Impact of young age on local control after partial breast irradiation in Japanese patients with early stage breast cancer

Sato, Kazuhiko; Mizuno, Yoshio; Fuchikami, Hiromi; Kato, Masahiro; Shimo, Takahiro; Kubota, Jun; Takeda, Naoko; Inoue, Yuko; Seto, Hiroshi; Okawa, Tomohiko

doi:10.1007/s12282-016-0669-4

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…Overall, 36 studies published from 1989 to 2017 were used for the network meta-analysis . All trials were carried out in North America and Europe except one trial that was conducted in Japan (53). The reported mean or median age ranged from 42.4 to 70.8 years across the eligible studies.…”

Section: Characteristics Of the Identified Studiesmentioning

confidence: 99%

A Network Meta-Analysis of Surgical Treatment in Patients With Early Breast Cancer

Gui¹,

Liu²,

Chen³

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background In early breast cancer treatment, the preferred surgical regimen remains a topic of controversy, and conventional pairwise meta-analysis cannot provide a hierarchy based on clinical trial evidence. Therefore, a network meta-analysis was performed both for direct and indirect comparisons and to assess the survival outcomes of surgical regimens. Methods Randomized clinical trials comparing different surgical regimens for the treatment of early breast cancer were identified. Overall survival (OS) and disease-free-survival (DFS) were analyzed using random-effects network meta-analysis on the hazard ratio (HR) scale and calculated as combined HRs and 95% confidence intervals (CIs). All statistical tests were two-sided. Results The network meta-analysis compared 11 different surgical regimens that consisted of 13 and 17 direct comparisons between strategies for OS (34 trials; n = 23 587 patients) and DFS (32 trials; n = 22 552 patients), respectively. The values of surface under the cumulative ranking for OS and DFS after mastectomy (M)+radiotherapy (RT) were observed to be the largest. Breast-conserving surgery (BCS)+axillary node sampling+RT almost achieved the threshold for inferiority compared with the other surgical treatment arms and was statistically significantly associated with worse OS (HR = 0.51, 95% CI = 0.24 to 0.94; HR = 0.48, 95% CI = 0.22 to 0.92; HR = 0.51, 95% CI = 0.23 to 0.96). No statistically significant difference between BCS+sentinel lymph node biopsy (SLNB)+RT vs BCS+SLNB+intraoperative RT was observed in carrying out network meta-analysis (HR = 0.95, 95% CI = 0.64 to 1.36). Conclusions M+RT is safer than other surgical regimens for the treatment of early breast cancer patients because of the favorable balance between the survival outcomes. Early breast cancer patients who receive BCS should be given SLNB and not axillary node sampling. Intraoperative RT is no better than postoperative RT in patients who receive SLNB.

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Section: Characteristics Of the Identified Studiesmentioning

confidence: 99%

A Network Meta-Analysis of Surgical Treatment in Patients With Early Breast Cancer

Gui¹,

Liu²,

Chen³

et al. 2019

JNCI: Journal of the National Cancer Institute

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“…Although the current guidelines recommend optimal criteria for PBI, efforts to expand the PBI indications are still ongoing in many studies. A retrospective study on PBI with brachytherapy in 30 to 49 year-old patients found no significant difference in IBTR (97.6% vs. 95.5%, p = 0.70) and DFS (97.6% vs. 91.4%, p = 0.87) compared to WBI, suggesting the broader potential of PBI, even in younger patients [ 24 ]. Another retrospective study has suggested that PBI is a viable alternative to WBI in selected patients with invasive lobular histology [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated Partial Breast Irradiation With Intensity-Modulated Radiotherapy in Early Breast Cancer or Carcinoma In Situ: An Investigational Short-Term Analysis

