Breast Preservation Therapy in Stage I and II Carcinoma: Factors Affecting Outcome
Resumo
Records were reviewed of 511 patients with 519 histologically confirmed carcinomas of the breast treated with wide local excision of tumor and irradiation to the breast (4600 to 5000 cGy in 5 weeks) and, in 109 patients, to regional lymphatics. In 271 patients with T1 and 98 with T2 tumor, boost to primary tumor site (1000-2000 cGy) was delivered using electrons (9-12 MeV); in 72 patients with T1 and 34 with T2 tumors, 192Ir implant was performed. Pathologic staging was T1 in 373 and T2 in 146 lesions (1988 AJC). Sixty-seven patients (18%) with T1 and 46 (32%) with T2 tumors had microscopically positive axillary lymph nodes.
Actuarial breast relapse rates at 5 years were 5% in T1 and 10% in T2 tumors and at 10 years 12% and 18%, respectively. Lymph node recurrenses were noted in 1% of T1 and 5% of T2 tumors. Distant metastases were detected in 5% of T1 and 22% of T2 tumors. Five-year actuarial breast relapse rates were 10% in T1 tumors and 18% in T2 (p = 0.04). Differences in 5- years breast relapse for patients with extensive intraductal component (EIC) were not statistically signifi-cant ( 7% in T1 tumors with EIC and 4% without it; 14% in T2 tumors with EIC and 7% without it). There was minimal correlation of irradiation dose to primary tumor
with breast relapse (in T1 from 2% to 7% and in T2 from 7% to 9% with doses >5500 cGy in contrast to 20% with 5000 to 5500 cGy). No correlation was noted with either type of boost (electrons or interstitial brachytherapy). Desease-free survival for patients with T1 tumors was 87% at 5 years and 82% at 10 years; for patients with T2 tumors, it was 75% at 5 years and 70% at 10 years.
Excellent/good cosmetic results were obtained in 78% of the patients. No difference was observed between the group treated with electrons or 192 Ir implant to the boost area.
Better understanding of prognostic factors and refinement of treatment techniques will enhance the results of breast conservation therapy.
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Referências
1 - Blichert-Toft M: A Danish randomized trial comparing breast preservation
with mastectomy in mammary carcinoma.
Proceedings of the NIH Consensus Development Conference Early Stage Breast
Cancer, June 1990, pp 28-31.
2 - Fisher B. Redmond C, Poisson R,
et al: Eight-year results of a randomized
clinical trial comparing total mastectomy
and lumpectomy with or without irradiation in the tratment of breast cancer. N
Engl J Med. 320:822-828, 1989.
3 - Glatstein E. Straus K. Lichter A.
Lippman M, Danforth D, Swain S, Cowan
K, de Moss E, McDonald H, d'Angelo T,
Steinberg S, Merino M, Bader J, Findlay P,
Rosenberg S: Results of the NCI early
breast cancer trial. Proceedings of the
NIH Consensus Development Conference
Early Stage Breast Cancer, June 1990, pp
32-33.
4 - Ryoo ME, Kagan AR, Wollin M,
Tome MA, Tedeschi AA, Rao AR, Hintz BL,
Kuruvilla AM, Nussbaum H, Streeter OE,
Jabola BR, Miller MJ: Prognostic factors
for recurrence and cosmesis in 393 patients after radiation therapy for early
mammary carcinoma. Radiology 172:555-
559, 1989.
5 - Van Dongen JA: Randomized clinical trial to assess the value of breast
conserving therapy in stage I and II breast
cancer: EORTC trial 10801. Proceedings
of the NIH Consensus Development Conference Early Stage Breast Cancer, June
1990, pp. 25-27.
6 - Veronesi U, Banfi A, DelVecchio M,
Saccozzi R, Clement C, Greco M, Luini A,
Maruloini E, Muscolina G, Rilke F, Sacchini
V, Salvatori B, Zecchini A, Zucali R: Comparison of Halsted mastectomy with
quadrantectomy, axillary dissection and
radiotherapy in early breast cancer: Longterm results. Eur J Cancer Clin Oncol.
22:1085-1089, 1986.
7 - Beadle GF, Harris JR, Silver B,
Botnick L, Hellman S: Cosmetic results
following primary radiation therapy for
early breast cancer. Cancer. 54:2911-
2918, 1984
8 - Kuske RR, Garcia DM, Perez CA,
Philpott GW, Lyss AP, Movsas T, Fineberg
B: Cosmesis after breast conservation
therapy: Surgical radiotherapeutic, chemotherapeutic, host, and tumor factors
influencing results. Int J Radiat Oncol Biol
Phis. (submitted for publication).
