scholarly journals Clinicogenomic Radiotherapy Classifier Predicting the Need for Intensified Locoregional Treatment After Breast-Conserving Surgery for Early-Stage Breast Cancer

2019 ◽  
Vol 37 (35) ◽  
pp. 3340-3349 ◽  
Author(s):  
Martin Sjöström ◽  
S. Laura Chang ◽  
Nick Fishbane ◽  
Elai Davicioni ◽  
Shuang G. Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cumulative Incidence ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Treatment Strategies ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Phase Iii ◽  
Primary Tumors ◽  
Tumor Bed

PURPOSE Most patients with early-stage breast cancer are treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) to prevent locoregional recurrence (LRR). However, no genomic tools are used currently to select the optimal RT strategy. METHODS We profiled the transcriptome of primary tumors on a clinical grade assay from the SweBCG91-RT trial, in which patients with node-negative breast cancer were randomly assigned to either whole-breast RT after BCS or no RT. We derived a new classifier, Adjuvant Radiotherapy Intensification Classifier (ARTIC), comprising 27 genes and patient age, in three publicly available cohorts, then independently validated ARTIC for LRR in 748 patients in SweBCG91-RT. We also compared previously published genomic signatures for ability to predict benefit from RT in SweBCG91-RT. RESULTS ARTIC was highly prognostic for LRR in patients treated with RT (hazard ratio [HR], 3.4; 95% CI, 2.0 to 5.9; P < .001) and predictive of RT benefit ( Pinteraction = .005). Patients with low ARTIC scores had a large benefit from RT (HR, 0.33 [95% CI, 0.21 to 0.52], P < .001; 10-year cumulative incidence of LRR, 6% v 21%), whereas those with high ARTIC scores benefited less from RT (HR, 0.73 [95% CI, 0.44 to 1.2], P = .23; 10-year cumulative incidence of LRR, 25% v 32%). In contrast, none of the eight previously published signatures were predictive of benefit from RT in SweBCG91-RT. CONCLUSION ARTIC identified women with a substantial benefit from RT as well as women with a particularly elevated LRR risk in whom whole-breast RT was not sufficiently effective and, thus, in whom intensified treatment strategies such as tumor-bed boost, and possibly regional nodal RT, should be considered. To our knowledge, ARTIC is the first classifier validated as predictive of benefit from RT in a phase III clinical trial with patients randomly assigned to receive or not receive RT.

scholarly journals Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer

Cancer ◽  
2010 ◽  
Vol 117 (12) ◽  
pp. 2590-2598 ◽  
Author(s):  
Anthony E. Dragun ◽  
Bin Huang ◽  
Thomas C. Tucker ◽  
William J. Spanos
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer

scholarly journals Association between waiting time for radiotherapy after surgery for early-stage breast cancer and survival outcomes in Ontario: a population-based outcomes study

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
M. J. Raphael ◽  
R. Saskin ◽  
S. Singh
Keyword(s):  
Breast Cancer ◽  
Waiting Time ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Survival Outcomes ◽  
Event Free Survival ◽  
Free Survival

Background: Following surgery for early stage breast cancer, adjuvant radiotherapy decreases the risk of locoregional recurrence and death from breast cancer. It is unclear if delays to the initiation of adjuvant radiotherapy are associated with inferior survival outcomes. Methods: This population-based, prospective cohort study included a random sample of 25% of all women with stage I and II breast cancer treated with adjuvant radiotherapy in Ontario, Canada between September 1, 2001 and August 31, 2002, when due to capacity issues, wait times for radiation were abnormally long. Pathology reports were manually abstracted and deterministically-linked to population-level administrative databases to obtain information on recurrence and survival outcomes. Cox proportional hazard modeling was used to evaluate the association between waiting time and survival outcomes. A composite survival outcome was used to ensure that all possible measurable harms of delay would be captured. The composite outcome, event-free survival, included locoregional recurrence, development of metastatic disease or breast cancer-specific mortality. Results: We identified 1,028 women with Stage I and II breast cancer who were treated with breast-conserving surgery and adjuvant radiotherapy. Among 599 women who were treated with adjuvant radiation without intervening chemotherapy, waiting time ≥12 weeks from surgery to start of radiation appears to be associated with worse event-free survival after a median follow-up of 7.2 years (HR, composite outcome = 1.44, 95% CI: 0.98-2.11; p= 0.07). Among 429 women who received intervening adjuvant chemotherapy, waiting time ≥6 weeks from completion of chemotherapy to start of radiation was associated with worse event-free survival after a median follow-up of 7.4 years (HR 1.50, 95% CI: 1.00-2.22; p= 0.047). Conclusion: Delay to the initiation of adjuvant radiotherapy following breast-conserving surgery is associated with inferior breast cancer survival outcomes. The good prognosis for patients with early stage breast cancer limits the statistical power to detect an effect of delay to radiotherapy. Given that there is no plausible advantage to delay, we agree with Mackillop et al, that time to initiation of radiotherapy should be kept “as short as reasonably achievable.”

scholarly journals IOERT versus external beam electrons for boost radiotherapy in stage I/II breast cancer: 10-year results of a phase III randomized study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Antonella Ciabattoni ◽  
Fabiana Gregucci ◽  
Gerd Fastner ◽  
Silvio Cavuto ◽  
Antonio Spera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Control ◽  
Early Stage ◽  
Randomized Study ◽  
Cumulative Risk ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Phase Iii ◽  
External Beam