Kang,

Sung,

Kim

et al. 2024

J Breast Cancer

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Purpose This study aimed to analyze the treatment outcomes and adverse effects of moderately hypofractionated partial breast irradiation (PBI) in patients with early breast cancer. Methods In total, 473 patients with early breast cancer or carcinoma in situ were diagnosed with Tis or T1N0 disease and underwent PBI following breast-conserving surgery. All histologic tumor types, close surgical margins within 1 mm of the tumor, and multifocal tumors were included in this study. A radiation dose of 50 Gy in 20 fractions was delivered over 4 weeks using intensity-modulated radiotherapy technique. Dosimetric data, recurrence patterns, survival outcomes, and adverse events were retrospectively analyzed. Results During a median follow-up of 28.9 months, seven patients (1.5%) experienced ipsilateral breast tumor recurrence (IBTR). Two patients had regional recurrence, four patients developed contralateral breast cancer, and no distant metastases were observed. The locoregional recurrence rate in the ipsilateral breast was 1.8%. Two deaths occurred during the follow-up period, but were not attributed to breast cancer. The 2-year disease-free survival and 2-year overall survival rates were was 94.0% and 99.8%, respectively. Acute adverse events occurred in 131 patients (27.1%), and were distributed among all grades, with only two patients (0.4%) experiencing grade 3 events. Late adverse events were noted in 16 patients (3.4%), and were distributed among all grades, including grade 3 events in four patients (0.8%). No grade 4 or 5 events were observed. Conclusion Hypofractionated PBI demonstrated favorable IBTR rates in patients with early breast cancer, with low incidence of acute and late toxicities in the short-term analysis.

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“…From Japan, Sato et al . compared the results of MIB with the outcomes of WBRT as adjuvant treatment following BCS, focusing particularly on patients’ age [ 34 ]. Of overall 184 patients, 99 received MIB and 85 WBRT, with patients’ age ranging from 30 to 49 years.…”

Section: Discussionmentioning

confidence: 99%

“…From Japan, Sato et al compared the results of MIB with the outcomes of WBRT as adjuvant treatment fol- lowing BCS, focusing particularly on patients' age [34].…”

Section: Discussionmentioning

confidence: 99%

HDR-brachytherapy for accelerated partial breast irradiation: Long-term experience from a Japanese institution

Yoshida¹,

Kotsuma²,

Takaoka³

et al. 2023

jcb

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Purpose We investigated the long-term oncological outcome of high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIB) for adjuvant accelerated partial breast irradiation (APBI) after breast conserving surgery in Japanese patients. Material and methods Between June 2002 and October 2011, 86 breast cancer patients were treated at National Hospital Organization Osaka National Hospital (trial number of the local institutional review board, 0329). Median age was 48 years (range, 26-73 years). Eighty patients had invasive and 6 patients non-invasive ductal carcinoma. Tumor stage distribution was pT0 in 2, pTis in 6, pT1 in 55, pT2 in 22, and pT3 in one patient, respectively. Twenty-seven patients had close/positive resection margins. Total physical HDR dose was 36-42 Gy in 6-7 fractions. Results At a median follow-up of 119 months (range, 13-189 months), the 10-year local control (LC) and overall survival rate was 93% and 88%, respectively. Concerning the 2009 Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology risk stratification scheme, the 10-year LC rate was 100%, 100%, and 91% for patients considered as low-risk, intermediate-risk, and high-risk, respectively. According to the 2018 American Brachytherapy Society risk stratification scheme, the 10-year LC rate was 100% and 90% for patients ‘acceptable’ and ‘unacceptable’ for APBI, respectively. Wound complications were observed in 7 patients (8%). Risk factors for wound complications were the omission of prophylactic antibiotics during MIB, open cavity implantation, and V 100 ≥ 190 cc. No grade ≥ 3 late complications (CTCVE version 4.0) were observed. Conclusions Adjuvant APBI using MIB is associated with favorable long-term oncological outcomes in Japanese patients for low-risk, intermediate-risk, and acceptable groups of patients.

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Impact of young age on local control after partial breast irradiation in Japanese patients with early stage breast cancer

Abstract: This is the first report of PBI efficacy in young patients in Asia. Although it is a nonrandomized retrospective chart review of a small cohort of patients with a relatively short follow-up period, PBI may be a better option than WBI following BCS in some young patients with breast cancer.

Cited by 9 publications

References 33 publications

A Network Meta-Analysis of Surgical Treatment in Patients With Early Breast Cancer

A Network Meta-Analysis of Surgical Treatment in Patients With Early Breast Cancer

Hypofractionated Partial Breast Irradiation With Intensity-Modulated Radiotherapy in Early Breast Cancer or Carcinoma In Situ: An Investigational Short-Term Analysis

HDR-brachytherapy for accelerated partial breast irradiation: Long-term experience from a Japanese institution

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