Results Of Breast-conserving Therapy Research Articles

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.

Long-term results of breast-conservation therapy for Japanese women classified according to intrinsic subtype

e11578 Background: Microarray analysis has identified breast cancer subtypes with distinct gene expression profiles according to the estrogen receptor (ER) and the human epidermal growth factor 2 (HER2) expression. The luminal subtypes (ER-positive) appear to be associated with the better prognosis, whereas the basal and HER2 subgroups tend to have worse recurrence rates. The impact of intrinsic subtype for Japanese women with early-stage invasive breast cancer on prognosis is unknown. The purpose of this study is to address whether breast cancer subtype is associated with recurrence among Japanese women who receive breast-conservation therapy (BCT). Methods: The study cohort included 770 consecutive women with invasive breast cancer who received BCT at University of Tokyo Hospital from 1994 through 2007. Among them, 285 women had complete information on the ER and HER2 status of their primary tumors. The number of patients according to luminal A (ER+HER2- ), luminal B (ER+ HER2+), basal (ER-HER2-) and HER2 (ER-HER2+) subtype was 162, 66, 40 and 17, respectively. All patients received external-beam radiation therapy to the whole breast. The most common doses were 50 Gy in 25 fractions to the whole breast plus a tumor-bed boost to 60 Gy. Results: Median follow-up time was 55 months (range, 6 to 144 months). No significant difference was observed between 5-year disease control and four major subtypes. The 5-year relapse free survival rate of HER2-positive and -negative patients was 77% vs. 95%, which was of statistically significance (p = 0.001). Multivariate analysis showed that T stage, N stage, HER2 status and lymphatic vessel invasion correlated significantly with shorter relapse free survival. Multivariate analysis showed that only N stage was associated with decreased overall survival (p = 0.017). Conclusions: Overall, the 5-year relapse free survival rate after BCT was high, and no significant difference was found in four major subtypes as approximated using ER and HER2 status in Japanese women who receive BCT. Only HER2 status was a statistically significant risk factor after BCT. Although further follow-up is needed, BCT may still be optimal option in Japanese women with early-stage invasive breast cancer to whichever intrinsic subtype their tumors belong. No significant financial relationships to disclose.

The results of breast-conserving therapy in 67 patients of primary early stage breast cancer

Objective To discuss the effects of breast-conserving therapy with early primary breast car-cinoma. Methods 67 patients with early primary breast carcinoma were operated with wide local excision and axillary lymph node dissection. The radiotherapy and chemotherapy after breast conservative surgery were done on the whole breast. Results After a median followed-up of 26 months(range 3 ～ 55 months), the approval rate for their breast was 88%. There were one case death and one patient suffered from ipsilateral breast tumor relapse.The three years local relapse rate was 2. 5%. Conclusion The early results of breast-conserving therapy are satisfactory for early stage primary breast cancer. The long-term follow-up is needed for the final outcome. Key words: Breast neoplasms ; Theatment outcome ; Breast-conserving therapy

Risk Factors of Local Recurrence after Breast Conserving Therapy in Invasive Breast Cancer

유방보존술이증가하면서유방보존술후발생하는국소재발 Purpose: Twenty-year follow-up results of two pioneering randomized controlled trials have demonstrated equal patient survival after mastectomy and breast conservation therapy. The use of breast conservation therapy has undoubtedly provided substantial progress towards a better quality of life for women with breast cancer. Outcomes of breast conservation therapy performed at Asan medical center were retrospectively reviewed and analyses were performed to determine significant risk factors of local recurrence. Methods: A total of 578 women with stage I, stage II or stage III breast cancer were treated with conservative surgery and radiation therapy between January 1997 and December 2002. Outcomes of local recurrence and survival were recorded. Results: During a median follow-up of 54.1 months, 21 patients (3.6%) developed local recurrence as first event and 10 patients (1.7%) developed regional recurrence and 19 patients (3.3%) developed systemic recurrence. Univariate analysis of the prognostic factors determined that age (p=0.005), nuclear grade (p=0.013), estrogen receptor negativity (p=0.008), lymphovascular invasion (p=0.009), progesterone receptor negativity (p=0.016) and lack of hormone therapy (p=0.005) were statistically significant factors associated only with locoregional recurrence. Results of multivariate analysis determined that lymphovascular invasion (p=0.045) strongly independent predictors for local recurrence. Conclusion: Age, nuclear grade, estrogen receptor negativity, lymphovascular invasion, progesterone receptor negativity and lack of hormone therapy were associated with local recurrence after Breast conserving surgery. The lymphovascular invasion was the strongest independent risk factors for local recurrence.

Long Term Results of Breast Conservation Therapy in an Asian Population: Results from National Cancer Centre Singapore

To examine the long-term clinical outcomes in Asian women who have undergone breast conservation therapy (BCT) for early stage breast cancer in a single institution with regards to loco-regional control, disease-free (DFS) and overall survival (OS).

Implications from long-term follow-up after breast-conserving therapy for patient selection and duration of follow-up: The Edinburgh experience

555 Background: There are a few large population-based series assessing the long-term outcomes of breast-conserving therapy (BCT). Methods: A consecutive series (1981–98) of 1,812 women managed by wide local excision and postoperative radiotherapy (45Gy in 20–25 fractions). Results: Mean age was 54.9 years, range 24–91. Median clinical tumor size was 20mm. Histology was no special type in 1,477 patients (78.8%), tubular in 95 patients and lobular in 121. Tumor grade was available in 1,734 patients (450 grade 1, 767 grade 2, and 517 grade 3). Of 1,725 patients with margin status recorded, there was involvement by IBC in 250 and DCIS in 50. Axillary surgery was node sample in 1,385 patients (76.4%), level III clearance in 391 patients, and level II dissection in 36. Axillary lymph nodes were histologically node negative in 1,318 patients (72.7%). Adjuvant systemic therapy was tamoxifen alone in 1,179 patients (65.1%) and other hormone therapy in 250 patients. 306 patients received chemotherapy with half the...

The Effect of Silicone Implants on the Diagnosis, Prognosis, and Treatment of Breast Cancer

Because of the prevalence of breast cancer, many augmented women eventually will develop the disease. This article reviews what is known about the effect of implants on the detection, prognosis, and treatment of carcinoma of the breast. Observations were made on 4082 breast cancer patients (3953 nonaugmented and 129 augmented) treated over a 23-year time span. Findings in the two groups were compared and differences analyzed statistically. Mammograms of all women with palpable lesions were reviewed to assess mammographic sensitivity in patients with and without implants. Cosmetic outcomes in augmented patients treated with breast conservation therapy were reviewed. Augmented patients presented more frequently with palpable lesions, invasive tumors, axillary nodal metastases, and false-negative mammograms. However, there was no significant difference in stage of disease, tumor size, recurrence rates, or survival between the two groups. Augmented patients treated with breast conservation therapy often experienced poor cosmetic results and frequently required reoperation. Despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage of disease and have a comparable prognosis. Implants may impair mammography but appear to facilitate tumor detection on physical examination. Magnetic resonance imaging and breast ultrasound may be useful adjuncts, but conventional mammography remains the most reliable tool for diagnosing early breast cancer in augmented patients. Breast implants do not interfere with mastectomy or breast reconstruction but may compromise the outcome of breast conservation therapy.

