钼靶影像下乳腺癌生物学特征对保乳术切缘状态的影响

目的 探讨钼靶影像下乳腺癌生物学特征对保乳术切缘状态的影响。方法120例Ⅰ～Ⅱ期可扪及肿块的乳腺癌患者根据钼靶影像学表现分为肿块组、钙化组、肿块伴钙化组、不对称致密组和结构扭曲组。手术切除病灶范围采用距离肿物边缘1 cm,术中快速病理确定初始切缘状态,石蜡病理证实切缘状态及肿瘤分型,分析乳腺癌钼靶影像特征与保乳术切缘状态的关系。结果 保乳术的初始切缘状态与肿瘤大小、病理类型、组织学分级、淋巴结转移、雌激素受体状态、孕激素受体状态及HER-2表达等临床病理特征无关,而与脉管内有无癌栓有关（P＜0.05）;脉管内有癌栓者的切缘阳性率为26.3％（5／19）,高于脉管内无癌栓的6.9％（7／101）。5组患者保乳术初始切缘状态的差异无统计学意义（P=0.241）,但当包含两种及以上肿瘤类型时,乳腺癌钼靶影像特征与切缘状态的差异有统计学意义（P=0.005）。结论 行保乳术的乳腺癌患者术前应用钼靶影像评估手术切缘状态时,需要根据肿瘤影像学特征判断可能存在的病理类型,以便降低切缘阳性的概率。     

Micro-computed tomography (micro-CT) for intraoperative surgical margin assessment of breast cancer: A feasibility study in breast conserving surgery

Purpose

Around 15%–30% of patients receiving breast-conserving surgery (BCS) for invasive breast carcinoma or ductal carcinoma in situ (DCIS) need a reoperation due to tumor-positive margins at final histopathology. Currently available intraoperative surgical margin assessment modalities all have specific limitations. Therefore, we aimed to assess the feasibility and accuracy of micro-computed tomography (micro-CT) as a novel method for intraoperative margin assessment in BCS.

Absence of residual fluorescence in the surgical bed at near-infrared fluorescence imaging predicts negative margins at final pathology in patients treated with breast-conserving surgery for breast cancer

IntroductionPositive margins after breast-conserving surgery (BCS) for breast cancer (BC) remain a major concern. In this study we investigate the feasibility and accuracy of indocyanine green (ICG) fluorescence imaging (FI) for the in vivo assessment of surgical margins during BCS.Materials and methodsPatients with BC admitted for BCS from October 2015 to April 2016 were proposed to be included in the present study (NCT02027818). ICG (0.25 mg/kg) was intravenously injected at induction anesthesia and ICG-FI of the surgical beds was correlated with final pathology results.ResultsFifty patients consented to participate and thirty-five patients were retained for final analysis, 15 patients having been excluded for, respectively, incomplete video records data for signal to background ratio (SBR) calculation (11) and in situ tumors (4). The final pathological assessment of 35 breast specimens identified 5 (14.7%) positive margins. Intraoperative ICG-FI revealed hyperfluorescent signals in 15 (42.9%) patients and an absence of fluorescent signals in 20 (57.1%). Median SBR in patients with involved margins was 1.8 (SD 0.7) and was 1.25 (SD 0.6) in patients with clear margins (p = 0.05). The accuracy, specificity, positive and negative predictive value of ICG-FI for breast surgical margin assessment were 71%, 60%, 29% and 100%, respectively.ConclusionICG-FI of BC surgical beds has a high negative predictive value for surgical margin assessment during BCS. The absence of residual fluorescence in the surgical bed of patients with fluorescent tumors predicts negative margins at final pathology and allows the surgeon to avoid further intraoperative analysis.     

