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Abramson Cancer CenterNCI CANCERLIT® Search: Radiotherapy for Breast Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 10760830
AU - Schmoor C; Bastert G; Dunst J; Bojar H; Christmann D; Unbehaun V;
TI -
Tummers G; Bauer W; Sauerbrei W; Schumacher M
Randomized trial on the effect of radiotherapy in addition to 6 cycles
CMF in node-positive breast-cancer patients. The German Breast-Cancer
Study Group.
SO - Int J Cancer 2000 May 1;86(3):408-15
AD - Institute of Medical Biometry and Medical Informatics, University of
Freiburg, Freiburg, Germany. cs@imbi.uni-freiburg.de
In 1984 the GBSG started a multicenter randomized trial to compare the
effectiveness of 6 cycles of cyclophosphamide, methotrexate and
fluorouracil (CMF) with or without radiotherapy (RT) as adjuvant
treatment in node-positive breast-cancer patients treated by mastectomy.
During 5 years, 199 patients were randomized. After a median follow-up
of about 9 years, the treatment groups 6 x CMF and 6 x CMF + RT were
compared regarding time to recurrence and death. As the first event of
failure, we observed locoregional recurrence in 22 patients, distant
metastases in 66 patients, a secondary malignancy in 9 patients and
death without previous event in 5 patients. For event-free survival
(EFS), no significant difference was observed [relative risk (RR) 6 x
CMF + RT vs. 6 x CMF 0.82, 95% confidence interval (CI) 0.55-1.21].
Event-specific analysis showed a significant decreased risk after
radiotherapy for locoregional recurrence. The risk for distant
metastases was estimated as slightly decreased and the risk for
secondary malignancy and for death without previous event was estimated
as increased in treatment group 6 x CMF + RT in comparison with
treatment group 6 x CMF, but these effects were not significant. For
overall survival (OS) and breast-cancer-specific survival (BCS), no
significant treatment effect could be demonstrated. There is a
beneficial effect of radiotherapy on locoregional recurrence. For EFS
and BCS, a tendency in favour of radiotherapy is observed, but this is
not significant; for OS, no difference can be demonstrated, but the
power of the study is too low to detect small treatment effects.
Copyright 2000 Wiley-Liss, Inc.
2
UI - 10897049
AU - Ragaz J; Spinelli JJ
TI -
Wide-field radiation as adjunct to adjuvant chemotherapy in high-risk
cases with early breast cancer: do it or not?
SO - Int J Cancer 2000 Aug 1;87(3):423-6
AD - Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
jragaz@bccancer.bc.ca
3
UI - 11247064
AU - Marinova L; Todorov Y; Bildirev N; Koleva I; Zakhariev Z; Dimitrova V
TI -
[Factors influencing the cosmetic outcome in early breast cancer
patients following salvage surgery and radioisotope teletherapy]
SO - Khirurgiia (Sofiia) 1998;53(6):23-6
AD - University Hospital "Queen Joanna," Radiological Clinic, Sofia,
Bulgaria.
It is the purpose of the report to analyze the factors exerting effect
on the cosmetic outcome in breast cancer patients (I-II clinical stage),
following organ-salvaging operation in conjunction with
telegammatherapy. Assessment of the cosmetic results in 100 female
patients with early mammary gland cancer is done 5 years after complex
treatment (conservative surgery, postoperative radiotherapy, and chemo-
and/or hormonotherapy when indicated). The influence of eight factors on
the cosmetic outcome attained is evaluated through correlative
statistical analysis, namely: breast size, scope of the surgical
intervention, number of lymph nodes dissected, type of operative
cicatrix, dose exposure of the entire mamma, homogeneity of radiation
dose distribution in tre entire mammary gland, dose exposure of the
tumor bed and adjuvant therapy. The analysis performed points to the
important practical implications of three of the factors: size of
operative intervention (axillary dissection range), breast volume and
homogeneity of the irradiation dose in the entire breast.
4
UI - 11247065
AU - P'rvanova V
TI -
[Salvage therapy in early stage breast carcinoma. II. Radiotherapy - an
essential and necessary component in a new therapeutic approach]
SO - Khirurgiia (Sofiia) 1998;53(6):27-32
AD - National Oncological Center, Sofia, Bulgaria.
A concerving surgery in the treatment of early breast carcinoma
definitely need to be followed by radiotherapy to control local
recurrence of disease. However, the rate of local recurrence is lowest
with quadrantectomy versus tumotectomy, while the reverse is true as
regards cosmetic results. Progressive integration of the different
therapeutic approaches is expected to characterise the coming years, to
combine safety with good esthetic results.
5
UI - 11899393
AU - Chakravarthy A; Nicholson B; Kelley M; Beauchamp D; Johnson D;
TI -
Frexes-Steed M; Simpson J; Shyr Y; Pietenpol J
A pilot study of neoadjuvant paclitaxel and radiation with correlative
molecular studies in stage II/III breast cancer.