Clinical Outcome of Breast Conservation Therapy for Breast Cancer in Hong Kong: Prognostic Impact of Ipsilateral Breast Tumor Recurrence and 2005 St. Gallen Risk Categories

The aim of this study was to evaluate the clinical outcome of breast conservation therapy (BCT) for invasive breast cancers in our predominantly Chinese population. Clinical outcomes of 412 T1-2 invasive breast cancers treated by wide local excision and external radiotherapy from 1994 to 2003 were retrospectively analyzed. Only 7% lesions were first detected by mammograms. Adjuvant tamoxifen and chemotherapy were added in 74% and 45% patients, respectively. The median follow-up was 5.4 years. The 5-year actuarial ipsilateral breast tumor recurrence (IBTR) rate, distant failure-free survival, cause-specific survival, and overall survival were 4%, 92%, 96%, and 98%, respectively. The 5-year distant failure-free survival for the low-risk, intermediate-risk, and high-risk categories (2005 St. Gallen) were 98%, 91%, and 80%, respectively (p = 0.0003). Cosmetic results were good to excellent in more than 90% of the assessable patients. Grade 3 histology (hazard ratio [HR], 4.461; 95% CI, 1.216-16.360; p = 0.024), age (HR, 0.915; 95% CI, 0.846-0.990; p = 0.027), and close/positive final margins (HR, 3.499; 95% CI, 1.141-10.729; p = 0.028) were significant independent risk factors for IBTR. Both St. Gallen risk categories (p = 0.003) and IBTR (HR, 5.885; 95% CI, 2.494-13.889; p < 0.0005) were independent prognostic factors for distant failure-free survival. Despite the low percentage of mammographically detected lesions, the overall clinical outcome of BCT for invasive breast cancers in the Chinese population is comparable to the Western series. The 2005 St. Gallen risk category is a promising clinical tool, but further validation by large studies is warranted.

P220: Predictors of locoregional recurrence to plan breast conservation therapy for breast cancer

Introduction: Since 20-year follow-up results of two pioneering randomized controlled trials demonstrating equal survival after mastectomy and breast conservation therapy, breast conservation therapy undoubtedly represents substantial progress for a better quality of life for women with breast cancer. The outcome of breast conservation therapy at Seoul Asan Medical Center were retrospectively reviewed, and analyses carried out to obtain the 5 year disease free survival rates and significant prognostic factors.

166: Delayed Breast Cellulitis: An Evolving Complication of Breast Conservation

166: Delayed Breast Cellulitis: An Evolving Complication of Breast Conservation

Treatment outcome of breast-conserving therapy in patients with positive or close resection margins: Japanese multi institute survey for radiation dose effect

The relationship between a positive resection margin and the risk of ipsilateral breast tumor recurrence (IBTR) is controversial. To evaluate the radiation dose and other factors influencing the ipsilateral breast tumor control (IBTC) in patients with positive or close resection margins after breast conserving surgery (BCS), the Japanese Radiation Oncology Study Group (JROSG) S-99-3 study group conducted a multi-institute survey of these patients. The patients with less than 5 mm tumor-free margins after BCS were eligible for this study. A total of 971 patients from 18 institutes were enrolled in the analysis. The final pathological margin status was classified into 3 groups. Radiation doses to the tumor bed were less than 60 Gy in 252 patients, 60 Gy in 456 patients and more than 60 Gy in 233 patients. IBTR was observed in 55 patients (5.8%). The IBTC rates at 5 and 10 years by the Kaplan Meier method were 95.6% and 87.3%, respectively. There was no significant difference in 10-year IBTC rates according to marginal status; 85.9% in positive margin patients, 91.0% in equal or less than 2 mm margin patients and 87.0% in 2.1-5 mm margin patients. Radiation dose to the tumor bed was a marginally significantly associated with the 10-year IBTC rate (> or = 60 Gy 90.8% vs < 60 Gy 84.2%, p = 0.057). In patients with positive margins, IBTC with radiation dose equal to or more than 60 Gy was significantly better (p = 0.039). The other factors influencing the IBTC were age (> or = 35 years vs < 35 years: p < 0.0001), menopausal status (p < 0.0001) and tumor size (p = 0.023). In patients with positive margins, IBTC with radiation dose equal to or more than 60 Gy was significantly better than the others. We recommend that the tumor bed be irradiated with at least 60 Gy in the patients with positive margins. Further follow-up is necessary to draw final conclusions.

Radiation Therapy and Breast Conservation: Cosmetric Results and Complications.

