Her-2 prognostic value in very early-stage breast cancer: a single-institution retrospective analysis.

To evaluate overall survival, distant metastases-free survival and local relapse-free survival rates in a subgroup of patients affected by breast cancer expressing Her-2/neu. Data of 195 women affected by very early-stage breast cancer (pT1a-b pN0) who underwent whole breast radiotherapy after conservative surgery with or without chemotherapy and/or hormone therapy between January 2000 and December 2006 were evaluated. Chi-square test was used to compare the distribution of variables (age, tumour histology, oestrogens and progesterone receptors, tumour grading and adjuvant chemotherapy) between Her-2-positive and Her-2-negative patients. Survival rates were analysed with Kaplan-Meier curves; impact of variables on poor outcome was evaluated with Cox regression method. Median follow-up time was 63.5 months (range 13.8-113.6). Her-2/neu-positive patients (32/16.4%), compared to Her-2/neu-negative patients (163/83.6%), were younger (P = 0.0001), were affected by ductal infiltrating carcinoma (P = 0.039), had negative oestrogens receptors (P = 0.0001) and were not treated with chemotherapy (P = 0.001). Her-2-positive patients had lower overall survival (P = 0.00001) and lower distant metastases-free survival (P = 0.00001) compared to Her-2-negative patients, but no difference in local relapse-free survival was found between the two groups (P = 0.28). After multivariate analysis, Her-2-positive status was a prognostic factor for overall survival (P = 0.00001) and for distant metastases-free survival (P = 0.0001), but not for local relapse-free survival (P = 0.97). Her-2-positive patients have lower overall survival and distant metastases-free survival when compared to Her-2 negative patients but similar local relapse-free survival rates. These patients could be treated with conservative surgery, if feasible, but should receive more aggressive and tailored systemic adjuvant therapies.

Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?

To evaluate if biologically effective dose (BED), and in particular the duration of radiation treatment, has an effect on local relapse risk. Between January 2000 and December 2008 a total of 762 patients with T1-2 N0/+ breast cancer was treated with breast-conserving surgery and radiotherapy, with and without hormone therapy and chemotherapy. Adjuvant radiation therapy was administered to a total dose of 60-66 Gy in 30-33 fractions. The computed BEDs were divided in four groups: <43.1, 43.1-44.9, 45.0-46.1, and >46.1 Gy (A-D, respectively). Kaplan-Meier method was used to calculate local relapse rates. Cox regression method was used to identify prognostic factors of local relapse. Evaluated variables were age, tumor histology, tumor size, surgical margin status, axillary nodal status, tumor grading, adjuvant therapies, adjuvant chemotherapy alone, adjuvant hormone therapy alone, adjuvant anthracyclines, and BEDs values. 8-year local relapse rates were 18.0% for group A, 8.5% for group B, 4.6% for group C, and 2.7% for group D (P=0.008). Multivariate Cox regression analysis showed that BEDs values were associated with higher local relapse risk (P=0.001). In our study, a prolongation of radiotherapy treatment, intended as a lower BED value, after breast-conserving surgery is associated with an increased risk of local relapse. Considering the wide range of results published in other studies, hypofractionation for breast cancer should be considered, at the moment, feasible in selected patients.

Prognostic impact of triple negative phenotype in conservatively treated breast cancer.

To evaluate overall survival (OS), disease-free survival (DFS), and local-recurrence free survival (LRFS) rates in a subgroup of patients affected by breast cancer expressing a particular phenotype (estrogen receptor negative, progesterone receptor negative, and Human Epidermal Growth Factor receptor 2 negative) known as "triple negative" (TN). Data of 387 women affected by early breast cancer who underwent whole-breast radiotherapy after conservative surgery with or without chemotherapy and/or hormone therapy between January 2002 and December 2008, in the Department of Radiotherapy at Regional Cancer Center, were retrospectively evaluated. Chi-squared test was used to compare prognostic factors (age, histology, tumor size, nodal status, grading, and adjuvant therapy) between TN patients and non-TN patients. OS, DFS, and LRFS rates were analyzed using Kaplan--Meier proportional log-rank test; impact of prognostic factors on poor outcome was evaluated using Cox regression stepwise method on univariate and multivariate analysis. Mean follow-up time was 57.6 months (range13.7-109.7). TN patients were more likely to have ≥T2 tumors (p = 0.0003), grade 3 tumors (p = 0.0001) and to receive chemotherapy as adjuvant therapy (p =< 0.0001). TN patients had lower 5-years-OS (p = 0.039) and lower 5-years-DFS (p = 0.003) compared with non-TN patients. No difference in 5-years LRFS was found (p = 0.49). After multivariate analysis, TN status was found to be a predictive factor for OS (p = 0.004) and for DFS (p = 0.01), but not for LRFS (p = 0.8). TN patients have lower survival when compared with non-TN patients, but similar LRFS rates. These patients can be treated in a conservative surgical protocol, but should receive more aggressive and tailored adjuvant therapies.

Interval between breast-conserving surgery and start of radiation therapy in early-stage breast cancer is not predictive of local recurrence: a single-institution experience.

BACKGROUND: The aim of this study was to evaluate if the interval between breast-conserving surgery and the start of radiotherapy has an effect on local relapse risk. MATERIALS AND METHODS: Between January 2000 and December 2006 a total of 387 patients with T1-2N0+ breast cancer were treated with breast-conserving surgery and radiotherapy, with and without hormone therapy and chemotherapy. Adjuvant radiotherapy was administered to a total dose of 60 to 66 Gy in 30 to 33 fractions. The time intervals between breast-conserving surgery and the start of radiotherapy were < 60, 61 to 120, 121 to 180 and > 180 days. The Kaplan-Meier method was used to calculate local relapse-free survival rates, and the Cox regression method was used to identify predictive factors of local relapse. Evaluated variables were age, tumor location, tumor histologic type, tumor size, surgical margin status, axillary node status, estrogen receptors, tumor grading, adjuvant therapy, adjuvant chemotherapy, radiation therapy, boost dose, and interval between breast-preserving surgery and start of radiation therapy. RESULTS: Five-year local relapse-free survival rates were 97.3% ± 1.5% for patients who did not receive chemotherapy and 94.5% ± 1.9% for patients who received chemotherapy (P = .71). There was no significant difference in local relapse among the 4 interval groups (P = .9). Multivariate Cox regression analysis showed that intervals between breast-conserving surgery and radiotherapy were not associated with higher local relapse risk. CONCLUSION: In our study a delay in administering radiotherapy after breast-conserving surgery was not associated with an increased risk of local relapse. Taking into account contrasting results of many published studies, a larger evaluation of this issue is warranted.