Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T19:50:37.487Z Has data issue: false hasContentIssue false
  • English
  • Français

Therapeutic benefit of radiotherapy after surgery in patients with T1–T2 breast tumour

Published online by Cambridge University Press:  25 February 2010

Budhi S. Yadav ,
Suresh C. Sharma ,
Firuza D. Patel ,
S.M. Bose ,
Sushmita Ghoshal  and
Rakesh K. Kapoor
Budhi S. Yadav
Affiliation:
Radiation Oncology, Pinnacle Oncology International, Ivy Hospital, Mohali, India
Suresh C. Sharma
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Firuza D. Patel
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
S.M. Bose
Affiliation:
Fortis Hospital, Mohali, India
Sushmita Ghoshal
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Rakesh K. Kapoor
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose: To look for the therapeutic benefit of radiotherapy after surgery in patients with T1–T2 breast tumour.

Methodology: From 1990 to 2000, 915 patients with T1–T2 breast tumour who underwent mastectomy or conservative breast surgery (CBS) with or without radiotherapy were analysed retrospectively for age, disease stage, radiation therapy technique, dose, the use of chemotherapy or hormonal therapy and other clinical and/or pathologic characteristics. The Kaplan–Meier method was used to estimate locoregional recurrence-free survival (LRRFS) and overall survival (OS). The Cox proportional hazard regression model was used to determine significant prognostic factors affecting LRRFS and OS.

Results: At a median follow up of 74 months, LRR rate was 5.3% and distant metastases rate was 19%. Disease-free survival (DFS) and OS at 10 year was 72% and 76%, respectively. LRR in patients with CBS followed with radiation was 3% as compared to 33% without radiation. LRR in patients with post-mastectomy radiation was 3% as compared to 19% without radiation. In patients with N0 nodes, LRR was 4% with radiation and 20% without radiation. Worst case was in patients with CBS-N0 who were not given radiation. LRR in such patients was 32% as compared to 5% in those who were given radiation post-CBS. In patients with mastectomy with N0 status, LRR was 3% with radiation as compared to 18% with out radiation. On univariate analysis factors affecting LRRFS were type of surgery, nodal involvement, radiotherapy and hormonal therapy. Factors affecting OS were nodal involvement, grade, lymphovascular invasion (LVI), ductal carcinoma in situ (DCIS), extracapsular extension (ECE), chemotherapy and radiotherapy. On multivariate analysis factors affecting LRRFS were type of surgery, nodal involvement, radiotherapy and hormonal therapy. Factors affecting OS were nodal involvement, LVI, DCIS, ECE, chemotherapy and radiotherapy.

Conclusion: Radiation use offered a therapeutic advantage for all patients with T1–T2 breast cancer.

