Breast-conserving Surgery Followed by Whole-breast Irradiation Offers Survival Benefits over Mastectomy Without Irradiation

Overview

Journal Br J Surg

Specialty General Surgery

Date 2018 Jun 22

PMID 29926900

Citations 27

Authors

J de Boniface

J Frisell

L Bergkvist

Y Andersson

Affiliations

Soon will be listed here.

Abstract

Background: The prognostic equivalence between mastectomy and breast-conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking.

Methods: The Swedish Multicentre Cohort Study prospectively included clinically node-negative patients with breast cancer who had planned sentinel node biopsy between 2000 and 2004. Axillary lymph node dissection was undertaken only in patients with sentinel node metastases. For the present investigation, adjusted survival analyses were used to compare patients who underwent BCS and postoperative radiotherapy with those who received mastectomy without radiotherapy.

Results: Of 3518 patients in the Swedish Multicentre Cohort Study, 2767 were included in the present analysis; 2338 had BCS with postoperative radiotherapy and 429 had mastectomy without radiotherapy. Median follow-up was 156 months. BCS followed by whole-breast irradiation was superior to mastectomy without irradiation in terms of both overall survival (79·5 versus 64·3 per cent respectively at 13 years; P < 0·001) and breast cancer-specific survival (90·5 versus 84·0 per cent at 13 years; P < 0·001). The local recurrence rate did not differ between the two groups. The axillary recurrence-free survival rate at 13 years was significantly lower after mastectomy without irradiation (98·3 versus 96·2 per cent; P < 0·001).

Conclusion: The present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model.

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References

Shaikh T, Tam T, Li T, Hayes S, Goldstein L, Bleicher R . Multifocal and multicentric breast cancer is associated with increased local recurrence regardless of surgery type. Breast J. 2015; 21(2):121-6. DOI: 10.1111/tbj.12366. View

Lynch S, Lei X, Hsu L, Meric-Bernstam F, Buchholz T, Zhang H . Breast cancer multifocality and multicentricity and locoregional recurrence. Oncologist. 2013; 18(11):1167-73. PMC: 3825299. DOI: 10.1634/theoncologist.2013-0167. View

Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J . Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg. 2014; 149(3):267-74. DOI: 10.1001/jamasurg.2013.3049. View

Orecchia R, Huscher A, Leonardi M, Gennari R, Galimberti V, Garibaldi C . Irradiation with standard tangential breast fields in patients treated with conservative surgery and sentinel node biopsy: using a three-dimensional tool to evaluate the first level coverage of the axillary nodes. Br J Radiol. 2005; 78(925):51-4. DOI: 10.1259/bjr/29242407. View

van Maaren M, de Munck L, de Bock G, Jobsen J, van Dalen T, Linn S . 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol. 2016; 17(8):1158-1170. DOI: 10.1016/S1470-2045(16)30067-5. View

Galimberti V, Cole B, Zurrida S, Viale G, Luini A, Veronesi P . Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013; 14(4):297-305. PMC: 3935346. DOI: 10.1016/S1470-2045(13)70035-4. View

Nieweg O, Jansen L, Valdes Olmos R, Rutgers E, Peterse J, Hoefnagel K . Lymphatic mapping and sentinel lymph node biopsy in breast cancer. Eur J Nucl Med. 1999; 26(4 Suppl):S11-6. DOI: 10.1007/s002590050572. View

Fisher B, Redmond C, POISSON R, MARGOLESE R, Wolmark N, Wickerham L . Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989; 320(13):822-8. DOI: 10.1056/NEJM198903303201302. View

Ye J, Yan W, Christos P, Nori D, Ravi A . Equivalent Survival With Mastectomy or Breast-conserving Surgery Plus Radiation in Young Women Aged < 40 Years With Early-Stage Breast Cancer: A National Registry-based Stage-by-Stage Comparison. Clin Breast Cancer. 2015; 15(5):390-7. PMC: 5912884. DOI: 10.1016/j.clbc.2015.03.012. View

10.

Bantema-Joppe E, de Munck L, Visser O, Willemse P, Langendijk J, Siesling S . Early-stage young breast cancer patients: impact of local treatment on survival. Int J Radiat Oncol Biol Phys. 2011; 81(4):e553-9. DOI: 10.1016/j.ijrobp.2011.02.060. View

11.

Pepels M, Vestjens J, de Boer M, Smidt M, van Diest P, Borm G . Safety of avoiding routine use of axillary dissection in early stage breast cancer: a systematic review. Breast Cancer Res Treat. 2010; 125(2):301-13. DOI: 10.1007/s10549-010-1210-7. View

12.

van Wely B, Teerenstra S, Schinagl D, Aufenacker T, de Wilt J, Strobbe L . Systematic review of the effect of external beam radiation therapy to the breast on axillary recurrence after negative sentinel lymph node biopsy. Br J Surg. 2011; 98(3):326-33. DOI: 10.1002/bjs.7360. View

13.

Jatoi I, Proschan M . Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol. 2005; 28(3):289-94. DOI: 10.1097/01.coc.0000156922.58631.d7. View

14.

Zumsteg Z, Morrow M, Arnold B, Zheng J, Zhang Z, Robson M . Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013; 20(11):3469-76. PMC: 5730455. DOI: 10.1245/s10434-013-3011-9. View

15.

Schule J, Frisell J, Ingvar C, Bergkvist L . Sentinel node biopsy for breast cancer larger than 3 cm in diameter. Br J Surg. 2007; 94(8):948-51. DOI: 10.1002/bjs.5713. View

16.

Andersson Y, de Boniface J, Jonsson P, Ingvar C, Liljegren G, Bergkvist L . Axillary recurrence rate 5 years after negative sentinel node biopsy for breast cancer. Br J Surg. 2011; 99(2):226-31. DOI: 10.1002/bjs.7820. View

17.

de Boniface J, Frisell J, Bergkvist L, Andersson Y . Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study. Br J Surg. 2017; 104(3):238-247. DOI: 10.1002/bjs.10411. View

18.

Vila J, Gandini S, Gentilini O . Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast. 2015; 24(3):175-81. DOI: 10.1016/j.breast.2015.02.002. View

19.

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A . Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16):1227-32. DOI: 10.1056/NEJMoa020989. View

20.

Reed D, Lindsley S, Mann G, Austin-Seymour M, Korssjoen T, Anderson B . Axillary lymph node dose with tangential breast irradiation. Int J Radiat Oncol Biol Phys. 2005; 61(2):358-64. DOI: 10.1016/j.ijrobp.2004.06.006. View