Learning curves in intraoperative ultrasound guided surgery in breast cancer based on complete breast cancer excision and no need for second surgeries

BackgroundIntraoperative ultrasound guided surgery (IOUS) is an effective surgical technique for breast cancer with advantages over wire localization guided surgery (WL), enabling smaller lumpectomies without compromising margins. Nevertheless, it has had a slow implementation, maybe due to lacking a learning curve. Also differences in costs are not clearly reported. The aim of the study is to assess differences in volume of healthy breast tissue excised, to establish a learning curve and to prove it is cost saving.Patients and methodsFrom February 2009 to April 2013, women diagnosed with invasive breast cancer eligible for IOUS or WL breast conserving surgery were recorded into a prospectively maintained database. Both groups were compared for differences in margin status, second surgeries and excess of healthy tissue resected, defined by the calculated resection ratio (CRR). A raw cost study was assessed. IOUS learning curve was analyzed using Cumulative sum control chart (CUSUM).ResultsThe study included 214 patients, 148 (69.16%) in the IOUS group and 66 (30.84%) in the WL group. IOUS showed significantly smaller surgical volumes (p = 0.02), smaller CRR (p = 0.006), higher rate of negative margins (p = 0.017) and less surgical time (p = 0.006) than WL. Learning curves based on complete tumor excision and no need for second surgeries showed that 11 cases were enough to master the technique. Around 900€ per surgery was saved using IOUS vs. WL.ConclusionIOUS decreases excision of healthy breast tissue while increasing negative margin rates compared to WL. IOUS can be easily implemented; 11 cases are enough to acquire skills for performing the technique. Savings can be up to 900€ per surgery.     

乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性研究

目的 探讨乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性。方法 220例Ⅰ～Ⅱ期可扪及肿块、非特殊类型乳腺癌患者,术前采用空心针穿刺,根据病理组织学及免疫组化染色进行分子分型：Luminal A型32例,Luminal B型75例,Luminal HER-2型38例,HER-2过表达型33例,三阴性乳腺癌（TNBC）42例。钼靶影像特征采用BI-RADS分类标准,分为肿块、钙化、结构扭曲、不对称致密和毛刺征。手术切除病灶范围采用距离肿物边缘1 cm,术中快速病理及石蜡病理证实切缘状态,结合分子亚型分析乳腺癌的影像特征与保乳手术再切除率的关系。结果 乳腺癌单一影像征象在Luminal A 组、Luminal B组、Luminal HER-2组、HER-2过表达型组和TNBC组中的比例分别为37.5％（12／32）、29.3％（22／75）、28.9％（11／38）、15.2％（5／33）和61.9％（26／42）;乳腺癌混合影像征象在Luminal A组、Luminal B组、Luminal HER-2组、HER-2过表达型组和TNBC组中的比例分别为62.5％（20／32）、70.7％（53／75）、71.1％（27／38）、84.8％（28／33）和38.1％（16／42）,差异有统计学意义（P＜0.001）。乳腺癌边缘征象（毛刺征）在Luminal A 组、Luminal B组、Luminal HER-2组、HER-2过表达型组和TNBC组中的比例分别为50.0％（16／32）、42.7％（32／75）、50.0％（19／38）、18.2％（6／33）和7.1％（3／42）,差异有统计学意义（P＜0.001）。保乳手术的再切除率在Luminal A 组、Luminal B组、Luminal HER 2组、HER 2过表达型组和TNBC组分别为12.5％（4／32）、9.3％（7／75）、21.1％（8／38）、18.2％（6／33）和0（0／42）,差异有统计学意义（P=0.01）。在乳腺癌的影像特征包含两种或两种以上影像学征象时,HER 2表达状态与保乳术再切除率有关,差异有统计学意义（P=0.001）。结论 对非特殊型乳腺癌患者行保乳手术时,应结合分子分型、乳腺钼靶影像学征象及边缘征象来确定个体化的切除范围,以便降低再切除手术的概率。     

Impact of robotic learning curve on histopathology in rectal cancer: A pooled analysis

