National Cancer Institute®
Last Modified: February 1, 2002
UI - 11521809
AU - Veronesi U; Marubini E; Mariani L; Galimberti V; Luini A; Veronesi P;
TI - Salvadori B; Zucali R Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial.
SO - Ann Oncol 2001 Jul;12(7):997-1003
AD - Department of Senology, European Institute of Oncology, Milano, Italy. firstname.lastname@example.org
BACKGROUND: Breast-conserving surgery followed by radiotherapy is a widely accepted form of treatment in patients with breast cancer of limited extent. Many attempts have been made to identify subgroups of patients who might avoid radiotherapy. PATIENTS AND METHODS: Between 1987 and 1989, 579 women with carcinoma of the breast were randomly assigned to quadrantectomy, axillary dissection and radiotherapy (299) and to quadrantectomy with axillary dissection without radiotherapy (280). Eligible patients were women with a breast carcinoma less than 2.5 cm in maximum diameter up to 70 years of age. Primary endpoints were intra-breast tumour reappearance (IBTR) and all-cause mortality. RESULTS: The number of IBTRs was significantly higher in patients treated with surgery alone (59 cases out of 273; 10-year crude cumulative incidence of 23.5%) than in patients treated with surgery plus radiotherapy (16 cases out of 294; 10-year crude cumulative incidence of 5.8%). The difference in IBTR frequency between the two treatments appeared to be particularly high in women up to 45 years of age, tending to decrease with increasing age up to no apparent difference in women older than 65 years. Overall survival curves for the two groups, did not differ significantly (P = 0.326). However, a limited survival advantage was evident after radiotherapy for node-positive women. CONCLUSIONS: After breast-conserving surgery radiotherapy appears indicated in all patients up to 55 years of age, in patients with positive axillary nodes, and in patients with extensive intraductal component at histology. The data suggest that radiotherapy may be avoided in patients older than 65, and may be optional in women aged 56-65 years with negative nodes.
UI - 11791117
AU - Morrow M
TI - Treatment selection in ductal carcinoma in situ.
SO - Breast Cancer 2001;8(4):275-82
AD - Lynn Sage Breast Cancer Program and Department of Surgery, Northwestern University, Chicago, IL 60611, USA. email@example.com
UI - 10219800
AU - Marks LB; Hardenbergh PH; Winer ET; Prosnitz LR
TI - Assessing the cost-effectiveness of postmastectomy radiation therapy.
SO - Int J Radiat Oncol Biol Phys 1999 Apr 1;44(1):91-8
AD - Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
PURPOSE: To assess the cost-effectiveness of postmastectomy local-regional radiation therapy (RT) for patients with breast cancer with regard to local-regional relapse (LRR) and quality-adjusted life years (QALY). METHODS AND MATERIALS: Data from the literature are used to estimate the risk of LRR, and the impact of RT on the risk of LRR and survival. The risk of LRR is related linearly to the number of positive axillary nodes 1% rate of LRR = 10 + (4 x number of positive nodes)]. RT reduces the risk of LRR by 67%. LRRs are treated with excision or biopsy followed by RT; half being controlled locally and half receiving additional salvage surgery and chemotherapy. Absolute improvements in 10-year overall survival due to RT are assumed to vary between 1 and 12%; and accrue linearly during the initial 10-year follow-up period. Professional and technical charges are used as a surrogate for costs. Money spent and benefits recognized in future years are discounted to 1997 values using a 3% annual rate. Quality factors are used to adjust for treatment, disease, and toxicity status. RESULTS: The cost per LRR prevented with the addition of routine postmastectomy RT is highly dependent upon the number of positive axillary nodes and ranges from $100,000-$200,000 for patients with 0-2 nodes, and $25,000-$75,000 for > or = 4 nodes. The cost per QALY gained at 10 years is $10,000-$110,000 for survival benefits > or = 3%. CONCLUSIONS: The cost per LRR prevented decreases with increasing numbers of positive axillary nodes. There is not a sharp cutoff at the < or = 3 vs. > or = 4 lymph node number, suggesting that using this cutoff for recommending or not recommending RT following mastectomy is not economically logical. The cost per QALY of $10,000-$100,000 compares favorably to that of other accepted medical procedures. Modest changes in the quantitative assumptions do not qualitatively alter the results. Concerns regarding costs should not generally preclude the use of postmastectomy RT.