9 - Rose MA Olivotto I, Cady B, et al:
Conservative surgery and radiation
therapy for early breast cancer: Longterm cosmetic results. Ann urg. 124:153-
157, 1989.
10 - Boyages J, Recht A, Connolly SJ,
Gelman R, Kooy H, Love S, Osteen RT,
Cady B, Silver B, Harris JR: Early breast
cancer: Predictors of breast recurrencе
for patients treated with conservative
surgery and radiation therapy. Radiother
Oncol. 19:29-41, 1990.
11 - Danoff B. Goodman RL: Identification of subset of patients with early
breast cancer in whom conservative surgery and radiation is contraindicated. Int
J Radiat Oncol Biol Phys. 11:104, 1985.
12 - Eberlein TJ, Connolly JL, Schitt
SJ, Recht A, Osteen RT, Harris JR: Predictors of local recurrence following conservative breast surgery and radiation
therapy: The influence of tumor size. Arch
Surg. 125:771-777, 1990.
13 - Fisher ER, Sass R, Fisher B.
Gregory R, Brown R, Wickerham L, NSABP
Investigators: Pathologic findings from
the National Surgical Adjuvant Breast
Project (Protocol 6). II. Relation of local
breast recurrence to multicentricitty. Cancer 57:1717-1724, 1986.
14- Haffty BG, Fischer D, Rose M,
Beinfield M, Mckhann C: Prognostic factors for local recurrence in the conservatively treated breast cancer patient: A
cautious interpretation of the data. J Clin
Oncol. 9:997-1003, 1991.
15 - Kurtz JM, Jacquemier J, Amalric
R, Brandone H, Ayme Y, Hans D, Bressac
C, Roth J, Spitalier J-M: Risk factors for
breast recurrence in premenopausal and
postmenopausal patients with ductal cancers treated by conservation therapy.
Cancer. 65:1867-1878, 1990.
16 - Schitt SJ, Connoly JL, Recht A,
Silver B, Harris JR: Breast relapse following primary radiation therapy for early
breast cancer. II. Detection of pathologic
features and prognostic significance. Int
J Radiat Oncol Biol Phys. 11:1277-1284,
1985.
17 - Zafrani B, Vielh P, Fourquet A,
Mosseri V, Durand JC, Salmon RJ, Vilcoq
JR: Conservative treatment of early breast
cancer: Prognostic value of ductal in situ
component and other pathologic variables on local control and survival. Eur J
Cancer Clin Concol. 25:1645-1650, 1989.
18- Kurtz JM, Amalric R, Brandone H,
Qyme Y, Spitalier J-M: How important is
adequate radiotherapy for the long-term
results of breast-conserving treatment?
Radiother Oncol. 20:84-90, 1991.
19 - Recht A, Silver B. Schnitt S.
Connelly J, Hellman S, Harris JR: Breast
relapse following primary radiation
therapy for early breast cancer. I - Classification, frequency and salvage. Int J
Radiat Oncol Biol Phys 11:1271-1276,
1985.
20 - Haffty BG, Goldberg NB, Fisher
D,, Mckhann C, Beinfield M, Weissberg
JB, Carter D, Geral W: Conservative surgery and radiation therapy in breast carcinoma: Local recurrence and prognostic
implications. int J Radiat Oncol Biol Phys.
17:727-732, 1989.
21 - Hallahan De, Michel Ag, Halpern
HJ, Awan AM, Desser R, Bitran J, Recant
W, Wyman B, Spelbring DR,
Weichselbaum RR: Breast conservating
surgery and definitive irradiation for early
stage breast cancer. Int J Radiat Oncol
Biol Phys. 17:1211-1216, 1989.
22 - Rutqvist LE, Cedermark B, Glas U,
Johansson H, Rotstein S, Skoog L, Somell
A, Theve T, Askergren J, Friberg S,
Bergstrom J, Blomstedt B, Rat L,
Silfversward C, Einhorn J: Radiotherapy,
chemotherapy, and taxoxifen as adjuncts
to surgery in early breast cancer: A summary of three ramdomized trials. int J
Radiat Oncol Biol Phys. 15:629, 1989.
23 - Beahrs OH, Henson DE, Hutter
RVP, Myers MM (eds): Manual for staging of cancer, 3rd ed. Philadelphia, JB
Lippincott, 1988.