BackgroundA beneficial impact of robotic proctectomy on circumferential resection margin (CRM) is expected due to the robot's articulating instruments in the pelvis. There are however concerns about a negative impact on the quality of total mesorectal excision (TME) due to the lack of tactile feedback. The aim of this study was to assess whether surgeons' learning curve impacted CRM and TME quality.MethodsIn a multicenter study, individual patient data of robotic proctectomy for resectable rectal cancer were pooled. Patients were stratified into two phases of surgeons’ learning curve. Cumulative sum (CUSUM) analysis was used to determine the transition from learning phase (LP) to plateau phase (PP), which were compared. CRM was microscopically measured in mm by pathologists. TME quality was classified by pathologists as complete, nearly complete or incomplete. T-test and Chi-squared tests were used to compare continuous and categorical variables, respectively.Results235 patients underwent robotic proctectomy by five surgeons. 83 LP patients were comparable to 152 PP patients for age (p = 0.20), gender (67.5% vs. 65.1% males; p = 0.72), BMI (p = 0.82), cancer stage (p = 0.36), neoadjuvant chemoradiation (p = 0.13), distance of tumor from anal verge (5.8 ± 4.4 vs. 5.5 ± 3.3; p = 0.56). CRM did not differ (7.7 ± 11.4 mm vs. 8.4 ± 10.3 mm; p = 0.62). The rate of complete TME quality was significantly improved in PP patients as compared to LP patients (73.5% vs. 92.1%; p < 0.001).ConclusionWhile learning had no impact on circumferential resection margins, the quality of TME significantly improved during surgeons’ plateau phase as compared to their learning phase.     

Individual learning curve of cytoreductive surgery for peritoneal metastasis from colorectal cancer: A process with an impact on survival

BackgroundThis study aimed to assess the learning curve (LC) of cytoredutive surgery (CRS) of peritoneal metastasis (PM) from colorectal cancer (CRC). Information about learning curves is important for developing teaching tools and well-structured training programs for the implementation of this complex procedure in new healthcare centers. The aim of this study was to estimate how many procedures an inexperienced surgeon must perform (the length of the learning period) in order to demonstrate an acceptably low rate of locoregional recurrence.MethodsAll consecutive 74 patients with CRS for CRC performed by a novice surgeon between 2012 and 2017 in a tertiary cancer center were included. The learning curve was calculated by a cumulative sum control chart (CUSUM) graph. Two groups were formed based on the length of the learning period and were compared on overall and disease free survival.ResultsThe risk of locoregional recurrence decreased after surgeons had performed 19 cases, suggesting a learning period of this length. Overall survival and postoperative morbidity were not significantly different between learning and proficiency periods. Multiple linear regression analysis showed that the learning period and peritoneal cancer index are the only factors affecting disease free survival. A second learning period was observed in cases where patient care became more complex.ConclusionsThis study confirms that learning period has negative impacts on disease-free survival. An initial experience supervised in specialized centers allow to have a short learning curve for CRS for peritoneal metastases for CRC.     

Cytoreductive surgery plus perioperative intraperitoneal chemotherapy in pseudomyxoma peritonei: Aspects of the learning curve

Background

Cytoreductive surgery (CRS) plus perioperative intraperitoneal chemotherapy is a highly invasive treatment of peritoneal metastasis and requires many surgical procedures before mastering. The aim of this study was to estimate how many procedures are needed before stabilization can be seen in surgical outcome (R1 surgery, adverse events and bleeding) in patients with pseudomyxoma peritonei (PMP).

Patients and methods

All 128 patients with PMP who were treated with CRS alone or CRS plus perioperative intraperitoneal chemotherapy between 2003 and 2008 at the Uppsala University Hospital, Uppsala, Sweden, were included. The learning curve was calculated using the partial least square (PLS) and cumulative sum control chart (CUSUM) graph. Two groups were formed based on the results of the learning curve. The learning curve plateau was considered the same as the stabilization in the CUSUM graph. Group I consisted of patients included during the learning period (n = 73) and Group II of patients treated after the learning period ended (n = 55). Comparisons between the groups were made on surgical outcome, survival and adverse events.

Results

Stabilization was seen after 220 ± 10 procedures. A higher occurrence of R1 surgery was seen in Group II (80%) compared to Group I (48%; P = 0.0002). Overall survival increased at four years after surgery in Group II compared to Group I (80% vs. 63%; P = 0.02).

Conclusion

CRS plus perioperative intraperitoneal chemotherapy is a highly demanding procedure that requires more than 200 procedures before optimisation in surgical outcome is seen.     

Rapid and safe learning of robotic gastrectomy for gastric cancer: Multidimensional analysis in a comparison with laparoscopic gastrectomy

Background

The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success.

Methods

We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality.

Results

Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success.

Conclusions

The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory.     

