Breast conservation in the treatment of early breast cancer a 20-year follow-up (original) (raw)
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International Journal of Radiation Oncology*Biology*Physics, 2008
Background-For patients with stage II breast cancer with 1-3 positive lymph nodes, controversy exists as to whether radiation as a component of treatment provides a survival benefit. Methods-We analyzed the data from breast cancer patients with stage II breast cancer with 1-3 positive lymph nodes diagnosed between 1988-2002 in the Surveillance, Epidemiology, and End Results registry and compared the outcome of the 12,693 patients treated with breast conservation therapy with radiation (BCT + XRT) to the18,902 patients treated with mastectomy without radiation (MRM w/o XRT). Results-Patients treated with BCT + XRT were younger, were more likely to be treated in recent years of the study period, more commonly had T1 primary tumors, and had fewer involved nodes compared to those treated with MRM w/o XRT (p<0.001 for all differences). The 15-year breast cancer specific survival for the BCT +RT group was 80% vs. 72% for the MRM w/o RT group (p<0.001). Cox regression analysis showed that MRM w/o XRT was associated with a hazard ratio for breast cancer death of 1.19 (p<0.001) and for overall death of 1.25 (p<0.001). The survival benefit in BCT + RT group was not limited to subgroups with high-risk disease features. Conclusions-Radiation use was independently associated with an improved survival for patients with stage II breast cancer with 1-3 positive lymph nodes. As multivariate analyses of
Radiation Oncology, 2011
Background: We aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM). Methods: Ninety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/ dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed. Results: Differences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3%vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90,2% vs 61,9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS.
Survival Benefit with Radiation Therapy in Node-Positive Breast Carcinoma Patients
Strahlentherapie und Onkologie, 2009
Background and Purpose: Postoperative radiation therapy (RT) has been the subject of discussion, especially in patients with one to three positive lymph nodes (≤ 3 pN+) in the axillary dissection. The authors investigated whether postoperative RT provides a survival benefit for pT1-2 pN+ breast cancer patients. Patients and Methods: Patients included were selected from the SEER database (NCI -Surveillance, Epidemiology and End Results, release 2000; n = 24,410) and the UZ Brussel database (1984-2002; n = 1,011) according to the following criteria: women aged 25-95, no previous cancer, unilateral pT1-pT2 breast tumors, total mastectomy (ME) or breast-conserving surgery (BCS), postoperative RT, and an axillary dissection showing at least one pathologic lymph node. Results: The overall survival (OS) of patients in the SEER and UZ Brussel databases who received postoperative RT was identical. However, patients in the SEER database who did not receive RT had a significantly worse outcome (p < 0.0001). After ME or BCS, all patients (SEER and UZ Brussel) who had ≥ 4 pN+ and received RT had comparable outcomes after 15 years. The 15-year OS in the subgroup with ME and ≤ 3 pN+ nodes was 57.0% and 46.6% (p = 0.0004) with RT (UZ Brussel) and without RT (SEER), respectively. For BCS and ≤ 3 pN+, the same significant difference in OS at 15 years was seen: 63.8% after RT (UZ Brussel) and 60.4% without RT (SEER; p = 0.0029). Conclusion: RT provides a survival benefit in patients with ≤ 3 or ≥ 4 pN+; the indication for postoperative RT should therefore be adapted in future consensus meetings.