SO - Clin Breast Cancer 2000 Apr;1(1):68-71
AD - Department of Radiation Oncology, Vanderbilt University Medical Center,
1301 22nd Avenue South, Nashville, Tennessee 37232, USA.
bapsi.chak@mcmail.vanderbilt.edu
A commonly used approach to the management of locally advanced breast
cancer currently involves neoadjuvant chemotherapy, followed by surgery
and radiation. Earlier neoadjuvant regimens had utilized doxorubicin,
making concurrent treatment with radiation less desirable given
dose-limiting normal tissue toxicities. With the development of
paclitaxel, we can now reconsider the use of concurrent chemoradiation
in the treatment of breast cancer. Although paclitaxel is a known
radiation sensitizer, its precise mechanism of action is still unclear.
One of its proposed mechanisms is that it binds tubulin and induces an
M-phase arrest. As cells in M-phase are very sensitive to radiation, it
thereby increases radiation sensitivity. The ability to predict tumor
response for individual patients would allow us to tailor subsequent
therapy for the individual patient. This study is designed to evaluate
if paclitaxel's effects on the cell cycle of an individual patient can
predict the responsiveness of that patient's tumor to paclitaxel and
radiation. Patients will be treated with 3 cycles of paclitaxel followed
by concurrent paclitaxel and radiation prior to definitive surgery.
6
UI - 11888866
AU - Wong JS; Harris JR
TI -
Can specific axillary radiotherapy be omitted in undissected, clinically
node-negative patients who undergo breast-conserving therapy?
SO - Ann Surg Oncol 2002 Mar;9(2):117-9
7
UI - 11888872
AU - Zurrida S; Orecchia R; Galimberti V; Luini A; Giannetti I; Ballardini B;
TI -
Amadori A; Veronesi G; Veronesi U
Axillary radiotherapy instead of axillary dissection: a randomized
trial. Italian Oncological Senology Group.
SO - Ann Surg Oncol 2002 Mar;9(2):156-60
AD - Department of Senology, European Institute of Oncology, Milan, Italy.
francesca.morelli@ieo.it
BACKGROUND: Surgical dissection of the axilla is a standard part of the
treatment of breast cancer but, by itself, does not improve prognosis;
furthermore, most patients with small-sized breast cancer and a
clinically uninvolved axilla never develop axillary metastases. We
evaluated disease-free and overall survival in patients with early
breast cancer treated by breast-conservation surgery without dissection
of axillary lymph nodes, receiving or not receiving axillary
radiotherapy (RT). METHODS: From 1995 to 1998, 435 patients older than
45 years with breast cancer up to 1.2 cm were randomized, 214 to breast
conservation without axillary treatment and 221 to breast conservation
plus axillary RT. RESULTS: After a follow-up of 28 to 68 months (median,
42 months), two women (1%) in the no axillary treatment group and one
(.5%) in the axillary RT group developed axillary metastases. Rates of
distant metastases and local treatment failure were also very low, and
5-year overall survival was 99%. CONCLUSIONS: After a mean of 46 months
of follow-up, our results indicate that axillary dissection can be
safely avoided in patients with very small invasive carcinomas and a
clinically negative axilla. Whether axillary RT should be added can be
assessed only by longer follow-up.
8
UI - 11680099
AU - Fodor J; Polgar C; Peley G; Nemeth G
TI -
[Management of the axilla in breast cancer: evidences and unresolved
issues]
SO - Orv Hetil 2001 Sep 9;142(36):1941-50
AD - Sugarterapias Osztaly, Orszagos Onkologiai Intezet, Budapest.
In this study the evidences governing the management of the axilla were
examined and on the base of these evidences, the optimal clinical
practice was outlined. Computerized searches for publications, debating
specific treatment of axilla, were done of MEDLINE data. Level of
evidence was determined using standard criteria: 1. metaanalysis of
randomized trials, 2. randomized trial, 3. prospective and retrospective
studies, 4. reports and opinion of expert committees and working teams.
The probability of lymph node involvement is related directly to the
size of the primary tumour, and even with small tumour (up to 10 mm),
the risk of nodal metastases is in the order of 10-20%. To date, the
best strategy for determining complete lymph node status (qualitative
and quantitative information) is through axillary dissection. For an
accurate staging, at least ten nodes have to be obtained. Formal
axillary sampling does not provide total quantitative data in patients
with involved axilla. Sentinel node biopsy is a promising alternative to
axillary dissection for staging but it is still under way. Axillary
dissection should be omitted in patients with ductal carcinoma in situ
since the probability of nodal involvement is less than 1%. In invasive
breast cancer, the risk of axillary recurrence in the untreated axilla
varies from about 10% to 40%. For women with stage I-II breast cancer at
least level I and II axillary node dissection should be offered as the
standard procedure to reduce the risk of regional recurrence. Women at
high risk of axillary recurrence (> or = 4 involved nodes, < 6 nodes
were obtained from a positive axilla) will require axillary irradiation
after axillary dissection. However, there is a lack of higher level
evidence to support the benefit of post-dissection axillary irradiation.