24 - Perez CA, Garcia DM, Kuske RR,
Halverson KJ, Coke C, McBurney L,
Myerson R, Philpott G, Levy J, Simpson
JR, Tucker G, Vest M, Lockett MA, Rush
C: Organ preservation therapy in stage T1
and T2 carcinoma of the breast. Front
Radiat Ther Oncol. (in press).
25 - Dixon WJ: BMDP Statistical Software. Los Angeles, University of California Press, 1982.
26 - Dixon WJ: News for 1987 release
of BMDP statistical software. Los Angeles, University of California press, 1986.
27 - Cutler SJ. Ederer F: Maximum
utilization of the life table method in analyzing survival. J Chron Dis. 8:699-713,
1958.
28 - Miller R: Survival Analysis. New
York, John Willey, 1981.
29 - Tarone R, Ware J: On distribution
free tests for equality of survival distributions. Biometrika. 64:156-160, 1977.
30 - Tarone R: Tests for trend in life
table analysis. Biometrika.
31 - Perez CA, Garcia DM. Kuske RR,
levitt SH: Breast: Stage T, and T2 tumors;
In Perez CA, Brady LW (eds): Principlesand practice of radiation oncology, 2nd
ed. Philadelphia, JB Lippincott, 1992.
32 - Harris JR, Connolly JL, Schnitt
SJ, Cady B, Love S, Osteen RT, Patterson
WB, Shirley R, Hellman S, Cohen RB,
Silen W: The use of pathologic features in
selecting the extent of surgical resection
necessary for breast cancer patients
treated by primary radiation therapy. Ann
Surg. 210:164-169, 1985.
33 - Sarrazin D, Le MG, Arriagada R,
Contesso G, Fontaine F, Spielmann M,
Rochard F, le Chevalier TH, Lacour J: Tenyear results of a randomized trial comparing a conservative treatment to
mastectomy in early breast cancer.
Radiother Oncol 14:177, 1989.
34 - Calle R, Pilleron J, Schlienger P,
Vilcoq JR: Conservative management of
operable breast cancer: Ten years' experience at the Foundation Curie. Cancer.
42:2045-2053, 1978.
35-Cedermark B,Askergren J, Alveryd
A, et al: Breast-conserving treatment for
breast cancer in Stockholm, Sweden, 1977
to 19881. Cancer. 53:1253-1255, 1984.
36- Clark RM, Wilkinson RH, Mahoney
LJ, Reid JG, MacDonald WD: Breast cancer: A 21 year experience with conservative surgery and radiation. Int J Radiat
Oncol Biol Phys. 8:967-975, 1982.
37 Clarke DH, Le MG, Sarrazin D,
Lacombe MJ, Fountaine F, Travagly J-P,
May-Levin F, Contesso G, Arriagada R:
Analysis of local-regional relapses in patients with early breast cancers treated by
excision and radiotherapy: Experience of
the Institut Gustave-Roussy. int J Radiat
Oncol Biol Phys. 11:137-145, 1985.
38 - Dubois JB, Gary-Bobo J, F
Pourquier H, Pujol H: Tumorectomy and
radiotherapy in early breast cancer: A
report on 392 patients. Int J Radiat Oncol
Biol Phys. 15:1275-1282, 1988.
39 - Fowble BL, Solin LJ, Schultz DJ,
Goodman RL: Ten year results of conservative surgery and irradiation for stage I
and II breast cancer. Int J Radiat Oncol
Biol Phys. 21:269-277, 1991.
40 - Sarrazin D, JA Arriagada R,
Behamou S, Benhamou E, Lasser P,
Fontaine F, Travagly JR, Spielmann M, le
Chevalier T, Contesso G: Conservative
management of breast cancer. Br J Surg.
77:604-606, 1986.
41 - Bartelink H, Borger JH, van Dogen
JA, et al: The impact of tumor size and
histology on local control after breastconserving therapy. Radiother Oncol.
11:297-303, 1988.
42 - Fisher B, Redmond C, Dimirov
NV, Bowman D, Legault-Poisson S,
Wicherham L, Wolmark N, Fisher E,
Margolese R, Sutehrland C, Glass A, Foster R, Caplan R: A randomized clinical trial
evaluating sequential methotrexate and
fluorouracil in the treatment of patients
with node-negative breast cancer who
have estrogen-receptor-negative tumors.
N Engl J Med. 320:473-478, 1989.
43 - Veronesi U, Salvador B, Luini A,
Banfi A, Zucali R, Del Vecchio M, Saccazzi
R. Beretta E, Boracchi P, Farante G,
Galimberti V. Mezzanotte G. Sacchini V,
Tana S, Marubini E: Conservative treatment of early breast cancer: Long-term
results of 1232 cases treated with
quadrantectomy, axillary dissection and
radiotherapy. Ann Surg. 211:250-259,
1990.