Although the oncologic results of breast-conserving therapy are highly satisfactory, its possible superiority to mastectomy as a treatment option depends to a great extent on offering the patient an esthetic and functional result superior to that obtained by total mastectomy and breast reconstruction, while minimizing the risk of complications. It is the responsibility of the radiation oncologist to be aware of the cosmetic results and potential complications associated with current techniques and to take into account the factors known to contribute to an unfavorable outcome. Only the well-informed radiation oncologist is in a position to tailor the technique of radiotherapy and its coordination with other treatment modalities to match the oncologic risk faced by the individual patient.

Results of breast conservation therapy from a single-institution community hospital in Hawaii with a predominantly Japanese population

To evaluate the outcome data from breast conservation therapy performed at the Kuakini Medical Center in Honolulu, Hawaii. The remarkably low rates of recurrence found in this study prompted a review of the literature and evaluation of the prognostic factors that may explain these results. The data from patients with Tis, T1 or T2 breast tumors, treated with lumpectomy and radiotherapy during the 12-year period between January 1990 and December 2001 were retrospectively reviewed and compared to results found in national publications. Current follow-up data was available in 97.1% of patients who met these criteria, identifying a total of 896 patients who were analyzed in this study. With a median follow-up exceeding 6 years, the local in-breast failure rate was 0.67%. Survival data was superior to the National Cancer Data Base for each stage of disease. This low rate of local relapse is extraordinary and unmatched by the published results generally cited in the literature. The findings are consistent with other studies reporting unusually low rates of breast cancer recurrence in patients of Japanese ancestry.

A comparison of different boost types in breast conserving therapy (BCT): Retrospective considerations

A comparison of different boost types in breast conserving therapy (BCT): Retrospective considerations

73 oral TI breast cancer tumors: results of breast-conserving therapy

73 oral TI breast cancer tumors: results of breast-conserving therapy

Outcome of breast-conserving therapy in the Tokyo Women's Medical University Breast Cancer Society experience.

The results of BCT in Japanese women have not been fully evaluated. The Tokyo Women's Medical University Breast Cancer Society initiated BCT protocols in 1987. Here, we present a retrospective analysis of BCT outcomes and identify prognostic factors. The study population comprised 348 patients (353 breasts) with UICC clinical stage 0,I or II breast cancer, for whom wide excision (n= 294), quadrantectomy (n= 56) and tumorectomy (n= 3) were performed. The final pathological margin states were positive in 102 breasts (cancer cells remained within 5 mm of the surgical margin). The whole breast was irradiated to a total dose with 44 Gy/20 fractions or 46 Gy/23 fractions in the patients with negative surgical margins. The patients with positive or close margins received 48.4 Gy/22 fractions or 50 Gy/25 fractions irradiation to the whole breast. All but 2 patients received a radiation boost to the tumor bed and all tumor beds were irradiated to more than 53 Gy. Adjuvant therapy was administered in 240 cases. The median follow-up time was 4.3 years. The 5-year overall, cause-specific and disease-free survival rates were 95.8%, 97.3% and 92.5%, respectively. Recurrence was observed in 29 patients including 11 patients with loco-regional recurrence. Local recurrence was observed in 6 patients, 5 of whom were premenopausal. The 5-year local control and loco-regional control rates were 98.9% and 96.6%, respectively. T status (T1 to T2) was the only significant prognostic factor for disease-free survival. No severe morbidity has been observed. Cosmetic results were excellent or good in 73% of patients. Our BCT protocols provide a high rate of local control and good cosmetic outcome. Pathologic margin status was not a major prognostic factor for local recurrence. Long term follow-up is required to reach a definite conclusion on optimal BCT protocols.

