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Schmitz R, Sondermeijer C, van der Noort V, Engelhardt E, Gerritsma M, Verschuur E, van Oirsouw M, Bleiker E, Bijker N, Mann R, van Duijnhoven F, Wesseling J. The successful patient-preference design for the LORD-trial to test whether active surveillance for low-risk Ductal Carcinoma In Situ is safe. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Boersma L, Sattler M, Maduro J, Bijker N, Essers M, van Gestel C, Klaver Y, Petoukhova A, Rodrigues M, Russell N, van der Schaaf A, Verhoeven K, van Vulpen M, Schuit E, Langendijk J. Model-Based Selection for Proton Therapy in Breast Cancer: Development of the National Indication Protocol for Proton Therapy and First Clinical Experiences. Clin Oncol (R Coll Radiol) 2022; 34:247-257. [DOI: 10.1016/j.clon.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/11/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022]
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3
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Raphael D, Russell N, Winkens B, Immink J, Westhoff P, Stenfert Kroese M, Stam M, Bijker N, van Gestel C, van der Weijden T, Boersma L. A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices. Tech Innov Patient Support Radiat Oncol 2021; 20:1-9. [PMID: 34589620 PMCID: PMC8461042 DOI: 10.1016/j.tipsro.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict. MATERIAL AND METHODS We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis. RESULTS After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time. CONCLUSIONS Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
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Affiliation(s)
- D.B. Raphael
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - N.S. Russell
- Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute,Maastricht University, Maastricht, the Netherlands
| | - J.M. Immink
- Department of Radiation Oncology, Reinier de Graaf Hospital, Delft, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - P.G. Westhoff
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - M.R. Stam
- Radiotherapy Group, Arnhem, the Netherlands
| | - N. Bijker
- Department of Radiation Oncology, Amsterdam University Medical Centers, the Netherlands
| | | | - T. van der Weijden
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - L.J. Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Maliko N, Bijker N, Bos M, Vrancken-Peeters M. Nationwide population-based study: Patterns of care in young breast cancer patients in the Netherlands. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maliko N, Bijker N, Wouters M, Vrancken-Peeters M. Defining a “dedicated” breast cancer team. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schreuder K, Maduro J, Spronk P, Bijker N, Poortmans P, van Dalen T, Struikmans H, Siesling S. Variation in the Use of Boost Irradiation in Breast-Conserving Therapy in the Netherlands: The Effect of a National Guideline and Cofounding Factors. Clin Oncol (R Coll Radiol) 2019; 31:250-259. [DOI: 10.1016/j.clon.2018.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
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Crama K, Visser J, Bijker N, Kolff M, Bel A. EP-2361: What is the gain of breath hold for re-irradiation of recurrent left-sided breast cancer with VMAT? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wesseling J, Elshof LE, Tryfonidis K, Poncet C, Aalders K, van Leeuwen-Stok E, Skinner V, Loo C, Winter-Warnars G, Bleiker E, Retèl V, Pijnappel R, Bijker N, Rutgers E, van Duijnhoven F. Abstract OT3-07-01: Update of the randomized, non-inferiority LORD trial testing safety of active surveillance for women with screen-detected low risk ductal carcinoma in situ (EORTC-1401-BCG/BOOG 2014-04, DCIS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-07-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The introduction of population-based breast cancer screening and implementation of digital mammography have led to an increased incidence of ductal carcinoma in situ (DCIS) without a decrease in the incidence of advanced breast cancer. This suggests DCIS overdiagnosis exists.
We hypothesize that asymptomatic, low-grade DCIS can safely be managed by active surveillance. If progression to invasive breast cancer would still occur, this will be low-grade and hormone receptor positive with excellent survival rates. Also, breast-conserving treatment will still be an option, if no prior radiotherapy has been applied. Management by active surveillance also may save many low-grade DCIS patients intensive treatment.
Therefore, we will compare active surveillance with conventional treatment, being either mastectomy, wide local excision (WLE) only, or WLE plus radiotherapy, possibly followed by hormonal therapy for primary low-grade DCIS. For this, we conduct a phase III, open-label, non-inferiority, multi-center, randomized clinical trial sponsored by the European Organization for Research and Treatment of Cancer (EORTC-1401-BCG). The Dutch Centers are coordinated by the Dutch Breast Cancer Research Group (BOOG) (BOOG 2014-04). This trial is developed and implemented in close collaboration with patient advocates.