UI - 11072153
AU - Dunscombe P; Samant R; Roberts G
TI - A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients.
SO - Int J Radiat Oncol Biol Phys 2000 Nov 1;48(4):977-82
AD - Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada. firstname.lastname@example.org
PURPOSE: To calculate cost-effectiveness and cost-utility ratios for adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients and to place these ratios in the context of generally accepted medical expenditures. MATERIALS AND METHODS: A spreadsheet-based activity costing model using 1997 Canadian (cdn) capital, operating, and administrative costs has been used to identify, from the institutional perspective, the incremental cost of adding radiotherapy to surgery and chemotherapy for this group of patients. Outcome data were derived from two recently published clinical trials and were converted to discounted incremental life years and quality-adjusted life years gained. Recommended health economics principles were employed in the quantification of both costs and outcomes, and a sensitivity analysis was performed. Three referenced publications provide a context within which to evaluate the calculated cost-effectiveness and cost-utility ratios. RESULTS: The incremental cost of adjuvant radiotherapy for this group of patients is calculated to be approximately $7,000cdn in 1997 Canadian dollars and in the Canadian socialized health-care environment. Based on published work the discounted incremental outcome benefit is calculated to be 0.5 life years or 0.45 quality-adjusted life years at ten years. Thus, cost effectiveness and cost-utility ratios are estimated to be $14,000cdn and $15,600cdn, respectively. CONCLUSION: Within the context of generally accepted medical expenditures, adjuvant postmastectomy locoregional radiotherapy for premenopausal node-positive breast cancer patients would be regarded as a cost-effective treatment strategy.
UI - 11503614
AU - Samant R; Dunscombe P; Roberts G
TI - A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in high-risk postmenopausal breast cancer patients.
SO - Int J Radiat Oncol Biol Phys 2001 Aug 1;50(5):1376
UI - 11688515
AU - Schootman M; Aft R
TI - Rural-urban differences in radiation therapy for ductal carcinoma in-situ of the breast.
SO - Breast Cancer Res Treat 2001 Jul;68(2):117-25
AD - Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA. email@example.com
PURPOSE: Rural women in the United States are at a documented disadvantage with regard to breast cancer detection, diagnosis, and treatment and generally do not receive state-of-the-art therapy. The objective of the study was to determine if, and to what extent, rural women were less likely to receive radiation therapy (XRT) following breast conserving surgery (BCS) for ductal carcinoma in-situ (DCIS). METHODS: Our analyses were based on 1991-1996 data provided by the Surveillance, Epidemiology, and End Results (SEER) Program. Only women who were diagnosed with their first primary, microscopically confirmed DCIS breast cancer were included. BCS and XRT were defined according to SEER definitions. Multiple logistic regression was used in the analysis. RESULTS: During this time period, 6,988 women were treated with BCS for DCIS, 50.1% of whom received XRT. In multivariate analysis, rural women in general (OR = 0.58) and younger women (<65) in particular (OR = 0.38) were less likely to receive XRT. Local availability of XRT was not associated with receipt among younger women, while older women without this availability were less likely to receive XRT (OR = 0.48). CONCLUSIONS: Barriers to XRT following BCS for DCIS may be different between younger and older rural women relative to their urban counterparts.
UI - 11583188
AU - Vaidya JS; Baum M; Tobias JS; D'Souza DP; Naidu SV; Morgan S; Metaxas M;
TI - Harte KJ; Sliski AP; Thomson E Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer.
