Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level

e11532 Background: Adjuvant!Online is a very useful tool for prognosis assessment of early breast cancer (EBC) patients. In the validation study, made on mostly untreated (45%) Canadian EBC patients, Adjuvant!Online proved to be a very reliable prognostic tool. The aim of our study was to validate Adjuvant!Online on EBC patients mainly treated with some kind of adjuvant systemic therapy. Methods: 753 EBC patients diagnosed and treated at the Institute of Oncology Ljubljana, Slovenia, with at least 10-year follow-up were included into the study. All patients received radical local therapy. Adjuvant chemotherapy (ChT) was either CMF or anthracycline-based schema and hormonal therapy (HT) was mainly tamoxifen. Adjuvant!Online 8.0 individual prediction of OS was calculated (with default value of “minor problems” as comorbidity for all patients). The average prediction over all patients was compared to the observed 10-year OS. Results: The predicted and observed 10-year OS of the whole group were 65.5% and 61.5%, respectively. The differences between predicted and observed OS did not differ substantially in the subgroups of patients stratified according to the classical prognostic factors, however, a large difference was found when stratifying by adjuvant systemic therapy. The puzzling difference in patients without systemic therapy (ST) can be both due to small group size and due to special selection of these patients (comorbidity). Conclusions: According to our observation, Adjuvant!Online is a reliable tool for prognosis assessment in EBC patients treated with HT, but it seems to overestimate prognosis in patients treated with ChT, alone or in combination with HT. This is evident even for our collective of EBC patients mainly treated with the first generation ChT - CMF or anthracyclines. Apparently, both Adjuvant!Online and Overview overestimate the positive effect of ChT, disregarding the biologic characteristics of the tumors and inherent effect of HT in HR+ patients. [Table: see text] No significant financial relationships to disclose.

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Local control and the sequencing of adjuvant systemic therapy with primary radiation for patients with early breast cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(92)90296-t ◽

1992 ◽

Vol 24 ◽

pp. 221-222 ◽

Cited By ~ 1

Author(s):

Beryl McCormick ◽

Thomas Hakes ◽

Joachim Yahalom ◽

David Kinne ◽

Larry Norton

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Local Control ◽

Systemic Therapy ◽

Adjuvant Systemic Therapy ◽

Primary Radiation

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Relationship Between Tumor Location and Relapse in 6,781 Women With Early Invasive Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.15.2828 ◽

2000 ◽

Vol 18 (15) ◽

pp. 2828-2835 ◽

Cited By ~ 90

Author(s):

Caroline Lohrisch ◽

Jeremy Jackson ◽

Amanda Jones ◽

Donna Mates ◽

Ivo A. Olivotto

Keyword(s):

Breast Cancer ◽

High Risk ◽

Adjuvant Therapy ◽

Early Breast Cancer ◽

Systemic Therapy ◽

Survival Rates ◽

Tumor Location ◽

Adjuvant Systemic Therapy ◽

Cancer Death ◽

Breast Cancer Death

PURPOSE: To explore the independent prognostic impact of medial hemisphere tumor location in early breast cancer. PATIENTS AND METHODS: A comprehensive database was used to review patients referred to the British Columbia Cancer Agency from 1989 to 1995 with early breast cancer. Patients were grouped according to relapse risk (high or nonhigh) and adjuvant systemic therapy received. Multiple regression analysis was used to determine whether the significance of primary tumor location (medial v lateral hemisphere) was independent of known prognostic factors and treatment. RESULTS: In the adjuvant systemic therapy groups, medial location was associated with a 50% excess risk of systemic relapse and breast cancer death compared with lateral location. Five-year systemic disease-free survival rates were 66.3% and 74.2% for high-risk medial and lateral lesions, respectively (P < .005). Corresponding 5-year disease-specific survival rates were 75.7% and 80.8%, respectively (P < .03). No significant differences were observed between medial and lateral location for low-risk disease regardless of adjuvant therapy or for high-risk disease with no adjuvant therapy. Local recurrence rates were similar for all risk and therapy groups. CONCLUSION: The two-fold risk of relapse and breast cancer death associated with high-risk medial breast tumors may be due to occult spread to internal mammary nodes (IMNs). Enhanced local control, such as with irradiation of the IMN chain, may be one way to reduce the excess risk. Ongoing randomized controlled trials may provide prospective answers to the question of the optimal volume of radiotherapy.

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