Prognostic role of adjuvant radiotherapy in triple‐negative breast cancer: A historical cohort study

The value of adjuvant radiotherapy in triple‐negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N = 1,138) were included. Survival between patients receiving mastectomy only, breast‐conserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23–96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node‐negative disease. The majority of patients received adjuvant chemotherapy (n = 861, 76%) comprising predominantly anthracycline‐based regimes. In 775 women with T1‐2, N0‐1, M0 TNBCs, 5‐year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8–98.8%), followed by BCT (90.8%, 95% CI: 85.0–94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4–88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3‐4, N2‐3, M0 TNBCs, BCT was associated with highest 5‐year RSR (94.1%, 95% CI: 81.3–99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3–70.1%), and mastectomy only (58.6%, 95% CI: 43.5–71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.     

Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer

BACKGROUND: Choice of treatment for early-stage breast cancer depends on many factors, including the size and stage of the cancer, the woman's age, comorbid conditions, and perhaps the costs of treatment. We compared the costs of all medical care for women with early-stage breast cancer cases treated by breast-conserving therapy (BCT) or mastectomy. METHODS: A total of 1675 women 35 years old or older with incident early-stage breast cancer were identified in a large regional nonprofit health maintenance organization in the period 1990 through 1997. The women were treated with mastectomy only (n = 183), mastectomy with adjuvant hormonal therapy or chemotherapy (n = 417), BCT with radiation therapy (n = 405), or BCT with radiation therapy and adjuvant hormonal therapy or chemotherapy (n = 670). The costs of all medical care for the period 1990 through 1998 were computed for each woman, and monthly costs were analyzed by treatment, adjusting for age and cancer stage. All statistical tests were two-sided. RESULTS: At 6 months after diagnosis, the mean total medical care costs for the four groups differed statistically significantly (P:<.001), with BCT being more expensive than mastectomy. The adjusted mean costs were $12 987, $14 309, $14 963, and $15 779 for mastectomy alone, mastectomy with adjuvant therapy, BCT plus radiation therapy, and BCT plus radiation therapy with adjuvant therapy, respectively. At 1 year, the difference in costs was still statistically significant (P:<.001), but costs were influenced more by the use of adjuvant therapy than by type of surgery. The 1-year adjusted mean costs were $16 704, $18 856, $17 344, and $19 081, respectively, for the four groups. By 5 years, BCT was less expensive than mastectomy (P:<.001), with 5-year adjusted mean costs of $41 930, $45 670, $35 787, and $39 926, respectively. Costs also varied by age, with women under 65 years having higher treatment costs than older women. CONCLUSIONS: BCT may have higher short-term costs but lower long-term costs than mastectomy.     

Breast-conserving surgery for T3/T4 breast cancer: an analysis of 196 patients

Introduction Breast conservation therapy (BCT) increases quality of life and self-esteem of breast cancer patients. In special cancer centers up to 90% of patients are treated with BCT. T3/T4 breast cancer is one of the few contraindications for BCT. However, retrospective data suggest that BCT may be eligible in selected cases of T3/T4 breast cancer. Method We analyzed retrospectively 196 breast cancer patients (operated between 1995 and 2004) suffering from T3/T4 tumors and compared BCT and radiotherapy with mastectomy in these patients in terms of overall survival (OS), local recurrence free-survival (LRFS) and breast cancer-related death (BCRD). Result Demographic data showed no significant differences in prognostic factors between patients treated with mastectomy compared with BCT. Kaplan-Meier curves demonstrated no significant difference for OS, LRFS and BCRD between the two groups. Discussion Our data strongly suggest that BCT with R0 resection followed by radiotherapy is feasible in patients with T3/T4 breast cancer. Prospective studies have to be performed to further investigate this issue.     

