.0.co;2-z] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical trials established the value of breast-conserving treatment (BCT) including the macroscopic removal of the tumor followed by local radiation therapy (RT) for Stage I and II invasive carcinomas. The occurrence of local tumor recurrence is related to the extent and multifocality of the tumor. Various studies aim to identify those tumors that could be proper candidates for conventional BCT. Furthermore, recent studies have focused on the identification of tumors that may be treated by breast-conserving surgery alone without RT. Small, localized tumors theoretically should be the potential candidates for this type of treatment. The mammographic and pathologic criteria for the identification of tumors with limited extent are not yet established; furthermore, the optimal extent of the surgical excision and the method for margin examination are controversial. METHODS Surgical breast-conserving procedures were simulated in a review of 135 mastectomy specimens of patients treated for an invasive carcinoma (> or = 4 cm in size, all pathologic types except invasive lobular carcinoma) who were theoretically eligible for conservative treatment. Tumor spread including possible multifocality and multicentricity was studied by the technique of correlated specimen radiography and pathology. Breast carcinoma of limited extent (BCLE), the proper tumor profile for BCT, was defined as having no invasive carcinoma, ductal carcinoma in situ, and lymphatic emboli foci beyond 1 cm from the edge of the dominant mass. RESULTS Fifty-three percent of the patients in this series had a BCLE. No statistically significant relation was found between BCLE and patient age, pathologic size, type and grade of the tumor, lymph node status, mode of detection, and mammographic aspect of the index tumor. Based on mammography, the absence of calcification or tumor density beyond the edge of index tumor appears to be the best predictor for BCLE (P < 0.0001). A 1-cm microscopically tumor free margin as the outer rim of a macroscopic surgical margin of 2 cm gives the best positive predictive value based on pathology (P < 0.0001). By applying the above conditions, 72 of the 135 cancers were identified as being potential BCLE cases in this series. However, whereas 64 of these 72 tumors (89%) were correctly identified as being true BCLE, 8 (11%) were erroneously identified as such (non-BCLE cases), having "residual" tumor foci beyond 2 cm from the edge of the dominant tumor. CONCLUSIONS We conclude, that approximately 50% of invasive ductal carcinomas may have limited extent. The accuracy of identifying this group of cancers, the proper candidates for BCT, by applying state-of-the-art mammography and pathology may be as high as 90%. A subset of these tumors might represent the potential candidates for treatment with surgery alone without RT. As a result, the routine application of BCT complemented by RT would have led to the overtreatment of 89% of the patients with a BCLE in this series; conversely, 11% of the tumors may have recurred without the use of RT. Considering that these conclusions are based on a theoretic morphologic model, further clinical studies with facilities for high quality team approach in diagnosis and therapy are needed to evaluate the impact of BCLE on BCT strategies. The results of this study should not justify the withholding of RT outside the context of clinical trials.
Collapse
Affiliation(s)
- D R Faverly
- Department of Pathology, Radboud University Hospital, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | | | | |
Collapse
|
64
|
|
65
|
Cutuli B. The impact of loco-regional radiotherapy on the survival of breast cancer patients. Pro. Eur J Cancer 2000; 36:1895-902. [PMID: 11000566 DOI: 10.1016/s0959-8049(00)00279-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Cutuli
- Radiotherapy Department, Polyclinique de Courlancy, 38 rue de Courlancy, 51100, Reims, France.
| |
Collapse
|
66
|
Abstract
As breast cancers are diagnosed at increasingly early stages, and there is little biological rationale for mastectomy in most patients, breast conservation is likely to be practised with increased frequency in the future. Newer breast imaging techniques, particularly magnetic resonance imaging (MRI), should contribute to improved pretherapy planning, both aiding in the selection of patients for conservation approaches, and estimating the residual tumour burden following minimally invasive surgical interventions. Image-guided tumour mapping may permit local treatment to be individualised, most importantly allowing definition of subgroups not requiring treatment directed at the whole breast. Moreover, interventional radiology opens new possibilities for focalised treatments, which may come to be employed in the management of small lesions. The increasing use of primary chemo- or chemoendocrine therapy will also tend to favour the option of breast conservation. Functional imaging techniques, including MRI, may prove valuable in the assessment of response to medical therapy, allowing more individualised use of radiotherapy and surgery. Technical progress and the development of biological response modifiers may further improve the therapeutic ratio associated with radiation treatment.