Randomization will be in a 1:1 ratio among one of the following arms: (1) active surveillance or (2) standard treatment per local policy. In total, 1,240 women (≥ 45 years) will be included without prior breast cancer, but with asymptomatic, pure, low-grade DCIS, based on a minimum of tissue harvested by biopsy from calcifications detected by population-based or opportunistic screening. Assuming 25% of randomized women qualified to enroll in the study will drop out or will be excluded from per protocol evaluation, at least 1,240 women need to be randomized to obtain the 930 patients required for the evaluation of the primary endpoint. The same follow-up scheme will be applied in both study arms, i.e. annual mammography for a period of 10 years. The primary end-point is ipsilateral invasive breast tumor-free rate at 10 years. Secondary end-points are among others: overall survival, breast cancer-specific survival, mastectomy rate, patient reported outcomes and cost-effectiveness. Accrual has started in the Netherlands in February 2017 and will start internationally in over 30 centers shortly.
Acknowledgements: This trial is funded by Pink Ribbon Netherlands, the Dutch Cancer Society and Dutch Cancer Society/Alpe d'HuZes, and Cancer Research UK.
Citation Format: Wesseling J, Elshof LE, Tryfonidis K, Poncet C, Aalders K, van Leeuwen-Stok E, Skinner V, Loo C, Winter-Warnars G, Bleiker E, Retèl V, Pijnappel R, Bijker N, Rutgers E, van Duijnhoven F. Update of the randomized, non-inferiority LORD trial testing safety of active surveillance for women with screen-detected low risk ductal carcinoma in situ (EORTC-1401-BCG/BOOG 2014-04, DCIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- J Wesseling
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - LE Elshof
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - K Tryfonidis
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - C Poncet
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - K Aalders
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E van Leeuwen-Stok
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - V Skinner
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - C Loo
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - G Winter-Warnars
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E Bleiker
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - V Retèl
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - R Pijnappel
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - N Bijker
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E Rutgers
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - F van Duijnhoven
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
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Goudschaal K, Bijker N, Bel A, Van Wieringen N, Kamphuis M. OC-0450: Geometric variation of the axillary lymph node region in locoregional breast/chest wall irradiation. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Heijkoop S, Westerveld G, Bijker N, Feije R, Sharfo A, Van Wieringen N, Mens J, Heijmen B, Stalpers L, Hoogeman M. OC-0461: Does the dosimetric advantage of prone setup persist in small-margin IMRT for gynecological cancer? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Goudschaal K, Kamphuis M, Bijker N, Frank M, Bel A, Van Wieringen N. OC-0261: Does chin fixation improve the setup accuracy of the patients receiving locoregional treatment for breast cancer? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Ductal carcinoma in situ (DCIS) is a pre-invasive stage of breast cancer with a heterogeneous clinical behaviour. Since the introduction of mammographic screening programmes, the incidence of DCIS has shown a dramatic increase. Treatment should focus on the prevention of progression to invasive disease. If progression occurs, poorly differentiated DCIS frequently gives rise to grade III invasive breast cancer, whereas well differentiated DCIS more often recurs as grade I invasive disease. However, at present, validated diagnostic test are lacking to predict progression accurately. The majority of women with DCIS are suitable for breast conserving therapy. Obtaining clear surgical margins is the most important goal of a local excision. Radiotherapy is effective in reducing the risk of local recurrence with about 50 % in all subgroups of patients with DCIS. (Breast cancer specific) survival of women with DCIS is excellent, and radiotherapy does not further improve this. Future research should be directed in enabling to select women who have a high risk of--invasive--recurrence, so in which radiotherapy should be standard part of the breast conserving approach, and those women with a more indolent lesion, in which after surgery a watchful waiting approach can be followed.
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Affiliation(s)
- N Bijker
- Department of Radiation Oncology, Academic Medical Center, P.O. Box 22700, 1100DE, Amsterdam, The Netherlands.