The learning curve of robotic nipple sparing mastectomy for breast cancer: An analysis of consecutive 39 procedures with cumulative sum plot

BackgroundThe preliminary experience and learning curve of robotic nipple sparing mastectomy (R-NSM) in the management of breast cancer were analyzed and reported.MethodsThe medical records of patients who underwent R-NSM for breast cancer during the period of March 2017 to June 2018 were collected from the same surgeon in a single institute. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, and operation time were prospective collected. Learning curve of R-NSM was evaluated and analyzed by the cumulative sum (CUSUM) plot method.ResultsA total of 39 consecutive R-NSM procedures from 35 patients were analyzed. The time needed for “docking”, “R-NSM”, and “R-NSM and immediate prosthesis breast reconstruction (IPBR)” decreased after cases experience accumulated, and in mature phase procedures could finished within 10 min, 100mins, and 240 min, separately. In CUSUM plots analysis of learning curve, the cases needed to decrease operation time for “docking”, “R-NSM”, and “total time for R-NSM and IPBR” were 13th, 13th, and 12th procedures separately. Mastectomy weight and lymph node metastasis were factors related to operation time. The rate of total nipple areolar complex necrosis for R-NSM was 0%. One (2.9%, 1/35) R-NSM procedure was found to have positive margin involved in the final pathologic check-up. No implant loss, or local recurrence was observed during a mean follow-up of 8.6 ± 4.5 (1.3–16.7) months.ConclusionFrom our preliminary experience, R-NSM and IPBR (or R-NSM alone) is a safe procedure, and the operation time needed significantly decrease after cases experience accumulated.     

Prospective randomized comparison of conventional instruments and the Harmonic Focus device in breast-conserving therapy for primary breast cancer

Background

In recent years, surgeons have utilized Harmonic instruments to perform breast cancer resection. Retrospective and prospective studies have demonstrated that the use of this surgical device for mastectomy and axillary dissection can reduce perioperative blood loss, seroma formation, and duration and total amount of drainage. No study has analyzed the feasibility of Harmonic instruments in breast-conserving surgery. We conducted a prospective, randomized clinical trial comparing Harmonic instrument and conventional surgery in the performance of breast-conserving surgery and axillary procedures to determine differences in surgical procedures, postoperative outcome, and complications.

Methods

One hundred and six patients with operable breast cancer who underwent breast-conserving surgery at a single institution between December 2009 and January 2011 were included in the analysis. Surgery was performed in 52 patients with the Harmonic Focus^® device and in 54 with scissors and electrocautery. This study focused on operative time, drainage volume, and postoperative outcome measures like blood loss, surgery related complications and patient-reported postoperative pain.

Results

We found a multivariable independent influence in axillary seroma formation and volume of breast drainage with HS. Evident difference in volume and duration of axillary and breast drainage, subjective and objective postoperative pain, reduction in serum hemoglobin, size and weight of resected breast tissue and length of hospital stay in favor of the Harmonic instrument could also be shown.

Discussion

The Harmonic instrument provides key benefits in surgical technique, postoperative outcome, and complication rates in breast cancer surgery.     

Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis

BackgroundThe increased use of neoadjuvant chemotherapy (NACT) facilitates an increase in breast-conserving surgery and immediate breast reconstruction. While NACT is considered to have the same oncological safety as adjuvant chemotherapy, evidence on the impact of NACT on surgical outcomes following breast surgery is unclear and varies across studies. The aim of this systematic review and meta-analysis was to assess the impact of NACT on surgical complications in breast cancer patients undergoing any kind of breast surgery.MethodsDatabase searches were conducted (March 26, 2021) to identify studies assessing the impact of NACT on postoperative complications. Studies were included if they compared a group of patients treated with NACT to a control group that was not, and if they reported at least one of our defined outcomes. Primary effect measures were odds ratios (ORs) and mean difference with a 95% confidence interval. Study quality was assessed by the Newcastle-Ottawa Scale.ResultsTwenty-six studies comprising 134,191 patients were included. NACT was not associated with an increased complication rate for overall complications (OR: 1.13, 95% CI: 0.86 to 1.47, p = 0.38), individual postoperative complications, nor surgery duration. There was a non-significant trend towards NACT increasing the risk of seroma, wound complications, skin or nipple necrosis, flap ischemia or loss, and implant loss. A significant difference in blood loss was found, favouring NACT (MD = ?75.85, 95% CI: -107.47 to ?44.23, p < 0.00001). Heterogeneity was significant between the studies (I²>50%).ConclusionCompared to a control group, NACT was not found to affect the surgical complications adversely.     

