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No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT

Killander, F. LU ; Karlsson, P.; Anderson, H. LU ; Mattsson, J.; Holmberg, E.; Lundstedt, D.; Holmberg, L. and Malmström, P. LU (2016) In European Journal of Cancer 67. p.57-65
Abstract

Background Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. Patients and methods A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. Results After 15 years of... (More)

Background Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. Patients and methods A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. Results After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P < 0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P = 0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P = 0.68, nor was breast cancer–specific mortality significantly higher. Conclusions RT after BCS significantly reduced the incidence of IBTR at 15 years of follow-up. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systemic therapy are needed to omit RT after BCS.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Breast-conserving surgery, Contralateral breast cancer, Ipsilateral breast tumour recurrence, Randomised trial, Whole breast radiation
in
European Journal of Cancer
volume
67
pages
9 pages
publisher
Elsevier
external identifiers
  • Scopus:84985993150
ISSN
0959-8049
DOI
10.1016/j.ejca.2016.08.001
language
English
LU publication?
yes
id
7a4783a4-1330-4978-9fa4-698b5eb1fc94
date added to LUP
2016-09-28 16:08:41
date last changed
2016-11-17 12:18:56
@misc{7a4783a4-1330-4978-9fa4-698b5eb1fc94,
  abstract     = {<p>Background Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. Patients and methods A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. Results After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P &lt; 0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P = 0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P = 0.68, nor was breast cancer–specific mortality significantly higher. Conclusions RT after BCS significantly reduced the incidence of IBTR at 15 years of follow-up. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systemic therapy are needed to omit RT after BCS.</p>},
  author       = {Killander, F. and Karlsson, P. and Anderson, H. and Mattsson, J. and Holmberg, E. and Lundstedt, D. and Holmberg, L. and Malmström, P.},
  issn         = {0959-8049},
  keyword      = {Breast cancer,Breast-conserving surgery,Contralateral breast cancer,Ipsilateral breast tumour recurrence,Randomised trial,Whole breast radiation},
  language     = {eng},
  month        = {11},
  pages        = {57--65},
  publisher    = {ARRAY(0xb69de80)},
  series       = {European Journal of Cancer},
  title        = {No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT},
  url          = {http://dx.doi.org/10.1016/j.ejca.2016.08.001},
  volume       = {67},
  year         = {2016},
}