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Meijnen P, Bijker N, Koedooder C, Pieters B. PO-258 CLINICAL RESULTS OF VAGINAL BRACHYTHERAPY DELIVERED WITH A RING APPLICATOR FOR ENDOMETRIAL CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Donker M, Litière S, Werutsky G, Julien J, Fentiman I, Agresti R, Rouanet P, de Lara CT, Rutgers E, Bijker N. OC-0134 LOCAL EXCISION WITH OR WITHOUT RADIOTHERAPY IN DUCTAL CARCINOMA IN SITU: TREATMENT AND PROGNOSIS AFTER A RECURRENCE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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van den Assem M, Visser J, Zonderland H, van Tienhoven G, Crama K, Bijker N. 459 Pre-operative CT Scan in Breast Conserving Therapy for Determination of the Boost Volume for Radiotherapy. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Donker M, Litiére S, Werutsky G, Julien J, Fentiman I, Agresti R, Rouanet P, de Lara CT, Rutgers E, Bijker N. 217 Adjuvant Radiotherapy After Breast-conserving Surgery for Ductal Carcinoma in Situ – Fifteen-year Results of the EORTC Randomized Phase III Trial 10853. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70285-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bartelink H, Litière S, Collette S, Collette L, Bogaerts J, Rutgers E, Bijker N, Donker M, van Werkhoven E. 207 speaker UPDATE OF THREE MAJOR PHASE III RANDOMIZED TRIALS FROM THE EORTC BREAST AND RADIOTHERAPY GROUP. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70329-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010; 2010:162-77. [PMID: 20956824 PMCID: PMC5161078 DOI: 10.1093/jncimonographs/lgq039] [Citation(s) in RCA: 418] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Individual patient data were available for all four of the randomized trials that began before 1995, and that compared adjuvant radiotherapy vs no radiotherapy following breast-conserving surgery for ductal carcinoma in situ (DCIS). A total of 3729 women were eligible for analysis. Radiotherapy reduced the absolute 10-year risk of any ipsilateral breast event (ie, either recurrent DCIS or invasive cancer) by 15.2% (SE 1.6%, 12.9% vs 28.1% 2 P <.00001), and it was effective regardless of the age at diagnosis, extent of breast-conserving surgery, use of tamoxifen, method of DCIS detection, margin status, focality, grade, comedonecrosis, architecture, or tumor size. The proportional reduction in ipsilateral breast events was greater in older than in younger women (2P < .0004 for difference between proportional reductions; 10-year absolute risks: 18.5% vs 29.1% at ages <50 years, 10.8% vs 27.8% at ages ≥ 50 years) but did not differ significantly according to any other available factor. Even for women with negative margins and small low-grade tumors, the absolute reduction in the 10-year risk of ipsilateral breast events was 18.0% (SE 5.5, 12.1% vs 30.1%, 2P = .002). After 10 years of follow-up, there was, however, no significant effect on breast cancer mortality, mortality from causes other than breast cancer, or all-cause mortality.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/prevention & control
- Carcinoma, Intraductal, Noninfiltrating/drug therapy
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Meta-Analysis as Topic
- Middle Aged
- Multicenter Studies as Topic/statistics & numerical data
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/prevention & control
- Radiotherapy, Adjuvant/statistics & numerical data
- Randomized Controlled Trials as Topic/statistics & numerical data
- Tamoxifen/therapeutic use
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Bijker N, van Heumen M, Vreeswijk S, van Vliet-Vroegindeweij C, Alberding F, Wittkamper F, Russell N. Prone position breast irradiation for women with larger or pendulous breasts: an intensity modulated radiotherapy (IMRT) planning study. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bijker N, van Heumen M, Alberding F, van Vliet-Vroegindeweij C, Minkema D, Wittkämper F, Russell N. 2036 POSTER Prone position breast irradiation; an intensity modulated radiotherapy (IMRT) planning study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Strom E, Solin L, Vicini F, Taylor M, Olivotto I, Haffty B, Pierce L, Marks L, Jhingran A, Wai E, Bijker N, Harry B. Long-term results for women with mammographically detected ductal carcinoma in-situ of the breast treated with breast-conserving surgery and definitive breast irradiation. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01068-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Rutgers EJT, Peterse JL, Bijker N. Ductal carcinoma in situ of the breast; diagnostic assessment and treatment. Scand J Surg 2003; 91:268-72. [PMID: 12449470 DOI: 10.1177/145749690209100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E J Th Rutgers
- Department of Surgery, Pathology, and Radiation Oncology, Netherlands Cancer Institute, Amsterdam.