保乳手术与根治手术治疗早期乳腺癌的疗效比较

目的探讨早期乳腺癌患者行保乳手术和根治手术效果的区别,以及保乳手术的应用价值。方法选择2007年3月至2010年6月间就诊的早期乳腺癌患者60例,30例患者实施改良根治手术,30例患者实施保乳手术,比较两组患者手术指标、术后3年的局部复发、远处转移和生存情况,并比较两组患者手术美容满意度。结果保乳组患者在手术时间、术中出血量、住院时间以及并发症发生率上均明显优于根治组,差异有统计学意义(P<0.05)。保乳组与根治组治疗效果相近,差异无统计学意义(P>0.05)。保乳组患者美容满意度高达96.7%,明显优于根治组患者的43.3%,差异有统计学意义(P<0.05)。结论保乳手术与改良根治手术的治疗效果相近,但外观影响小,美容满意度高,临床允许的情况下可以考虑优先实施。     

乳腺癌保乳手术的疗效及生活质量的评估

目的探讨乳腺癌保乳手术的疗效及其生存质量。方法选取180例早期乳腺癌患者,其中56例患者行保乳手术,63例患者行标准根治手术,61例患者行改良根治术。结果保乳手术组具有住院时间较少、手术时间较短、术中出血少等优势,与根治术组(标准根治术组+改良根治术组)相比,差异有统计学意义(P<0.05)。3组患者的生存率、远处转移率、术后复发率差异无统计学意义(P>0.05),保乳手术组患者的心理因子、躯体因子、精神因子和社会支持因子4个方面均显著高于标准根治术组和改良根治术组患者(P<0.05);保乳手术组、标准根治术组及改良根治术组患者术后乳房外观及美容效果差异有统计学意义(P<0.05)。结果早期乳腺癌患者保乳手术的近期疗效较满意,严格掌握相关手术指征、规范切除和术后放化疗等综合治疗措施是保乳手术成功的关键。     

保乳手术与改良根治术对早期乳腺癌患者生活质量的影响

目的 探讨保乳手术与改良根治术对早期乳腺癌患者生活质量的影响。方法 回顾性分析2013年1月至2015年1月在本院确诊住院治疗的早期乳腺癌患者276例,其中保乳手术组138例,改良根治术组138例。采用患者满意度、抑郁自评量表（SDS）及焦虑自评量表（SAS）对采用两种手术方式的患者生活质量进行评价;采用Rosenberg自尊量表、家庭亲密度适应性量表及生命质量测量表（FA CT-B）对276例患者进行问卷调查分析。结果 保乳手术组患者的SAS及SDS评分均低于改良根治术组,差异有统计学意义（P＜0.05）。保乳手术组在患者满意度方面较改良根治术组有明显提高,两组比较差异有统计学意义（P＜0.05）;保乳手术组患者在Rosenberg自尊量表和FA CT-B中的测定结果均优于改良根治术组（P=0.03,P=0.04）;保乳手术组在家庭亲密度和适应性方面优于改良根治术组,两组比较差异均有统计学意义（P＜0.05）。结论 实施保乳手术能有效提高早期乳腺癌患者的生活质量,缓解患者心理和生理上的各种不适,促进患者康复。     

Prognostic value of breast cancer subtypes on breast cancer specific survival, distant metastases and local relapse rates in conservatively managed early stage breast cancer: A retrospective clinical study

Aim

To ascertain if breast cancer subtypes had prognostic effect on breast cancer specific survival, distant metastases and local relapse rates in women affected by early stage breast cancer.

Patients and methods

Data of 774 patients affected by early stage breast cancer and treated with breast-conserving therapy were reviewed. Patients were grouped, based on steroid receptor status and HER2 status as: Luminal A (ER+/PR+/HER2−), Luminal B (ER+/PR+/HER2+), Basal-like (ER−/PR−/HER2−) and HER2 (ER−/PR−/HER2+). Distribution of variables among subtypes was evaluated with Pearson’s test. Survival rates were calculated with life tables; Cox regression stepwise method was used to identify predictive variables of survival.

