Definitive Breast Irradiation Research Articles

Long-term risk of second malignancies in women with ductal carcinoma in situ or early-stage invasive breast cancer after breast conservation treatment.

e12103 Background: Women with ductal carcinoma in situ (DCIS) or early stage breast cancer have a good prognosis after breast conservation treatment (BCT), and are at risk for second malignant neoplasms (SMNs). The long-term risk of SMNs is not well established and carries important public health implications. Methods: A total of 755 women with DCIS or stage I-II invasive breast cancer underwent breast-conserving surgery followed by definitive breast irradiation between 1995 and 2001. Systemic therapy (chemotherapy and/or hormonal therapy) was given to 73% of the patients. We have previously described patient demographics and 15-year oncologic outcomes in detail (Vapiwala, Cancer, 2017). The patient records were reviewed for development of SMNs. SMNs of any anatomic site (other than contralateral breast cancer and basal/squamous cell carcinoma of the skin) were included for analysis. The Kaplan-Meier method was used to determine the rate of SMNs over time. Median follow-up was 13.8 years. Results: The 5-, 10-, and 15-year rates of developing any SMN were 3.6% (95% CI 2.4-5.3%), 7.8% (95% CI 6.0-10.2%), and 12.7% (95% CI 10.2-15.8%). The most common SMNs were uterine (n=12), leukemia/lymphoma (n=11), melanoma (n=10), ovarian (n=9), and lung (n=7). Conclusions: Development of SMNs is a substantial risk for a protracted period of time following BCT. Clinical patterns of specific SMN histologies, locations and time course of development suggest potential opportunities for screening and treatment to guide patient survivorship clinics and protocols.

Results of Breast Conservation Therapy of DCIS without Radiation: Comparison to Mastectomy in a Prospective Study.

Abstract Aim:To assess the long-term outcome for women with DCIS of the breast treated in clinical practice by breast conservation surgery (BCS) without definitive breast irradiation in comparison to those treated by mastectomy (ME).Patients and MethodsWe studied 534 (of 599) patients with DCIS treated between 1992 and 2003 in a German regional cancer center. 287 patients underwent BCS without adjuvant radiotherapy whereas 247 patients were treated by ME. The decision was made after radiologic-pathological correlation and based on results of standardized pathology work-up including radiograms of whole specimen and slices. The decision was based on margins in 6 directions and maximum size of DCIS. In all cases with margins <10 mm a re-resection was performed, all patients with lesions >40 mm with margins <10 mm were advised to ME. All patients who decided for ME although their lesions did not show these criteria as all patients who could not followed were excluded. The median follow-up for the study population was 82 months.ResultsDuring the follow-up period 8/287 (2.8 %) patients of the BCS group and 10/247 (4.0 %) patients of the ME showed local recurrences. 2/8 (25 %) and 5/10 (50 %) of the recurrences were invasive. Neither regional nor systemic metastases were found, no patient died. Regarding these events there was no statistical significant difference between both groups.The BCS and ME group differed significantly in maximum diameters of DCIS (median 23 mm vs. 64 mm; p<0.001). There was no significant difference in nuclear grade distribution (BCS: 52 (18 %) grade 1, 115 (40 %) grade 2, 120 (42 %) grade 3; ME: 54 (22 %) grade 1, 99 (40 %) grade 2, 94 (38 %) grade 3).ConclusionsOur results support that under the precondition of margins >10mm, patients treated with BCS without radiotherapy can expect very low local recurrence risks similar to those treated with ME. This study continues to support the incremental benefit of margin width on recurrence under the precondition of standardised readilogic and pathological work-up of the specimens. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 953.

Outcomes After Breast Conservation Treatment With Radiation in Women With Prior Nonbreast Malignancy and Subsequent Invasive Breast Carcinoma

Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy. The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years. The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone. Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled.