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Bijker N, Peterse JL, Fentiman IS, Julien JP, Hart AAM, Avril A, Cataliotti L, Rutgers EJT. Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS. Br J Cancer 2002; 87:615-20. [PMID: 12237770 PMCID: PMC2364244 DOI: 10.1038/sj.bjc.6600514] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2001] [Revised: 05/31/2002] [Accepted: 07/03/2002] [Indexed: 11/15/2022] Open
Abstract
Selection of patients for randomised clinical trials may have a large impact on the applicability of the study results to the general population presenting the same disorder. However, clinical characteristics and outcome data on non-entered patients are usually not available. The effects of patient selection for the EORTC 10853 trial investigating the role of radiotherapy in breast conserving therapy for ductal carcinoma in situ have been studied, in an analysis of all patients treated for ductal carcinoma in situ in five participating institutes. The reasons for not entering patients were evaluated and treatment results of the randomised patients were compared to those not entered. A total of 910 patients were treated for ductal carcinoma in situ. Of these, 477 (52%) were ineligible, with the size of the lesion being the main reason for ineligibility (30% of all ductal carcinoma in situ). Of the 433 eligible patients, 278 (64%) were randomised into the trial. The main reasons for non-entry of eligible patients were either physicians' preference for one of the treatment arms (26%) or patients' refusal (9%). These percentages showed significant variation among the institutes. At 4 years follow-up, those patients not entered in the trial and treated with local excision and radiotherapy, had higher local recurrence rates than the patients randomised in the trial and treated with the same approach, (17 vs 2%, P=0.03). The patients treated with local excision alone had equal local recurrence rates (11% in both groups). Selection of patients may explain the differences in outcome of the randomised patients, and those not-entered. Thus, the results of this trial may not be applicable to all patients with ductal carcinoma in situ.
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Affiliation(s)
- N Bijker
- Department of Radiation Oncology, The Netherlands Cancer Institute Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Bijker N, Peterse JL, Duchateau L, Julien JP, Fentiman IS, Duval C, Di Palma S, Simony-Lafontaine J, de Mascarel I, van de Vijver MJ. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001; 19:2263-71. [PMID: 11304780 DOI: 10.1200/jco.2001.19.8.2263] [Citation(s) in RCA: 405] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In view of the increasing number of patients treated with breast-conserving treatment (BCT) for ductal carcinoma-in-situ (DCIS), risk factors for recurrence and metastasis should be identified. PATIENTS AND METHODS Clinical and pathologic characteristics from patients with DCIS in the European Organization for Research and Treatment of Cancer trial 10853 (excision with or without radiotherapy) were related to the risk of recurrence. Pathologic features were derived from a central review of 863 of the 1,010 randomized cases (85%). The median follow-up was 5.4 years. RESULTS Factors associated with an increased risk of local recurrence in the multivariate analysis were young age (< or = 40 years) (hazard ratio, 2.14; P =.02), symptomatic detection of DCIS (hazard ratio, 1.80; P =.008), growth pattern (solid and cribriform) (hazard ratios, 2.67 and 2.69, respectively; P =.012), involved margins (hazard ratio, 2.07; P =.0008), and treatment by local excision alone (hazard ratio, 1.74; P =.009). The risk of invasive recurrence was not related to the histologic type of DCIS (P =.63), but the risk of distant metastasis was significantly higher in poorly differentiated DCIS compared with well-differentiated DCIS (hazard ratio, 6.57; P =.01). CONCLUSION Patients with poorly differentiated DCIS have a high risk of distant metastasis after invasive local recurrence. Margin status is the most important factor in the success of BCT for DCIS; additionally, young age and symptomatic detection of DCIS have negative prognostic value.
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Affiliation(s)
- N Bijker
- Departments of Radiation Oncology and Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
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Julien J, Bijker N, Fentiman I, Delledonne V, Rouanet P, Avril A, Sylvester R, Mignolet F, Bartelink F, Van Dongen J. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Cancer Radiother 2001. [DOI: 10.1016/s1278-3218(00)00064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bijker N, Rutgers EJ, Peterse JL, Fentiman IS, Julien JP, Duchateau L, van Dongen JA. Variations in diagnostic and therapeutic procedures in a multicentre, randomized clinical trial (EORTC 10853) investigating breast-conserving treatment for DCIS. Eur J Surg Oncol 2001; 27:135-40. [PMID: 11289747 DOI: 10.1053/ejso.2000.1062] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the diagnostic and therapeutic procedures which were followed in a European Organization for Research and Treatment of Cancer (EORTC) randomized clinical trial investigating the role of radiotherapy in breast-conserving treatment (BCT) for ductal carcinoma in situ (DCIS) of the breast. METHODS The medical files of 824 of the 1010 randomized patients (82%) were reviewed during site visits to 30 participating institutes. RESULTS Large variations occurred, particularly in the surgical procedures and histopathological work-up which were performed. Important risk factors like tumour size and margin status were poorly quantified in the medical files. CONCLUSIONS These findings emphasize the need for establishing uniform guidelines for diagnostic and therapeutic procedures for DCIS, and for clearly defined risk factors for recurrence after BCT for DCIS. Because of its randomized nature, the main question of the trial, i.e. the effect of radiotherapy on the risk of local recurrence, will not be influenced by variation. The risk of local recurrence in itself, and hence the success of BCT for DCIS, may however be influenced by the quality of the initial procedures that were conducted.
