Postoperative Radiotherapy in High-Risk Premenopausal Women with Breast Cancer Who Receive Adjuvant Chemotherapy

Overgaard, Marie; Hansen, Per Krogh; Overgaard, Jens; Rose, Carsten; Andersson, Michael; Bach, Flemming W.; Kjær, Mogens; Gadeberg, C.; Mouridsen, Henning T.; Jensen, Maj‐Britt; Zedeler, Karin

doi:10.1056/nejm199710023371401

Cited by 2,347 publications

(1,114 citation statements)

References 22 publications

Supporting

Mentioning

1,025

Contrasting

Unclassified

Order By: Relevance

“…Several studies now support the idea that uncontrolled regional disease in the axilla can also act as a source for systemic tumor (re)seeding in the metastasized setting [23,24]. The study of Kahn et al [7] provides some evidence of an additional beneficial effect of axillary clearance when performed in the same session as the breast tumor removal.…”

Section: Discussionmentioning

confidence: 95%

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Ruiterkamp

Voogd

Bosscha

et al. 2009

Breast Cancer Res Treat

102

View full text Add to dashboard Cite

According to current treatment standards, patients with metastatic breast cancer at diagnosis receive palliative therapy. Local treatment of the breast is only recommended if the primary tumor is symptomatic. Recent studies suggest that surgical removal of the primary tumor has a favorable impact on the prognosis of patients with primary metastatic breast cancer. We performed a systematic review of the literature to weigh the evidence for and against breast surgery in this patient group. Ten retrospective studies were found in which the use of breast surgery in primary metastatic breast cancer and its impact on survival was examined. The hazard ratios of the studies were pooled to provide an estimate of the overall effect of surgery, and the results and conclusions of the studies were analyzed. A crude analysis, without adjustment for potential confounders, showed that surgical removal of the breast lesion in stage-IV disease was associated with a significantly higher overall survival rate in seven of the ten studies, and a trend toward a better survival in the three remaining studies. Surgery of the primary tumor appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with hazard ratios ranging from 0.47 to 0.71. The pooled hazard ratio for overall mortality was 0.65 (95% CI 0.59-0.72) in favor of the patients undergoing surgery. This systematic review of the literature suggests that surgery of the primary breast tumor in patients with stage-IV disease at initial presentation does have a positive impact on survival. In order to provide a definite answer on whether local tumor control in patients with primary metastatic disease improves survival, a randomized controlled trial comparing systemic therapy with and without breast surgery is needed.

show abstract

Section: Discussionmentioning

confidence: 95%

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Ruiterkamp

Voogd

Bosscha

et al. 2009

Breast Cancer Res Treat

102

View full text Add to dashboard Cite

show abstract

“…The Danish Breast Cancer Cooperative Group, 82b and 82c, trials in conjunction with findings from the Canadian trial, collectively demonstrate that patients randomised to receive post-mastectomy radiation have a lower 10-year rate of local regional recurrence and an additional survival advantage associated with post-mastectomy radiotherapy [4,5]. Based on these, and similar studies, there are now clear guidelines regarding the indications for postmastectomy radiation which are; large tumour size, direct involvement of the skin, and 4 or more metastatic axillary lymph nodes [6][7][8].…”