Early operable breast cancer

Opinion statement Early operable breast cancer is a potentially curable disease. However, a substantial number of patients are at risk for systemic recurrence and death. Breast conservation therapy (BCT) should be considered the preferred surgical option for most women with early operable breast cancer. Adjuvant systemic chemotherapy or hormonal therapy can substantially reduce, although not eliminate, the risk of recurrence and death. Neoadjuvant or primary systemic therapy (PST) in operable breast cancer slightly increases the number of women treated with breast conservation versus mastectomy. Although PST may identify women who are likely to have a better prognosis (those with a pathologic complete response), current PST strategies do not offer a survival advantage over standard adjuvant approaches. Early results of high-dose chemotherapy trials thus far have not shown any advantage over conventional dose therapy in high-risk patients with 10 or more positive lymph nodes. The role of adjuvant radiation therapy after mastectomy for all patients with high-risk early operable breast cancer is not fully defined.     

Preliminary analysis of a clinical trial for three-dimensional conformal radiation therapy after conservative surgery

Objective

The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery.

Methods

Among 80 patients, 44 were treated by modified radical mastectomy followed by adjuvant radiotherapy (modified radical mastectomy, MMT), 36 were treated with breast conservative surgery with adjuvant irradiation [breast-conservation therapy (BCT)]. Tangential fields were used to deliver 6 MV X-ray beams to a total dose of 50 Gy. Another 16 Gy was added to the tumor bed with 6–9 MeV electron beams for BCT.

Results

In MMT group, the local control, metastasis-free and death were 41, 41 and 1 respectively; in BCT group, the local control, metastasis-free and death were 35, 35 and 0. The difference of the above two indicators between the two groups showeed no statistical insignificance (P > 0. 05). In MMT group, 32 patients suffer radiation dermatitis above 2-level, 12 patients suffer radiation pneumonia, and 10 patients suffer edema of illness-side upper extremity; in BCT group, the above indicators were only 6, 2 and 1 respectively. Three months, six months and one year after radiation therapy, 90%, 92% and 95% patients were assessed as excellence in fine cosmetic state in BCT group.

Conclusion

The effects of three-dimensional conformal radiation therapy after conservative surgery are the same as that of modified radical mastectomy, while the former has better cosmetic results and lower radiation therapy induced complications.     

Radiotherapy of the chest wall following mastectomy for early-stage breast cancer: impact on local recurrence and overall survival

INTRODUCTION: Recent studies have renewed an old controversy about the efficacy of adjuvant radiotherapy following mastectomy for breast cancer. Radiotherapy is usually recommended for advanced disease, but whether or not to use it in pT1-T2 pN0 situations is still being debated. This study was designed to clarify whether or not routine radiotherapy of the chest wall following mastectomy reduces the risk of local recurrence and if it influences the overall survival rate. METHODS: Retrospective analysis of patients treated with mastectomy for pT1-T2 pN0 tumors and no systemic treatment. Patients treated with radiotherapy of the chest wall following mastectomy (Group A) are compared with those treated with mastectomy alone (Group B). RESULTS: A total of 918 patients underwent mastectomy. Patients who received adjuvant radiotherapy after mastectomy (n = 114) had a significantly lower risk for local recurrence. Ten years after the primary diagnosis, 98.1% of the patients with radiotherapy were disease free compared to 86.4% of the patients without radiotherapy. The average time interval from primary diagnosis until local recurrence was 8.9 years in Group A and 2.8 years in Group B. The Cox regression analysis including radiotherapy, tumor size and tumor grading found the highest risk for local recurrence for patients without radiotherapy (p < 0.0004). In terms of overall survival however, the Kaplan-Meier analysis showed no difference between the two groups (p = 0.8787) and the Cox regression analysis failed to show any impact on overall survival. CONCLUSION: With observation spanning over 35 years, this study shows that adjuvant radiotherapy of the chest wall following mastectomy reduces the risk for local recurrence in node-negative patients with pT1-T2 tumors but has no impact on the overall survival rate.     