Relationship of Breast Magnetic Resonance Imaging to Outcome After Breast-Conservation Treatment With Radiation for Women With Early-Stage Invasive Breast Carcinoma or Ductal Carcinoma in Situ

To determine the relationship of breast magnetic resonance imaging (MRI) to outcome after breast-conservation treatment (BCT) with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. A total of 756 women with early stage invasive breast carcinoma or ductal carcinoma in situ underwent BCT including definitive breast irradiation during 1992 to 2001. At the time of initial diagnosis and evaluation, routine breast imaging included conventional mammography. Of the 756 women, 215 women (28%) had also undergone a breast MRI study, and 541 women (72%) had not undergone a breast MRI study. The median follow-up after treatment was 4.6 years (range, 0.1 to 13.5 years). For the women with a breast MRI study compared with the women without a breast MRI study, there were no differences in the 8-year rates of any local failure (3% v 4%, respectively; P = .51) or local-only first failure (3% v 4%, respectively; P = .32). There were also no differences between the two groups for the 8-year rates of overall survival (86% v 87%, respectively; P = .51), cause-specific survival (94% v 95%, respectively; P = .63), freedom from distant metastases (89% v 92%, respectively; P = .16), or contralateral breast cancer (6% v 6%, respectively; P = .39). The use of a breast MRI study at the time of initial diagnosis and evaluation was not associated with an improvement in outcome after BCT with radiation.

Comorbidity and outcomes in elderly women treated with breast-conserving therapy

599 Background: Breast cancer incidence increases with age and is a major cause of morbidity and mortality among elderly women. Co-morbidities are often considered in treatment management of elderly women. Methods: Between 1979 and 2002, 238 women age 70 or older with unilateral stage I or II invasive breast cancer underwent conventional breast conservation treatment with radiation. The age distribution was 122 women (51%) age 70–74 years, 71 women (30%) age 75–79 years, and 45 women (19%) age ≥80 years. Surgical axillary staging was performed in 73% (n= 173) of patients, of which 73% (n=126) were N0, and 27% (n=47) were N1. Co-morbidities were scored using the Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS). Median follow-up was 6.2 years. Results: On analysis by age groups, the 10-year cancer specific outcomes were not significantly different (see Table ). However, distant metastases were the most common site of first failure in all age groups: 9% for age 70–74; 12% for age 75–79 and 11% for age >/= 80. Second malignancies were the second most common cause of first failure in all age groups. Death from intercurrent disease was significantly more likely in the older age groups. In this cohort, moderate and severe co-morbidities were not significantly more common in the older age groups, and CIRS score did not correlate with overall survival. Conclusions: Breast conserving surgery and definitive breast irradiation provide excellent outcomes in appropriately selected elderly women. Older age itself is not a contraindication to breast conserving therapy. Women of any age with lower co-morbidity indices should be offered standard treatment. [Table: see text] No significant financial relationships to disclose.

Radiation Treatment Volumes and Doses for Patients With Early-Stage Carcinoma of the Breast Treated With Breast-Conserving Surgery and Definitive Irradiation.

Abstract Radiation of the patient following breast-conserving surgery remains a difficult and challenging area of treatment. Many controversial areas remain to be resolved. The radiation oncologist must integrate the knowledge of the surgical procedures performed, the pathology findings, and the use of systemic therapy in order to determine optimal treatment of the breast and regional lymph nodes. The technical treatment may have an impact on the risk of local recurrence, the risk of complications, and the cosmetic outcome. The proper selection of the radiation fields and dose fractionation scheme remains an important component of optimizing the outcome of treatment for women treated with breast-conserving surgery and definitive breast irradiation for early-stage carcinoma of the breast.

Long‐term outcome after breast‐conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) is detected most commonly on routine screening mammography in the asymptomatic patient, and has a long natural history. The objective of the current study was to determine the long-term outcome after breast-conservation surgery followed by definitive breast irradiation for women with mammographically detected DCIS of the breast. In total, 1003 women with unilateral, mammographically detected DCIS of the breast underwent breast-conserving surgery followed by definitive breast irradiation. These women were treated in 10 institutions in North America and Europe. The median follow-up was 8.5 years (mean, 9.0 years; range, 0.2-24.6 years). The 15-year overall survival rate was 89%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 97%. In total, there were 100 local failures (10%) in the treated breast. The 15-year rate of any local failure was 19%, and the 15-year rate of local only first failure was 16%. Patient age > or = 50 years at the time of treatment and negative final pathology margins from the primary tumor excision both were associated independently with a lower risk of local failure in univariate analysis (P = 0.00062 and P = 0.024, respectively) and in multivariate analysis (P = 0.00057 and P = 0.0026, respectively). For favorable subgroups of patients age > or = 50 years or with negative resection margins, the 10-year risk of local failure was < or = 8%. The current results support the use of breast-conserving surgery followed by definitive breast irradiation for the treatment of patients with mammographically detected DCIS of the breast. Patient age > or = 50 years at the time of treatment and negative resection margins both were associated independently with a decreased risk of local failure.