Collapse
Affiliation(s)
- J M Kurtz
- Division of Radiation Oncology, University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva, Switzerland.
| | | |
Collapse
|
67
|
McCready DR, Chapman JA, Hanna WM, Kahn HJ, Yap K, Fish EB, Lickley HL. Factors associated with local breast cancer recurrence after lumpectomy alone: postmenopausal patients. Ann Surg Oncol 2000; 7:562-7. [PMID: 11005553 DOI: 10.1007/bf02725334] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have been following a cohort of patients who underwent a lumpectomy without receiving adjuvant radiotherapy or adjuvant systemic therapy. We now report the experience of a postmenopausal subgroup. METHODS The postmenopausal subgroup included 244 patients accrued between 1977 and 1986 and followed up. The end point was ipsilateral local breast cancer recurrence. The factors studied were the patient's age in years; tumor size (in mm); nodal status (N-, Nx, N+); estrogen and progesterone receptor status (< 10, - 10 fmol/mg protein); presence or absence of lymphovascular/perineural invasion; presence or absence, and type, of DCIS (none, non-comedo, comedo); percentage of DCIS; histological grade (1,2,3); and nuclear grade (1,2,3). Univariate analyses consisted of Kaplan-Meier plots and the Wilcoxon (Peto-Prentice) test statistic; the multivariate analyses were step-wise Cox and log-normal regressions. RESULTS The median follow-up of those patients still alive was 9.1 years, and the overall relapse rate was 24% (59/244). The univariate results indicated that the characteristics of smaller tumor size, negative nodes, positive ER status, and no lymphovascular or perineural invasion were associated with significantly (P <.05) lower relapse. From the multivariate analyses, the factors lymphovascular or perineural invasion, age, and amount of DCIS were all significantly associated with local relapse with both Cox and log-normal regressions. Additionally, there was weak evidence of an association between ER (P = .08 in the Cox regression and in the log-normal) and nodal status (P = .09 in the log-normal regression) with local relapse. We also are able to define a low-risk subgroup (N-, age -65, no comedo, ER positive, no emboli) with a crude 10-year local recurrence rate of 9%. CONCLUSION With longer follow-up, and for postmenopausal patients, there continues to be support for the theory that local relapse is affected by the factors lymphovascular or perineural invasion, age, amount of DCIS, ER, and nodal status. A low risk subgroup has been identified.
Collapse
Affiliation(s)
- D R McCready
- Department of Surgical Oncology, University Health Network, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
68
|
Lagios MD. Breast conservation without irradiation for invasive disease: legendary quest or definable reality? Ann Surg Oncol 2000; 7:552-3. [PMID: 11005551 DOI: 10.1007/bf02725331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
69
|
Wazer DE. Contemporary Issues in the use of Radiation Therapy for Early Invasive Breast Cancer. Surg Oncol Clin N Am 2000. [DOI: 10.1016/s1055-3207(18)30142-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
70
|
Affiliation(s)
- A Wallgren
- Department of Oncology, University Hospital, SE-413 45, Sahlgrenska, Sweden
| |
Collapse
|
71
|
Affiliation(s)
- E E Harris
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA,
| | | |
Collapse
|
72
|
Hall TC, Shokeir MO, Taylor MA, Wreggit GR, Crabo L. Treatment of mammographically detected minimal breast cancer in an older woman. MEDICAL AND PEDIATRIC ONCOLOGY 2000; 34:53-7; discussion 58. [PMID: 10611586 DOI: 10.1002/(sici)1096-911x(200001)34:1<53::aid-mpo10>3.0.co;2-s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- T C Hall
- Department of Medicine, St. Joseph Hospital, Bellingham, Washington 98225, USA.