Breast conserving therapy and mastectomy revisited: Breast cancer‐specific survival and the influence of prognostic factors in 129,692 patients

This large population‐based study compared breast‐conserving surgery with radiation therapy (BCT) with mastectomy on (long‐term) breast cancer‐specific (BCSS) and overall survival (OS), and investigated the influence of several prognostic factors. Patients with primary T1‐2N0‐2M0 breast cancer, diagnosed between 1999 and 2012, were selected from the Netherlands Cancer Registry. We investigated the 1999–2005 (long‐term outcome) and the 2006–2012 cohort (contemporary adjuvant systemic therapy). Cause of death was derived from the Statistics Netherlands (CBS). Multivariable analyses, per time cohort, were performed in T1‐2N0‐2, and separately in T1‐2N0‐1 and T1‐2N2 stages. The T1‐2N0‐1 stages were further stratified for age, hormonal receptor and HER2 status, adjuvant systemic therapy and comorbidity. In total, 129,692 patients were included. In the 1999–2005 cohort, better BCSS and OS for BCT than mastectomy was seen in all subgroups, except in patients < 40 years with T1‐2N0‐1 stage. In the 2006–2012 cohort, superior BCSS and OS were found for T1‐2N0‐1, but not for T1‐2N2. Subgroup analyses for T1‐2N0‐1 showed superior BCSS and OS for BCT in patients >50 years, not treated with chemotherapy and with comorbidity. Both treatments led to similar BCSS in patients <50 years, without comorbidity and those treated with chemotherapy. Although confounding by severity and residual confounding cannot be excluded, this study showed better long‐term BCSS for BCT than mastectomy. Even with more contemporary diagnostics and therapies we identified several subgroups that may benefit from BCT. Our results support the hypothesis that BCT might be preferred in most breast cancer patients when both treatments are suitable.     

早期乳腺癌保乳治疗的临床研究

目的：探讨早期乳腺癌保乳术后综合治疗的效果。方法：对１０８例早期乳腺癌行保乳治疗,并与同期行改良根治术治疗的１２１例早期乳腺癌行对比研究。保乳治疗患者年龄３１～６１岁,中位年龄４４.５岁。保乳术后行全乳腺放疗和瘤床加量,处方剂量５０Ｇｙ／５周,瘤床追加６～９ＭｅＶ电子线１０～１５Ｇｙ／７～１０天。改良根治术患者年龄３４～６８岁,中位年龄４７.６岁。改良根治术后放疗的范围根据肿块大小和淋巴结转移情况决定,处方剂量５０Ｇｙ／５周。两组均采用ＣＡＦ或ＣＭＦ方案化疗,ＥＲ或ＰＲ阳性的患者给予内分泌治疗。结果：１０８例保乳治疗患者中３例复发,５例出现远处转移（２例为骨转移,１例为骨、肝、肺多发转移,２例为肺转移）。术后６个月美容效果评估优、良者为９１.７％,术后１年为９２.６％。１２１例改良根治术患者中３例复发,７例出现远处转移（３例为骨转移,３例为肺转移,１例为多发脏器转移）。两组的近期疗效差异均无统计学意义（Ｐ＞０.０５）。结论：早期乳腺癌采用保乳术及术后综合治疗的疗效不低于改良根治术,且美容效果更优。     

Predictive factors for local recurrence in breast cancer

Risk factors for local recurrence in breast cancer after breast conserving therapy (BCT) differ from those for local recurrence after mastectomy. To better guide optimal treatment of individual patients, it is desirable to identify patients at high risk for local recurrence. Several clinical and histopathologic factors, such as young age and presence of ductal carcinoma in situ, are known to be predictors for local recurrence after BCT. After mastectomy, lymph node status and tumor size are dominant risk factors for local recurrence. The results of recent expression profiling studies have explained differences in prognosis and risk for local recurrence and also explained response to different therapies (adjuvant systemic therapy and radiotherapy). Because of the variation in different subtypes of breast cancer and the difference in amount of tumor burden remaining after surgery, finding robust predictive profiles is complex. In this review, we describe the predictive and prognostic factors for local recurrence after mastectomy and BCT and also describe the role of radiosensitivity in local recurrence.     

