Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients

Abstract

BackgroundPostoperative radiotherapy after breast-conserving surgery (BCS) is the standard in the management of breast cancer. The optimal timing for starting postoperative radiation therapy has not yet been well defined. In this study, we aimed to evaluate if the time interval between BCS and postoperative radiotherapy is related to the incidence of local and distant relapse in women with early node-negative breast cancer not receiving chemotherapy.MethodsWe retrospectively analyzed clinical data concerning 615 women treated from 1984 to 2010, divided into three groups according to the timing of radiotherapy: ≤60, 61–120, and >120 days. To estimate the presence of imbalanced distribution of prognostic and treatment factors among the three groups, the χ2 test or the Fisher exact test were performed. Local relapse-free survival, distant metastasis-free survival (DMFS), and disease-free survival (DFS) were estimated with the Kaplan–Meier method, and multivariate Cox regression was used to test for the independent effect of timing of RT after adjusting for known confounding factors. The median follow-up time was 65.8 months.ResultsDifferences in distribution of age, type of hormone therapy, and year of diagnosis were statistically significant. At 15-year follow-up, we failed to detect a significant correlation between time interval and the risk of local relapse (p = 0.09) both at the univariate and the multivariate analysis. The DMFS and the DFS univariate analysis showed a decreased outcome when radiotherapy was started early (p = 0.041 and p = 0.046), but this was not confirmed at the multivariate analysis (p = 0.406 and p = 0.102, respectively).ConclusionsOur results show that no correlation exists between the timing of postoperative radiotherapy and the risk of local relapse or distant metastasis development in a particular subgroup of women with node-negative early breast cancer.

Large Tumor Size is an Indicator for the Timely Administration of Adjuvant Radiotherapy in Luminal Breast Cancer with Positive Lymph Node

“…Previous studies have attempted to define the role of TI in predicting the tumor prognosis; however, their findings were inconsistent. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] One previous study that included 18 050 breast cancer patients treated with surgery and adjuvant radiotherapy, reported that a long TI was associated with the increased likelihood of local recurrence (hazard ratio=1.19, 95% confidence interval: 1.01 to 1.39, P=0.033). 6 A systematic review of 34 relevant studies with a total of 79,616 breast cancer patients reported that the relative risk of local recurrence per month of delay was 1.08 (95% confidence interval 1.02-1.14).…”

“…A study by Caponio et al, in which 615 breast cancer patients were divided into three groups according to the timing of radiotherapy (≤60, 61–120, and >120 days) and followed up for 15 years, reported no relationship between the TI and the risk of local recurrence. 11 In another study, Barbieri et al included a total of 387 patients with T1-2 breast cancer were treated with breast-conserving surgery and radiotherapy, showing no impact of a delay in radiotherapy on the risk of local relapse. 12 However, a major limitation of this study was in the selection criteria, which did not consider the differences in TI between patients who did and did not undergo chemotherapy.…”

“…[5][6][7][8][9] Meanwhile, other studies reported that the TI did not affect tumor prognosis. [10][11][12][13][14][15][16] These inconsistencies are likely accounted for by methodological discrepancies between studies, in particular, eligibility criteria. Some patients require adjuvant chemotherapy, leading to a delay in radiotherapy, which tends to be administered after chemotherapy.…”

Saving the Breast Saves the Lives of Breast Cancer Patients

“…is supports the evidence that receiving radiation or not could be considered as an independent variable. e time of radiation therapy after surgery is another challenging issue, which is not approved in many independent studies [40][41][42][43]. In a trial with 16 years follow-up, RT confirmed no increased risk of local recurrence when administered 2, 4, and 7 months after surgery and initial systemic therapy [44].…”

Effect of Delayed Adjuvant Radiotherapy in Early Breast Cancer on Local Control, Distant Metastasis and Overall Survival: an Evidence-Based Case Report

“…Some studies found that there was no decreased in survival or increased local or distant recurrence, 4.5 while other studies found that there was a decreased in survival and increased local recurrence in patients who received radiotherapy more than 6 weeks. 5 Because of differences in the results of the study, we were interested to make this critical appraisal.…”