SO - Ann Oncol 2001 Aug;12(8):1075-80
AD - Department of Surgery, University College London, UK. firstname.lastname@example.org
INTRODUCTION: We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast. We present here the clinico-pathological basis for this view, as well as a novel therapeutic approach that allows intra-operative radiotherapy to be safely and accurately delivered to the target tissues in a standard operating theatre. THE RATIONALE: Whole-organ analysis of mastectomy specimens reveals that 80% of occult cancer foci are situated remote from the index quadrant. In contrast, over 90% of local recurrences after breast conservative therapy occur near the original tumour, even when radiotherapy is not given. Therefore, the remote occult cancer foci may be clinically irrelevant and radiotherapy to the index quadrant alone might be sufficient. A NOVEL TECHNIQUE: The Photon Radiosurgery System (PRS) is an ingenious portable electron-beam driven device that can typically deliver intra-operative doses of 5-20 Gy, respectively, to 1 cm and 0.2 cm from the tumour bed over about 22 min. The pliable breast tissue--the target--wraps around the source, providing perfect conformal radiotherapy. Being soft X-rays, the dose attenuates rapidly (alpha approximately 1/r3), reducing distant damage. RESULTS: In our pilot study of 25 patients (age 30-80 years, T = 0.42-4.0 cm), we replaced the routine post-operative tumour bed boost with targeted intra-operative radiotherapy. There have been no major complications and no patient has developed local recurrence, although the median follow-up time is short, at 24 months. CONCLUSION: It is safe and feasible to deliver targeted intraoperative radiotherapy (Targit) for early breast cancer. We have begun a randomised trial--the first of its kind--comparing Targit with conventional six-week course of radiotherapy. If proven equivalent in terms of local recurrence and cosmesis, it could eliminate the need for the usual six-week course of post-operative radiotherapy.
UI - 11583190
AU - Pergolizzi S; Settineri N; Santacaterina A; Spadaro P; Maisano R;
TI - Caristi N; Adamo V; De Renzis C; Mesiti M; Cascinu S Ipsilateral supraclavicular lymph nodes metastases from breast cancer as only site of disseminated disease. Chemotherapy alone vs. induction chemotherapy to radical radiation therapy.
SO - Ann Oncol 2001 Aug;12(8):1091-5
AD - Institute of Radiological Science, Department of Radiation Oncology University of Messina, Italy. email@example.com
BACKGROUND: To define the role of radiotherapy (RT) in the treatment of ipsilateral supraclavicular lymph-nodes metastases (ISLM) from breast cancer as only site of disseminated disease, we started a prospective non-randomized clinical trial in 1989. Here we report the final results with a median follow-up of 8.75 years. PATIENTS AND METHODS: Thirty-seven patients (pts), with ISLM from breast cancer, were consecutively enrolled into two arms. Arm A (18 pts): chemotherapy (CT) for six courses. Arm B (19 pts): CT for three courses followed by RT to the site of ISLM at 'radical' dose of 50-60 Gy. RESULTS: In arm A, a median Time to Progression (TtP) of 7 months with a median Overall Survival (OS) of 28 months was recorded. In comparison, patients in arm B had a longer median TtP with 20 months as well as a better median OS with 41 months, respectively. An actuarial five-year disease-free survival of 5.5% was obtained in arm A vs. 21% in arm B. A statistically significant difference in TtP was demonstrated between the two groups (P = 0.01). CONCLUSIONS: These data demonstrate that a better event-free survival could be achieved in patients with ISLM submitted to induction CT and radical irradiation. This also translated into a longer survival although this did not achieve statistical significance. We want to stress the importance of local control by RT since it does imply that not all of these patients have micrometastases at the time of relapse in the supraclavicular fossa.
UI - 11711308
AU - Wang J; Chen P; Su ZF; Vallis K; Sandhu J; Cameron R; Hendler A; Reilly
TI - RM Amplified delivery of indium-111 to EGFR-positive human breast cancer cells.