| | | | | | | | | |
Collapse
|
73
|
Fowble B. Ipsilateral breast tumor recurrence following breast-conserving surgery for early-stage invasive cancer. Acta Oncol 1999; 38 Suppl 13:9-17. [PMID: 10612491 DOI: 10.1080/028418699432716] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Ipsilateral breast tumor recurrence (IBTR) following conservative surgery and radiation for early stage invasive cancer occurs in approximately 15% of all patients at 10 years and is diminished with surgical excisions which achieve negative margins. Treatment strategies of breast-conserving surgery with or without radiation that result in IBTR rates of 30 40% will impact negatively on survival and the magnitude of this effect will be influenced by the predominant pattern of local failure as well as initial and subsequent distant metastases. Optimal local control in early-stage invasive breast cancer is important to minimize the risk of a salvage mastectomy and maximize the potential for long-term survival.
Collapse
Affiliation(s)
- B Fowble
- Fox Chase Cancer Center, Philadelphia PA 19111, USA
| |
Collapse
|
74
|
Abstract
Radiation therapy for breast cancer has gone through two revolutions in the last two decades: the routine use of radiation therapy in conjunction with breast-conserving surgery as an equivalent treatment to mastectomy, and the use of radiation therapy following mastectomy in advanced or node-positive disease. Indeed, the perception of postmastectomy radiation has gone full circle: from having no benefit when used for all cases, to being detrimental because of cardiac irradiation, to the present in which the selective use of irradiation in high-risk patients provides both an improvement in local control and an improvement of 8% to 10% in the survival rate. Improvements in radiation technique have reduced complications, in particular late cardiac deaths. The major issues still to be resolved are the targets for postmastectomy irradiation, determining which patients do not need radiation therapy for DCIS and for node-negative disease, and the efficacy of delivering radiation to just the affected quadrant rather than to the whole breast. At present, most patients approach radiation therapy for breast cancer with the knowledge that it has a very high probability of being successful.
Collapse
Affiliation(s)
- A G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | | |
Collapse
|
75
|
Vanuytsel L. The crucial role of adjuvant irradiation after surgery for breast cancer. Crit Rev Oncol Hematol 1999; 31:225-38. [PMID: 10532197 DOI: 10.1016/s1040-8428(99)00035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- L Vanuytsel
- Department of Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
| |
Collapse
|
76
|
Kurtz J. Breast Irradiation: A Commentary on the State of the Art. J R Coll Physicians Edinb 1999. [DOI: 10.1177/147827159902900206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
77
|
A Retrospective Study of Breast Cancer Patients Treated with Quadrantectomy without Radiation Therapy. Breast Cancer 1999; 6:109-116. [PMID: 11091701 DOI: 10.1007/bf02966916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND: Radiation therapy after breast-conserving surgery (BCS) reduces the risk of local recurrence. However, whether radiation therapy is necessary forall patients undergoing BCS remains unclear. METHODS: In order to determine the selection criteria for patients who can safely omit radiation therapy and to confirm the survival benefit of quadrantectomy without radiation therapy, we reviewed 107 patients who underwent quadrantectomy without radiation therapy between February 1988 and July 1995. RESULTS: The 5-year overall survival, disease-free survival and cumulative local recurrence rates were 93.7%, 80.7% and 12.1% respectively. There were no significant differences of 5-year overall survival (94.0% vs 94.1%) and disease-free survival rates (83.1% vs 70.0%) between patients with or without tamoxifen. The 5-year cumulative local recurrence rate of patients with tamoxifen, however, tended to be lower (p = 0.0810) than that of patients without tamoxifen. The 5-year cumulative local recurrence rate of the patients aged 45 or less was significantly higher than that of patients aged from 45 to 55 years and those over 55 (p= 0.0090 and 0.0089, respectively). In ER positive patients, the 5-year cumulative local recurrence rate of patients with tamoxifen tended to be lower (p= 0.0791) than that of patients without tamoxifen. CONCLUSION: The survival rate of quadrantectomy without radiation therapy wasacceptable. While the risk of local recurrence following quadrantectomy withoutradiation therapy is substantial, radiation therapy following quadrantectomy might not be necessary in elderly ER positive women receiving adjuvant tamoxifen therapy.
