Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

Abstract

The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction </=7 and be excised with at least 1 cm margin. During a mean follow-up time of 6.7 years, 13 (18.1%) cancers recurred locally in the no-XRT and 6 (7.5%) in the XRT group (P = 0.03). There was no difference between the groups in the ultimate breast preservation rate (95.0% vs. 94.4% in XRT and no-XRT, respectively, P = 0.88), distant metastasis-free survival (P = 0.36), or 5-year cancer-specific survival (97.1% in XRT and 98.6 in no-XRT). Radiation therapy given after lumpectomy reduces the frequency of ipsilateral breast recurrences even in women with small breast cancer with several favourable clinical and biological features. However, the breast preservation rate may not increase due to more frequent use of salvage mastectomies in patients treated with postoperative radiotherapy.

References 29

1. 1.
   Histological Grading and Prognosis in Breast Cancer · 1957

   No notice
2. 2.

   Clark R. M., McCulloch P. B., Levine M. N., Lipa M., Wilkinson R. H., Mahoney L. J., Basrur V. R., Nair B. D., McDermot R. S., Wong C. S. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84(9):683-689.

   Not in our library10.1093/jnci/84.9.683

3. 3.

   Clarke D. H., Martinez A. A. Identification of patients who are at high risk for locoregional breast cancer recurrence after conservative surgery and radiotherapy: a review article for surgeons, pathologists, and radiation and medical oncologists. J Clin Oncol. 1992;10(3):474-483.

   Not in our library10.1200/jco.1992.10.3.474

4. 4.

   Dalberg K., Eriksson E., Kanter L., Sandelin K., Liedberg A., Auer G., Thorstensson S., Fredriksson I., Johansson U., Rutqvist L. E. Biomarkers for local recurrence after breast-conservation--a nested case-control study. Breast Cancer Res Treat. 1999;57(3):245-259.

   Not in our library10.1023/a:1006281718793

5. 5.

   Fisher B., Anderson S., Fisher E. R., Redmond C., Wickerham D. L., Wolmark N., Mamounas E. P., Deutsch M., Margolese R. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991;338(8763):327-331.

   Not in our library10.1016/0140-6736(91)90475-5

6. 6.

   Fisher B., Anderson S., Redmond C. K., Wolmark N., Wickerham D. L., Cronin W. M. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333(22):1456-1461.

   Not in our library10.1056/nejm199511303332203

7. 7.

   Fisher B., Dignam J., Wolmark N., Mamounas E., Costantino J., Poller W., Fisher E. R., Wickerham D. L., Deutsch M., Margolese R. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16(2):441-452.

   Not in our library10.1200/jco.1998.16.2.441

8. 8.

   Forrest A. P., Stewart H. J., Everington D., Prescott R. J., McArdle C. S., Harnett A. N., Smith D. C., George W. D. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet. 1996;348(9029):708-713.

   Not in our library10.1016/s0140-6736(96)02133-2

9. 9.

   Fourquet A., Campana F., Zafrani B., Mosseri V., Vielh P., Durand J. C., Vilcoq J. R. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1989;17(4):719-725.

   Not in our library10.1016/0360-3016(89)90057-6

10. 10.

    Fowble B. L., Schultz D. J., Overmoyer B., Solin L. J., Fox K., Jardines L., Orel S., Glick J. H. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys. 1994;30(1):23-33.

    Not in our library10.1016/0360-3016(94)90515-0

11. 11.

    Gage I., Schnitt S. J., Nixon A. J., Silver B., Recht A., Troyan S. L., Eberlein T., Love S. M., Gelman R., Harris J. R. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78(9):1921-1928.

    Not in our library10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-#

12. 12.

    Holland R., Connolly J. L., Gelman R., Mravunac M., Hendriks J. H., Verbeek A. L., Schnitt S. J., Silver B., Boyages J., Harris J. R. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990;8(1):113-118.

    Not in our library10.1200/jco.1990.8.1.113

13. 13.

    Julien J. P., Bijker N., Fentiman I. S., Peterse J. L., Delledonne V., Rouanet P., Avril A., Sylvester R., Mignolet F., Bartelink H. 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(9203):528-533.

    Not in our library10.1016/s0140-6736(99)06341-2

14. 14.

    Kearney T. J., Morrow M. Effect of reexcision on the success of breast-conserving surgery. Ann Surg Oncol. 1995;2(4):303-307.

    Not in our library10.1007/bf02307061

15. 15.

