Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer

Dongen, J.A. van; Bartelink, Harry; Fentiman, Ian S.; Lerut, T.; Mignolet, F; Olthuis, G; Schueren, Emmanuel van der; Sylvester, Richard; Tong, David; Winter, Janet; Zijl, K van

doi:10.1016/0959-8049(92)90118-l

Cited by 254 publications

(96 citation statements)

References 2 publications

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“…[44][45][46] Patients with positive axillary nodes do not have an increased risk of breast recurrence when treated with conservative surgery and radiation. [4][5][6]8,21,44,47 This is in contrast to patients undergoing mastectomy where the number of positive axillary nodes correlates with the incidence of chest wall recurrence. The diminished risk of breast recurrence in node-positive patients may be related to the combined effects of chemotherapy and/or tamoxifen with radiation in these patients.…”

Section: Elements Of the Breast Physical Exammentioning

confidence: 41%

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Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

298

165

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Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

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Section: Elements Of the Breast Physical Exammentioning

confidence: 41%

“…[1][2][3][4][5][6][7][8][9] Whole breast irradiation with doses of 45 to 50 Gy was used in all of the trials, and a boost to the primary site was employed in five of the six trials. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) trial, a dose of 50 Gy was delivered to the entire breast without a boost.…”

Section: Prospective Randomized Trialsmentioning

confidence: 99%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

298

165

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“…However, the increase is not infinite, as trials have shown that breast-conserving therapy is only as effective as modified radical mastectomy for localised small cancers, and several studies have shown definitive contraindications (Bartelink et al, 1988;van Dongen et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Changes in use of breast-conserving therapy in years 1978-2000

Koning

Dongen²,

Maas³

1994

Br J Cancer

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Summary The treatment of breast cancer patients has changed rapidly in the past decade, but empirical data at local and national level are scarce. Predicting the consequences of screening for primary treatment is consequently difficult. The aim of this analysis of records on admissions to hospital of women with breast cancer and/or for breast surgery together with a survey of all Dutch radiotherapy departments is to show the change in breast-conserving therapy and other primary treatment before the start of breast cancer screening in The Netherlands. There was a modest increase in breast-conserving therapy after 1981, coinciding with the first publication on its trial, followed by a sharp increase between 1985 and 1990, after the second publication. At the end of that 5 year period, 36% of all women with newly diagnosed invasive breast cancer underwent this type of surgery. Breast-conserving surgery is always followed by radiotherapy, but there has been a clear reduction in post-operative radiation after mastectomy. The percentage of breast-conserving therapy is at present higher in The Netherlands than in the USA. Implementing the Dutch screening programme will result in a maximum increase in breast-conserving therapy at national level of 34%, which stabilises at + 21%, or a 50% maximum increase at local level. The number of women treated by mastectomy will ultimately decrease by 9%. Given the rapidity of change towards the use of breast-conserving surgery, which is enhanced by screening, recent information will be needed in predicting capacity and assessing whether screen-detected women are treated adequately.The treatment of breast cancer patients has changed rapidly in the past decade. Several trials have led to a better understanding of the possible results of different types of primary treatment. Breast-conserving therapy, limited surgery followed by high-dose radiation, has been shown to be as effective as modified radical mastectomy for most operable patients (Veronesi et al., 1981). For mastectomy patients, routine post-operative radiotherapy is now usually considered unnecessary (Edland, 1988;Harris & Hellman, 1988). It could be assumed that treatment practice would be influenced by the information from these trials, but empirical data at national and local level are scarce in most countries (Farrow et al., 1992;Chouillet et al., 1994).At the same time, countries have started to implement breast cancer screening, as trials have shown that a reduction in mortality from breast cancer can be expected for screened women aged 50-69. The impact on the number and type of surgical procedures and radiotherapy will be great as a result of both the temporary increase in the number of women detected with breast cancer and the increase in early cancers (de Koning et al., 1990). Bottlenecks in capacity are expected, but there is a lack of empirical data to support this hypothesis.As we were especially uncertain about the development of breast-conserving therapy (outside a screening programme), we have analysed dat...

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“…The rate of ipsilateral breast recurrences has been reported to vary between 9% and 35% in patients not receiving postoperative irradiation after breast-preserving surgery. Postoperative radiation reduces the local recurrence rate to about one third (Kurtz et al, 1989;Clark et al, 1992;van Dongen et al, 1992, Veronesi et al, 1993Liljegren et al, 1994;Early Breast Cancer Trialists Collaborative Group, 1995;Fisher et al, 1995;Veronesi et al, 1995;Forrest et al, 1996;Liljegren et al, 1996;Renton et al 1996), and it has reduced the risk of recurrence after breast-preserving surgery in randomized studies regardless of whether tumours 2 cm or smaller (Liljegren et al, 1999), tumours smaller than 2.5 cm (Veronesi et al, 1993), or 4 cm or smaller in diameter (Clark et al, 1992;Fisher et al, 1995;Forrest et al, 1996) had been accrued, and regardless of whether only invasive or purely intraductal cancers were included in the studies (Fisher et al, 1998).…”

mentioning

confidence: 99%

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

et al. 2001

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SummaryThe 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.

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Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer

Cited by 254 publications

References 2 publications

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Changes in use of breast-conserving therapy in years 1978-2000

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

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