Matched-pair Analysis for Survival Endpoints Between Women With Early-stage Uterine Carcinosarcoma and Uterine Serous Carcinoma

85 Background: Previous studies have shown that young women with breast cancer treated with breast-conservation therapy (BCT) experience higher local recurrence rates. Whether such patients are better treated with mastectomy is unclear. The purpose of this study was to evaluate survival outcomes of young women with early-stage breast cancer treated with BCT or mastectomy using a large, population-based database. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients age 20 to 39 diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007 who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable analysis as well as a matched pair analysis were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy. Results: 14,760 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range: 0.5 to 17.9 years). Multivariable analysis revealed year of diagnosis, age, race/ethnicity, grade, PR status, tumor size, number of lymph nodes positive, and number of lymph nodes examined were independent predictors of OS and CSS while ER status was of borderline significance. After accounting for all patient and tumor characteristics, multivariable analysis found that BCT resulted in similar OS (HR: 0.93; CI: 0.83-1.04; p = 0.16) and CSS (HR: 0.93, CI: 0.83-1.05; p = 0.26) as mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5/10/15-year OS for BCT and mastectomy were 92.5%/83.5%/77.0% and 91.9%/83.6%/79.1%, respectively (p = 0.99) and the 5/10/15-year CSS for BCT and mastectomy were 93.3%/85.5%/79.9% and 92.5%/85.5%/81.9%, respectively (p = 0.88). Conclusions: Young women with early-stage breast cancer have equivalent survival whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options, and should not choose a mastectomy based on the assumption of improved survival.

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Clinical efficacy of 2-day versus 5-day accelerated partial breast irradiation delivered via balloon-based brachytherapy: Results of a matched pair analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.148 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 148-148

Author(s):

Peter Y. Chen ◽

Chirag Shah ◽

John Ben Wilkinson ◽

Michelle Wallace ◽

Hong Ye ◽

...

Keyword(s):

Early Stage ◽

Clinical Stage ◽

Distant Metastases ◽

Accelerated Partial Breast Irradiation ◽

Matched Pair ◽

Partial Breast Irradiation ◽

Patient Scheduling ◽

Breast Irradiation ◽

Matched Pair Analysis ◽

Pair Analysis

148 Background: This analysis compares the efficacy of a 2-day vs. 5-day accelerated partial breast irradiation (APBI) schedule in treatment of early-stage breast cancer. Methods: Patients were treated between 6/2000 and 1/2011 with balloon-based brachytherapy using a 2-day (700 cGy x 4 BID) or a 5-day (340 cGy x 10 BID) fractionation. The CTV was a 1cm expansion from the balloon surface with a single-lumen device used in all cases. To compare efficacy between the two treatment groups, a matched-pair analysis was performed using a 1:2 ratio which paired 38 two-day with 76 five-day patients. Match criteria included minimal follow-up (FU) > 1.0 yr, clinical stage, age (+/- 3 yrs), and ER status. Clinical outcomes analyzed include local-regional recurrence [LR, RR] distant metastases (DM), disease-free, cause-specific and overall survival [DFS, CSS, and OS]. Results: No significant differences were noted for age (p=0.838), clinical stage (p=1.000), ER (p=1.000), tumor size (p=0.236), margin status (p=0.556), nodal stage (p=0.381), PR (p=0.749), use of chemotherapy (p=0.927) or endocrine therapy (p=0.129). Per the ASTRO Consensus Guidelines, no differences were noted in the clinical groups between the 2-and 5-day treatments with the majority categorized as suitable or cautionary (2-day: 92% vs. 5-day: 87% p=0.436). With a mean FU of 4.7 yrs (4.9 yrs for 2-day vs. 4.5 yrs for 5-day, p=0.279), no differences were seen in the 5-year actuarial rates of LR (0.0% vs. 2.6%, p=0.359), DFS (94.4% vs. 96.1%, p=0.618), CSS (100% vs. 94.9 %, p=0.207), or OS (97.3% vs. 92.5%, p=0.811) between the 2-and 5-day groups, respectively. There was no RR in either group. DM rates were similar for both (5.6% vs. 1.3 %, p=0.456). Conclusions: With near 5-year FU for the 2-day schedule, APBI with the 2-day regimen yielded outcomes equivalent to the 5-day schema. Reduced on-treatment days by such hypofractionation offers flexibility in clinical and patient scheduling. Further FU and more patients will be needed to substantiate equivalence of hypofractionated APBI. An HIC-approved protocol randomizing patients between the 2 vs. 5-day treatments is currently open for accrual at our institution.

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