Patterns of Care Study in Japan: Analysis of Patients Subjected to Mastectomy Followed by Radiotherapy (original) (raw)
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International Journal of Radiation Oncology*Biology*Physics, 1993
Purpose: To determine the risk of local-regional failure following post-mastectomy radiotherapy and the incidence of complications associated with such treatment. Methods and Materials: We retrospectively analyzed the results in 309 patients with Stage I-III invasive breast cancer treated with post-mastectomy radiation therapy between 1975 and 1985. The median radiotherapy dose was 45 Gy in 1.8 to 2.25 Gy fractions. One hundred forty-seven (48%) of the patients received adjuvant systemic chemotherapy with 115 (78%) of these receiving a CMF-based or doxorubicin-containing regimen. The median follow-up time of surviving patients was 130 months (range, 28 to 191 months) after mastectomy. Results: Seventeen patients (6%) developed a local-regional failure at an interval of 4 to 87 months after radiotherapy. Moderate or severe complications related to radiotherapy and requiring treatment were uncommon. Symptomatic radiation pneumonitis occurred in four patients (1.3%), arm edema in 18 (5.8%), and brachial plexopathy in 2 (0.6%).
Controversies Regarding the Use of Radiation After Mastectomy in Breast Cancer
The Oncologist, 2002
Learning Objectives After completing this course, the reader will be able to:Explain the potential benefits of delivering radiation after mastectomy for patients with breast cancer.Provide a list of appropriate indications for selecting which patients would benefit from radiation after mastectomy and chemotherapy.Appreciate how radiation can potentially cause cardiovascular injuries and understand the importance of radiation technique in minimizing the risk for such injuries.Appreciate how immediate breast reconstruction can affect the delivery of postmastectomy radiation. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Despite years of clinical study, there are still many unanswered questions regarding postmastectomy radiation. It is clear that radiation therapy plays a critical role in the multidisciplinary management of patients with locally advanced or inflammatory breast cancer. It is also accepted that postmastecto...
European review for medical and pharmacological sciences, 2017
OBJECTIVE To assess the association of clinicopathologic and molecular features with loco-regional recurrence (LRR) in post-mastectomy breast cancer patients with or without adjuvant radiotherapy (PMRT). PATIENTS AND METHODS We retrospectively reviewed data of patients undergone to mastectomy followed or not by PMRT between January 2004 and June 2013. The patients were divided according to clinicopathologic and molecular sub-classification features. LRR and Cancer Specific Survival (CSS) were calculated using the Kaplan-Meier method; the prognostic factors were compared using long-rank tests and Cox regression model. RESULTS A total of 912 patients underwent to mastectomy of whom 269 (29.5%) followed by PMRT and 643 (70.5%) not; among the PMRT group, 77 underwent to the chest wall (CW) and 202 to the chest wall and lymphatic drainage (CWLD) irradiation. The median follow-up was 54 months (range, 3-118). No significant difference in terms of LRR and CSS was found between non-PMRT and...
The role of radiotherapy following total mastectomy for patients with early breast cancer
World Journal of Surgery, 1985
Analysis from a multicenter trial of the management of operable breast cancer now in its fifteenth year has confirmed earlier published results that there are no significant differences in survival and distant recurrence between the two treatment groups (“watch policy” and radiotherapy). However, patients receiving prophylactic radiotherapy at the time of mastectomy continue to have a reduced risk of developing local recurrence as the first sign of treatment failure (p<0.001). This increased risk is related to various known prognostic indicators such as tumor size and histological grade. Detailed analysis of local recurrence data has shown protection for the radiotherapy patients against recurrence in the chest wall and axilla but not in the supraclavicular area. The question of uncontrolled local disease persisting to death has also been addressed. L'analyse récente d'un essai multicentrique de traitement du cancer du sein opérable conduit depuis 15 ans est venue confirmer les résultats publiés antérieurement: il n'y a pas de différence significative en ce qui concerne le taux de récidive tardive et le taux de survie globale que les malades soient ou non traités par irradiation, cependant les malades qui sont soumis à la radiothérapie prophylactique au moment de la mastectomie présentent moins de risques de récidive locale qui signifie l'échec du traitement (p<0,001). L'augmentation du taux de ce risque est fonction de divers facteurs de pronostic: volume de la tumeur et stade histologique du cancer. L'analyse plus détaillée des récidives après radiothérapie montre que celles-ci concernent la région supraclaviculaire mais n'intéressent pas la paroi thoracique et le creux axillaire. La question du caractère incurable de certaines lésions mammaires est également envisagée. El análisis de un ensayo interinstitucional de manejo del cáncer mamario operable, el cual se encuentra en el año 15 de ejecución, ha confirmado los resultados previamente publicados que indican que no existen diferencias significativas en la supervivencia ni en la recurrencia a largo plazo entre los dos grupos del estudio, el de la “política de observación” y el de radioterapia. Sin embargo, las pacientes que recibieron radioterapia profiláctica en el momento de la mastectomía continúan demostrando un menor riesgo de desarrollar recurrencia local como primera manifestación de la falla del tratamiento (p<0.001). El mayor riesgo de desarrollar recurrencia local aparece relacionado con varios indicadores de pronóstico, tales como el tamaño del tumor y su gradación histológica. El análisis detallado de los datos de recurrencia local ha demostrado protección de la recuerrencia local en la pared torácica y en la axila en las pacientes sometidas a radioterapia, pero no en el área supraclavicular. Persiste el interrogante sobre la enfermedad local no controlable que persiste hasta la muerte, fenómeno que es causa de angustia para la paciente. Tal situación fué de ocurrencia mayor en le grupo de “política de observación” que en el de radioterapia.