Collapse
|
78
|
Magee B, Stewart AL, Swindell R. Outcome of radiotherapy after breast conserving surgery in screen detected breast cancers. Clin Oncol (R Coll Radiol) 1999; 11:40-5. [PMID: 10194585 DOI: 10.1053/clon.1999.9007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The treatment outcomes were reviewed for all the patients at this institute who underwent breast irradiation after breast conserving surgery in 1991. Of a total of 643 patients treated, 194 (30%) had presented with tumours detected by screening mammography. The breast was irradiated with a tangential pair of fields, giving a dose of 40 Gy in 15 fractions over 3 weeks in 97% of these patients. A boost was not used. With a median follow-up of 4.7 years, there was better cancer related survival in patients with screen detected cancers compared with those that were non-screen detected (94% versus 84% at 5 years; P = 0.002). The breast recurrence rate at 5 years was 1% for screen detected cancers compared with 6% for those that were non-screen detected (P = 0.01). Factors additional to screen detected status that were found to be significant for cancer survival were pathological stage (P = 0.03) and histological grade (P = 0.01). In a Cox multivariate analysis, only two factors were significant for breast recurrence: screen detected status (P = 0.023) and histological grade (P = 0.016). This study suggests that breast irradiation with 40 Gy given over 3 weeks after breast conserving surgery for screen detected breast cancer gives a high level of local control out to 5 years.
Collapse
MESH Headings
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Mammography
- Mass Screening
- Mastectomy, Segmental
- Middle Aged
- Multivariate Analysis
- Prospective Studies
- Radiation Dosage
- Radiotherapy, Adjuvant
- Survival Analysis
- Tamoxifen/therapeutic use
- Treatment Outcome
Collapse
Affiliation(s)
- B Magee
- Christie Hospital, Manchester, UK
| | | | | |
Collapse
|
79
|
Page DL, Jensen RA, Simpson JF. Routinely available indicators of prognosis in breast cancer. Breast Cancer Res Treat 1999; 51:195-208. [PMID: 10068079 DOI: 10.1023/a:1006122716137] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diagnosis coupled with prognostication is the challenge for and charge of the pathologist. In this time of rapidly developing basic knowledge and increasing sophistication in the evaluation of prognostic information, there has also been an important re-evaluation of the validity, reliability, and relevance of classic histopathology. Also, the precision of and criteria for evaluating tumor size and status of regional lymph nodes is under study. Our emphasis in this review is tissue pathology and further, its practical relevance to patient management. Histopathology remains the basis of diagnosis universally; the addition of other elements will increase precision of prediction, particularly of responsiveness to individual therapies. Histologic grade may be integrated to substratify high and low stage cases into prognostically more useful subsets. Histologic types also interact with size and nodal status to predict patients with excellent prognosis. Further refinement of these parameters may occur by analysis within clinical, pathologic, or therapeutic subsets.
Collapse
Affiliation(s)
- D L Page
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
| | | | | |
Collapse
|
80
|
Abstract
The updates of the Danish DBCG 82b trial and the British Columbia trial have confirmed a significant overall survival benefit with postoperative radiation therapy in patients with high-risk disease. These trials together with in-depth analyses of previous studies suggest that the mechanism of the survival benefit is eradication of subclinical locoregional deposits of tumor cells with a potential for further dissemination if left untreated. Despite these findings, several questions remain largely unanswered concerning the optimal way to integrate radiation therapy into routine clinical practice. For instance, which subgroups are likely to benefit from comprehensive treatment including the peripheral lymphatics as opposed to treatment of the breast/chest wall alone? The available randomized trials and overviews have convincingly demonstrated that it is essential to minimize long-term radiation side effects in the myocardium in order to achieve an overall survival benefit. An appropriate treatment technique is therefore essential. Individual treatment planning should be encouraged since some patients have an "unfavorable anatomy" with the heart located anteriorly in the mediastinum. Such patients may receive a high cardiac dose-volume even with conventional tangential field irradiation that does not include the internal mammary nodes.