中国乳腺癌保乳治疗的前瞻性多中心研究

目的 探讨早期乳腺癌保乳治疗的可行性,以及我国开展保乳综合治疗的模式。方法 中国医学科学院中国协和医科大学肿瘤医院等全国共10家三级甲等医院协作,进行早期乳腺癌保乳治疗与切除乳房治疗的大样本前瞻性多中心对照研究。结果 完成保乳手术872例,占符合保乳治疗条件乳腺癌患者的19．5％,占同期全部可手术乳腺癌患者的9．0％。保乳治疗组复发9例（1．0％）,远处转移11例（1．3％）,死亡1例（0．1％）;切除乳房组复发18例（0．5％）,远处转移49例（1．4％）,死亡4例（0．1％）。两组术后局部复发率、远处转移率与死亡率差异无统计学意义（P均〉0．05）。保乳治疗乳房美容效果评估优、良者术后6个月占89．7％,术后1年占91．1％,术后2年占86．6％。结论 保乳治疗在中国是可行的,对早期乳腺癌患者的生存率、复发率无负面影响,提高了患者的生活质量。保乳治疗必须严格把握手术适应证,需要多学科的有机配合,综合治疗是保乳治疗成功的保证。     

Two new CHEK2 germ-line variants detected in breast cancer/sarcoma families negative for BRCA1, BRCA2, and TP53 gene mutations

To compare the effectiveness of breast-conserving therapy (BCT) and mastectomy, all women aged ≤40 years, treated for early-stage breast cancer in the southern part of the Netherlands between 1988 and 2005, were identified. A total of 562 patients underwent mastectomy and 889 patients received BCT. During follow-up, 23 patients treated with mastectomy and 135 patients treated with BCT developed a local relapse without previous or simultaneous evidence of distant disease. The local relapse risk for patients treated with mastectomy was 4.4% (95% confidence interval (CI) 2.4–6.4) at 5 years and reached a plateau after 6 years at 6.0% (95% CI 3.5–8.5). After BCT, the 5-, 10- and 15-year risks were 8.3% (95% CI 6.3–10.5), 18.4% (95% CI 15.0–21.8) and 28.2% (95% CI 23.0–33.4), respectively (P < 0.0001). Adjuvant systemic therapy following BCT reduced the 15-year local relapse risk from 32.9% (95% CI 26.7–39.1) to 16.1% (95% CI 9.1–23.1), (P = 0.0007). In conclusion, local tumor control in young patients with early-stage breast cancer is worse after BCT than after mastectomy. Adjuvant systemic therapy significantly improves local control following BCT and also for that reason it should be considered for most patients ≤40 years. Long-term follow-up is highly recommended for young patients after BCT, because even with systemic treatment an annual risk of local relapse of 1% remains up to 15 years after treatment.     

T1-2N0M0 Triple-Negative Breast Cancer Treated With Breast-Conserving Therapy Has Better Survival Compared to Mastectomy: A SEER Population-Based Retrospective Analysis

BackgroundFor early-stage breast cancer, the two current mainstay treatments are breast-conserving therapy (BCT; lumpectomy followed by radiotherapy [RT] and BCT) and mastectomy. Generally, triple-negative breast cancer (TNBC) is more aggressive compared to hormone receptor–positive breast cancer. We sought to investigate the effect of BCT compared to mastectomy on overall survival (OS) and breast cancer–specific survival (BCSS) in T1-2N0M0 TNBC.Patients and MethodsA population-based retrospective analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Patients included in the analysis were divided into 3 groups according to surgical modality and RT: BCT, mastectomy alone, and mastectomy with RT. The survival end points were OS and BCSS, and survival analysis was performed by the Kaplan-Meier method and the log-rank test among treatment types.ResultsA total of 14,910 female subjects with T1-2N0M0 TNBC diagnosed between 2010 and 2014 were included. A total of 7381 patients had BCT; 6967 had mastectomy alone, and 562 had mastectomy with RT. Patients treated with BCT had better OS (log-rank P < .05) and BCSS (log-rank P < .05) than those receiving mastectomy with or without RT. The 5-year OS was 88.6% for BCT, 83.0% for mastectomy alone, and 79.6% for mastectomy with RT. The 5-year BCSS was 94.3% for BCT, 93.3% for mastectomy alone, and 83.7% for mastectomy with RT.ConclusionIn patients with T1-2N0M0 TNBC, BCT was associated with superior OS and BCSS compared to mastectomy with or without RT. After mastectomy, there was no evidence of survival benefit of RT.     