Adjuvant radiotherapy after breast conserving surgery – A comparative effectiveness research study
Radiotherapy and Oncology, 2014
Breast cancer Breast conserving surgery Radiotherapy Comparative effectiveness research Outcome a b s t r a c t Purpose: The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population. Methods: Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan-Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression. Results: Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (p < 0.001). 10-year overall survival rates were 55.2% with surgery alone vs. 82.2% following postoperative radiotherapy (p < 0.001). Variables predicting omission of postoperative radiotherapy included advanced age (women P80 years; OR: 0.082; 95% CI: 0.071-0.094, p < 0.001).
CANCER REPORTS
Background: Radiotherapy is an effective local control therapy for breast cancer. Locoregional control is associated with distant metastasis risk and survival after surgery. Aim: We aimed to evaluate whether Japanese standard postoperative radiotherapy after surgery correlates with disease-free survival (DFS) and overall survival and clarify the characteristics of patients who benefit from it. Method and Results: This retrospective study included 626 operable breast cancer patients. Tumor characteristics and survival outcomes were compared between patients who received radiotherapy and those who did not. Cox proportional hazard analysis was used to analyze prognostic factors for DFS and perform subgroup analysis. Propensity score matching was used to evaluate the efficacy of radiotherapy using a logistic regression model in patients who received radiotherapy or did not. The median follow-up duration after diagnosis of breast cancer was 63 months. DFS and overall survival were better in the irradiated group (P= .002 and P = .001, respectively). Radiotherapy was more effective for estrogen receptor (ER)-positive disease and for early breast cancer without lymph node metastasis. Multivariate analysis revealed that radiotherapy was a dependent risk factor for recurrence or metastasis. Conclusion: Radiotherapy prevents distant metastasis and recurrence in early breast cancer patients. In particular, ER-positive, node-negative patients benefit from Japanese standard tangent field radiation. KEYWORDS early breast cancer, Japanese standard tangent field radiotherapy, radiation therapy 1 | INTRODUCTION Whole-breast radiation therapy (WBRT) after breast-conserving surgery and postmastectomy radiation therapy (PMRT) for node-positive patients reduces locoregional recurrence rates and overall mortality. 1-4 Local control after breast cancer surgery is associated with distant metastasis and overall survival (OS). Thus, radiation therapy is performed appropriately as primary therapy for early-stage breast cancer patients. However, aggressive irradiation including regional lymph nodes increases the risks of pneumonitis, lymphedema, cardiac disease, and late secondary neoplasms. 5-7 The WBRT area recommended by Japanese Society of Therapeutic Radiology (JASTRO) guidelines 8 usually includes a wider region, especially in the axillary area, than that recommended by the American Society of Radiation
Oncotarget, 2017
Purpose: This study was performed to identify a subset of patients who may benefit from post-mastectomy radiotherapy (PMRT) among node-negative breast cancer patients. Materials and Methods: We retrospectively reviewed 1,828 patients with pT1-2N0 breast cancer, treated with mastectomy without PMRT from 2005 to 2010 at 10 institutions. Univariate and multivariate analyses for locoregional recurrence (LRR) and any first recurrence (AFR) were performed according to clinicopathologic factors and biologic subtypes. Results: During a median follow-up period of 5.9 years (range: 0.7-10.4 years), 98 patients developed AFR (39 isolated LRR, 13 LRR with synchronous distant metastasis, and 46 isolated distant metastasis), and 52 patients developed LRR. The 7-year LRR and AFR rates were 3.8% and 6.7%, respectively. Multivariate analysis revealed that age of ≤ 40 years (p<0.001) and T2 stage (p=0.013) were independent risk factors for LRR. The 7-year LRR rates were 2.5% with no risk factors, 4.5% with one risk factor, and 12.4% with two risk factors. Multivariate analysis for AFR revealed that age of ≤ 40 years (p<0.001), T2 stage (p<0.001), and triple-negative biological subtype (p=0.045) were independent risk factors for AFR. The 7-year AFR rates were 3.9% with no risk factors, 8.4% with one risk factor, and 15.7% with two to three risk factors. Conclusions: Mastectomy without PMRT is a sufficient local treatment for pT1-2N0M0 breast cancer. Nevertheless, PMRT might be considered for patients with Clinical Research Paper