Results of biopsies performed after breast conservation therapy for stage I-II breast cancer

843 Background: This study was performed to identify the factors predictive of positive biopsy after breast conservation therapy with definitive breast irradiation (RT) for early stage breast cancer. Methods: The records of patients treated for stage I-II unilateral or bilateral invasive breast cancer between 1977 and 1996 were reviewed to identify patients who had undergone post-treatment ipsilateral breast biopsies. Results: There were 195 biopsies performed in 193 treated breasts. The median time to biopsy was 49 months (mos) after irradiation. Among all biopsies, 59% were positive and 41% were negative. Subsequent biopsies were performed in 28 breasts, of which 27% were positive, thus 12% of women with a negative first biopsy later developed local recurrence. Biopsies were positive in 41% of patients with physical exam (PE) findings only, in 69% with mammographic findings only and in 80% with physical exam and mammographic abnormalities (p=0.001). When analyzed by type of biopsy, core biopsies were positive in 85% (6 of 7), excisional biopsies in 58%, and fine needle aspirations were positive in 28% (p=0.025). When analayzed by age at diagnosis, positive biopsies were obtained in 54% of patients age 51 or older, in 59% of patients age 36 to 50 and in 83% of patients 35 years or younger (p=0.05). Positive biopsy rate also increased with the interval from completion of radiation, as follows: ≤ 60 months = 50%; 61–120 months = 67%; 121–180 months = 80%; ≥ 181 months = 100% positive biopsies (p=0.01). Positive biopsy rate was not correlated with location of recurrence, pathologic T or N stage, ER/PR status or final pathologic margins of excision (all p ≥ 0.15). Conclusions: Biopsy remains the standard for diagnosis of local recurrence after breast conservation therapy. In this study, we identified groups at high risk for a positive biopsy. No significant financial relationships to disclose.

Results of biopsies performed after breast conservation therapy for stage I-II breast cancer

843 Background: This study was performed to identify the factors predictive of positive biopsy after breast conservation therapy with definitive breast irradiation (RT) for early stage breast cancer. Methods: The records of patients treated for stage I-II unilateral or bilateral invasive breast cancer between 1977 and 1996 were reviewed to identify patients who had undergone post-treatment ipsilateral breast biopsies. Results: There were 195 biopsies performed in 193 treated breasts. The median time to biopsy was 49 months (mos) after irradiation. Among all biopsies, 59% were positive and 41% were negative. Subsequent biopsies were performed in 28 breasts, of which 27% were positive, thus 12% of women with a negative first biopsy later developed local recurrence. Biopsies were positive in 41% of patients with physical exam (PE) findings only, in 69% with mammographic findings only and in 80% with physical exam and mammographic abnormalities (p=0.001). When analyzed by type of biopsy, core biopsies were positive in 85% (6 of 7), excisional biopsies in 58%, and fine needle aspirations were positive in 28% (p=0.025). When analayzed by age at diagnosis, positive biopsies were obtained in 54% of patients age 51 or older, in 59% of patients age 36 to 50 and in 83% of patients 35 years or younger (p=0.05). Positive biopsy rate also increased with the interval from completion of radiation, as follows: ≤ 60 months = 50%; 61–120 months = 67%; 121–180 months = 80%; ≥ 181 months = 100% positive biopsies (p=0.01). Positive biopsy rate was not correlated with location of recurrence, pathologic T or N stage, ER/PR status or final pathologic margins of excision (all p ≥ 0.15). Conclusions: Biopsy remains the standard for diagnosis of local recurrence after breast conservation therapy. In this study, we identified groups at high risk for a positive biopsy. No significant financial relationships to disclose.

