scholarly journals Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4044
Author(s):  
Ivica Ratosa ◽  
Gaber Plavc ◽  
Nina Pislar ◽  
Tina Zagar ◽  
Andraz Perhavec ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Treatment ◽  
Disease Free Survival ◽  
Breast Conserving Therapy ◽  
Stage I ◽  
Study Cohort ◽  
Postoperative Radiation Therapy ◽  
Distant Relapse

In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.

Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute.

1992 ◽  
Vol 10 (6) ◽  
pp. 976-983 ◽  
Author(s):  
A S Lichter ◽  
M E Lippman ◽  
D N Danforth ◽  
T d'Angelo ◽  
S M Steinberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Study ◽  
Breast Conservation ◽  
Disease Free Survival ◽  
Excisional Biopsy ◽  
Breast Conserving Therapy ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Tumor Bed ◽  
Local Regional Control

PURPOSE Mastectomy versus excisional biopsy (lumpectomy) plus radiation for the treatment of stage I and II breast cancer was compared in a prospective randomized study. PATIENTS AND METHODS From 1979 to 1987, 247 women were randomized and 237 were treated on this study. All patients received a full axillary dissection and all node-positive patients received adjuvant chemotherapy with cyclophosphamide and doxorubicin. Radiation consisted of external-beam therapy to the whole breast with or without supraclavicular nodal irradiation followed by a boost to the tumor bed. RESULTS The minimum time on the study was 18 months and the median time on the study was 68 months. No differences in overall survival or disease-free survival were observed. Actuarial estimates at 5 years showed that 85% of mastectomy-treated patients were alive compared with 89% of the lumpectomy/radiation patients (P2 = .49; 95% two-sided confidence interval [CI] about this difference, 0% to 9% favoring lumpectomy plus radiation). The probability of failure in the irradiated breast was 12% by 5 years and 20% by 8 years according to actuarial estimates. Of 15 local breast failures, 14 were treated with and 12 were controlled by mastectomy; the ultimate local-regional control was similar in both arms of the trial. CONCLUSION These data add further weight to the conclusion that breast conservation using lumpectomy and breast irradiation is equivalent to mastectomy in terms of survival and ultimate local control for stage I and II breast cancer patients.

Effect of hormone receptor status and local treatment on overall survival for early-stage breast cancer.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 60-60
Author(s):  
Catherine Parker ◽  
Heather Y. Lin ◽  
Yu Shen ◽  
Liang Li ◽  
Meeghan Ann Lautner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Cox Model ◽  
Local Treatment ◽  
Local Therapy ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Matched Cohort ◽  
Double Robust

60 Background: Mastectomy and breast conserving therapy (BCT) have been established as interventions with equivalent survival for early stage breast cancer. However, trials comparing these approaches pre-date the understanding of breast cancer heterogeneity. We hypothesized that if heterogeneity is considered, the surgical approach may impact survival. Methods: Using the National Cancer Database (NCDB) from 2004 to 2005, we evaluated the overall survival (OS) of women with Stage I breast cancer who underwent mastectomy, BCT (surgery with radiation), or breast conserving surgery (BCS, surgery without radiation). Since only ER and PR data were available, we categorized tumors as ER and/or PR positive (HR+) or ER and PR negative (HR-). We performed propensity score-matched analysis using the covariates associated with the choice of surgical therapy. We used the Cox proportional hazards model for analyses of OS in pre-matched and matched cohorts. Double robust estimation under the Cox model was used in the analyses of the matched cohort. Results: A total of 16,646 female patients met study criteria: 1,845 (11%) received BCS, 11,214 (67%) received BCT, and 3,587 (22%) underwent mastectomy. Patients undergoing BCT had superior survival outcomes compared to those undergoing mastectomy or BCS (5-year OS was 96% vs 90% vs 87% respectively, p<0.001). After adjusting for other risk factors, BCT remained significantly associated with OS (HR 0.57 [95% CI 0.50, 0.66] for BCT vs BCS; HR 0.67 [95% CI 0.6, 0.76] for BCT vs mastectomy). In the matched cohort (1706 patients in each treatment group), comparison of OS in multivariate analysis confirmed the survival benefit associated with BCT over mastectomy (HR 0.73 [95% CI, 0.59, 0.89]) in the HR+ subset but not in the HR- subset (HR 0.91 [95%CI 0.62, 1.34]) of patients. BCT showed better OS than BCS in both HR+ and HR- subsets (HR 0.63 [95% CI, 0.52, 0.77], HR 0.67 [95%CI 0.46, 0.98] respectively). No differences were seen in OS between mastectomy and BCS in either HR+ or HR- cohorts (HR 0.87 [95%CI. 0.73, 1.03]), HR 0.73 [95%CI 0.51, 1.06] respectively). Conclusions: When tumor heterogeneity is considered, type of local therapy appears to impact the survival of women with Stage I breast cancer.

