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. 2001 Jan;84(2):164–169. doi: 10.1054/bjoc.2000.1571

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

K Holli 1, R Saaristo 2, J Isola 3, H Joensuu 4, M Hakama 5
PMCID: PMC2363696  PMID: 11161371

Abstract

The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction ≤7 and be excised with at least 1 cm margin. During a mean follow-up time of 6.7 years, 13 (18.1%) cancers recurred locally in the no-XRT and 6 (7.5%) in the XRT group (P = 0.03). There was no difference between the groups in the ultimate breast preservation rate (95.0% vs. 94.4% in XRT and no-XRT, respectively, P = 0.88), distant metastasis-free survival (P = 0.36), or 5-year cancer-specific survival (97.1% in XRT and 98.6 in no-XRT). Radiation therapy given after lumpectomy reduces the frequency of ipsilateral breast recurrences even in women with small breast cancer with several favourable clinical and biological features. However, the breast preservation rate may not increase due to more frequent use of salvage mastectomies in patients treated with postoperative radiotherapy. © 2001 Cancer Research Campaign http://www.bjcancer.com

Keywords: low risk breast cancer, conservative surgery, radiotherapy

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Selected References

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  1. BLOOM H. J., RICHARDSON W. W. Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 1957 Sep;11(3):359–377. doi: 10.1038/bjc.1957.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Clark R. M., McCulloch P. B., Levine M. N., Lipa M., Wilkinson R. H., Mahoney L. J., Basrur V. R., Nair B. D., McDermot R. S., Wong C. S. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992 May 6;84(9):683–689. doi: 10.1093/jnci/84.9.683. [DOI] [PubMed] [Google Scholar]
  3. Clarke D. H., Martinez A. A. Identification of patients who are at high risk for locoregional breast cancer recurrence after conservative surgery and radiotherapy: a review article for surgeons, pathologists, and radiation and medical oncologists. J Clin Oncol. 1992 Mar;10(3):474–483. doi: 10.1200/JCO.1992.10.3.474. [DOI] [PubMed] [Google Scholar]
  4. Dalberg K., Eriksson E., Kanter L., Sandelin K., Liedberg A., Auer G., Thorstensson S., Fredriksson I., Johansson U., Rutqvist L. E. Biomarkers for local recurrence after breast-conservation--a nested case-control study. Breast Cancer Res Treat. 1999 Oct;57(3):245–259. doi: 10.1023/a:1006281718793. [DOI] [PubMed] [Google Scholar]
  5. Fisher B., Anderson S., Fisher E. R., Redmond C., Wickerham D. L., Wolmark N., Mamounas E. P., Deutsch M., Margolese R. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991 Aug 10;338(8763):327–331. doi: 10.1016/0140-6736(91)90475-5. [DOI] [PubMed] [Google Scholar]
  6. Fisher B., Anderson S., Redmond C. K., Wolmark N., Wickerham D. L., Cronin W. M. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995 Nov 30;333(22):1456–1461. doi: 10.1056/NEJM199511303332203. [DOI] [PubMed] [Google Scholar]
  7. Fisher B., Dignam J., Wolmark N., Mamounas E., Costantino J., Poller W., Fisher E. R., Wickerham D. L., Deutsch M., Margolese R. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998 Feb;16(2):441–452. doi: 10.1200/JCO.1998.16.2.441. [DOI] [PubMed] [Google Scholar]
  8. Forrest A. P., Stewart H. J., Everington D., Prescott R. J., McArdle C. S., Harnett A. N., Smith D. C., George W. D. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet. 1996 Sep 14;348(9029):708–713. doi: 10.1016/s0140-6736(96)02133-2. [DOI] [PubMed] [Google Scholar]
  9. Fourquet A., Campana F., Zafrani B., Mosseri V., Vielh P., Durand J. C., Vilcoq J. R. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1989 Oct;17(4):719–725. doi: 10.1016/0360-3016(89)90057-6. [DOI] [PubMed] [Google Scholar]
  10. Fowble B. L., Schultz D. J., Overmoyer B., Solin L. J., Fox K., Jardines L., Orel S., Glick J. H. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):23–33. doi: 10.1016/0360-3016(94)90515-0. [DOI] [PubMed] [Google Scholar]
  11. Gage I., Schnitt S. J., Nixon A. J., Silver B., Recht A., Troyan S. L., Eberlein T., Love S. M., Gelman R., Harris J. R. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996 Nov 1;78(9):1921–1928. doi: 10.1002/(sici)1097-0142(19961101)78:9<1921::aid-cncr12>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  12. Holland R., Connolly J. L., Gelman R., Mravunac M., Hendriks J. H., Verbeek A. L., Schnitt S. J., Silver B., Boyages J., Harris J. R. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990 Jan;8(1):113–118. doi: 10.1200/JCO.1990.8.1.113. [DOI] [PubMed] [Google Scholar]