SO - Nucl Med Biol 2001 Nov;28(8):895-902
AD - Division of Nuclear Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
A method is described to amplify the delivery of 111In to human breast cancer cells utilizing a novel human serum albumin-human EGF (HSA-hEGF) bioconjugate substituted preferentially in the HSA domain with multiple DTPA metal chelators for 111In. 111In-DTPA-HSA-hEGF exhibited a lower receptor-binding affinity than 111In-DTPA-hEGF but was rapidly and specifically bound, internalized and translocated to the nucleus in EGFR-positive MDA-MB-468 breast cancer cells. 111In-DTPA-HSA-hEGF was cytotoxic in vitro mainly through the emission of short-range Auger electrons and partially through the effects of the hEGF moiety to MDA-MB-468 cells overexpressing EGFR (1-2 x 10(6) receptors/cell) but not towards MCF-7 breast cancer cells with a 100-fold lower level of EGFR on their surface. The cytotoxicity in vitro against MDA-MB-468 cells of 111In-DTPA-HSA-hEGF substituted with nine DTPA chelators was enhanced 4-fold compared to 111In-DTPA-hEGF monosubstituted with DTPA. Studies are planned to further evaluate 111In-DTPA-HSA-hEGF in vivo as a new imaging and targeted radiotherapeutic agent for breast cancer.
UI - 11756722
AU - Formenti SC; Rosenstein B; Skinner KA; Jozsef G
TI - T1 stage breast cancer: adjuvant hypofractionated conformal radiation therapy to tumor bed in selected postmenopausal breast cancer patients--pilot feasibility study.
SO - Radiology 2002 Jan;222(1):171-8
AD - Department of Radiation Oncology, New York University School of Medicine, 566 First Ave, New York, NY 10016, USA.
PURPOSE: To explore the feasibility of a short course of hypofractionated conformal radiation therapy to the tumor bed as part of a breast preservation protocol in postmenopausal patients with nonpalpable pT1N0 stage breast cancer. MATERIALS AND METHODS: The tumor bed was imaged at computed tomography (CT) in the prone position on a dedicated table. The same table and position were used for treatment with a 4-MV linear accelerator. The planning target volume was the tumor bed plus a 1-2-cm margin defined at postmastectomy CT. A regimen of five fractions was tested in this pilot dose study. Cosmesis was assessed by patients and physicians before treatment and 36 months after treatment. RESULTS: Ten consecutive patients who were eligible for the study were assigned to one of three dose-per-fraction regimens; nine were treatable with the proposed technique on the basis of CT findings. Patients received five fractions over 10 days (total dose range, 25-30 Gy): Three received 5.0 Gy per fraction; four, 5.5 Gy; and two, 6.0 Gy. At minimum follow-up of 36 months (range, 36-53 months), all patients were alive and disease free with good to excellent cosmesis. CONCLUSION: Hypofractionated conformal breast radiation therapy is feasible. Further studies are warranted.
UI - 11830920
AU - Pribylova O; Petruzelka L; Honova H; Fischer J; Bustova I; Siffnerova H;
TI - Kuta M; Miller V; Hacklova M; Machacek J; Kohoutek M; Vodvarka P; Kysela T; Tajblova J; Suk J; Dorazilova V; Vedralova J; Bauer J [Tamoxifen or tamoxifen in combination with chemotherapy in adjuvant therapy of breast carcinoma. Results of a multicenter randomized study]
SO - Sb Lek 2001;102(1):65-76
AD - Onkologicka klinika 1: lekarske fakulty Univerzity Karlovy, U nemocnice 2, 128 08 Praha 2, Czech Republic. firstname.lastname@example.org pT1c-3a, pN0-1, M0, were randomised after surgery to adjuvant tamoxifen (20 mg per day) or to tamoxifen plus CMF (C 500 mg/m2, M 40 mg/m2 and F 600 mg/m2 on days 1st and 8th q 28 day) in 6 cycles. The median age (49-72 years, median 58), tumour size, number of involved lymphnodes (0-3), estrogens receptor status, grade (I-III) and type of operation were well balanced among the 50 pts on tamoxifen and the 53 pts on tamoxifen plus CMF pts, preferably postmenopausal. RESULTS: Grade of toxicity according to WHO criteria was not higher then two in both arms. Toxicity both haematological and non-haematological was higher in the group treated with chemotherapy (0 vs 32 resp. 20%) except weight gain (52% in both group). After median follow-up of 42 mos five recurrences in tamoxifen and seven in tamoxifen plus CMF pts were observed (p = NS). The projected 3-y DFS is 92% for tamoxifen and 88% for tamoxifen plus CMF (p = NS). The 3-y OS is 88% for tamoxifen and 80% for tamoxifen plus CMF pts (p = NS). CONCLUSIONS: Both regimens are equally effective with higher toxicity in the group with combined chemo- and hormonal therapy.