Collapse
Affiliation(s)
- L E Rutqvist
- Oncologic Centre, Karolinska Hospital, Stockholm, Sweden
| |
Collapse
|
81
|
Vicini F, Kini VR, Chen P, Horwitz E, Gustafson G, Benitez P, Edmundson G, Goldstein N, McCarthy K, Martinez A. Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy. J Surg Oncol 1999; 70:33-40. [PMID: 9989418 DOI: 10.1002/(sici)1096-9098(199901)70:1<33::aid-jso6>3.0.co;2-o] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUNDS AND OBJECTIVES We present the interim findings of our in-house protocol treating the tumor bed alone after lumpectomy with low-dose-rate (LDR) interstitial brachytherapy in selected patients with early-stage breast cancer treated with breast conserving therapy (BCT). METHODS From 1 March 1993 through 1 January 1995, 50 women with early-stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma < or =3 cm in diameter, surgical margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with < or =3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hr to the lumpectomy bed plus a 1-2-cm margin. Local control, cosmetic outcome, and complications were assessed. RESULTS Patients ranged in age from 40 to 84 years (median, 65). The median tumor size was 10 mm (range, 1-25). Seventeen of 50 patients (34%) had well-differentiated tumors, 22 (44%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node-negative while five (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up for surviving patients is 47 months (range, 37-59). No patient has experienced a local, regional, or distant failure. Three patients have died at 19, 33, and 39 months after treatment. All were without clinical evidence of recurrent disease and all deaths were unrelated to treatment. Good-to-excellent cosmetic results have been observed in 49 of 50 patients (98%) (median cosmetic follow-up was 44 months with a range of 19-59). No patient has experienced significant sequelae related to their implant. CONCLUSIONS Interim results with treatment of the tumor bed alone with an LDR interstitial implant appear promising. Long-term follow-up of these patients and additional studies will be necessary to establish the equivalence of this treatment approach compared to standard BCT.
Collapse
Affiliation(s)
- F Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
82
|
|
83
|
Cutuli B. [Influence of locoregional irradiation on local control and survival in breast cancer]. Cancer Radiother 1998; 2:446-59. [PMID: 9868387 DOI: 10.1016/s1278-3218(98)80032-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Locoregional control is a crucial step in the achievement of breast cancer cure. In ductal carcinoma in situ, breast irradiation significantly reduces the rates of local recurrence whatever the histological subtypes, as demonstrated by the NSABP-B17 trial (25.8% of local recurrences without radiotherapy vs. 11.4% with radiotherapy). In infiltrating breast carcinomas, complementary breast irradiation has been shown to significantly improve the local control and slightly the overall survival in five randomized trials. Following mastectomy, locoregional irradiation clearly reduces the chest wall and nodal relapse rates, especially in case of lesions more than 5 cm or with nodal involvement and/or large lymphatic or vascular emboli. Two recent randomized trials confirmed the benefit of well-adapted locoregional irradiation in all subgroups, especially in patients with one to three axillary involved nodes. In the Danish trial (including premenopausal high-risk women), radiotherapy reduced locoregional relapses from 32 to 9% (p < 0.001) and increased the 10-year survival rate from 45 to 54% (p < 0.001). In the Canadian trial, locoregional relapse rate decreased from 25 to 13% and the 10-year survival rate increased from 56 to 65%. The meta-analysis published in 1995 by the EBCTCG showed only a modest benefit due to locoregional irradiation in breast cancer. However, when small or old trials were excluded due to imperfect methodology or inadequate irradiation techniques, the benefit of modern radiotherapy became much more evident in a population of 7,840 patients. Locoregional irradiation appears to be able to reduce the risk of metastatic evolution occurring after local or nodal relapse and must be integrated in a multidisciplinary strategy. Treatment toxicity (especially toxicity due to irradiation of internal mammary nodes) is of special concern, as anthracycline-based chemotherapy is prescribed more often. The use of a direct field, with at least 60% of the dose delivered by electrons alternating with photons is recommended to protect the heart and lungs.