Locoregional and distant recurrences after breast conserving therapy in patients with triple-negative breast cancer: A meta-analysis

BackgroundWith higher incidence of recurrence, ongoing dispute exists on whether triple-negative breast cancer (TNBC) is a good candidate for breast conserving therapy (BCT).ObjectiveWe aimed to appraise the safety of BCT in treating TNBC, in comparison with modified radical mastectomy. The prognostic effect of TN phenotype in conservatively managed patients was also assessed.MethodsA systematic search for studies regarding recurrences in patients with TNBC or treated by BCT was conducted up to March 2013. Summary relative risks (RRs) for ipsilateral locoregional recurrence (ILRR) and distant metastasis (DM) were calculated in a fixed-effects model.ResultsTwenty-two studies concerning 15,312 breast cancer patients were analyzed. In the cohort of TNBC, the patients receiving BCT were less likely to develop ILRR and DM in comparison with mastectomy (RR 0.75, 95% CI 0.65–0.87; RR 0.68, 95% CI 0.60–0.76). In the cohort of BCT, the TN subtype increased the risks of both ILRR and DM than non-TN subtypes (RR 1.88, 95% CI 1.58–2.22; RR 2.12, 95% CI 1.72–2.62). Further subgroup analyses of BCT cohort revealed that the luminal phenotype had the most favorable prognosis. Notably, TN subtype was less likely to develop ILRR than HER-2 subtype (RR 0.69, 95% CI 0.53–0.91), there was no difference in DM rate between them.ConclusionsBCT benefits patients with TNBC than mastectomy does. However, TN subtype predicts a poorer prognosis than non-TN subtype, suggesting more aggressive adjuvant therapy for TNBC be established in future trials.     

Vascular endothelial growth factor independently predicts the efficacy of postoperative radiotherapy in node-negative breast cancer patients.

PURPOSE: Vascular endothelial growth factor (VEGF) is a mediator of angiogenesis and is up-regulated under hypoxic conditions. Hypoxic tumors are known to exhibit resistance to radiotherapy. We investigated the association between VEGF levels in tumor tissue and the effect of radiotherapy for relapse-free survival (RFS) and overall survival (OS) in node-negative breast cancer. EXPERIMENTAL DESIGN: The study was performed on 489 patients; 221 patients received postoperative radiotherapy as part of the breast-conserving therapy (BCT), and 268 patients were treated by mastectomy only. VEGF levels were measured using a quantitative ELISA. None of the patients received adjuvant systemic therapy. The median follow-up was 64 months (range, 2-149) after BCT and 59 months (range, 2-117) after mastectomy. Correlations with well-known prognostic factors were studied, and univariate and multivariate survival analyses were performed. RESULTS: Only in the BCT group, high VEGF levels (equal or above the median level) predicted a reduced RFS and OS in univariate survival analysis (P = 0.004 and P = 0.028, respectively), implying that patients with high VEGF levels have less benefit from BCT. This was seen as a significant interaction between local treatment and VEGF for the total population for RFS (P = 0.012) and OS (P = 0.004). The interaction between local treatment and tumor size was also significant for both RFS (P = 0.046) and OS (P = 0.019) in the multivariate analysis. CONCLUSIONS: These results show that, in node-negative patients, both tumor size and VEGF content predict for a reduced efficacy of postoperative radiotherapy as part of BCT, indicating that the choice of local treatment of these patients can also be modified based on tumor VEGF content.     

Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial

BACKGROUND: Breast-conserving therapy (BCT) has been shown to be as effective as mastectomy in the treatment of tumors 2 cm or smaller. However, evidence of its efficacy, over the long term, in patients with tumors larger than 2 cm is limited. From May 1980 to May 1986, the European Organization for Research and Treatment of Cancer carried out a randomized, multicenter trial comparing BCT with modified radical mastectomy for patients with tumors up to 5 cm. In this analysis, we investigated whether the treatments resulted in different overall survival, time to distant metastasis, or time to locoregional recurrence. METHODS: Of 868 eligible breast cancer patients randomly assigned to the BCT arm or to the modified radical mastectomy arm, 80% had a tumor of 2.1-5 cm. BCT comprised lumpectomy with an attempted margin of 1 cm of healthy tissue and complete axillary clearance, followed by radiotherapy to the breast and a supplementary dose to the tumor bed. The median follow-up was 13.4 years. All P values are two-sided. RESULTS: At 10 years, there was no difference between the two groups in overall survival (66% for the mastectomy patients and 65% for the BCT patients; P =.11) or in their distant metastasis-free rates (66% for the mastectomy patients and 61% for the BCT patients; P =.24). The rate of locoregional recurrence (occurring before or at the same time as distant metastasis) at 10 years did show a statistically significant difference (12% of the mastectomy and 20% of the BCT patients; P =. 01). CONCLUSIONS: BCT and mastectomy demonstrate similar survival rates in a trial in which the great majority of the patients had stage II breast cancer.     

Locoregional recurrence of pT3N0M0 breast cancer after mastectomy is not higher than that of pT1‐2N0M0: An analysis for radiotherapy

The purpose of this study was to investigate the value of post‐operative radiotherapy in the treatment of pT3N0M0 breast cancer after mastectomy. We analyzed the clinical data of 1390 patients with pT1‐3N0M0 breast cancer who were admitted and treated from 1998 to 2007 at the Sun Yat‐sen University Cancer Center. All patients underwent mastectomy and did not receive radiotherapy. The locoregional recurrence‐free survival, distant metastasis‐free survival and overall survival of different T stages of breast cancer were compared. The median follow‐up duration was 72 months. The 10‐year locoregional recurrence‐free survival patients with pT1N0, pT2N0 and pT3N0 breast cancers were 95.3, 91.9 and 93.6%, respectively (χ² = 2.550, P = 0.279). The 10‐year distant metastasis‐free survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 88.1%, 81.0% and 78.4%, respectively (χ² = 8.254, P = 0.016). The 10‐year overall survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 91.9%, 83.5% and 73.0%, respectively (χ² = 12.403, P = 0.002). Univariate analyses failed to identify any prognostic factors for locoregional recurrence in pT3N0 patients. Multivariate analysis showed that the T stage had no effect on locoregional recurrence. The locoregional recurrence rate in patients with pT3N0M0 breast cancer who underwent mastectomy and did not receive postoperative radiotherapy was not higher than that in patients with pT1‐2N0M0 breast cancer who received the same treatment, suggesting that routine adjuvant post‐operative radiotherapy should not be recommended in this patient population.     

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

PURPOSE: To assess the need for adjuvant radiotherapy following mastectomy for patients with node-negative breast tumors 5 cm or larger. METHODS AND MATERIALS: Between 1981 and 2002, a total of 70 patients with node-negative breast cancer and tumors 5 cm or larger were treated with mastectomy and adjuvant systemic therapies but without radiotherapy at three institutions. We retrospectively assessed rates and risk factors for locoregional failure (LRF), overall survival (OS), and disease-free survival (DFS) in these patients. RESULTS: With a median follow-up of 85 months, the 5-year actuarial LRF rate was 7.6% (95% confidence interval, 3%-16%). LRF was primarily in the chest wall (4/5 local failures), and lymphatic-vascular invasion (LVI) was statistically significantly associated with LRF risk by the log-rank test (p=0.017) and in Cox proportional hazards analysis (p=0.038). The 5-year OS and DFS rates were 83% and 86% respectively. LVI was also significantly associated with OS and DFS in both univariate and multivariate analysis. CONCLUSIONS: This series demonstrates a low LRF rate of 7.6% among breast cancer patients with node-negative tumors 5 cm and larger after mastectomy and adjuvant systemic therapy. Our data indicate that further adjuvant radiation therapy to increase local control may not be indicated by tumor size alone in the absence of positive lymph nodes. LVI was significantly associated with LRF in our series, indicating that patients with this risk factor require careful consideration with regard to further local therapy.     