Abstract Background Intraoperative radiotherapy with electrons (IOERT) boost could be not inferior to external beam radiotherapy (EBRT) boost in terms of local control and tissue tolerance. The aim of the study is to present the long-term follow-up results on local control, esthetic evaluation, and toxicity of a prospective study on early-stage breast cancer patients treated with breast-conserving surgery with an IOERT boost of 10 Gy (experimental group) versus 5 × 2 Gy EBRT boost (standard arm). Both arms received whole-breast irradiation (WBI) with 50 Gy (2 Gy single dose). Methods A single-institution phase III randomized study to compare IOERT versus EBRT boost in early-stage breast cancer was conducted as a non-inferiority trial. Primary endpoints were the evaluation of in-breast true recurrences (IBTR) and out-field local recurrences (LR) as well as toxicity and cosmetic results. Secondary endpoints were overall survival (OS), disease-free survival (DFS), and patient’s grade of satisfaction with cosmetic outcomes. Results Between 1999 and 2004, 245 patients were randomized: 133 for IOERT and 112 for EBRT. The median follow-up was 12 years (range 10–16 years). The cumulative risk of IBTR at 5–10 years was 0.8% and 4.3% after IOERT, compared to 4.2% and 5.3% after EBRT boost (p = 0.709). The cumulative risk of out-field LR at 5–10 years was 4.7% and 7.9% for IOERT versus 5.2% and 10.3% for EBRT (p = 0.762). All of the IOERT arm recurrences were observed at > 100 months’ follow-up, whereas the mean time to recurrence in the EBRT group was earlier (55.2 months) (p < 0.05). No late complications associated with IOERT were observed. The overall cosmetic results were scored as good or excellent in physician and patient evaluations for both IOERT and EBRT. There were significantly better scores for IOERT at all time points in physician and patient evaluations with the greatest difference at the end of EBRT (p = 0.006 objective and p = 0.0004 subjective) and most narrow difference at 12 months after the end of EBRT (p = 0.08 objective and p = 0.04 subjective analysis). Conclusion A 10-Gy IOERT boost during breast-conserving surgery provides high local control rates without significant morbidity. Although not significantly superior to external beam boosts, the median time to local recurrences after IOERT is prolonged by more than 4 years.

The 21-gene recurrence score and effects of adjuvant radiotherapy after breast conserving surgery in early-stage breast cancer

2019 ◽  
Vol 15 (14) ◽  
pp. 1629-1639 ◽  
Author(s):  
Yong Dong ◽  
Wen-Wen Zhang ◽  
Jun Wang ◽  
Jia-Yuan Sun ◽  
Zhen-Yu He ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Recurrence Score ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer

scholarly journals Radiotherapy and Adjuvant Trastuzumab in Operable Breast Cancer: Tolerability and Adverse Event Data From the NCCTG Phase III Trial N9831

2009 ◽  
Vol 27 (16) ◽  
pp. 2638-2644 ◽  
Author(s):  
Michele Y. Halyard ◽  
Thomas M. Pisansky ◽  
Amylou C. Dueck ◽  
Vera Suman ◽  
Lori Pierce ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cumulative Incidence ◽  
Early Stage ◽  
Growth Factor Receptor ◽  
Breast Conserving Surgery ◽  
Phase Iii ◽  
Cardiac Events ◽  
Adjuvant Trastuzumab ◽  
Significant Difference

Purpose To assess whether trastuzumab (H) with radiotherapy (RT) increases adverse events (AEs) after breast-conserving surgery or mastectomy. Patients and Methods Patients with early-stage resected human epidermal growth factor receptor 2 (HER-2) –positive breast cancer (BC) were randomly assigned to doxorubicin (A) and cyclophosphamide (C), followed by weekly paclitaxel (T; AC-T-H or AC-TH-H). RT criteria (with or without nodal RT) were postlumpectomy breast or (optional) postmastectomy chest wall. RT of internal mammary nodes was prohibited. RT commenced within 5 weeks after T, concurrently with H. Analysis included 1,503 irradiated patients for RT-associated AEs across treatment arms. Rates of cardiac events (CEs) with and without RT were compared within arms. Results No significant differences among arms were found in incidence of acute skin reaction, pneumonitis, dyspnea, cough, dysphagia, or neutropenia. A significant difference occurred in incidence of leukopenia, with higher rates for AC-T-H versus AC-T (odds ratio = 1.89; 95% CI, 1.25 to 2.88). At a median follow-up of 3.7 years (range, 0 to 6.5 years), RT with H did not increase relative frequency of CEs regardless of treatment side. The cumulative incidence of CEs with AC-T-H was 2.7% with or without RT. With AC-TH-H, the cumulative incidence was 1.7% v 5.9% with or without RT, respectively. Conclusion Concurrent adjuvant RT and H for early-stage BC was not associated with increased acute AEs. Further follow-up is required to assess late AEs.

scholarly journals Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer

2021 ◽  
Vol 18 (5) ◽  
pp. 2738
Author(s):  
Mohammad Shoaib Abrahimi ◽  
Mark Elwood ◽  
Ross Lawrenson ◽  
Ian Campbell ◽  
Sandar Tin Tin
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
New Zealand ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Clinical Factors ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000–2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05–1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives.

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