Patterns of care in radiotherapy of breast cancer in Austria 1985: data acquisition and comparison with data of US-PCS 1983

PurposeIn Austria, a Patterns of Care Study (PCS) has been conducted to evaluate the standards of practice for breast cancer patients. The year 1985 was selected in order to establish a base data set. Materials and methodsAt all nine radiation therapy facilities active in patient treatment in 1985, ten patients charts were randomly selected and reviewed. Evaluation of the radiotherapeutic standards was the principal purpose, however, surgical and histopathological parameters were also considered. ResultsResults of the Austrian PCS (including 90 patients) were compared with the “1983 Patterns of Care Process Survey for Definitive Breast Irradiation” performed in 1983 in the U.S. (including 191 patients). Documentation of pathologic tumour size (83% vs. 73%), histologic tumour subtype (99% vs. 97%) and microscopic margin analysis (60% vs. 51%) showed comparable results. Technical equipment was obviously quite different in the two countries, cobalt therapy was used in 25% in the US-PCS compared to 71% in the Austrian PCS. A clear difference also was obtained concerning the use of wedges for tangential breast/thoracic wall fields (64% vs. 21%) and the frequency of portal films (93% vs. 26%). ConclusionsComparing both PCS studies, we found overall many similarities. Differences could be obtained in the quality level of radiation treatment, as for example use of wedges for tangential fields and the number of portal films. In a next step, a further Austrian PCS is planned to compare the Austrian base data from 1985 with quality standards from 1993 and 2001.

Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy.

The authors evaluated the risk factors for regional lymph node recurrence and the prognosis of patients with regional nodal recurrence after breast conservation therapy for Stage I-II breast carcinoma. Between 1977 and 1995, 1293 women with pathologic Stage I and II (T1-2, N0-1) breast carcinoma were treated with breast-conserving therapy including lumpectomy, axillary lymph node dissection, and definitive breast irradiation. A total of 39 women (3%) had any regional lymph node recurrence. The median follow-up was 8.5 years (range, 1.5-24 years). Among 39 patients with a regional lymph node recurrence, 10 women had regional recurrence only, 16 had simultaneous locoregional recurrence, and 13 had simultaneous regional and distant recurrence. Regional recurrence occurred in the axillary lymph nodes only (n = 21; 51%), supraclavicular lymph nodes only (n = 8; 23%), internal mammary lymph nodes only (n = 3; 8%), infraclavicular lymph nodes only (n = 3; 8%), or multiple lymph node sites (n = 4; 10%). The median time to regional lymph node recurrence was 3.1 years (range, 0.2-20.9 years). Overall survival after regional-only disease recurrence was 44%, locoregional disease recurrence was 26%, and regional with distant disease recurrence was 12%. Cause-specific survival rates at 10 years for the 3 groups were 44%, 40%, and 12%, respectively. For patients who presented with simultaneous regional and distant metastases, the median survival period was 1.1 years, compared with 5.2 years for women who developed distant disease subsequent to regional recurrence. Regional lymph node recurrence after breast conservation therapy may be salvaged, but is associated with a high rate of either simultaneous or subsequent distant metastatic dissemination and poor overall prognosis.

Long-term results for women with mammographically detected ductal carcinoma in-situ of the breast treated with breast-conserving surgery and definitive breast irradiation

Long-term results for women with mammographically detected ductal carcinoma in-situ of the breast treated with breast-conserving surgery and definitive breast irradiation

Conservative management of Paget disease of the breast with radiotherapy: 10- and 15-year results.

