Long-Term Cosmesis Following a Novel Schedule of Accelerated Partial Breast Radiation in Selected Early Stage Breast Cancer: Result of a Prospective Clinical Trial

Abstract

reviewed. All received neoadjuvant chemotherapy and mastectomy. Of them, 404 (77.2%) patients received postmastectomy radiotherapy (PMRT) and 119 (22.8%) not. 420(80.3%)had adjuvant chemotherapy. 289 out of 348 (83.0%) patients with ER and/or PR positive disease had hormone therapy. 67 out of 204 (32.8%) patients with Her2 positive disease had trastuzumab targeted therapy. The locoregional recurrence (LRR), diseasefree Survival (DFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method, and differences were compared using the logrank test. Multivariate prognostic analysis was performed using the Cox regression model. Results: With a median follow up time of 66 months (range, 4-201 months), the 5-year LRR, DFS and OS were 16.3%, 61.4% and 82.1% respectively. For patients with and without PMRT, the 5-year LRR rates were 13.9% and 24.8%(P Z 0.013)，DFS were 64.1% and 53.9% (P Z 0.048)，and OS were 83.2% and 78.2%(P Z 0.389) respectively. In the subgroups of patients with ypT3-4, ypN2-3 and Stage III disease, PMRT significantly reduced LRR (P 0.01 for all comparisons)，and improved OS (P 0.003 for all comparisons). Of the 158 patients who achieved ypN0, the 5-year LRR rates were 1.0% and 12.4% (P Z 0.004)，DFS were 89.9% and 70.1%(pZ0.009)，and OS were 96.9% and 95.8%(P Z 0.802)for patients with and without PMRT. Of 41 patients who achieved pCR, 2 patients without PMRT developed LRR, whereas none of patients with PMRT had LRR (P Z 0.020). Multivariate analysis indicated that lack of PMRT was an independent prognostic factor associated with increased LRR and decreased DFS for all patients and ypN0 patients respectively. Conclusion: For patients with clinical stage IIIA and IIIB breast cancer treated with neoadjuvant chemotherapy and mastectomy, PMRT reduces LRR significantly for all patients, and reduces both recurrence and mortality risk for patients presenting with ypT3-4, ypN2-3 and pathologic stage III. PMRT might not be omitted safely for patients who achieved ypN0 or pCR, and further research is warranted.

Whole-Breast Irradiation Is the Preferred Standard of Care for the Majority of Patients With Early-Stage Breast Cancer

“…Subsequent studies suggest that giving 40 Gy in 10 fractions once daily over 2 weeks causes much less fibrosis. [36][37][38] Performing interstitial brachytherapy well is particularly challenging, with early studies especially showing significant complication rates even in experienced hands. 39 Stringent guidelines and quality control efforts can overcome this problem, 32 but these are not easy to implement.…”

Evaluation of tissue computed tomography number changes and dosimetric shifts after conventional whole-breast irradiation in patients undergoing breast-conserving surgery

“…6 Therefore, novel breast RT techniques based on these concepts have been recently developed over the past few years. [6][7][8][9] In conventional fractionation whole-breast irradiation (WBI), the addition of boost on the primary tumor bed after BCS improved local control rates without a significant difference in overall survival (OS). 10 In a 10-year follow-up of the European Organisation for Research and Treatment of Cancer (EORTC) 22881/10882 trial, improved local control after additional boost RT was also demonstrated in all the age groups.…”