Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence

Abstract

Background. The impact of delaying irradiation to the intact breast for patients receiving chemotherapy for lymph node positive breast cancer is controversial. Methods. From 1974 to 1989, 474 patients underwent lumpectomy and intact breast irradiation for early stage invasive breast cancer. Chemotherapy was administered to 84 patients (1 patient with bilateral breast cancer) because of positive axillary lymph nodes. Time from definitive breast surgery (lumpectomy or reexcision) to the initiation of breast irradiation was 21–314 days, with a median of 124 days. Forty‐two patients began receiving radiation therapy before 120 days (early) and 42 more than 120 days after surgery (delayed). In the early group, cyclophosphamide/methotrexate/5‐fluorouracil (CMF) was administered to 32 patients, doxorubicin, cyclophosphamide or cyclophosphamide, doxorubicin, 5‐fluorouracil (AC or CAF) to 6 patients, and other regimens to 4 patients; in the delayed group, CMF was given to 29 patients, CAF to 12 patients, and L‐PAM/5‐fluorouracil to 1 patient. Results. Median follow‐up was 62 months. There was one breast recurrence in the early group, compared with six in the patients receiving delayed irradiation. The actuarial relapse rates for these groups at 5 years were 2% and 14%, respectively (P = 0.05). Survival and distant disease free survival were not significantly different between the two groups. Conclusions. Delays in the initiation of irradiation are associated with increased risk of relapse in the breast. When possible, the interval between definitive breast surgery (lumpectomy or reexcision) and the initiation of radiation therapy should be fewer than 120 days.

Quality of adjuvant CMF chemotherapy for node-positive primary breast cancer: a population-based study

“…The timing of postoperative RT and adjuvant chemotherapy following breast cancer surgery has been subject of controversy over the last decades (Recht et al 1991;Hartsell et al 1995;Pronzato et al 1993;Dubey et al 1999;Recht et al 1996;Wallgren et al 1996). Some studies have suggested an increased risk of local failure associated with delayed administration of RT.…”

Prise en charge du cancer du sein infiltrant de la femme non ménopausée

“…Lorsque l'exé rè se est ré alisé e selon les recommandations de la peau ou du tissu sous-cutané jusqu'au plan musculaire, l'analyse des berges sera concentré e sur les berges laté rales. En effet, des marges positives ou proches en superficie ou en profondeur sur le muscle pectoral n'ont pas la mê me signification et le mê me impact qu'au niveau des berges laté rales d'exé rè se [68,110] ; des berges d'exé rè se saines sont-elles indispensables ? Afin d'argumenter la né cessité d'obtenir des berges d'exé rè se saines, nous é tudierons les donné es de la litté rature ayant rapporté le taux de reliquat tumoral aprè s ré exé rè se et le taux de ré cidive locale en fonction du statut des berges.…”

Modell zur primären und sekundären Metastasierung beim Mammakarzinom und dessen klinische Bedeutung

“…Umgehende Operation bei größeren Tumoren rettet Leben. