Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial

Veronesi, Umberto; Marubini, Ettore; Mariani, Luigi; Galimberti, Viviana; Luini, Alberto; Veronesi, Paolo; Salvadori, B; Zucali, R

doi:10.1023/a:1011136326943

Cited by 664 publications

(362 citation statements)

References 14 publications

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“…Basis for classification of IBTR. have reported similar relative rates of NP and CLBC (20,22 (22) reported similar NP and CLBC rates in 579 women treated with quadrantectomy and randomized to receive breast radiotherapy or not. However, the absolute numbers of NP and CLBC reported were small (10 and 22 patients, respectively).…”

Section: No Mets N=46mentioning

confidence: 90%

“…The 5-year risk of IBTR after breast-preserving surgery has previously been reported as 5 to 10% (15,22), corresponding to an annual risk of 1 to 2% (15). Several studies have attempted to differentiate between true recurrences and new primaries (20,(23)(24)(25), from which common themes are apparent: the majority of IBTR are LR, which tend to occur earlier, metastasize earlier and more often, and have a shorter overall and disease-free survival than NP.…”

Section: Discussionmentioning

confidence: 99%

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Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

Gujral

Sumo

Owen³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose: The justification for partial breast radiotherapy after breast conservation surgery assumes that ipsilateral breast tumor relapses (IBTR) outside the index quadrant are mostly new primary (NP) tumors that develop despite radiotherapy. We tested the hypothesis that whole-breast radiotherapy (WBRT) is ineffective in preventing NP by comparing development rates in irradiated and contralateral breasts after tumor excision and WBRT. Methods and Materials: We retrospectively reviewed 1,410 women with breast cancer who were entered into a prospective randomized trial of radiotherapy fractionation and monitored annually for ipsilateral breast tumor relapses (IBTR) and contralateral breast cancer (CLBC). Cases of IBTR were classified into local recurrence (LR) or NP tumors based on location and histology and were subdivided as definite or likely depending on clinical data. Rates of ipsilateral NP and CLBC were compared over a 15-year period of follow-up. Results: At a median follow-up of 10.1 years, there were 150 documented cases of IBTR: 118 (79%) cases were definite or likely LR; 27 (18%) cases were definite or likely NP; and 5 (3%) cases could not be classified. There were 71 cases of CLBC. The crude proportion of definite-plus-likely NP was 1.9% (27/1,410) patients compared with 5% (71/1,410) CLBC patients. Cumulative incidence rates at 5, 10, and 15 years were 0.8%, 2.0%, and 3.5%, respectively, for definite-plus-likely NP and 2.4%, 5.8%, and 7.9%, respectively for CLBC, suggesting a difference in the rates of NP and CLBC. Conclusions: This analysis suggests that WBRT reduces the rate of ipsilateral NP tumors. The late presentation of NP has implications for the reporting of trials that are testing partial breast radiotherapy. Ó 2011 Elsevier Inc.Breast cancer, Ipsilateral, Contralateral, Relapse, Radiotherapy.

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Section: No Mets N=46mentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

Gujral

Sumo

Owen³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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“…Several randomized trials have demonstrated that local recurrence rates are significantly higher if RT is omitted after BCS. 2,[4][5][6][7][8][9] In a recent meta-analysis, the EBCTCG estimated that the absolute 5-year local recurrence risk is 19% lower for women who receive RT after BCS, and the absolute benefit was greater in younger women. 10 In our population-based analysis, we observed that the group of women who are most likely to benefit from RT is the same group that had significantly lower rates of RT.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Several randomized trials have demonstrated that local recurrence rates are significantly higher for patients who undergo BCS without RT. 2,[4][5][6][7][8][9] The overview analysis from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) recently reported that breast cancer mortality rates also were significantly higher for patients who did not receive RT after BCS. 10 The patterns of surgical treatment for stage I and II breast cancer changed after the National Institutes of Health Consensus Conference.…”