    Kurtz J. M., Amalric R., Brandone H., Ayme Y., Jacquemier J., Pietra J. C., Hans D., Pollet J. F., Bressac C., Spitalier J. M. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer. 1989;63(10):1912-1917.

    Not in our library10.1002/1097-0142(19890515)63:10<1912::aid-cncr2820631007>3.0.co;2-y

16. 16.

    Kurtz J. M. Factors influencing the risk of local recurrence in the breast. Eur J Cancer. 1992;28(2-3):660-666.

    Not in our library10.1016/s0959-8049(05)80121-2

17. 17.

    Kurtz J. M., Jacquemier J., Amalric R., Brandone H., Ayme Y., Hans D., Bressac C., Roth J., Spitalier J. M. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990;65(8):1867-1878.

    Not in our library10.1002/1097-0142(19900415)65:8<1867::aid-cncr2820650833>3.0.co;2-i

18. 18.

    Liljegren G., Holmberg L., Adami H. O., Westman G., Graffman S., Bergh J. Sector resection with or without postoperative radiotherapy for stage I breast cancer: five-year results of a randomized trial. Uppsala-Orebro Breast Cancer Study Group. J Natl Cancer Inst. 1994;86(9):717-722.

    Not in our library10.1093/jnci/86.9.717

19. 19.

    Liljegren G., Holmberg L., Bergh J., Lindgren A., Tabár L., Nordgren H., Adami H. O. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17(8):2326-2333.

    Not in our library10.1200/jco.1999.17.8.2326

20. 20.

    Locker A. P., Ellis I. O., Morgan D. A., Elston C. W., Mitchell A., Blamey R. W. Factors influencing local recurrence after excision and radiotherapy for primary breast cancer. Br J Surg. 1989;76(9):890-894.

    Not in our library10.1002/bjs.1800760906

21. 21.

    Renton S. C., Gazet J. C., Ford H. T., Corbishley C., Sutcliffe R. The importance of the resection margin in conservative surgery for breast cancer. Eur J Surg Oncol. 1996;22(1):17-22.

    Not in our library10.1016/s0748-7983(96)91253-6

22. 22.

    Sinn H. P., Anton H. W., Magener A., von Fournier D., Bastert G., Otto H. F. Extensive and predominant in situ component in breast carcinoma: their influence on treatment results after breast-conserving therapy. Eur J Cancer. 1998;34(5):646-653.

    Not in our library10.1016/s0959-8049(97)10106-x

23. 23.

    Veronesi U., Luini A., Del Vecchio M., Greco M., Galimberti V., Merson M., Rilke F., Sacchini V., Saccozzi R., Savio T. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993;328(22):1587-1591.

    Not in our library10.1056/nejm199306033282202

24. 24.

    Veronesi U., Salvadori B., Luini A., Greco M., Saccozzi R., del Vecchio M., Mariani L., Zurrida S., Rilke F. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer. 1995;31A(10):1574-1579.

    Not in our library10.1016/0959-8049(95)00271-j

25. 25.

    Veronesi U., Zucali R., Del Vecchio M. Conservative treatment of breast cancer with QU.A.R.T. Technique. World J Surg. 1985;9(5):676-681.

    Not in our library10.1007/bf01655180

26. 26.

    Voogd A. C., Peterse J. L., Crommelin M. A., Rutgers E. J., Botke G., Elkhuizen P. H., van Geel A. N., Hoekstra C. J., van Pel R., van de Vijver M. J. Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer. Dutch Study Group on local Recurrence after Breast Conservation (BORST). Eur J Cancer. 1999;35(13):1828-1837.

    Not in our library10.1016/s0959-8049(99)00220-8

27. 27.

    Whelan T., Clark R., Roberts R., Levine M., Foster G. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group. Int J Radiat Oncol Biol Phys. 1994;30(1):11-16.

    Not in our library10.1016/0360-3016(94)90513-4

28. 28.

    de la Rochefordiere A., Asselain B., Campana F., Scholl S. M., Fenton J., Vilcoq J. R., Durand J. C., Pouillart P., Magdelenat H., Fourquet A. Age as prognostic factor in premenopausal breast carcinoma. Lancet. 1993;341(8852):1039-1043.

    Not in our library10.1016/0140-6736(93)92407-k

29. 29.

    de la Rochefordière A., Abner A. L., Silver B., Vicini F., Recht A., Harris J. R. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys. 1992;23(5):925-931.

    Not in our library10.1016/0360-3016(92)90896-p

Cited by papers we hold 1

• Accelerated Partial Breast Irradiation (APBI): A review of available techniques · 2010
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.