Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Abstract

BackgroundThe 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.MethodsThe 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.ResultsOf 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).ConclusionThe 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.

WITHDRAWN: Assessment of Suspected Breast Lesions in Early Stage Triple Negative Breast Cancer During Follow-up After Breast Conserving Surgery Using Multiparmetric MRI

“…It is typically followed by breast radiotherapy and results in survival rates comparable to those observed after mastectomy. Although the recurrence rate is low, it is not non-existent [28,29].…”

Thrombin generation predicts early recurrence in breast cancer patients

“…48,49 Given the preliminary evidence of univariate association between time to DR and TG-ETP and TG-peak levels, we further A worse prognosis in terms of disease-free and overall survival rates has already been reported in patients who underwent mastectomy alone compared with breast conserving surgery plus radiotherapy. [50][51][52][53][54] In comparison to mastectomy, after breast-conserving surgery plus radiotherapy both axillary and distant recurrence rates decrease. The reason why breast-conserving surgery is favored over mastectomy is considered to be related to the effect of radiotherapy.…”

Short- and long-term recurrence of early-stage invasive ductal carcinoma in middle-aged and old women with different treatments: A nationwide population-based cohort study

“…A retrospective study in China between 1999 and 2014 reported that BCT has locoregional recurrence-free survival rates similar to that of MAS but better distant metastasis-free survival and overall survival rates [15]. A prospective Swedish multicenter cohort study carried out between 2000 and 2004 reported that local recurrence rates do not differ between BCT and MAS in patients with clinically node-negative breast cancer [16]. A randomized study with a 20-year follow-up in Italy in 2002 reported that the cumulative incidence of local recurrence in women with early breast cancer receiving BCT is 8.8%, which is higher than that in women receiving MAS (2.3%) [17].…”