Evidences suggest that axillary irradiation is as effective as axillary
dissection in preventing regional recurrence. The following factors have
to be considered for decisions regarding dissection or irradiation:
patient wishes, general condition, age, the necessity of pathological
nodal status for systemic therapy and the risk of post-treatment
morbidity. At this time, there is no well defined subgroup of patients
in whom axillary intervention can be safely omitted. In selected
patients with clinically negative axilla, the decision to observe the
axilla rather than use surgery or irradiation should be made jointly
between the women and her specialists (surgeon, radiation and medical
oncologist). The benefits of axillary treatment in prolonging survival
are unclear. Studies have reported different effects on survival. Until
evidences remain insufficient, the risk of axillary recurrence has to be
minimized, and more and more patients have to be provide to get
treatments in randomized clinical trials. Patient should be fully
informed about the benefits and the potential side effects of
treatments. A combination of radiotherapy and axillary dissection
results an increased morbidity rate compared with either alone.
9
UI - 11780698
AU - Lawrence GA; Crawford J
TI -
Maximizing radiation benefit in breast cancer.
SO - Oncology (Huntingt) 2001 Dec;15(12):1545-6
10
UI - 11862040
AU - Rudman F Jr; Stanec S; Stanec M; Stanec Z; Margaritoni M; Zic R;
TI -
Milanovic R; Krizanac S; Separovic V
Rare complication of breast cancer irradiation: postirradiation
osteosarcoma.
SO - Ann Plast Surg 2002 Mar;48(3):318-22
AD - Department of Plastic Surgery, Clinical Hospital "Dubrava", Zagreb,
Croatia.
Radiation-induced osteosarcoma is a rare complication of radiation
therapy for breast cancer. The authors present a 60-year-old patient in
whom osteosarcoma of the chest wall developed 5 years after modified
radical mastectomy and radiation therapy for breast cancer. One year
after resection of the chest osteosarcoma, metastasis to the
contralateral axillary lymph nodes developed and these were removed.
Radiation-induced osteosarcoma is difficult to treat and has a poor
prognosis, thus early diagnosis is necessary for optimal treatment.
11
UI - 11836188
AU - Granel B; Serratrice J; David M; Fossat C; Disdier P; Weiller PJ
TI -
Paroxysmal nocturnal haemoglobinuria following breast cancer
radiotherapy.
SO - Haematologica 2002 Feb;87(2):ELT11
AD - e de Medecine Interne, 264 rue Saint-Pierre, 13385 Marseille Cedex 5,
France.
12
UI - 11888003
AU - Overgaard M
TI -
Radiotherapy as part of a multidisciplinary treatment strategy in early
breast cancer.
SO - Eur J Cancer 2001 Oct;37 Suppl 7():S33-43
AD - Department of Oncology, Aarhus University Hospital, Denmark.
13
UI - 11677099
AU - Bartelink H
TI -
Commentary on the paper "A preliminary report of intraoperative
radiotherapy (IORT) in limited-stage breast cancers that are
conservatively treated". A critical review of an innovative approach.
SO - Eur J Cancer 2001 Nov;37(17):2143-6
AD - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The
Netherlands. hbart@nki.nl
14
UI - 11687148
AU - Rauschecker H; Clarke M; Gatzemeier W; Recht A
TI -
Systemic therapy for treating locoregional recurrence in women with
breast cancer.