UI - 11811349
AU - Wengstrom Y; Haggmark C; Forsberg C
TI - Coping with radiation therapy: effects of a nursing intervention on coping ability for women with breast cancer.
SO - Int J Nurs Pract 2001 Feb;7(1):8-15
AD - Department of Oncology, Karolinska Institutet, Stockholm, Sweden. email@example.com
A randomized study was carried out to investigate whether a nursing intervention, using Orem's self-care theory as a framework, would affect the coping ability of women with breast cancer during and following radiation therapy. The intervention consisted of promoting of behaviours to support the patient to restore, maintain or increase their abilities to interact with the situation and adapt to the demands of radiation treatment. The control and experimental groups both consisted of 67 patients. The Wheel Questionnaire was used to evaluate the effect of the intervention. Our results showed that the intervention provided patients older than 59 years the ability to cope with the treatment (df = 2, F = 3.463, P = > 0.05). The present study supports the idea that individual interventions aimed at improving well-being helps patients. It also highlights the fact that individual approaches to improving well-being are needed. Such interventions should be directed to patients at risk for poor adjustment, such as those older than 50 years of age.
UI - 11845581
AU - Rudman F; Stanec S; Stanec M; Margaritoni M; Stanec Z; Zic R; Milanovic
TI - R [Surgical treatment of irradiation-induced sarcoma after treatment for breast carcinoma, personal experience: 4 case reports] ]
SO - Lijec Vjesn 2001 Sep-Oct;123(9-10):251-4
AD - Odjel za plasticnu kirurgiju Klinike za kirurgiju, KB Dubrava, Av. Gojka Suska 6b, 10000 Zagreb.
In the Department of Plastic Surgery of "Dubrava" University Hospital from 1993 to 1999 four patients were treated for radiation induced sarcoma. All of the patients were formerly operated for breast cancer and irradiated postoperatively. The mean time span between radiotherapy and development of sarcoma was 4.75 years. Four patients were treated with wide excision and immediate reconstruction with local flaps. One of the patients had fibrosarcoma, two patients had lymphangiosarcoma, and one patient had osteosarcoma. Two patients died within two years. Radiation induced sarcomas are therapy resistant, and the review of literature did not show large controlled investigations which would offer the most optimal treatment. Most frequently a rapid progression of the disease is seen.
UI - 11769858
AU - Recht A
TI - Rheumatologic disorders and radiotherapy.
SO - Cancer J 2001 Nov-Dec;7(6):475-6
AD - Department of Radiation Oncology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA.
UI - 11769859
AU - Pierce LJ
TI - Minimizing cardiotoxicity following breast radiotherapy: treatment planning is the key.
SO - Cancer J 2001 Nov-Dec;7(6):477-9
AD - Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, USA.
UI - 11769860
AU - Chen AM; Obedian E; Haffty BG
TI - Breast-conserving therapy in the setting of collagen vascular disease.