  13. Julien J. P., Bijker N., Fentiman I. S., Peterse J. L., Delledonne V., Rouanet P., Avril A., Sylvester R., Mignolet F., Bartelink H. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet. 2000 Feb 12;355(9203):528–533. doi: 10.1016/s0140-6736(99)06341-2. [DOI] [PubMed] [Google Scholar]
  14. Kearney T. J., Morrow M. Effect of reexcision on the success of breast-conserving surgery. Ann Surg Oncol. 1995 Jul;2(4):303–307. doi: 10.1007/BF02307061. [DOI] [PubMed] [Google Scholar]
  15. Kurtz J. M., Amalric R., Brandone H., Ayme Y., Jacquemier J., Pietra J. C., Hans D., Pollet J. F., Bressac C., Spitalier J. M. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer. 1989 May 15;63(10):1912–1917. doi: 10.1002/1097-0142(19890515)63:10<1912::aid-cncr2820631007>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  16. Kurtz J. M. Factors influencing the risk of local recurrence in the breast. Eur J Cancer. 1992;28(2-3):660–666. doi: 10.1016/s0959-8049(05)80121-2. [DOI] [PubMed] [Google Scholar]
  17. Kurtz J. M., Jacquemier J., Amalric R., Brandone H., Ayme Y., Hans D., Bressac C., Roth J., Spitalier J. M. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990 Apr 15;65(8):1867–1878. doi: 10.1002/1097-0142(19900415)65:8<1867::aid-cncr2820650833>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  18. Liljegren G., Holmberg L., Adami H. O., Westman G., Graffman S., Bergh J. Sector resection with or without postoperative radiotherapy for stage I breast cancer: five-year results of a randomized trial. Uppsala-Orebro Breast Cancer Study Group. J Natl Cancer Inst. 1994 May 4;86(9):717–722. doi: 10.1093/jnci/86.9.717. [DOI] [PubMed] [Google Scholar]
  19. Liljegren G., Holmberg L., Bergh J., Lindgren A., Tabár L., Nordgren H., Adami H. O. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999 Aug;17(8):2326–2333. doi: 10.1200/JCO.1999.17.8.2326. [DOI] [PubMed] [Google Scholar]
  20. Locker A. P., Ellis I. O., Morgan D. A., Elston C. W., Mitchell A., Blamey R. W. Factors influencing local recurrence after excision and radiotherapy for primary breast cancer. Br J Surg. 1989 Sep;76(9):890–894. doi: 10.1002/bjs.1800760906. [DOI] [PubMed] [Google Scholar]
  21. Renton S. C., Gazet J. C., Ford H. T., Corbishley C., Sutcliffe R. The importance of the resection margin in conservative surgery for breast cancer. Eur J Surg Oncol. 1996 Feb;22(1):17–22. doi: 10.1016/s0748-7983(96)91253-6. [DOI] [PubMed] [Google Scholar]
  22. Sinn H. P., Anton H. W., Magener A., von Fournier D., Bastert G., Otto H. F. Extensive and predominant in situ component in breast carcinoma: their influence on treatment results after breast-conserving therapy. Eur J Cancer. 1998 Apr;34(5):646–653. doi: 10.1016/s0959-8049(97)10106-x. [DOI] [PubMed] [Google Scholar]
  23. Veronesi U., Luini A., Del Vecchio M., Greco M., Galimberti V., Merson M., Rilke F., Sacchini V., Saccozzi R., Savio T. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993 Jun 3;328(22):1587–1591. doi: 10.1056/NEJM199306033282202. [DOI] [PubMed] [Google Scholar]
  24. Veronesi U., Salvadori B., Luini A., Greco M., Saccozzi R., del Vecchio M., Mariani L., Zurrida S., Rilke F. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer. 1995 Sep;31A(10):1574–1579. doi: 10.1016/0959-8049(95)00271-j. [DOI] [PubMed] [Google Scholar]
  25. Veronesi U., Zucali R., Del Vecchio M. Conservative treatment of breast cancer with QU.A.R.T. Technique. World J Surg. 1985 Oct;9(5):676–681. doi: 10.1007/BF01655180. [DOI] [PubMed] [Google Scholar]
  26. Voogd A. C., Peterse J. L., Crommelin M. A., Rutgers E. J., Botke G., Elkhuizen P. H., van Geel A. N., Hoekstra C. J., van Pel R., van de Vijver M. J. Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer. Dutch Study Group on local Recurrence after Breast Conservation (BORST) Eur J Cancer. 1999 Dec;35(13):1828–1837. doi: 10.1016/s0959-8049(99)00220-8. [DOI] [PubMed] [Google Scholar]
  27. Whelan T., Clark R., Roberts R., Levine M., Foster G. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group. Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):11–16. doi: 10.1016/0360-3016(94)90513-4. [DOI] [PubMed] [Google Scholar]
  28. de la Rochefordiere A., Asselain B., Campana F., Scholl S. M., Fenton J., Vilcoq J. R., Durand J. C., Pouillart P., Magdelenat H., Fourquet A. Age as prognostic factor in premenopausal breast carcinoma. Lancet. 1993 Apr 24;341(8852):1039–1043. doi: 10.1016/0140-6736(93)92407-k. [DOI] [PubMed] [Google Scholar]
  29. de la Rochefordière A., Abner A. L., Silver B., Vicini F., Recht A., Harris J. R. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys. 1992;23(5):925–931. doi: 10.1016/0360-3016(92)90896-p. [DOI] [PubMed] [Google Scholar]

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