Collapse
MESH Headings
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Mastectomy
- Neoplasm Recurrence, Local/prevention & control
- Risk Factors
- Survival Analysis
- Treatment Outcome
Collapse
Affiliation(s)
- B Cutuli
- Département de radiothérapie, Centre Paul-Strauss, Strasbourg, France
| |
Collapse
|
84
|
|
85
|
Schulgen G, Schmoor C, Sauerbrei W, Schumacher M. A note on estimating local recurrence rates in clinical trials on the treatment of breast cancer. Breast Cancer Res Treat 1998; 49:87-91. [PMID: 9694615 DOI: 10.1023/a:1005969923607] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Local recurrence rates play an important role in the evaluation and judgement of local treatment modalities in breast cancer. In the medical literature different methods for the calculation of these rates have been used. In this note we discuss the methods, the observed differences, and the interpretation of the resulting estimates.
Collapse
Affiliation(s)
- G Schulgen
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Germany
| | | | | | | |
Collapse
|
86
|
Goy JC, Dobbs HJ, Henderson S, Humphreys S, Michell MJ. Variations in referral pattern for postoperative radiotherapy of patients with screen-detected breast cancer in the south Thames (east) region. Clin Oncol (R Coll Radiol) 1998; 10:24-9. [PMID: 9543611 DOI: 10.1016/s0936-6555(98)80107-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper describes the findings of a region-wide audit undertaken in 1995-1996 of post-operative radiotherapy treatment for patients with screen-detected breast cancer. The study covers the first 3 years from the start of the South Thames (East) Breast Screening Programme in June 1988 up to March 1992. The audit shows that only 60% of the patients with invasive carcinoma who were treated by conservation surgery are known to have received radiotherapy. A considerable variation in referral patterns was observed across the region. Analysis suggests that whilst geographical, patient choice and tumour factors may play an important role in the selection of patients for radiotherapy treatment after conservative surgery for early breast cancer, management protocols of surgical units were the most critical factor, and that these appear to vary, depending on the level of involvement of the clinician with the screening programme (as measured by case-load).
Collapse
Affiliation(s)
- J C Goy
- South Thames (East) Breast Screening QA Reference Center, UK
| | | | | | | | | |
Collapse
|
87
|
Cosentino D, Valli MC. Clinical Application of Integrated Treatments in Breast Cancer. TUMORI JOURNAL 1998; 84:223-8. [PMID: 9620249 DOI: 10.1177/030089169808400221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper we analyse the problems related to the “state of the art” in the treatment of stage I and II breast cancer which has become, in Italy too, an increasingly prominent problem: it is the most frequently diagnosed female cancer, accounting for about 45,000 new cases/year (150/100,000 women). In the last decade the approach to this disease has greatly evolved because of new surgical techniques, advances in adjuvant medical therapies, innovations in the field of radiotherapy, and wider use of biological parameters. We emphasize the emerging problem of ductal and lobular carcinoma in situ, because their biological patterns will be better indentified and the related treatment extensively practiced in the next future. The innovations in surgery, which has now a less demolishing role, are reviewed focusing on the “sentinel axillary node” and the actual need for axillary dissection. In relation to chemotherapy (CT), we evaluate the role of adjuvant treatment also in node negative patients, and the impact of neoadjuvant schedules on survival and toxicity. Radiotherapy (RT) is complementary to conservative surgery, and its important role in preventing local relapse and in increasing OS (overall survival) has been established; recent and more sophisticated techniques have reduced its acute and late toxicity. We are however waiting for answers concerning the usefulness of a booster dose, the impact of RT on local relapse in DCIS, and the impact of RT to the breast regional lymph nodes on OS and disease-free survival (DFS). The optimal sequencing and timing of postoperative RT and CT are unknown, both concerning each other and surgery. Some possibilities include giving all planned CT before RT, all CT after RT, giving both concurrently, or giving a portion of CT before RT and then completing CT afterwards (sandwich technique): we analyse the advantages and the problems of these different therapeutic schedules in relation to the OS, the DFS and cosmesis. In conclusion, there are very few certainties to guide us in the clinical practice: the general feeling is that we need to collect more data on homogeneous groups of patients to better understand which are the prognostic factors we can rely on, in order to choose the best treatment strategy, and which are the optimal schedules of adjuvant treatments (CT and RT), with the aim of improving OS, DFS and cosmesis.
