Breast-conserving treatment versus mastectomy in T1-2N0 breast cancer: which one is better for Indonesian women.

Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT) and mastectomy for T1-2N0 breast cancer patients. Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), and disease-free survival (DFS). Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 – 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 – 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 – 0.80) and DFS (HR 0.38; 95% CI 0.19 – 0.78). Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS.

Feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation for the selected early stage breast cancer patients after breast-conserving surgery / 中华放射肿瘤学杂志

ObjectiveTo explore the feasibility,efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients.MethodsFrom June 2003 to December 2010,Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery.Twenty patients had CT simulation scan in moderate deep inspiration breathing hold,and twenty-four patients in free breathing.EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT)with four noncoplanar beams.The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients,twice per day at an interval of at least six hours,in five consecutive days.Results The number of patients with follow up time of 2,3 and 5 years were 39,31 and 16.Grade 1 acute radiationinduced dermatitis was observed in 17 patients (39％) at three months.Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95％ cases at two years after radiotherapy.The 2-,3-and 5-year local control rates were 100％,99％ and 94％,respectively.The 2-,3-,and 5-year survival rates were all 100％ and no metastases occurred.Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery.The cosmetic effect,local control rate and long-term survival rate are satisfactory,and acute radiation toxicity is very low.

A correlation study on the displacement of the whole breast target after breast-conserving surgery based on four-dimensional computed tomography / 中华放射医学与防护杂志

Objective To investigate the correlations of the whole breast displacement in different respiratory cycle during free breathing (FB) following breast-conserving surgery to the displacement of selected skin marker,nipple,and selected surgical clip based on four-dimensional computed tomography (4D-CT).Methods Thirteen breast cancer patients who had undergone breast-conserving surgery received whole breast intensity-modulated radiotherapy (IMRT).Respiration-synchronized 4D-CT image data were gathered during FB and were exported to the Varian Eclipse treatment planning system,and the whole breast target,nipple,superior clip,and metal marker on the skin at the anterior body midline were delineated on the CT images of ten phases of the respiratory cycle by the same radiotherapist based on the same delineating criteria.The displacement distances of the delineated target in the mediolateral (x),anteroposterior (y),and superoinferior (z) axles were achieved,and the correlations of the whole breast target displacement to the displacement of the clip,nipple,and skin marker were analyzed.The ipsilateral lung was delineated on the CT images of every phase of the respiratory cycle,and the changes in ipsilateral lung volume were analyzed during the respiratory cycle relative to the displacement of the breast.Results The maximal displacement distances of the whole breast target in the x,y,and z axles during FB were 0.71,0.76 and 1.29 mm,respectively ( F =5.755,P ＜ 0.05 ).There was no relationship between the three-dimensional (3D) displacement of the whole breast and the volume of the whole breast (r =-0.264,P ＜ 0.05 ),and there was no relationship between the displacemeat of the whole breast and the volume change of the ipsilateral lung ( r =0.346,P ＜ 0.05).There was no significant difference among the mean target displacement distances in 3 axles,and among 2 selected successive end-inspiration (EI) phases and 3 selected successive end-expiration (EE) phases.There was no significant difference between the volumes of the whole breast targets at the selected El and EE phases.There was no relationship between the displacement of the whole breast target and the displacement of the nipple,skin marker or superior clip in the cavity along the x- and z-axles.Along the y-axle,8/13,7/11 and 9/13 of the patients showed displacement of the whole breast target relative to the displacement of the nipple,skin marker and superior clip respectively.However,according to a population-based analysis,the displacement of the whole breast target was only significantly associated with the displacement of the superior clip ( r =0.657,P ＜ 0.05 ).Conclusions The clip registration is more credible and sensitive than a skin marker or the nipple for measuring and correcting the displacement of the whole breast target during radiotherapy.

The National Survey of Breast Cancer Treatment Pattern in Korea (1998): The Use of Breast-Conserving Treatment / 대한방사선종양학회지

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

The 1998, 1999 Patterns of Care Study for Breast Irradiation After Breast-Conserving Surgery in Korea / 대한방사선종양학회지

PURPOSE: To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was performed. MATERIALS AND METHODS: A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998~999 from 15 hospitals were reviewed. RESULTS: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the casses, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast+supraclavicular fossa (SCL) in 5% of the cases, and breast+SCL+posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45~9.4 Gy (median 50.4) and boost dose was 8~20 Gy (median 10 Gy). The total radiation dose delivered was 50.4~70.4 Gy (median 60.4 Gy). CONCLUSION: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.

Radiotherapy for Breast Cancer

Radiation plays an important role in the management of breast cancer. The role of radiotherapy in the management of breast cancer can be defined in four categories as follows : (1) primary radiotherapy in breast-conserving treatment(BCT) for early breast cancer including ductal carcinoma in situ(DCIS). (2) Adjuvant radiotherapy after mastectomy for high-risk patients. (3) Radiotherapy with or without surgery after neo-adjuvant chemotherapy in locally advanced breast cancers. (4) Palliative radiotherapy for metastatic disease, mostly bone and brain metastases, and locoregional recurrences. Recently, the application of radiotherapy in the management of breast is increasing. The increased use of mammographic screening have dramatically increased the percentage of cases of breast cancer diagnosed at noninvasive or early stages of disease. As BCT has become the standard treatment for woman with DCIS and a preferred treatment method for early invasive cancers, the proportion of patients who need a radiotherapy is increasing. Also, post-mastectomy radiotherapy(PMRT) is re-appraised because some studies proved that PMRT not only decreased local recurrence but also improved survival rate. Many patients live for decades after treatment. Therefore, technical excellence in irradiating the intact breast or chest wall is very important to reduce long-term complications as well as to control the disease. Rationale, indications, and technical aspects of primary radiotherapy in breast-conserving therapy for early breast cancer and PMRT for operable breast cancer wareas reviewed.

Conservative surgery for the treatment of breast cancer:Analysis of 148 cases / 中国微创外科杂志

Objective To investigate the therapeutic procedures,indications and efficacy of breast-conserving therapy (BCT). Methods BCT was carried out in 148 patients with breast carcinoma in this hospital from January 1996 to October 2003.There were 5 patients in stage 0,85 patients in stage Ⅰ,55 patients in stage Ⅱ,and 3 patients in stage Ⅲ.The surgical treatment was quadrantectomy or local wide excision of tumor,combined with axillary lymph node dissection.Routine adjuvant irradiation,chemotherapy and hormone therapy were given postoperatively. Results Pathological examinations of breast specimens found no positive margins.Follow-up observations for a median of 54 months (range,2 ～ 84 months) revealed a local recurrence rate of 2 7% ( 4/148 ;3 patients in breast and 1 patient in axillary fossa).Distant metastasis occurred in 5 patients (3 4%) and 3 of them died.Sites of metastasis included lung,liver,meninges and bone.The duration from surgery to distant metastasis was 6 ～ 43 months.Evaluation of cosmetic results in 108 patients who had received BCT for at least 12 months showed that good outcomes were achieved in 32 4% of the patients (35/108),fair outcomes,in 49 1% of the patients (53/108),and poor,in 18 5% (20/108). Conclusions For patients with early stage breast carcinoma,and part of those with local advanced breast cancer who have received neoadjuvant chemotherapy and gotten downstaging effects,the effects of BCT is satisfactory.Standard excision,postoperative irradiation and systemic combination treatment are crucial to BCT.Most patients receiving BCT have good cosmetic results.