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Category: Volume 06 Issue 05 May 2018
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Title: Retrospective Comparison of Adjuvant Radiotherapy in Early Stage Breast Cancer and Impact of Delayed PMRT

Authors: Dr Sanjal Kumar.V, Dr S.N. Jagadesh Kumar, Dr Sanjitha, Dr Harishkumar.P

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.38

Abstract

Objectives: To retrospectively evaluate the importance of post mastectomy radiotherapy in early stage breast cancer and impact of timing of starting radiotherapy in terms of local control and disease free survival.

Methodology: This retrospective descriptive study was based on a database of 765 patients who were diagnosed and treated from 2006 to 2012 with 5 years minimum follow up. Patients were divided into three arms

            1.ARM I – Patients with T1/2 N0 M0 with no classical indication of PMRT-No PMRT given

  1. ARM II – Patients with T1/2 N0 M0 with no classical Indication of PMRT who received PMRT
  2. ARM III - – Patients with T3/4 N+ M0 or with classical

Indication of PMRT who received PMRT

ARM III was subdivided as follows

III A – Patients who received Adjuvant radiotherapy within 6 months of completing surgery

III B – Patients who received Adjuvant radiotherapy after 6 months of completing surgery

Case sheets were scrutinised and data regarding stage, Neoadjuvant chemo, surgery dates, timing of starting radiotherapy ,completion of radiotherapy and toxicity , regular follow ups and if any disease progression the timing of metastasis etc. were collected.

The Kaplan–Meier method was used for calculation and Plotting of the LRFS and DMFS curves of the patient groups, and the Log-rank test was used for the comparison of the survival curves. The results were investigated using the Cox proportional hazards model

Results: ARM I – 92, ARM II – 85, ARM III – 588, III A – 330/588 (56.1%)

III B – 258/588 (43.9%)

Local Recurrence - 17 patients in arm l ,6 patients in arm ll and 47 patients in arm lllB had chest wall recurrence. Regional nodal recurrence was not seen in any of the arms

Distant Metastases- 15 patients in arm l, 11 patients in arm ll and 70 patients in arm lll (23 patients in arm llla and 47 patients in arm lllb) had distant metastases.

Disease Free Survival - DFS in arm l was at an average of 10.14 and median DFS was at 10, DFS in arm ll was at an average of 13.39 and median DFS was at 14, in arm lllA was at an average of 9.3 years and median DFS at 9 years, In arm IIIB was at an average of 8.5 years and median DFS at 9 years, In the whole study, ARM II was significant<p=0.541>in comparison with ARM I and ARM IIIA and IIIB. When you compare ARM IIIA and IIIB, there is no significant difference <p<0.103>.

Conclusions: DFS was significantly better in patients receiving RT compared with those not receiving RT when compared with ARM I and ARM II. Thus signifying some beneficial role in T1-2N0M0 . Timing of initiating pmrt did not affect the disease free survival or overall survival. This is a single institution study further meta-analysis is needed to opine regarding timing of starting Radiotherapy and role of PMRT in early stage breast cancer.

Keywords: adjuvant radiotherapy in breast, post mastectomy radiotherapy, early stage breast cancer, PMRT.

References

  1. Recht A1, Edge SB.Evidence-based indications for postmastectomyirradiation. The Surgical Clinics of North America 2003,Aug;83(4):995-101
  2. Van dee Steene J, Soete G, Strome G. Adjuvant radiotherapy forbreast cancer significantly improves overall survival: the missing link. Radiother Oncol. 2000;55:23–73
  3. EBCTCG Favourable and unfavourable effects on long term survivalof radiotherapy for early breast cancer; an overview of the randomized trials. Lancet. 2000;355:757–70
  4. Overgaard M, Hansen PS, Overgaard J, Rose C, Anderson M, BachF, et al. Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast cooperative 82b Trial. N Engl J Med. 1997;337:949–55
  5. Whelan TJ, Julian J, Wright J, Jadad Ar, Levine ML. Does radiationtherapy improve survival in breast cancer? A Meta-analysis. J Clin Oncol. 2000;18:1220–9
  6. Tsoutsou PG, Belkacemi Y, Gligorov J, et al. Optimal Sequence of Implied Modalities in the Adjuvant Setting of Breast Cancer Treatment: An Update on Issues To Consider. The Oncologist. 2010;15(11):1169-1178. doi:10.1634/theoncologist.2010-0187.
  7. Clinical impact of adjuvant radiation therapy delay after neoadjuvant chemotherapy in locally advanced breast cancer. Silva SB1, Pereira AAL1, Marta GN2, de Barros Lima KML1, de Freitas TB1, Matutino ARB1, de Azevedo Souza MCL1, de Azevedo RGMV1, de Viveiros PAH1, da Silva Lima JM1, Filassi JR3, de Andrade Carvalho H1, Piato JRM3, Mano MS4.
  8. He Z-Y, Wu S-G, Zhou J, et al. Postmastectomy Radiotherapy Improves Disease-Free Survival of High Risk of Locoregional Recurrence Breast Cancer Patients with T1-2 and 1 to 3 Positive Nodes. Camphausen K, ed. PLoS ONE. 2015;10(3):e0119105. doi:10.1371/journal.pone.0119105.
  9. van der Hage JA, Putter H, Bonnema J, Bartelink H, Therasse P,van de Velde CJ, et al. (2003) Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer 39:2192–2199. pmid:14522378
  10. Radiotherapy can decrease locoregional recurrence and increase survival in mastectomy patients with T1 to T2 breast cancer and one to three positive nodes with negative estrogen receptor and positive lymphovascular invasion status.Yang PS1, Chen CM, Liu MC, Jian JM, Horng CF, Liu MJ, Yu BL, Lee MY, Chi CW.
  11. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), PetoR, Davies C, Godwin J, Gray R, Pan HC, et al. (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials.Lancet 383:2127–2135. pmid:24656685
  12. Duraker N, Demir D, Bati B, Yilmaz BD, Bati Y, Çaynak ZC, et al.(2012) Survival benefit of post-mastectomy radiotherapy in breast carcinoma patients with T1–2 tumor and 1–3 axillary lymph node(s) metastasis. Jpn J Clin Oncol 42:601–608. pmid: 22511807
  13. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), PetoR, Davies C, Godwin J, Gray R, Pan HC, et al. (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135. pmid:24656685
  14. Smith BD, Smith GL, Haffty BG. Postmastectomy radiation andmortality in women with T1-2 node-positive breast cancer, J Clin Oncol , 2005, vol. 23 (pg. 1409-19)
  15. Impact of timeliness of adjuvant chemotherapy and radiotherapy onthe outcomes of breast cancer; a pooled analysis of three clinical trials Omar Abdel-Rahman.
  16. Clinical impact of delaying initiation of radiotherapy in patients withbreast cancer: stages 0, I and II, a retrospective observational study Raquel Cobos Campos1, Antxon Apiñaniz Fernández de Larrinoa2, Arantza Sáez de Lafuente Moriñigo1,Naiara Parraza Diez1, Felipe Aizpuru Barandiaran1,3,4, Avelino Alia Ramos5, Aurora Lasso Varela

Corresponding Author

Dr Sanjal Kumar.V

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