Section: Introductionmentioning

confidence: 94%

Radiotherapy and breast reconstruction: a meta-analysis

Barry

Kell

2011

Breast Cancer Res Treat

223

121

View full text Add to dashboard Cite

To cite this version:M Barry, M. R. Kell. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Research and Treatment, Springer Verlag, 2011, 127 (1) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured.. Results:1,105 patients were identified from 11 appropriately selected studies.Patients undergoing PMRT and BR are more likely to suffer morbidity compared to patients not receiving PMRT ((OR) = 4.2; 95% CI, 2.4-7.2(no PMRT vs. PMRT)). Reconstruction technique was also examined with outcome whenPMRT was delivered after BR and this demonstrated that autologous reconstruction is associated with less morbidity in this setting ((OR) = 0.21; (95% CI, 0.1-0.4 (autologous vs. implant based)). Delaying BR until after PMRT had no significant effect on outcome ((OR) =0.87; 95% CI, 0.47-1.62 (delayed vs. immediate)).Conclusions: PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared to implant based reconstruction. 3 INTRODUCTION:Breast Eligibility CriteriaAll trials whether randomized or non-randomized, prospective or retrospective were eligible that examined the effects of radiotherapy on immediate or delayed breast reconstruction using either a prosthesis or autologous tissue (Latissimus Dorsi (LD) or Trasversus Rectus Abdominis Muscle (TRAM). Case series orreports were not included. Studies where the data could not be accurately extracted were also excluded. Data Extraction and OutcomesThe following information regarding each eligible trial was recorded: authors' names, journal, patient numbers, timing and method of reconstruction, addition of radiotherapy and the post-operative complication rate. The primary end point of 7 this meta-analysis was postoperative morbidity including capsular contracture, fibrosis, fat necrosis, surgical site infections requiring removal of prosthesis/reoperation (see tables 2, 4 and 6). Statistical AnalysisFor post-operative complications in each study, the odds ratio (O.R.) of the simple proportions of events was estimated with its variance and 95% CI.Heterogeneity between the O.R.s for the same outcome between studies was assessed by use of the X 2 -based Q statistic [24]. Data were then combined across studies by the use of general variance methods with fixed and random effects models [14]. Analyses were conducted using StatsDirect version 2.5.6(StatsDirect Ltd, Chesire, United Kingdom) and SPSS version 12.0 (SPSS, Inc, Chicago, IL). All statistical tests were two tailed. 8 RESULTS:Eligible Studies 20 potentially eligible studies were identified that examined the effects of radiotherapy on immediate or delayed breast reconstructions. 9 studies were excluded from the meta-analysis due to low numbers (e.g. n < 15) or incomplete data set regarding postoperative morbidity. Of the 11 studies selected, 4 were studies that examined the effects of RT...

show abstract

“…Postmastecomy chest wall radiotherapy (PMRT) is a common treatment modality for high‐risk breast cancer patients following mastectomy because it has been shown to improve local control and survival 1 , 2 , 3 . The RTOG breast atlas (4) defines the chest‐wall target volume as extending cranially to the caudal border of the clavicle head, caudally to the loss of computed‐tomography (CT) apparent contralateral breast, laterally to the mid‐axillary line, medially to the sternal‐rib junction, posteriorly to the rib‐pleural interface, and anteriorly to the skin.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

Manger

Paxton

Cerviño

2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

Brass mesh bolus has been shown to be an acceptable substitute for tissue‐equivalent bolus to increase superficial dose for chest wall tangent photon radiotherapy. This work investigated the increase in surface dose, the change in the dose at depth, and the safety implications of higher energy photon beams when using brass mesh bolus for postmastectomy chest wall radiotherapy. A photon tangent plan was delivered to a thorax phantom, and the superficial dose ranged from 40%–72% of prescription dose with no bolus. The surface dose increased to 75%–110% of prescription dose with brass mesh bolus and 85%–109% of prescription dose with tissue‐equivalent bolus. It was also found that the dose at depth when using brass mesh bolus is comparable to that measured with no bolus for en face and oblique incidence. Monte Carlo calculations were used to assess the photoneutron production from brass mesh bolus used with 15 MV and 24 MV photon beams. The effective dose from photoneutrons was approximated and found to be relatively small, yet not negligible. Activation products generated by these photoneutrons, the surface dose rate due to the activation products, and the half‐life of the activation products were also considered in this work. The authors conclude that brass mesh bolus is a reasonable alternative to tissue‐equivalent bolus, and it may be used with high‐energy beam; but one should be aware of the potential increased effective dose to staff and patients due to the activation products produced by photoneutrons.PACS number(s): 87.53.Kn, 87.55.K

show abstract

Postoperative Radiotherapy in High-Risk Premenopausal Women with Breast Cancer Who Receive Adjuvant Chemotherapy

Abstract: The addition of postoperative irradiation to mastectomy and adjuvant chemotherapy reduces locoregional recurrences and prolongs survival in high-risk premenopausal women with breast cancer.

Cited by 2,347 publications

References 22 publications

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Radiotherapy and breast reconstruction: a meta-analysis

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

Contact Info

Product

Resources

About