At 5-year follow-up, patients with Paget disease of the breast who were treated with breast-conserving surgery (BCS) and radiotherapy (RT) had excellent results. The current report provides 10- and 15-year rates of tumor control in the breast, as well as disease-free and overall survival rates following BCS and RT in a cohort of patients with Paget disease presenting without a palpable mass or mammographic density. Through a collaborative review of patients treated with BCS and RT from seven institutions, 38 cases of Paget disease of the breast presenting without a palpable mass or mammographic density were identified. All patients had pathologic confirmation of typical Paget cells at time of diagnosis. Thirty-six of 38 patients had a minimum follow-up greater than 12 months and constitute the study cohort. Ninety-four percent of patients underwent complete or partial excision of the nipple-areola complex and all patients received a median external beam irradiation dose of 50 Gy (range, 45-54 Gy) to the whole breast. Ninety-seven percent of patients also received a boost to the remaining nipple or tumor bed, a median total dose of 61.5 Gy (range, 50.4-70 Gy). With median follow-up of 113 months (range, 18-257 months), 4 of 36 patients (11%) developed a first recurrence of disease in the treated breast only. Two of the four recurrences in the breast were ductal carcinoma in situ (DCIS) only and two were invasive with DCIS. Two additional patients had a recurrence in the breast as a component of first failure. Actuarial local control rates for the breast as the only site of first recurrence were 91% at 5 years (95% confidence interval [CI], 80-100%) and 87% (95% CI, 75-99%) at both 10 and 15 years. Actuarial local control rates for breast recurrence, as a component of first failure, were 91% (95% CI, 80-100%), 83% (95% CI, 69-97%), and 76% (95% CI, 58-94%) at 5, 10, and 15 years, respectively. No clinical factors were identified as significant predictors for breast recurrence. Five-, 10- and 15-year actuarial rates for survival without disease of 97% (95% CI, 90-100%) and 5-, 10-, and 15-year actuarial rates of overall survival of 93% (95% CI, 84-100%) at 5 years and 90% (95% CI, 78-100%) at 10 and 15 years were reported. These data confirm excellent rates of local control, disease-free survival, and overall survival at 10 and 15 years following BCS and RT for Paget disease of the breast. This study continues to support the recommendation of local excision and definitive breast irradiation as an alternative to mastectomy in the treatment of patients with Paget disease presenting without a palpable mass or mammographic density.

The conservative management of Paget’s disease of the breast with radiotherapy: 10- and 15-year results

BACKGROUND. At 5-year follow-up, patients with Paget disease of the breast who were treated with breast-conserving surgery (BCS) and radiotherapy (RT) had excellent results. The current report provides 10- and 15-year rates of tumor control in the breast, as well as disease-free and overall survival rates following BCS and RT in a cohort of patients with Paget disease presenting without a palpable mass or mammographic density. METHODS. Through a collaborative review of patients treated with BCS and RT from seven institutions, 38 cases of Paget disease of the breast presenting without a palpable mass or mammographic density were identified. All patients had pathologic confirmation of typical Paget cells at time of diagnosis. Thirty-six of 38 patients had a minimum follow-up greater than 12 months and constitute the study cohort. Ninety-four percent of patients underwent complete or partial excision of the nipple-areola complex and all patients received a median external beam irradiation dose of 50 Gy (range, 45-54 Gy) to the whole breast. Ninety-seven percent of patients also received a boost to the remaining nipple or tumor bed, a median total dose of 61.5 Gy (range, 50.4-70 Gy). RESULTS. With median follow-up of 113 months (range, 18-257 months), 4 of 36 patients (11%) developed a first recurrence of disease in the treated breast only. Two of the four recurrences in the breast were ductal carcinoma in situ (DCIS) only and two were invasive with DCIS. Two additional patients had a recurrence in the breast as a component of first failure. Actuarial local control rates for the breast as the only site of first recurrence were 91% at 5 years (95% confidence interval [CI], 80-100%) and 87% (95% Cl, 75-99%) at both 10 and 15 years. Actuarial local control rates for breast recurrence, as a component of first failure, were 91% (95% CI, 80-100%), 83% (95% CI, 69-97%), and 76% (95% CI, 58-94%) at 5, 10, and 15 years, respectively. No clinical factors were identified as significant predictors for breast recurrence. Five-, 10- and 15-year actuarial rates for survival without disease of 97% (95% CI, 90-100%) and 5-, 10-, and 15-year actuarial rates of overall survival of 93% (95% CI, 84-100%) at 5 years and 90% (95% Cl, 78-100%) at 10 and 15 years were reported. CONCLUSIONS. These data confirm excellent rates of local control, disease-free survial, and overall survival at 10 and 15 years following BCS and RT for Paget disease of the breast. This study continues to support the recommendation of local excision and definitive breast irradiation as an alternative to mastectomy in the treatment of patients with Paget disease presenting without a palpable mass or mammographic density.

Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status

Purpose: This study was performed to determine the long-term outcome for women with mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. Methods and Materials: An analysis was performed of 422 mammographically detected intraductal breast carcinomas in 418 women from 11 institutions in North America and Europe. All patients were treated with breast-conserving surgery followed by definitive breast irradiation. The median follow-up time was 9.4 years (mean, 9.4 years; range, 0.1–19.8 years). Results: The 15-year overall survival rate was 92%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 94%. There were 48 local failures in the treated breast, and the 15-year rate of any local failure was 16%. The median time to local failure was 5.0 years (mean, 5.7 years; range, 1.0–15.2 years). Patient age at the time of treatment and final pathology margin status from the primary tumor excision were both significantly associated with local failure. The 10-year rate of local failure was 31% for patient age ≤ 39 years, 13% for age 40–49 years, 8% for age 50–59 years, and 6% for age ≥ 60 years ( p = 0.0001). The 10-year rate of local failure was 24% when the margins of resection were positive, 9% when the margins of resection were negative, 7% when the margins of resection were close, and 12% when the margins of resection were unknown ( p = 0.030). Patient age ≤ 39 years and positive margins of resection were both independently associated with an increased risk of local failure ( p = 0.0006 and p = 0.023, respectively) in the multivariable Cox regression model. Conclusions: The 15-year results from the present study demonstrated high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of mammographically detected ductal carcinoma in situ of the breast using breast-conserving surgery and definitive breast irradiation. Younger age and positive margins of resection were both independently associated with an increased risk of local failure. The 15-year results in the present study serve as an important benchmark for comparison with other treatment modalities. These results support the use of breast-conserving surgery and definitive breast irradiation for the treatment of appropriately selected patients with mammographically detected ductal carcinoma in situ of the breast.

Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience

Purpose: To evaluate the significance of final microscopic resection margin status on treatment outcomes in women with early breast cancer who are treated with breast-conserving surgery and definitive breast irradiation.Methods and Materials: An analysis was performed of 1021 consecutive women with clinical Stage I or II invasive carcinoma of the breast treated with breast-conserving surgery and definitive breast irradiation. Complete gross excision of tumor was performed in all cases, and an axillary staging procedure was performed to determine pathologic axillary lymph node status. The 1021 patients were divided into four groups based on the final microscopic margin from the tumor excision or from the re-excision if performed. These four groups were: (a) 518 patients with negative margins; (b) 124 patients with focally positive margins; (c) 96 patients with focally close margins (≤ 2 mm); and (d) 283 patients with unknown margins.Results: Local failure was not significantly different in patients with negative, focally positive, focally close or unknown final pathologic margins of resection at 8 years (8% vs. 10% vs. 17% vs. 16%, respectively, p = 0.21). The 8-year outcome also was not different among the four groups for overall survival (86% vs. 83% vs. 88% vs. 81%, respectively, p = 0.13), cause-specific survival (89% vs. 86% vs. 88% vs. 83%, respectively, p = 0.14), no evidence of disease survival (81% vs. 73% vs. 86% vs. 77%, respectively, p = 0.09), and freedom from distant metastases (85% vs. 75% vs. 86% vs. 79%, respectively, p = 0.08).Conclusion: These results demonstrate that selected patients with focally positive or focally close microscopic resection margins can be treated with breast-conserving surgery and definitive breast irradiation with 8-year local control rates and survival rates that are similar to those seen in breast-conservation patients with negative or unknown final resection margins.

The 1993–94 patterns of care process survey for definitive breast irradiation after breast-conserving surgery—Comparison with the 1992 ACR standard for breast conservation treatment

The 1993–94 patterns of care process survey for definitive breast irradiation after breast-conserving surgery—Comparison with the 1992 ACR standard for breast conservation treatment

Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation: The university of pennsylvania experience