Adjuvant or neoadjuvant chemotherapy in early stage triple negative breast cancer (TNBC) comparison of outcomes in both BRCA positive and BRCA negative patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 576-576
Author(s):  
Katherine Clifton ◽  
Angelica Gutierrez Barrera ◽  
Junsheng Ma ◽  
Roland L. Bassett ◽  
Jennifer Keating Litton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Early Stage ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Eligibility Criteria ◽  
Genetic Test Results ◽  
Significant Difference ◽  
Brca Negative

576 Background: NSABP Protocol B-18 was a randomized trial which found no statistically significant difference in overall survival (OS) in patients (pts) receiving neoadjuvant (NAC) or adjuvant chemotherapy (AC), however outcome was not analyzed by breast cancer subtypes. Subsequent retrospective studies in TNBC reported conflicting results with an initial study showing a significant OS benefit with AC and later studies showing a trend toward improved survival with NAC. Furthermore, studies have not included a significant number of pts with BRCA mutations. This study aims to analyze outcomes of AC versus NAC in pts with early stage TNBC with and without BRCA germline mutations. Methods: Pts with stage I or II TNBC who had BRCA testing were identified from a prospective cohort study of 4027 pts at MD Anderson Cancer Center. Clinical, demographic, genetic test results, chemotherapy, recurrence, survival data were collected. OS and disease free survival (DFS) were estimated using the Kaplan-Meier method, and log-rank tests were used to compare groups. Results: 305 pts with stage I and II TNBC who met eligibility criteria were included in the analysis. Pts who received both NAC and AC or no chemotherapy were excluded. 181 received AC (59.3%) and 124 received NAC (40.7%). The majority of the pts were less than 50 years old (236, 77.4%) and white (194, 63.8%). 134 were BRCA positive (44.1%) and 170 were BRCA negative (55.9%). The majority of the pts received an anthracycline and taxane regimen (223, 73.1%). There was no significant association between OS or DFS and treatment with NAC versus AC in the overall cohort. Furthermore, there were no significant differences between pt subgroups (NAC BRCA positive, NAC BRCA negative, AC BRCA positive, and AC BRCA negative) with respect to either OS or DFS. Conclusions: NAC versus AC with standard anthracycline and taxane containing regimens results in similar DFS and OS survival amongst pts with stage I and II TNBC regardless of BRCA status. Further studies are needed to evaluate whether similar results are observed with newer agents, such as platinums, PARP inhibitors and other targeted agents.

scholarly journals The role of capecitabine-based neoadjuvant and adjuvant chemotherapy in early-stage triple-negative breast cancer: a systematic review and meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xingfa Huo ◽  
Jinming Li ◽  
Fuxing Zhao ◽  
Dengfeng Ren ◽  
Raees Ahmad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Randomized Clinical Trials ◽  
Triple Negative ◽  
Early Stage ◽  
Meta Analysis ◽  
Disease Free Survival

