Randomized Clinical Trial of Breast Irradiation Following Lumpectomy and Axillary Dissection for Node-Negative Breast Cancer: an Update

Clark, Roy M.; Whelan, Timothy J.; Levine, Mark; Roberts, Robin S.; Willan, Andrew R.; McCulloch, Peter; Lipa, Michael; Wilkinson, Robert H.; Mahoney, Leo J.

doi:10.1093/jnci/88.22.1659

Cited by 542 publications

(237 citation statements)

References 10 publications

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“…Those assigned to breast radiotherapy were treated using a tangential parallel pair of fields, receiving a total breast dose of 40 Gy/16 fractions, followed by a boost to the tumour bed of 12.5 Gy/5 fractions, all using daily fractionation, as described previously. 27 Tissue specimens and immunohistochemistry for p53 and p21 WAF1/CIP1 For each patient's tumour, several 4-m sections were cut from one representative block for molecular analyses. The sections were stained with haematoxylin and eosin and were reviewed and graded 28 by 2 pathologists (D.B.…”

Section: Patientsmentioning

confidence: 99%

Dysregulated PTEN‐PKB and negative receptor status in human breast cancer

Shi

Zhang

Pintilie

et al. 2003

Intl Journal of Cancer

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Recent studies demonstrate that abnormalities in PTEN may be one of the most frequent genetic events observed in human cancers. PTEN dysfunction leads to tumorigenesis through unopposed survival signals mediated via activated protein kinase B (PKB), which may also be associated with hormone-independence. We therefore investigated the relationship between PTEN-PKB and receptor status in human breast cancer. Several molecular variables, including immunohistochemical staining for PTEN, PKB (phosphorylated on ser473), p53 and p21 were evaluated. The p53 gene was sequenced from exons 2-11. Seventy-eight participants in a randomised breast cancer trial served as the cohort for our study. Twenty-eight of 77 (36%) patients' tumours demonstrated absent or reduced PTEN expression; 17 of 78 (22%) tumours over-expressed P-PKB. A significant inverse relationship was observed between reduced PTEN and increased P-PKB expression. Reduced PTEN also correlated with reduced ER or PR expression. None of the molecular variables correlated with survival. ER and PR negative tumours, however, experienced a significantly inferior disease-free survival than other ER/PR status tumours. Immunohistochemical analyses of ER expression in mammary carcinomas arising in PTEN heterozygous knockout mice did not demonstrate a reduction in ER immunoreactivity, in comparison to wildtype mice. Our data demonstrate that the PTEN-PKB pathway is abnormal in approximately 1 ⁄3 of lymph node negative breast cancer. Dysregulated PTEN-PKB was also associated with reduced ER/PR expression, but this does not appear to be a simple direct causal relationship. These observations support the contention that dysregulation in PTEN-PKB contributes to disease progression and hormone resistance of human breast cancer.

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Section: Patientsmentioning

confidence: 99%

Dysregulated PTEN‐PKB and negative receptor status in human breast cancer

Shi

Zhang

Pintilie

et al. 2003

Intl Journal of Cancer

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“…Although mastectomy and BCS (with follow-up radiation therapy) have equivalent outcomes (breast carcinoma recurrence rates, survival rates) for treating early-stage breast carcinoma, BCS without follow-up radiation therapy has an increased risk of breast carcinoma recurrence [5][6][7][8][9][10][11] and mortality. 12 Results of studies on racial differences in the use of BCS are inconsistent.…”

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confidence: 99%

Racial differences in treatment and survival from early‐stage breast carcinoma

Joslyn

2002

Cancer

108

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BACKGROUNDAfrican‐American women have a significantly worse prognosis from breast carcinoma compared with white women, even when the stage at diagnosis is equivalent. The purpose of this study was to analyze racial differences in the treatment (use of breast‐conserving surgery and radiation therapy) of women with early‐stage breast carcinoma and the resulting effects on survival rates.METHODSSubjects included 10,073 African‐American and 123,127 white women diagnosed with Stage I, IIA, or IIB breast carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results program between 1988 and 1998. Comparisons were made by race with treatment, age, hormone receptor status, and stage at the time of diagnosis. Survival analyses were conducted to compare risk of death for African‐American and white women while controlling for age, stage, and hormone receptor status.RESULTSAmong women diagnosed with early‐stage breast carcinoma who receive breast‐conserving surgery, African‐American women were significantly less likely to receive follow‐up radiation therapy in every 10‐year age group except in the older than 85 age group. Whether treatment was equivalent or suboptimal, survival for African‐American women with early‐stage breast carcinoma was significantly worse. However, when treatment was equivalent, the effects of racial differences on survival were significantly less compared with survival associated with suboptimal treatment.CONCLUSIONSSignificant racial differences exist in the treatment of women with early‐stage breast carcinoma. Public health efforts to eliminate suboptimal treatment would reduce, but not eliminate, racial disparity in survival. Cancer 2002;95:1759–66. © 2002 American Cancer Society.DOI 10.1002/cncr.10827

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“…Traditional BCT consists of a lumpectomy followed by a daily treatment course of whole breast external beam irradiation for approximately six weeks. A number of clinical studies 1 , 4 have shown that most ipsilateral breast recurrences after BCT arise in the peripheral lumpectomy cavity, implying that whole breast irradiation might be unnecessary for these patients. Consequently, the practice of treating only a limited volume of breast tissue surrounding the lumpectomy cavity (1 to 2 cm for patients with negative margins) has been introduced.…”

Section: Introductionmentioning

confidence: 99%

A commissioning procedure for breast intracavitary electronic brachytherapy systems

Hiatt

Cardarelli

Hepel

et al. 2008

J Applied Clin Med Phys

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In this work, we report a comprehensive quality assurance (QA) process for the commissioning of an Electronic Brachytherapy (EB) system at one of the first U.S. sites to apply the device clinically. Thus far, EB systems have been released only for intracavitary breast treatments. As such, EB as an Accelerated Partial Breast Irradiation (APBI) treatment modality is relatively unstudied and is unfamiliar to many medical physicists. We present our documented experience as a guide for other institutions' EB commissioning process. Our tests included eight elements: A) well‐chamber constancy, B) beam stability, C) source positional accuracy, D) output stability, E) timer linearity, F) dummy marker/source position coincidence, G) controller functionality and safety interlocks, and H) treatment planning data verification following the AAPM TG‐43 recommendations. Together with TG‐43, our methodology provides a comprehensive EB system check for medical physicists commissioning such a device.PACS Numbers: 87.53.Jw, 87.53.Xd

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Randomized Clinical Trial of Breast Irradiation Following Lumpectomy and Axillary Dissection for Node-Negative Breast Cancer: an Update

Abstract: Breast irradiation was shown to reduce cancer recurrence in the breast, but there was no statistically significant reduction in mortality. A subgroup of patients with a very low risk for local breast recurrence who might not require radiation therapy was not identified.

Cited by 542 publications

References 10 publications

Dysregulated PTEN‐PKB and negative receptor status in human breast cancer

Dysregulated PTEN‐PKB and negative receptor status in human breast cancer

Racial differences in treatment and survival from early‐stage breast carcinoma

A commissioning procedure for breast intracavitary electronic brachytherapy systems

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