44-NIH Consensus Conference: Treatment of early-stage breast cancer. JAMA.
265:391-395, 1991.
45 - Montague ED: Conservation surgery and radiation therapy in the treatment of operable breast cancer. Cancer.
53:700-704, 1984.
46 - Calle R, Volcoq JR, Zafrani B,
Vielh P, Fourquet A: Local control and
survival of breast cancer treatment by
limited surgery followed by irradiation.
Int J Radiat Oncol Biol Phys. 12:873-878,
1986.
47 - Delouche G, Bachelot F, Premont
M, Kurtz JM: Conservation treatment of
early breast cancer: Long-term results
and complications. Int J Radiat Oncol Biol
Phys. 13:29-34, 1987.
48- Van Limbergen E, Van den Bogaert
W, van der Schueren E, Rijnders A: Tumor
excision and radiotherapy as primary treatment of breast cancer: Analysis of patients and treatment parameters and local
control. Radiother Oncol. 8:1-9, 1987.
49 - Fisher B, Anderson S, Fisher ER,
Redmond C, Wickerham DL, Wolmark N,
Mamounas EP, Deutsch M, Margolese R:
Significance of ipsilateral breast tumour
recurrence after lumpectomy. Lancet.
338-327-331, 1991.
50 - Kurtz JM, Spitalier JM, Amalric R:
Late breast recurrence after lumpectomy
and irradiation. Int J Radiat Oncol Biol
Phys. 9:1191-1194, 1983.
51 - Schnitt SJ, Connolly JL, Khettry
U, Mazoujian G, Brenner M, Silver B,
Recht A, Beadle G, Harris JR: Pathologic
findings on re-excision of the primary site
in breast cancer patients considered for
treatment by primary radiation therapy.
Cancer. 59:675-681, 1987.
52 - Solin LJ. Fowble BL, Schultz DJ,
Goodman RL: The significance of the
pathology margins of the tumor excision
on the outcome of patients treated with
definitive irradiation for early stage breast
cancer. Int J Radiat Oncol Biol Phys.
21:279-287, 1991.
53 - Kurtz JM, Jacquemier J, Amalric
R, Brandone H, Ayme Y, Hans D, Bressac
C, Spitalier J: Why are local recurrences
after breast conserving therapy more frequent in young patients? J Clin Oncol.
8:591, 1990.
54- Fourquet A, Campana F, Zafrani B,
Mosseri V, Vielh P, Durand J-C, Vilcoq JR:
Prognostic factors of breast recurrence
in the conservative management of early
breast cancer: A 25-year follow-up. Int J
Radiat Oncol Biol Phys. 17:719-725, 1989.
55 - Olivotto IA, Rose MA, Osteen RT,
Love S, Cady B, Recht A, Harris JR: Late
cosmetic outcome after conservative surgery and radiotherapy: Analysis of causes
of cosmetic failure. Int J Radiat Oncol Biol
Phys. 17:747-753, 1989.
56 - Ray GR, Fish VJ: Biopsy and
definitive radiation therapy in stage I and
Il adenocarcinoma of the female breast:
Analysis of cosmesis and the role of
electron beam supplementation. Int J
Radiat Oncol Biol Phys. 9:813-818, 1983.
57 - Recht A, Come SE, Gelman RS,
Goldstein M, Tishler S, Gore SM, Abner
AL, Vicini FA, Silver B, Connoly JL, Schnitt
SJ, Coleman CN, Harris JR: Integration of
conservative surgery, radiotherapy, and
chemotherapy for the treatment of earlystage, node-positive breast cancer: Sequencing, timing, and outcome. J Clin
Oncol. 9:1662-1667, 1991.
58 - Fowble B, Goodman RL, Glick JH,
Rosato EF: Breast cancer treatment: A
comprehensive guide to management.
St. Louis, Mosby Year Book, 1991.
59 - Harris JR, Hellman S, Henderson
IC, Kinne DW: Breast Diseases, 2nd ed.
Philadelphia, JB Lippincott, 1991.
60 - Dewar JA, Sarrazin D, Benhamou
E, et al: Management of the axilla in
conservatively treated breast cancer: 592
patients treated at Institu GustaveRoussy. Int J Radiat Oncol Biol Phys.
13:475-481, 1987.
61 - Fowble B, Solin LJ Schultz DJ,
Goodman RL: Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and
radiation for early breast cancer. Int J
Radiat Oncol Biol Phys. 17:703-710, 1989.
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