Age as a predictor of outcome for women with DCIS treated with breast-conserving surgery and radiation: The University of Texas M. D. Anderson Cancer Center experience

Purpose : To analyze the long-term outcome of breast conservation therapy in patients with ductal carcinoma in situ (DCIS) in a single institution and to analyze the prognostic importance, if any, of young patient age. Methods and Materials : The hospital records of 150 patients with DCIS treated with surgical excision and radiotherapy at our institution between 1980 and 1997 were retrospectively reviewed. For most of the patients, intraoperative specimen radiographs or postoperative mammograms were available for use in assessing that an adequate surgical resection had been performed. The median patient age was 53 years (range 32–81), with 13% of patients ≤40 years old. Results : At a median follow-up of 63 months, 12 patients had local disease recurrence. The actuarial rate of local recurrence-free survival at 5 and 10 years was 96% and 88%, respectively. Local recurrence correlated with nuclear grade ( p = 0.002) but was not associated with patient age at diagnosis (<40 years vs. ≥40 years, p = 0.39). In all cases of local recurrence, patients underwent surgery with or without chemotherapy, and disease control was achieved. Conclusion : The results of this study demonstrate high rates of long-term overall survival, disease-specific survival, and local control in patients with DCIS of the breast treated conservatively with segmental mastectomy and radiotherapy. On the basis of the excellent long-term local control and 100% disease-specific survival rates, we found that patient age does not affect the outcome if the margins are clear. Continued studies in young patients treated with breast conservative therapy for DCIS are needed.

Breast-conserving surgery following radiation therapy of 50 Gy in Stages I and II carcinoma of the breast: The experience at one institute in Japan

This study evaluated the results of breast-conserving therapy experienced in one institute. A total of 217 breasts in 215 patients with clinical stages I and II breast cancer undergoing breast-conserving therapy between August 1991 and December 1999 were included. The actuarial 5-year local recurrence-free survival, disease-free survival and overall survival rates were 97.4%, 88.5% and 92.5%, respectively. Microscopic margins were negative in 176 (81.1%) of the total breasts and positive in 41 (18.9%). There were no differences in the age at operation, tumor size, clinical stage, lymph node status, estrogen receptor status, or distance from tumor to nipple between patients with positive surgical margins and with negative surgical margins. During the follow-up period, local recurrence occurred in seven patients. Local recurrence was significantly less frequent in patients with surgical margin-negative tumors than those with surgical margin-positive tumors, and also in ER-positive tumors than ER-negative or ER-unknown tumors. There was no difference in overall survival between patients with and without breast-recurrence. Using multivariate analysis, the surgical margin was determined to be an independent predictive factor for local recurrence in the conserved breast. Nodal status and ER status were independent prognostic factors, but local recurrence did not have an independent negative impact on survival. We conclude that microscopic surgical margin is the most important factor associated with local recurrence in the conserved breast among patients treated with breast-conserving surgery and radiation therapy of 50 Gy. Local recurrence however, has no adverse effect on survival of patients.

Conservative surgery and chemotherapy for breast carcinoma during pregnancy

Surgery 2002;131:108-10.

Results of breast-conserving therapy for ductal carcinoma in situ: the Kyoto University experiences.

The purpose of this study was to evaluate the results of breast-conserving therapy (BCT), defined as the combination of breast-conserving surgery with axillary dissection and definitive radiation therapy for ductal carcinoma in situ (DCIS). Between November 1987 and March 1998, 33 patients with DCIS undergoing BCT at our hospital were examined. The mean age was 48. All patients underwent quadrantectomy or wide excision as well as axillary dissection. Radiation therapy consisted of 50 Gy to the ipsilateral whole breast. Boost irradiation of 10 Gy was given to 15 patients with close or positive margins. Nearly all patients received adjuvant chemotherapy with 5-fluorouracil or its derivatives and adjuvant endocrine therapy with tamoxifen for 2 years. The minimum and median follow-up periods were 32 and 80 months, respectively. All patients but one were followed. Only one patient had a non-invasive local recurrence, 23 months after her operation. This patient was salvaged with simple mastectomy. Her prognostic index score was 8. The five-year local control rate was 97%. No serious acute or late complications were noted. The results of this retrospective study substantiate favorable data and appear to confirm the efficacy and reasonable local recurrence rate of BCT for the treatment of DCIS.