OncoTargets and Therapy
Objective: To evaluate the role of radiotherapy (RT) in overall survival (OS) and disease-free survival in postmastectomy breast cancer patients with tumor size ,5 cm, with 1-3 involved axillary lymph nodes (T1-2N1). Patients and methods: We conducted a retrospective study of 89 postmastectomy patients with T1-2N1 disease between 2005 and 2015 at the Radiation Oncology Clinic of Kayseri Training and Research Hospital. Clinicopathologic, demographic, and laboratory findings, as well as treatment regimens were investigated. OS and disease-free survival as well as factors that can be valuable in the prognosis were evaluated. Results: A total of 89 female patients with an average age of 53 years (range: 30-81 years) were included in the assessment. Five-year and 10-year local recurrence rates were found to be 6.6% in the RT group and 7.1% in the non-RT group. In the RT group, the mean OS was 110.3 months and progression-free survival was 104.4 months. In the non-RT group, the corresponding figures were 104.3 months and 92.1 months, respectively. Statistically significant correlation was observed between RT and the American Joint Committee on Cancer stage (P,0.001), histological type (P=0.013), tumor size (P,0.001), and lymph node metastasis (P,0.001). During the assessment, locoregional recurrence and/or distant metastasis occurred in nine patients (10%). Locoregional recurrence was observed mostly in patients with invasive ductal carcinoma, tumor .3.0 cm in size, grade II tumors, and perinodal invasion, and who were premenopausal at the time of diagnosis. Conclusion: In T1-2N1 breast cancer patients who underwent modified radical mastectomy, when the effects of postmastectomy RT were evaluated, there were no differences in terms of OS and progression-free survival. In addition, when subgroup analysis was made, in patients with invasive ductal carcinoma, tumor diameter .2 cm, three lymph node metastasis, and stage 2b, postmastectomy RT was seen to be useful.
Tumori
The aim of this study was to investigate the efficacy of postoperative locoregional radiotherapy in patients with T1-T2 breast cancer and four or more positive axillary lymph nodes submitted to mastectomy or breast-conserving surgery followed by standard-dose or high-dose adjuvant chemotherapy. The incidence of locoregional relapses and the survival correlated with the number of positive nodes were recorded for each treatment arm. From August 1992 to August 1999 86 breast cancer patients (median age, 54 years, T1-T2, N+ > or = 4) submitted to surgery were treated. Sixty-three patients received standard-dose chemotherapy while 23 patients with 10 or more positive nodes received high-dose chemotherapy. After four courses of standard-dose anthracycline-based chemotherapy peripheral blood stem cells were mobilized with cyclophosphamide (7 g/m2) and G-CSF (10-16 microg/kg/day/sc). High-dose chemotherapy consisted of etoposide 1000 mg/m2, thiotepa 500 mg/m2 and carboplatin 800 mg/m2. H...
Journal of the Formosan Medical Association = Taiwan yi zhi, 2000
To retrospectively assess the risk of locoregional recurrence (LRR) and analyze the prognostic factors of this pattern of failure in patients with breast cancer and one to three positive axillary lymph nodes treated with modified radical mastectomy (MRM) without adjuvant radiotherapy. From April 1991 through December 1997, 649 patients received a diagnosis of invasive breast cancer, and 545 were treated with MRM. Eighty-one of these patients who were found to have one to three positive axillary nodes and had a minimum follow-up of 2 years were included in this study. None of the 81 patients received adjuvant radiation therapy after mastectomy; 43 patients received adjuvant chemotherapy; and 60 patients received adjuvant hormone therapy. The median duration of follow-up was 39 months. Thirteen patients had LRR during follow-up, all within 2 years after mastectomy. The 3-year LRR rate was 14%. The 3-year rates of distant metastasis for patients with and without LRR were 48% and 14% (p...
Breast conservation treatment of early stage breast cancer: patterns of failure
International Journal of Radiation Oncology*Biology*Physics, 1995
Purpose: This study retrospectively assesses the patterns of failure in conservatively treated early stage breast cancer patients by correlating various clinical, pathologic, and treatment-related factors with local, axillary, and distant relapse. Methods and Materials: Between 1973 and 1990, 796 patients (817 breasts) received breast conservation surgery followed by radiotherapy. Local recurrences were counted as events even if they occurred simultaneously or after the appearance of axillary or distant metastases. Results: The 10-year actuarial relative disease-free survival (DFS) rate for TIN0, T2N0, and TI-2NI was 82%, 71%, and 54%, respectively. Stage NO patients had a significant DFS advantage over NI patients (p = 0.02). The 15-year actuarial local recurrence-free rate for TI and T2 tumors was 82% and 87%, respectively (p = nonsignificant).