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Affiliation(s)
- N Bijker
- Department of Pathology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek ziekenhuis, Amsterdam, The Netherlands
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Bijker N, Rutgers EJ, Duchateau L, Peterse JL, Julien JP, Cataliotti L. Breast-conserving therapy for Paget disease of the nipple: a prospective European Organization for Research and Treatment of Cancer study of 61 patients. Cancer 2001; 91:472-7. [PMID: 11169928 DOI: 10.1002/1097-0142(20010201)91:3<472::aid-cncr1024>3.0.co;2-q] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The purpose of the current study was to assess the outcome of breast-conserving therapy by means of a cone excision and radiotherapy in patients with Paget disease of the nipple without associated invasive breast carcinoma. METHODS Between 1987 and 1998, 61 eligible patients were registered in the European Organization for Research and Treatment of Cancer Study 10873. The majority of patients (97%) presented without an associated palpable mass. At histologic examination, the majority (93%%) of patients had an underlying ductal carcinoma in situ (DCIS); in the remaining 7%, only Paget disease was found. Treatment was comprised of a complete excision of the nipple-areolar complex including the underlying breast tissue with tumor free margins, followed by external irradiation to the whole breast (50 gray in 25 fractions). The primary endpoint was local recurrence. RESULTS At a median follow-up of 6.4 years, 4 of the 61 patients developed a recurrence in the treated breast (1 patient with DCIS and 3 patients with invasive disease). One patient with an invasive local recurrence died of disseminated breast carcinoma. The 5-year local recurrence rate was 5.2% (95% confidence interval, 1.8-14.1%). CONCLUSIONS Breast-conserving therapy is a feasible alternative for patients with Paget disease and a limited extent of underlying DCIS. To achieve good local control, treatment should be comprised of a complete excision of the nipple-areolar complex including the underlying disease, followed by irradiation to the whole breast.
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Affiliation(s)
- N Bijker
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Bijker N, Peterse JL, Duchateau L, Robanus-Maandag EC, Bosch CA, Duval C, Pilotti S, van de Vijver MJ. Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer 2001; 84:539-44. [PMID: 11207051 PMCID: PMC2363778 DOI: 10.1054/bjoc.2000.1618] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We have investigated primary ductal carcinomas in situ (DCIS) of the breast and their local recurrences after breast-conserving therapy (BCT) for histological characteristics and marker expression. Patients who were randomized in the EORTC trial 10853 (wide local excision versus excision plus radiotherapy) and who developed a local recurrence were identified. Histology was reviewed for 116 cases; oestrogen and progesterone receptor status, and HER2/ neu and p53 overexpression were assessed for 71 cases. Comparing the primary DCIS and the invasive or non-invasive recurrence, concordant histology was found in 62%, and identical marker expression in 63%. Although 11% of the recurrences developed at a distance from the primary DCIS, nearly all these showed the same histological and immunohistochemical profile. 5 patients developed well-differentiated DCIS or grade I invasive carcinoma after poorly differentiated DCIS. Although these recurrences occurred in the same quadrant as the primary DCIS, they may be considered as second primary tumours. Only 4 patients developed poorly differentiated DCIS or grade III invasive carcinoma after well differentiated DCIS. We conclude that in most cases the primary DCIS and its local recurrence are related histologically or by marker expression, suggesting that local recurrence usually reflects outgrowth of residual DCIS; progression of well differentiated DCIS towards poorly differentiated DCIS or grade III invasive carcinoma is a non-frequent event.
