When are breast cancer patients old enough for the quitclaim of local control?

Sautter-Bihl, Marie-Luise; Sedlmayer, Felix; Budach, Wilfried; Dunst, Jürgen; Feyer, Petra; Fietkau, Rainer; Harms, Wolfgang; Rödel, Claus; Souchon, Rainer; Wenz, Frederik; Sauer, Rolf

doi:10.1007/s00066-012-0253-6

Cited by 17 publications

(6 citation statements)

References 34 publications

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“…This can be attributed to unclear advantages of radiotherapy in this population when life expectancy, potential toxicity and comorbidities are taken in to account. There has been substantial recent discussion as to whether or not postoperative radiotherapy can be reasonably omitted in some women over the age of 70 with low-risk breast cancer [ 35 - 37 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study

Fisher

Gao

Yasui

et al. 2015

BMC Health Serv Res

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BackgroundBreast-conserving surgery (BCS) followed by radiotherapy is generally the preferred treatment for women diagnosed with early stage breast cancer. This study aimed to investigate the proportion of patients who receive BCS versus mastectomy and post-BCS radiotherapy, and explore factors associated with receipt of these treatments in Alberta, Canada.MethodsA retrospective population-based study was conducted that including all patients surgically treated with stage I-III breast cancer diagnosed in Alberta from 2002–2010. Clinical characteristics, treatment information and patient age at diagnosis were collected from the Alberta Cancer Registry. Log binomial multiple regression was used to calculate stage-specific relative risk estimates of receiving BCS and post-BCS radiotherapy.ResultsOf the 14 646 patients included in the study, 44% received BCS, and of those, 88% received post-BCS radiotherapy. The adjusted relative risk of BCS was highest in Calgary and lowest in Central Alberta for all disease stages. Relative to surgeries performed in Calgary, those performed in Central Alberta were significantly less likely to be BCS for stage I (RR = 0.65; 95% 0.57, 0.72), II (RR = 0.58; 95% 0.49, 0.68), and III (RR = 0.62; 95% CI: 0.37, 0.95) disease, respectively, adjusting for patient age at diagnosis, clinical and treatment characteristics. No significant variation of post-BCS radiotherapy was found.ConclusionsFactors such as region of surgical treatment should not be related to the receipt of standard care within a publicly-funded health care system. Further investigation is needed to understand the significant geographic variation present within the province in order to identify appropriate interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0680-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study

Fisher

Gao

Yasui

et al. 2015

BMC Health Serv Res

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“…The Radiation Therapy Oncology Group (RTOG) introduced a phase II prospective trial of repeat BCS adding 3D conformal partial breast reirradiation for local recurrence in 2010 [ 22 ]. Additionally, mutilating rescue surgery causes patients enormous emotional and physical distress [ 23 ]. Furthermore, the currently implemented close follow-up routine has led to detection of IBTR at early stages technically amenable to a second breast conserving approach.…”

Section: Therapy Of Ipsilateral Breast Tumor Recurrencementioning

confidence: 99%

DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences

et al. 2016

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ObjectiveTo update the practical guidelines for radiotherapy of patients with locoregional breast cancer recurrences based on the current German interdisciplinary S3 guidelines 2012.MethodsA comprehensive survey of the literature using the search phrases “locoregional breast cancer recurrence”, “chest wall recurrence”, “local recurrence”, “regional recurrence”, and “breast cancer” was performed, using the limits “clinical trials”, “randomized trials”, “meta-analysis”, “systematic review”, and “guidelines”.ConclusionsPatients with isolated in-breast or regional breast cancer recurrences should be treated with curative intent. Mastectomy is the standard of care for patients with ipsilateral breast tumor recurrence. In a subset of patients, a second breast conservation followed by partial breast irradiation (PBI) is an appropriate alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory. The largest reirradiation experience base exists for multicatheter brachytherapy; however, prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity.Following primary mastectomy, patients with resectable locoregional breast cancer recurrences should receive multimodality therapy including systemic therapy, surgery, and radiation +/− hyperthermia. This approach results in high local control rates and long-term survival is achieved in a subset of patients. In radiation-naive patients with unresectable locoregional recurrences, radiation therapy is mandatory. In previously irradiated patients with a high risk of a second local recurrence after surgical resection or in patients with unresectable recurrences, reirradiation should be strongly considered. Indication and dose concepts depend on the time interval to first radiotherapy, presence of late radiation effects, and concurrent or sequential systemic treatment. Combination with hyperthermia can further improve tumor control.In patients with isolated axillary or supraclavicular recurrence, durable disease control is best achieved with multimodality therapy including surgery and radiotherapy. Radiation therapy significantly improves local control and should be applied whenever feasible.

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“…The Radiation Therapy Oncology Group (RTOG) introduced in 2010 a phase II prospective trial of repeat BCS adding 3-dimensional (3D) conformal partial breast re-irradiation for local recurrence [20]. Additionally, a mutilating rescue surgery causes enormous emotional and physical distress for the patients [21,22]. The currently implemented close follow-up routine has led to the detection of IBTR at early stages, technically amenable to a second breast-conserving approach.…”

Section: Therapy Of Ipsilateral Breast Tumor Recurrencementioning

confidence: 99%

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

et al. 2015

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Patients with isolated locoregional breast cancer recurrences should be treated with curative intent. Mastectomy is regarded as the standard of care for patients with ipsilateral breast tumor recurrence. In a selected group of patients, partial breast irradiation after second breast-conserving surgery is a viable alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory, especially in patients who had not been irradiated previously. In case of re-irradiation, the largest experience exists for multi-catheter brachytherapy. Prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. In patients with resectable locoregional breast cancer recurrences after mastectomy, multi-modal therapy comprising complete resection, radiation therapy in previously unirradiated patients, and systemic therapy results in 5-year disease-free and overall survival rates of 69% and 88%, respectively. In radiation-naive patients with unresectable, isolated locoregional recurrences, radiation therapy is mandatory. In selected patients with previous irradiations and unresectable locoregional recurrences, a second irradiation as part of an individual treatment concept can be applied. The increased risk of severe toxicity should always be weighed up against the potential clinical benefit. A combination therapy with hyperthermia can further improve the treatment results.

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When are breast cancer patients old enough for the quitclaim of local control?

Cited by 17 publications

References 34 publications

Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study

Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study

DEGRO practical guidelines for radiotherapy of breast cancer VI: therapy of locoregional breast cancer recurrences

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

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