Section: Introductionmentioning

confidence: 99%

Omission of radiation therapy after breast‐conserving surgery in the United States

Tuttle

Jarosek

Habermann

et al. 2011

Cancer

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BACKGROUND: Radiation therapy (RT) after breast-conserving surgery (BCS) is associated with a significant reduction in ipsilateral breast tumor recurrence and breast cancer mortality rates in patients with early stage breast cancer. The authors of this report sought to determine which patients with breast cancer do not receive RT after BCS in the United States. METHODS: The Surveillance, Epidemiology, and End Results registry was used to determine the rates of RT after BCS for women with stage I through III breast cancer in the United States from 1992 through 2007. A multivariate analysis was performed to identify independent predictors of omission of RT. RESULTS: In total, 294,254 patients with invasive, nonmetastatic breast cancer were identified who underwent surgery from 1992 through 2007. Most patients (57%) underwent BCS; among those, 21.1% did not receive RT after BCS. The omission of RT increased significantly from 1992 (15.5%) to 2007 (25%). The receipt of RT also decreased significantly for patients with increased cancer stage, age <55 years, high-grade tumors, large tumors, positive or untested lymph node status, African American or Hispanic race, and negative or unknown estrogen receptor status. Significant geographic variation was observed in the rates of RT after BCS. CONCLUSIONS: The omission of RT after BCS was more common in recent years, especially among women who had an increased risk of breast cancer recurrence. This trend represents a serious health care concern because of the potential increased risk of local recurrence and breast cancer mortality.

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“…From the historical trials, the risk of breast cancer recurrence outside index quadrant without breast irradiation is in the range of 1.5-3.5% (8,9). PBI Perspective Patient selection for partial breast irradiation by intraoperative radiation therapy: can magnetic resonance imaging be useful?-perspective from radiation oncology point of view can be delivered over 1 day to 2 weeks, depending on the technique, i.e., IORT, interstitial brachytherapy, or external beam RT.…”

Section: Introductionmentioning

confidence: 99%

Patient selection for partial breast irradiation by intraoperative radiation therapy: can magnetic resonance imaging be useful?—perspective from radiation oncology point of view

Krengli

Pisani²,

Deantonio

2016

J. Thorac. Dis.

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The guidelines of the European and American Societies of Radiation Oncology (GEC-ESTRO and ASTRO) defined the selection criteria to offer partial breast irradiation (PBI) after lumpectomy in patients with low risk breast cancer regardless pre-operative staging. A recent publication by Tallet et al.explored the impact of preoperative magnetic resonance imaging (MRI) on patient eligibility for PBI. From their study, an ipsilateral BC was detected in 4% of patients, excluding these patients from intraoperative radiotherapy (IORT). The authors suggested that preoperative MRI should be used routinely for patient's candidate to IORT, because of the rate of ipsilateral breast cancer detected. In view of Tallet's article, we analyzed some aspects of this issue in order to envisage some possible perspective on how to better identify those patients who could benefit from PBI, especially using IORT. From historical studies, the risk of breast cancer recurrence outside index quadrant without irradiation is in the range of 1.5-3.5%. MRI sensitivity for detection of invasive cancer is reported up to 100%, and it is particularly useful in dense breast. Other imaging technique did not achieve the same sensibility and specificity as conventional MRI. Of note, none of randomized trials published and ongoing on PBI included preoperative MRI as part of staging. To perform a preoperative MRI in PBI setting is an interesting issue, but the available data suggest that this issue should be preferably studied in the setting of prospective clinical trials to clarify the role of MRI and the clinical meaning of the discovered additional foci.

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Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial

Cited by 664 publications

References 14 publications

Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

Omission of radiation therapy after breast‐conserving surgery in the United States

Patient selection for partial breast irradiation by intraoperative radiation therapy: can magnetic resonance imaging be useful?—perspective from radiation oncology point of view

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