Abstract Background The role of capecitabine in neoadjuvant and adjuvant chemotherapy for early-stage triple-negative breast cancer (TNBC) is highly controversial. Our meta-analysis was designed to further elucidate the effects of capecitabine on survival in early-stage TNBC patients and its safety. Methods PubMed, Embase, and papers presented at several main conferences were searched up to December 19, 2019, to investigate capecitabine-based versus capecitabine-free neoadjuvant and adjuvant chemotherapy in TNBC patients. Heterogeneity was assessed using I2 test, combined with hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) computed for disease-free survival (DFS), overall survival (OS), and over grade 3 adverse events (AEs). Results A total of 9 randomized clinical trials and 3842 TNBC patients were included. Overall, the combined capecitabine regimens in neoadjuvant and adjuvant chemotherapy showed significantly improved DFS (HR = 0.75; 95% CI, 0.65–0.86; P < 0.001) and OS (HR = 0.63; 95% CI, 0.53–0.77; P < 0.001). In subgroup analysis, there were improvements in DFS in the groups with addition of capecitabine (HR = 0.64; 95% CI, 0.53–0.78; P < 0.001), adjuvant chemotherapy (HR = 0.73; 95% CI, 0.63–0.85; P < 0.001), and lymph node positivity (HR = 0.62; 95% CI, 0.44–0.86; P = 0.005). Capecitabine regimens were related to higher risks of diarrhea (OR = 2.88, 95% CI 2.23–3.74, P < 0.001), stomatitis (OR = 2.01, 95% CI 1.53–2.64, P < 0.001) and hand–foot syndrome (OR = 8.67, 95% CI 6.70–11.22, P < 0.001). Conclusion This meta-analysis showed that neoadjuvant and adjuvant chemotherapy combined with capecitabine significantly improved both DFS and OS in early-stage TNBC patients with tolerable AEs. There were benefits to DFS in the groups with the addition of capecitabine, adjuvant chemotherapy, and lymph node positivity.

scholarly journals Validation of the AJCC prognostic stage for HER2-positive breast cancer in the ShortHER trial

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Maria Vittoria Dieci ◽  
Giancarlo Bisagni ◽  
Alba A. Brandes ◽  
Antonio Frassoldati ◽  
Luigi Cavanna ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Disease Free Survival ◽  
Clinical Trial Design ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Her2 Positive Breast Cancer ◽  
Distant Relapse ◽  
Positive Breast Cancer

Abstract Background The 8th edition of the American Joint Committee on Cancer (AJCC) staging has introduced prognostic stage based on anatomic stage combined with biologic factors. We aimed to validate the prognostic stage in HER2-positive breast cancer patients enrolled in the ShortHER trial. Methods The ShortHER trial randomized 1253 HER2-positive patients to 9 weeks or 1 year of adjuvant trastuzumab combined with chemotherapy. Patients were classified according to the anatomic and the prognostic stage. Distant disease-free survival (DDFS) was calculated from randomization to distant relapse or death. Results A total of 1244 patients were included. Compared to anatomic stage, the prognostic stage downstaged 41.6% (n = 517) of patients to a more favorable stage category. Five-year DDFS based on anatomic stage was as follows: IA 96.6%, IB 94.1%, IIA 92.4%, IIB 87.3%, IIIA 81.3%, IIIC 70.5% (P < 0.001). Five-year DDFS according to prognostic stage was as follows: IA 95.7%, IB 91.4%, IIA 86.9%, IIB 85.0%, IIIA 77.6%, IIIC 67.7% (P < 0.001). The C index was similar (0.69209 and 0.69249, P = 0.975). Within anatomic stage I, the outcome was similar for patients treated with 9 weeks or 1 year trastuzumab (5-year DDFS 96.2% and 96.6%, P = 0.856). Within prognostic stage I, the outcome was numerically worse for patients treated with 9 weeks trastuzumab (5-year DDFS 93.7% and 96.3%, P = 0.080). Conclusions The prognostic stage downstaged 41.6% of patients, while maintaining a similar prognostic performance as the anatomic stage. The prognostic stage is valuable in counseling patients and may serve as reference for a clinical trial design. Our data do not support prognostic stage as guidance to de-escalate treatment. Trial registration EUDRACT number: 2007-004326-25; NCI ClinicalTrials.gov number: NCT00629278.

Prognostic factors for survival after breast conserving therapy for stage I and II breast cancer. The role of local recurrence

1995 ◽  
Vol 31 (5) ◽  
pp. 690-698 ◽  
Author(s):  
H. Kemperman ◽  
J. Borger ◽  
A. Hart ◽  
H. Peterse ◽  
H. Bartelink ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Breast Conserving Therapy ◽  
Stage I
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