The Effect of Delaying Adjuvant Radiation Treatment after Conservative Surgery for Early Breast Cancer

Cèfaro, Giampiero Ausili; Genovesi, Domenico; Marchese, Rita; Tommaso, M. Di; Febo, Federica Di; Ballone, Enzo; Nicola, Marta Di

doi:10.1111/j.1524-4741.2007.00511.x

Cited by 25 publications

(25 citation statements)

References 23 publications

(24 reference statements)

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“…The impact of the TI from surgery to adjuvant therapy (radiation or concurrent chemoradiation) has been studied mainly in breast, endometrial, and head and neck cancers [101112132223]. Several retrospective cohort studies have found that a longer TI is associated with poor oncological outcomes of these cancers [10111222].…”

Section: Discussionmentioning

confidence: 99%

“…However, the impact of TI from surgery to the beginning of adjuvant therapy on oncological outcomes were not demonstrated by previous studies [1315]. A study by Cèfaro et al [13] examined the effect of delaying RT after conservative surgery on the risk of local recurrence in 969 women with early stage breast cancer, and found that the TI from surgery to RT was not associated with local recurrence. The reason for the discrepancy is not clear.…”

Section: Discussionmentioning

confidence: 99%

“…Ahmad et al [12] studied 195 endometrial cancer patients who received postoperative whole pelvic radiation and found that a delay in radiation therapy (RT) of >6 weeks was an independent significant predictor for poor disease-specific survival (p<0.005) and a marginally significant variable for decreased local control. However, several other studies have found that delaying adjuvant therapy did not affect the clinical outcomes in cancer patients after surgical treatment such as soft tissue sarcoma, breast, and gastric cancers [131415]. …”

Section: Introductionmentioning

confidence: 99%

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Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

et al. 2017

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ObjectiveTo determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissection (RHND) to adjuvant therapy on oncological outcomes in cervical cancer.MethodsThe study included 110 stage IA2–IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression.ResultsThe median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs. 81.0%, and 83.2% vs. 100.0%) or 5-year overall survival (OS) rates (90.9% vs. 97.2%, and 93.2% vs. 100.0%) between patients according to TI (≤4 vs. >4, and ≤6 vs. >6 weeks, respectively). Deep stromal invasion (p=0.037), and parametrial involvement (PI) (p=0.002) were identified as independent prognostic factors for RFS, together with the interaction between TI and squamous cell carcinoma histology (p<0.001). In patients with squamous cell carcinoma, a TI longer than 4 weeks was significantly associated with a worse RFS (hazard ratio [HR]=15.8; 95% confidence interval [CI]=1.4–173.9; p=0.024). Univariate analysis showed that only tumor size (p=0.023), and PI (p=0.003) were significantly associated with OS.ConclusionDelay in administering adjuvant therapy more than 4 weeks after RHND in early stage squamous cell cervical cancer results in poorer RFS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

et al. 2017

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“…A positive margin, the presence of disease on the inked surface, occurs in at least 30-35% of cases, and an additional 10-15% are classified as close margins (< 2 mm)(15). Local recurrence rates for breast conserving therapy followed by radiation were reported in 2-28% of cases with positive margins, 2-16% with close margins (<2 mm), and 2-8% with negative margins (15) which would be higher in the absence of radiation therapy (6, 8, 17, 18). …”

Section: Introductionmentioning

confidence: 99%

Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

et al. 2009

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As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm 2 regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histologic sections. A 17-patient training set used to establish standard imaging protocols and OCT evaluation criteria showed that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histologic findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results show the potential of OCT as a real-time method for intraoperative margin assessment in breast-conserving surgeries. [Cancer Res 2009;69(22):8790-6]

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“…Long wait criteria for adjuvant RT were six (node negative disease) or seven months (node positive disease) postsurgery if RT was preceded by CT, four months if it was not. 15,[42][43][44][45][46] These previous studies suggested that such waits, comprised of systemic delays and necessary waiting (investigations, preparation for treatment and post-surgical recovery periods) may be associated with disease recurrence, metastases and shorter survival. This study's descriptive epidemiologic analyses will allow for the practical empirical planning of future multivariate analyses of the relationships between breast cancer care waits and survival in Canada and the United States.…”

mentioning

confidence: 99%

Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

Gorey¹,

Luginaah²,

Holowaty³

et al. 2009

CIM

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Clin Invest Med 2009; 32 (3): E239-E249. AbstractPurpose. The demand for cancer care has increased among aging North American populations as cancer treatment innovations have proliferated. Gaps between supply and demand may be growing. This study examined whether socioeconomic status has a differential effect on waits for surgical and adjuvant radiation treatment (RT) of breast cancer in Canada and the US. Methods. Ontario and California cancer registries provided 929 and 984 breast cancer cases diagnosed between 1998 and 2000 in diverse urban and rural places. Residencebased socioeconomic data were taken from censuses. Cancer care variables were reliably abstracted from health records: stage, receipt of surgery and RT, and waits from diagnosis to initial and initial to adjuvant treatment. Median waits were compared within-and between-country with the non-parametric Mann-Whitney U-test. Categorically long, age-adjusted wait comparisons used the Mantel-Haenszel chi-square test.Results. There were significant associations between lower socioeconomic status and longer surgical waits, lower access to adjuvant RT and to longer RT waits across diverse places in California. None were observed in Ontario. The two cohorts did not practically differ on access to surgery or on surgical waits. Compared with their counterparts in California, low-income Ontarians, particularly those in small urban places, gained greater access to RT, while high-income Americans had shorter waits for RT. Conclusions. This historical study contextualized Canada's "waiting-list problems" with evidence on breast cancer care, where lower income Americans seemed to have waited as long as similar Canadians. Many more lowincome Americans seemed to experience the longest wait of all for adjuvant care. They simply did not receive it. In contrast to stark American socioeconomic inequity, this study evidenced remarkable equity in Canadian breast cancer care.Clinical and common wisdom converged in the 1990s to ignite scientific and political interest in Canada's "waiting-list problem. that the gap between supply and demand may have been getting larger in Canada than in America. 4,5 However, the only previous study to test that hypothesis found no significant treatment delay differences among women diagnosed with breast cancer in 1988 in Washington state and the province of British Columbia. 6 No study has since compared evidence on cancer care delays in Canada and the United States (US). Breast cancer care has been most studied in this field. For a number of reasons it seems a sentinel indicator of health care performance. The most common type of cancer among Canadian and American women, its prognosis is excellent with early diagnosis and timely access to the best treatments. 7,8 Moreover, surgical innovations and new adjuvant radiation therapies (RT) after both breast conserving surgery and mastectomy were advanced over the past 20 years, 4,9 so their timely access seems of legitimate clinical and policy concern. The possibility of socioeconomic status (...

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The Effect of Delaying Adjuvant Radiation Treatment after Conservative Surgery for Early Breast Cancer

Cited by 25 publications

References 23 publications

Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

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