Purpose : To determine whether patients with early-stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complications, and cosmesis. Methods and Materials : During the period 1977–1992, 55 women with State 0, I, or II concurrent ( n = 12) or sequential ( n = 43) bilateral breast cancer were treated with definitive irradiation following breast-conserving surgery. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, pathologic axillary lymph node status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Curves for survival, local control, and regional control were determined. Cosmetic outcome, complication rates, and matching technique were analyzed. The median total radiation dose delivered was 64 Gy *range 42–72) using tangential whole-breast irradiation followed by an electron or iridium implant boost. The tangential fields were matched with no overlap in 40 patients (73%); there was overlap on skin of up to 4 cm in 14 patients. (25%); and the matching technique was unknown in 1 patient (2%). The median follow-up for the 12 women with concurrent bilateral breast cancer was 4.0 years. The median follow-up for the other 43 women with sequential cancer was 9.3 and 4.9 years, respectively, after the first and second cancers. Results : For the overall group of 55 patients, the 5- and 10-year overall survival rates were 96% and 94%, respectively, after treatment of the first cancer, and 96% and 92%, respectively, after treatment of the second cancer. The 5- and 10-year actuarial relapse-free survival rates were 90% and 75%, respectively, after treatment of the first cancer, and 83% and 72%, respectively, after treatment of the second cancer. For the 110 treated breast cancers, th 5- and 10-year actuarial local failure rates were 5% and 15%, respectively. Complication rates were: 28% breast edema, 8% arm edema, 4% pneumonitis, 3% cellulitis, 1% rib fracture, and 1% brachial plexopathy; no patients developed matchline fibrosis. For patients with a minimum of 3 years of relapse-free follow-up, the rate of excellent or good cosmetic outcome for 104 treated beasts was 85%. Conclusion : Definitive irradiation after breast-consercing surgery is technically feasible for selected patients with concurrent or sequential early-stage bilateral breast cancer. Survival, local control, complication rates, and cosmetic outcomes appear comparable to historical reports of breast conservation treatment for unilateral disease. Bilateral definitive breast irradiation after breast-conservation surgery should be considered an acceptable alternative treatment to bilatera; mastectomy for selected patients with concurrent or sequential early-stage bilateral breast cancer.

Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast.

To determine the 15-year outcome for women with ductal carcinoma in situ (DCIS, intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. An analysis was performed of 270 intraductal breast carcinomas in 268 women from 10 institutions in Europe and the United States. In all patients, breast-conserving surgery included complete gross excision of the primary tumor followed by definitive breast irradiation. When performed, pathologic axillary lymph node staging was node-negative (n=86). The median follow-up time was 10.3 years (range, 0.9 to 26.8). The 15-year actuarial overall survival rate was 87%, and the 15-year actuarial cause-specific survival rate was 96%. The 15-year actuarial rate of freedom from distant metastases was 96%. There were 45 local recurrences in the treated breast, and the 15-year actuarial rate of local failure was 19%. The median time to local failure was 5.2 years (range, 1.4 to 16.8). A number of clinical and pathologic parameters were evaluated for correlation with local failure, and none were predictive for local failure (all P > or = .15). The results from the present study demonstrate high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of DCIS of the breast using breast-conserving surgery and definitive breast irradiation. These results support the use of breast-conserving surgery and definitive breast irradiation for the treatment of DCIS of the breast.

684 Is postoperative mammography prior to definitive breast irradiation therapy useful?

Following breast conserving surgery, the presence of abnormalities in postoperative mammography may influence the choice of subsequent treatment. We evaluated 120 pre- and post-operative mammograms of patients who underwent conservative surgery for breast cancer. The median interval between the pre and post-surgical mammograms was 98 days (range, 18–412 days). Clinical records of all patients were reviewed retrospectively. The site of surgery, postoperative complications, histologic characteristics, the dimensions of the resected tissues and the findings on physical examination of the breast befure and after surgery were recorded. The pre- and postoperative mammographic findings are analysed and the results compared with the literature. The purpose of this study was to evaluate the usefulness of post-operative mammography in determining the presence of residual tumor or other abnormalities before starting radiation therapy. Following breast conserving surgery, the presence of abnormalities in postoperative mammography may influence the choice of subsequent treatment. We evaluated 120 pre- and post-operative mammograms of patients who underwent conservative surgery for breast cancer. The median interval between the pre and post-surgical mammograms was 98 days (range, 18–412 days). Clinical records of all patients were reviewed retrospectively. The site of surgery, postoperative complications, histologic characteristics, the dimensions of the resected tissues and the findings on physical examination of the breast befure and after surgery were recorded. The pre- and postoperative mammographic findings are analysed and the results compared with the literature. The purpose of this study was to evaluate the usefulness of post-operative mammography in determining the presence of residual tumor or other abnormalities before starting radiation therapy.