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MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Breast Neoplasms/genetics
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Cell Differentiation
- Disease Progression
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Mastectomy, Segmental
- Neoplasm Invasiveness/genetics
- Neoplasm Recurrence, Local/genetics
- Peptide Fragments/biosynthesis
- Peptide Fragments/genetics
- Receptor, ErbB-2/biosynthesis
- Receptor, ErbB-2/genetics
- Receptors, Estrogen/biosynthesis
- Receptors, Estrogen/genetics
- Receptors, Progesterone/biosynthesis
- Receptors, Progesterone/genetics
- Tumor Suppressor Protein p53/biosynthesis
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- N Bijker
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX, 1066, The Netherlands
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Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, Avril A, Sylvester R, Mignolet F, Bartelink H, Van Dongen JA. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000; 355:528-33. [PMID: 10683002 DOI: 10.1016/s0140-6736(99)06341-2] [Citation(s) in RCA: 383] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) of the breast is a disorder that has become more common since it may manifest as microcalcifications that can be detected by screening mammography. Since selected women with invasive cancer can be treated safely with breast conservation therapy it is paradoxical that total mastectomy has remained the standard treatment for DCIS. We did a randomised phase III clinical trial to investigate the role of radiotherapy after complete local excision of DCIS. METHODS Between 1986 and 1996, women with clinically or mammographically detected DCIS measuring less than or equal to 5 cm were treated by complete local excision of the lesion and then randomly assigned to either no further treatment (n=503) or to radiotherapy (n=507; 50 Gy in 5 weeks to the whole breast). The median duration of follow-up was 4.25 years (maximum 12.0 years). All analyses were by intention to treat. FINDINGS 500 patients were followed up in the no further treatment group and 502 in the radiotherapy group. In the no further treatment group 83 women had local recurrence (44 recurrences of DCIS, and 40 invasive breast cancer). In the radiotherapy group 53 women had local recurrences (29 recurrences of DCIS, and 24 invasive breast cancer). The 4-year local relapse-free was 84% in the group treated with local excision alone compared with 91% in the women treated by local excision plus radiotherapy (log rank p=0.005; hazard ratio 0.62). Similar reductions in the risk of invasive (40%, p=0.04) and non-invasive (35%, p=0.06) local recurrence were seen. CONCLUSIONS Radiotherapy after local excision for DCIS, as compared with local excision alone, reduced the overall number of both invasive and non-invasive recurrences in the ipsilateral breast at a median follow-up of 4.25 years.
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Affiliation(s)
- J P Julien
- Department of Surgery, Centre Henri Becquerel, Rouen, France.
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Bijker N, Rutgers EJ, Peterse JL, van Dongen JA, Hart AA, Borger JH, Kroon BB. Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy. Cancer 1999; 85:1773-81. [PMID: 10223572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The purpose of the current study was to evaluate the locoregional recurrence rate after treatment of patients with operable breast carcinoma with a modification of the Halsted radical mastectomy and the selective use of radiotherapy and to identify risk factors for locoregional recurrence. METHODS Between 1979-1987, 691 consecutive patients underwent mastectomy after a negative biopsy of the axillary apical lymph nodes. The median age of the patients was 59 years (range, 26-89 years). The clinical tumor size was < 2 cm in 72 patients, 2-5 cm in 387 patients, and >5 cm in 169 patients; 16 patients had a T4 tumor. Surgery was comprised of a modification of the Halsted radical mastectomy, including at least part of the pectoralis major muscle and the entire pectoralis minor muscle, in 573 patients; 303 patients had positive axillary lymph nodes. Adjuvant radiotherapy to the chest wall and regional lymph nodes was given to 74 patients, whereas an additional 414 patients underwent irradiation to the internal mammary and medial supraclavicular lymph nodes. The median follow-up was 91 months. RESULTS The actuarial overall survival rate was 82% at 5 years and 63% at 10 years. The 10-year chest wall and regional lymph node control rates, including patients with prior distant failures, were 95% and 94%, respectively. The only two significant prognostic factors for locoregional recurrence on multivariate analysis were lymph node status and pathologic tumor size. CONCLUSIONS Excellent locoregional control can be achieved with a modified technique of radical mastectomy in patients with negative apical biopsy and the selective use of comprehensive radiotherapy. These results may serve as a reference outcome for comparison with other locoregional treatment strategies.
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Affiliation(s)
- N Bijker
- Department of Pathology, The Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam
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Julien J, Bijker N, Sylvester R, Fentiman I, Salvadori B, Rouanet P, Avril A. The role of radiotherapy in breast conserving treatment of ductal carcinoma in situ (DCIS): First results of EORTC trial 10853. Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80023-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bijker N, Peterse J, Rutgers E, Julien J, Cataliotti L, Mauriac L. PP-6-3 The selection of patients with DCIS for a clinical randomised trial: Differences between large participating centres. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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