No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT

Autor: Lars Holmberg, Per-Uno Malmström, Per Karlsson, Fredrika Killander, Erik Holmberg, Jan Mattsson, Harald Anderson, Dan Lundstedt
Rok vydání: 2016
Předmět:
0301 basic medicine
Adult
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Postoperative radiotherapy
Breast Neoplasms
Mastectomy
Segmental
Disease-Free Survival
Contralateral breast cancer
03 medical and health sciences
0302 clinical medicine
Breast cancer
Antineoplastic Combined Chemotherapy Protocols
Breast-conserving surgery
medicine
Humans
Longitudinal Studies
skin and connective tissue diseases
Cyclophosphamide
Aged
Neoplasm Staging
Sweden
business.industry
Estrogen Antagonists
Middle Aged
medicine.disease
Surgery
Tumor Burden
Radiation therapy
Tamoxifen
030104 developmental biology
Methotrexate
Oncology
Chemotherapy
Adjuvant
030220 oncology & carcinogenesis
Ipsilateral breast
Lymph Node Excision
Female
Radiotherapy
Adjuvant
Fluorouracil
Neoplasm Recurrence
Local
business
Follow-Up Studies
Zdroj: European journal of cancer (Oxford, England : 1990). 67
ISSN: 1879-0852
Popis: Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients.A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program.After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P=0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P=0.68, nor was breast cancer-specific mortality significantly higher.RT after BCS significantly reduced the incidence of IBTR at 15 years of follow-up. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systemic therapy are needed to omit RT after BCS.
Databáze: OpenAIRE
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