Evaluation of Eligibility and Utilization of Breast Conservation Treatment in an Asian Context

Background: Breast conservation treatment (BCT) has long been recognised to provide survival outcomesequivalent to mastectomy for the treatment of breast cancer. However, published reports of BCT rates in Asiancommunities are lower than those from Western countries. This study sought to investigate the eligibility andutilisation of BCT in a predominantly Asian population. Materials and Methods: All patients treated surgicallyby a single surgeon at a private medical facility between 2009 and 2011 were included in the study. Patients weredeemed to have successful BCT if they underwent breast conserving surgery with pathologic clear margins andcompleted all recommended adjuvant treatment. Those who did not complete adjuvant treatment were excludedfrom the analysis. Results: Data from a total of 161 patients who underwent treatment during the study periodwere analysed. The mean age was 48.8 years. One hundred and six patients (65.8%) were of Chinese ethnicity,12 were Indian (7.5%), 11 were Malay (6.8%), 18 were Caucasian (11.2%) and 14 (8.7%) were of other Asianethnicity. One hundred and thirty-eight women (85.7%) underwent BCT. Of the 23 (14.3%) who underwentmastectomy, 8 (5.4%) elected to undergo a mastectomy despite being eligible for BCT. In total, it was assessedthat 146 of 161 patients (90.7%) were eligible for BCT and utilisation was 94.5%. Conclusions: In this study,eligibility, utilisation of BCT and eventual successful breast conservation rates are similar to published ratesin Western communities. Additional research is needed to investigate the reasons for the lower published BCTrates in Asian countries and determine ways to improve them.     

A comparative analysis of radiotherapy use and patient outcome in males and females with breast cancer.

BACKGROUND: The aim was to determine whether gender was a significant prognostic factor for post-mastectomy relapse, after accounting for known prognostic factors and delivery of radiotherapy. PATIENTS AND METHODS: All patients diagnosed with invasive breast cancer between 1 January 1989 and 31 December 1998 who had undergone total mastectomy as primary therapy were identified from the British Columbia Cancer Agency's Breast Cancer Outcomes Unit database. Patients with pT4 or M1 disease were excluded. A comparison of patient, tumour and treatment factors was made between males and females. Outcomes were analysed in terms of locoregional-relapse free survival, breast cancer-specific survival and overall survival. RESULTS: Sixty males and 4181 females were identified. Multivariable analysis revealed increased tumour size, positive margin status, delivery of chemotherapy, positive nodal status and male gender to be significantly associated with the use of post-mastectomy radiotherapy. Multivariable analysis revealed tumour size, nodal status, tumour grade and presence of vascular space invasion to be significantly associated with locoregional recurrence. Gender was not a prognostic factor for locoregional recurrence, breast cancer-specific survival or overall survival on univariable or multivariable analysis. CONCLUSIONS: These data suggest that gender is not a prognostic factor in patients undergoing mastectomy for early stage breast cancer. Men having mastectomy for breast cancer should receive adjuvant radiotherapy following guidelines similar to those developed for females.     

Indications and limits of breast conserving treatment

In Japan, 41% of surgeries for breast cancer were breast conserving treatment (BCT) in 2000. The indications for BCT in the guidelines of the Japanese Breast Cancer Society (1999) are as follows: (1) tumor size is 3 cm or less, (2) image diagnosis indicates no sign of extensive intraductal spread, (3) cases with multiple tumor are excluded, (4) radiation therapy is possible, (5) the patient wants to receive BCT. The pathological negative margin is favorable in BCT; however, we estimate based on our study that only about 30% of all breast cancers can be completely resected by partial mastectomy. To extend the indications for BCT, the roles of postoperative radiotherapy, endocrine therapy and preoperative chemotherapy will be important. Patients with ipsilateral breast tumor recurrence (IBTR) have increased risk of distant metastases, and the presence of IBTR is an important predictive factor for distant metastases. When we discuss the indications and limits of BCT, we have to take the rate of IBTR into careful consideration.