Collapse
Affiliation(s)
- D Cosentino
- Department of Radiotherapy, Ospedale S. Anna, Como, Italy.
| | | |
Collapse
|
88
|
The Roles and Controversies of Radiation Therapy in Breast Conserving Therapy for Breast Cancer. Breast Cancer 1997; 4:127-133. [PMID: 11091587 DOI: 10.1007/bf02967066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Breast conserving therapy (BCT) is defined as a combination of conservative surgery for resection of the primary tumor, followed by radiation therapy (RT) for the eradication of residual microscopic disease in the breast. At NIH Consensus Development Conference in 1990, BCT was recognized as the preferred treatment for the majority of women with Stage I and II breast cancer. RT is a potent locoregional treament and its role in BCT in reducing local recurrence is already established. On the other hand, the influence of RT on survival outcome has not yet been closely demonstrated so far. RT appears to be useful as neoadjuvant therapy, and also as exclusive local treatment for patients achieving complete regression (CR) after neoadjuvant chemotherapy. The other possible role of RT is to use it as an alternative to axillary dissection in patients with clinically uninvolved nodes. The question of the appropriateness of using RT in all BCT cases is raised. Since the subgroup of patients who would not deserve any benefit by RT has not yet identified, RT should be delivered as standard treatment following breast conserving surgery for early stage breast cancer.
Collapse
|
89
|
Levitt SH. Radiotherapy is a necessary adjuvant in the treatment of early breast cancer. Strahlenther Onkol 1997; 173:435-6. [PMID: 9289864 DOI: 10.1007/bf03038323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
90
|
Abner A, Harris J. Conservative Management of Breast Cancer: Research at the Joint Center for Radiation Therapy, Harvard Medical School. Breast J 1997. [DOI: 10.1111/j.1524-4741.1997.tb00207.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
91
|
Marks LB, Prosnitz LR. The Role of Radiation Therapy after Local Excision of Invasive and Noninvasive Breast Cancer. Surg Oncol Clin N Am 1997. [DOI: 10.1016/s1055-3207(18)30333-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
92
|
Whelan T, Levine M. Radiation therapy following breast conservation surgery: can it ever be avoided? Ann Oncol 1997; 8:217-8. [PMID: 9137787 DOI: 10.1023/a:1008287920940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
93
|
Romestaing P, Mazeron JJ, Coquard R, Ardiet JM, Mornex F, Gérard JP. [Role of radiotherapy in the management of adenocarcinoma of the breast accessible to conservative surgery]. Cancer Radiother 1997; 1:14-28. [PMID: 9265530 DOI: 10.1016/s1278-3218(97)84053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Standard treatment for limited stage adenocarcinoma of the breast includes lumpectomy (or a quadrantectomy), axillary node dissection, regional radiation therapy and, if the prognostic factors are unfavourable, chemotherapy and/or hormone therapy. This is supported by the results of American and European randomised trials. There have been many attempts at improving the modalities of conservative surgery and postoperative radiation therapy in order to maximize local control and minimize late sequellae. It is also likely that induction chemotherapy and external beam radiotherapy applied in selected cases increase the proportion of patients who can be offered conservative surgery.
Collapse
Affiliation(s)
- P Romestaing
- Service de radiothérapie-oncologie, centre hospitalier Lyon-Sud, Pierre, France
| | | | | | | | | | | |
Collapse
|
94
|
|