Keywords

Breast cancerprognostic factorsradiotherapysurgery
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 9 , Issue 1 , March 2010 , pp. 33 - 40
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Nandakumar, A, Anantha, A, Venugopal, TC, Rengaswamy, Sankaranarayanan, Thimmasetty, K, Dhar, M. Survival in breast cancer: a population based study in Bangalore, India. Int J Cancer 1995; 60:593–596.Google Scholar
Bedi, R, Bhutani, M, Deo, SVS, Mohanti, BK, Raina, V, Rath, GK, Sharma, A, Shukia, NK. Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J Cancer 2005; 42:40–45.Google Scholar
Dinshaw, KA, Budrukkar, AN, Chinoy, RF, Sarin, R, Badwe, R, Hawaldar, R, Shrivatsava, SK. Profile of prognostic factors in 1022 Indian women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2005; 63:1132–1141.CrossRefGoogle ScholarPubMed
Clarke, M, Collins, R, Darby, Set al.; Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of randomized trials. Lancet 2005; 366:2087–2106.Google Scholar
Nielson, HM, Overgaard, M, Grau, C, Jansen, AR, Overgaard, J. Loco-regional recurrence after mastectomy in high-risk breast cancer – risk and prognosis. An analysis of patients from the DBCG 82b&c randomization trials. Radiother Oncol 2006; 79:147–155.CrossRefGoogle Scholar
Ragaz, J, Olivotto, IA, Spinelli, JJ, et al. Locoregional radiation therapy in patients with high risk breast cancer receiving adjuvant chemotherapy: 20-year results of British Columbia randomized trial. J Natl Cancer Inst 2005; 97:116–126.Google Scholar
Katz, A, Strom, EA, Buchholz, TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 2000; 18:2817–2827.CrossRefGoogle ScholarPubMed
Recht, A, Gray, R, Davidson, NEet al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen, without irradiation: Experience of the Eastern Cooperative Group. J Clin Oncol 1999; 17:1689–1700.Google Scholar
Taghian, A, Jeong, J-H, Mamounas, E, Anderson, S, Bryant, J, Deutsch, M, Wolmark, N. Pattern of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or with tamoxifen and with out radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 2004; 22:4247–4254.Google Scholar
Ribiero, GG, Magee, B, Swindell, R, Harris, M, Banerjee, SS. The Christie Hospital Breast Conservation Trial: an update at 8 years from inception. Clin Oncol 1993; 5:278–283.Google Scholar
National Cancer Registry Programme. Ten year consolidated report of the hospital based cancer registries 1984–1993. An assessment of the burden and care of cancer patients. New Delhi: Indian Council of Medical Research, 2001.Google Scholar
National Cancer Registry Programme. Consolidated report of the population based cancer registries 1990–1996. New Delhi: Indian Council of Medical Research, 2001.Google Scholar
National Cancer Registry Programme. Consolidated report of the population based cancer registries 1990–1996. Supplement year-wise tabulation of incident cancers and rates by site and gender. New Delhi: Indian Council of Medical Research, 2001.Google Scholar
Cheng, SH, Horng, CF, Clarke, JL, et al. Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients. Int J Radiat Oncol Biol Phys 2006; 64:1401–1409.CrossRefGoogle ScholarPubMed
Truong, PT, Olivotto, IA, Kader, HA, Panades, M, Speers, CH, Berthelet, E. Selecting breast cancer patients with T1–T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuant radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61:1337–1347.CrossRefGoogle Scholar
Woodward, WA, Strom, EA, Tucker, SL, et al. Locoregional recurrence after doxorubicin-based chemotherapy and postmastectomy: implications for breast cancer patients with early-stage disease and predictors for recurrence after posmastectomy radiation. Int J Radiat Oncol Biol Phys 2003; 57:336–344.CrossRefGoogle Scholar
Overgaard, M, Nielsen, HM, Overgaard, J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b & c randomized trials. Radiother Oncol 2007; 82:247–253.CrossRefGoogle ScholarPubMed
Truong, PT, Woodward, WA, Thames, HD, Ragaz, J, Olivotto, IA, Buchholz, TA. The ratio of positive to excised nodes identifies high risk subsets and reduces inter-institutional differences in locoregional recurrence risk estimates in breast cancer patients with 1–3 positive nodes: an analysis of the prospective data from British Columbia and the M.D. Anderson cancer center. Int J Radiat Oncol Biol Phys 2007; 68:59–65.CrossRefGoogle ScholarPubMed
van der Wal, BC, Butzelaar, RM, van der Meij, S, Boermeester, MA. Axillary lymph node ratio and total number of removed lymphnodes: predictors of survival in stage I and stage II breast cancer. Eur J Surg Oncol 2002; 28:481–489.CrossRefGoogle Scholar
Voordeckers, M, Vinh-Hung, V, Van de Steene, J, Lamote, J, Storme, G. The lymph node ratio as prognostic factor in node-positive breast cancer. Radiother Oncol 2004; 70:225–230.Google Scholar
Fortin, A, Dagnault, A, Blondeau, L, Vu, TT, Larochelle, M. The impact of the number of excised axillary nodes and of the percentage of involved nodes on regional nodal failure in patients treated by breast-conserving surgery with or with out regional irradiation. Int J Radiat Oncol Biol Phys 2006; 65:33–39.Google Scholar
Pisansky, TM, Ingle, JN, Schaid, DJ, Hass, AC, Krook, JE, Donohue, JH, Witzig, TE, Wold, LE. Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer: impact of clinical, histopathologica, and flow cytometric factors. Cancer 1993; 72:1247–1260.3.0.CO;2-S>CrossRefGoogle Scholar
Overgaard, M, Hansen, P, Overgaard, J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997; 337:949–955.Google Scholar
Overgaard, M, Jensen, MB, Overgaard, J, et al. Postoperative radiotherapy in high risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet 1999; 353:1641–1648.CrossRefGoogle Scholar
Whelan, J, Julian, J, Wright, J, Jadad, AR, Levine, ML. Does locoregional radiation therapy improve survival in breastcancer? A meta-analysis. J Clin Oncol 2000; 18:1220–1226.Google Scholar
Recht, A, Edge, SB, Solin, LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19:1539–1566.Google Scholar
Harris, JR, Halpin-Murphy, P, McNeese, M, Mendenhall, NP, Morrow, M, Robert, NJ. Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 1999; 44:989–990.CrossRefGoogle ScholarPubMed