Results

Median age was 55.0 years old (range 27–80) and median follow up time of 59.0 months (range 13.6–109.7). Breast cancer specific survival and distant metastases rates were different among breast cancer subtypes (both outcomes P = 0.00001) but there was no difference regarding local relapse rates (P = 0.07). Axillary nodes status (P = 0.00001), adjuvant therapy (P = 0.03) and breast cancer subtypes (P = 0.03) resulted prognostic factors of breast cancer specific survival; axillary node status (P = 0.00001) and breast cancer subtypes (P = 0.00001) had an impact on distant metastases. Age (P = 0.003), tumor size (P = 0.0001), positive or close surgical margin (P = 0.00001) and tumor grade 3 (P = 0.049) resulted prognostic factors of local relapse.

Conclusions

In our study, breast cancer subtype seems a prognostic factor of breast cancer specific survival and distant metastases rates, but not of local relapse rate. Patients could be submitted to conservative surgery, if feasible, but considering the differences in survivals, patients with worse prognosis should receive more aggressive adjuvant treatments.     

Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome,learning curve,and patient reported aesthetic results from preliminary 100 procedures

BackgroundEndoscopic assisted breast surgery was associated with small and inconspicuous scar and endoscopic assisted breast conserving surgery (E-BCS) for breast cancer was increasingly performed as well. The clinical outcomes, learning curve analysis and patient reported cosmetic result of E-BCS for breast cancer were reported along with a review of the current literature.MethodsA retrospective study analyzing the outcomes of E-BCS for breast cancer patients through an endoscopic breast surgery database in a single institution from June 2009 to May 2019 was performed and a literature review through Pubmed and Medline was conducted as well.Results100 consecutive breast cancer patients who underwent E-BCS were analyzed. The mean age of patients was 52.5 years old. Furthermore, the mean pathologic tumor size was 1.6 cm and majority of patients had early stage (13% stage 0, 56% stage I, and 30% stage II) breast cancer. The mean operation time of E-BCS in the current study was 133 ± 50 min and in learning curve analysis, after accumulation of 15 consecutive cases the operation time significantly decreased. The morbidities of E-BCS were minor and most of them were skin flap related. The margin involvement rate was 4%. About 98% of patients surveyed were satisfied with the incision length, location and scar appearance of E-BCS whereas all of them were satisfied with E-BCS in general. With a mean follow-up of 29.2 ± 24.4 months, 3% of patients developed locoregional recurrences, 3% had distant metastasis and there were 2 mortalities observed.ConclusionIn our preliminary experience, E-BCS is a promising surgical technique for selected early breast cancer patients with low morbidity, acceptable oncological outcomes and high patient satisfaction.     

Omission of radiotherapy in elderly patients with early breast cancer: 15-Year results of a prospective non-randomised trial

BackgroundWhether radiotherapy (RT) is beneficial in elderly (⩾70 years) patients undergoing conservative surgery for early breast cancer has long been controversial. Recent randomised trials show that most elderly patients do not benefit from RT. We started a prospective non-randomised trial to address this issue in 1987 and now present results for the 627 consecutive pT1/2cN0 patients recruited, and treated by conservative surgery (quadrantectomy) and tamoxifen, and assigned non-randomly to RT or no RT.MethodsWe used multivariate competing risks models to estimate 15-crude cumulative incidence (CCI) of ipsilateral breast tumour recurrence (IBTR), distant metastasis and breast cancer mortality. The models incorporated a propensity score as a measure of probability of receiving RT based on baseline characteristics, to account for the lack of randomisation.ResultsFor pT1 patients, 15-year CCIs of IBTR, distant metastasis and breast cancer death were indistinguishable in the RT and no RT groups. For pT2 patients, 15-year CCI of IBTR was much higher in those not given RT (14.6% versus 0.8%, p = 0.004), although breast cancer mortality and distant metastasis did not differ significantly between RT and no RT.ConclusionsConsistent with the findings of recent randomised trials, our long-term data indicate that most elderly, ER-positive patients with pT1 cN0 breast cancer treated by quadrantectomy do not benefit from RT. The 14.6% CCI of IBTR in our pT2 patients is an additional finding not presented in the trials and suggests that RT should be administered to elderly patients with pT2 disease.