SO - Cancer J 2001 Nov-Dec;7(6):480-91
AD - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
BACKGROUND: It is unclear whether the presence of collagen vascular disease should be considered a contraindication to irradiation. This study was undertaken to determine whether women with pre-existing collagen vascular disease have an increased incidence of complications after breast-conserving therapy. METHODS AND MATERIALS: A cohort of 36 patients with documented collagen vascular disease was conservatively treated for early-stage breast cancer between 1975 and 1998. All of these patients were treated with conventional radiation therapy to a total medium dose of 64 Gy. Seventeen had rheumatoid arthritis; four, scleroderma; four, Raynaud's phenomenon; five, lupus erythematosus; two, Sjogren's disease; and four, polymyositis. Each of these patients was matched to two control patients without a history of collagen vascular disease on the basis of age, radiation therapytechnique, chemotherapy or hormone therapy use, tumor histology, and date of treatment. Acute and late complications were assessed using a six-point scale from the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. The scoring system for both acute and late reactions ranged from 0 (no change over baseline) to 5 (radiation led to death). For the purpose of statistical analysis, patients were classified as having a significant complication if they had a score of 3 or greater. RESULTS: With a median clinical follow-up time of 12.5 years (range, 3.0-22.5 years), no significant difference was detected between the collagen vascular disease and control groups with respect to acute complications (14% vs 8%). With respect to late complications, a significant difference was observed (17% vs 3%) between the two groups. However, when patients in the collagen vascular disease group were analyzed by specific disease, this significance disappeared in all but the scleroderma group. CONCLUSIONS: Patients with scleroderma have a statistically significant increased incidence of radiation therapy complications after breast-conserving surgery and radiation therapy. The presence of other collagen vascular diseases should not be considered a contraindication for this treatment modality.
UI - 11769861
AU - Storey MR; Munden R; Strom EA; McNeese MD; Buchholz TA
TI - Coronary artery dosimetry in intact left breast irradiation.
SO - Cancer J 2001 Nov-Dec;7(6):492-7
AD - Department of Radiation Oncology and Radiology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
PURPOSE: The purpose of this article is to report dose-volume histograms of coronary vessels from irradiation of the intact left breast. PATIENTS AND METHODS: Fifteen women with cancer of the left breast underwent computed tomographic treatment planning for radiation treatments of an intact left breast. Images through the heart were reconstructed at 1-mm increments to permit contouring of the coronary vessels. Five treatment plans were created for each patient; one plan from the simulated treatment fields and four additional plans that were generated from virtual treatment fields created by shifting the isocenter 5 mm and 10 mm both superficially and deep. The radiation dose was calculated using a three-dimensional treatment planning system that incorporated heterogeneity correction factors. RESULTS: With no adjustment to the perpendicular lung distance, a mean volume of 12% of the left anterior descending coronary artery received 20 Gy, 6% received 30 Gy, and 3% received 40 Gy. The dose to the left anterior descending coronary artery varied significantly with changes in the perpendicular lung distance. From the mean perpendicular lung distance of 1.87 for the simulated fields, a 5-mm increase in the perpendicular lung distance resulted in an increase of 20%, 15%, and 12% in the percentage of the left anterior descending coronary artery treated to 20 Gy, 30 Gy, and 40 Gy, respectively. With a 10-mm increase, the respective volumes were increased to 49%, 41%, and 34%, respectively. A 5-mm reduction of lung distance in the original plan resulted in a decrease of 10%, 5%, and 3% in the percentage treated to 20 Gy, 30 Gy, and 40 Gy, respectively. The dose to the left main coronary artery, the right main coronary artery, and the left circumflex coronary artery was limited to scatter and was less than 7 Gy. Changes in the perpendicular lung distance did not significantly affect the dose administered to these vessels. DISCUSSION: The left anterior descending coronary artery is anatomically located at the edge of the cardiac silhouette on traditional treatment films. Small changes in the perpendicular lung distance can significantly change the dose delivered to this vessel. A fundamental change in the shape of the dose-volume histogram occurs at a perpendicular lung distance of 2.3 cm, whereas the dose is very low when the perpendicular lung distance is less than 1.3 cm. These points may serve as clinically important values in the treatment planning for cancer of an intact breast.
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