SO - Cochrane Database Syst Rev 2001;(4):CD002195
AD - University of Erlangen, Westermayerstr. 18, Rosenheim, Bavaria, Germany,
D-83022. rauschecker@t-online.de
BACKGROUND: Between 10% and 35% of women with operable breast cancer
will experience an isolated locoregional recurrence following their
primary treatment. There is currently no good evidence that adjuvant
systemic treatment is effective in this situation and there is no
standard treatment for women who have such a recurrence. OBJECTIVES: To
investigate whether additional systemic treatment will improve the
result of local therapy in regard to relapse-free and overall survival
in women with potentially curatively resected loco-regional recurrence
following breast cancer, who have not had a previous or synchronous
distant metastases. SEARCH STRATEGY: Searches were done, in the first
half of 2001, of the specialised register of the Cochrane Breast Cancer
Collaborative Review Group, The Cochrane Library, MEDLINE and EMBASE. In
addition, the records of the Early Breast Cancer Trialists'
Collaborative Group were checked for any relevant trials. The citations
in articles reviewing the treatment of locoregional recurrence of breast
cancer were checked. SELECTION CRITERIA: Randomised controlled trials or
trials in which women were allocated to treatment or observation by a
quasi-random process (such as alternation or date of birth) were
eligible. Our aim was to consider separately women with a first
incidence of isolated loco-regional recurrence in the treated breast,
the chest wall or the regional lymphnode areas (except clavicular nodes)
which can be resected without (R0) or with (R1) microscopically
demonstrable residual disease. Women with previous or synchronous
distant metastases were to be excluded from this part of the review. The
second part of the review was to consider women with inoperable
loco-regional recurrence and / or clavicular lymphnode involvement,
regardless of previous or synchronous metastases. DATA COLLECTION AND
ANALYSIS: We identified three closed studies in which there were a total
of four randomised comparisons of systemic therapy versus observation
for women who have received radiotherapy for loco-regional recurrence of
breast cancer. One trial assessed Actinomyicin-D and randomised 32
patients in the 1960s and another randomised the same number of women to
alpha-interferon versus observation in the early 1980s. The Swiss SAKK
trial assessed tamoxifen for "good risk" patients and combination
chemotherapy (Vincristine, Doxorubicin and Cyclophosphamide) for "poor
risk" patients. It randomised 178 and 50 women respectively during
1982-1991. Where possible, data on relapse-free and overall survival
were extracted for these trials and analysed using RevMan 4.1. No
attempt was made to pool the results of the studies because of clinical
heterogeneity and the small number of randomised patients. Three ongoing
trials of chemotherapy versus observation have been identified. MAIN
RESULTS: The trial of 32 women who received either radiotherapy alone or
in combination with systemic administration of Actinomycin-D found that
chemotherapy improved the local control rate but had no apparent effect
on overall survival. The interferon trial, which also included a total
of only 32 patients, showed that the addition of alpha-Interferon to
local treatment of locoregional recurrent breast cancer had no apparent
effect on the further course of the disease. The Swiss SAKK trial of
tamoxifen (178 women randomized) found an improvement in disease-free
survival but not in overall survival and no results are available for
the 50 women randomized into the concurrent trial of chemotherapy. The
three ongoing trials of chemotherapy have a total target accrual of
nearly 2000 patients. REVIEWER'S CONCLUSIONS: This systematic review of
randomised trials provides insufficient evidence to do other than
conclude that the most appropriate form of practice for women with
loco-regional recurrence of breast cancer is participation in randomised
trials of systemic treatment versus observation.
15
UI - 11878105
AU - Hery M
TI -
[The limitations of radiotherapy for breast cancer in the elderly
patient]
SO - Therapie 2001 Nov-Dec;56(6):763-4
AD - Service de Radiotherapie, Hopital Princesse Grace de Monaco, Avenue
Pasteur, 98000 Monaco.
16
UI - 11962190
AU - Thilmann C; Grosser KH; Rhein B; Zabel A; Wannenmacher M; Debus J
TI -
[Virtual bolus for inversion radiotherapy planning in
intensity-modulated radiotherapy of breast carcinoma within the scope of
adjuvant therapy]
SO - Strahlenther Onkol 2002 Mar;178(3):139-46
AD - Klinische Kooperationseinheit Strahlentherapie, Deutsches
Krebsforschungszentrum Heidelberg. c.thilmann@dkfz.de
BACKGROUND: Intensity modulated radiotherapy (IMRT) provides better
sparing of normal tissue. We investigated the feasibility of inverse
treatment planning for IMRT in adjuvant radiotherapy for breast cancer.
MATERIAL AND METHODS: In addition to radiotherapy planning in
conventional technique with tangential wedged 6-MV-photon beams we
performed inversely planned IMRT (KonRad). In the CT scans for treatment
planning we defined a 10-mm bolus of -60 HE density. The influence of
this bolus on planning optimization was determined by optimization
without and dose calculation with and without bolus. Dose calculation
after dose optimization with bolus was performed using different bolus
thickness to determine the influence of the bolus on dose calculation.
The results were compared with dose distribution in conventional
technique. RESULTS: Inverse optimization with a dose algorithm which
considers tissue inhomogeneity results in unintended dose increase at
the patient surface. With a virtual 10-mm bolus used for inverse
optimization the dose increase was reduced. Thus, skin sparing was
identical to conventional planning. The relative dose distribution was
negligibly affected by the use of a 10-mm bolus. Difference in absolute
dose was 3.4% compared to calculation without bolus. Therefore, the
bolus must be removed before final dose calculation. CONCLUSION: The
realization of inverse optimization for IMRT of the breast requires the
use of a virtual bolus. Thereby, IMRT in accordance to the consensus
recommendations of the EORTC, BCCG and EUSOMA is possible. Especially,
the same target definition as in conventional technique may be used.
IMRT techniques with a conventional beam arrangement of two tangential
fields or multiple beam techniques can be realized.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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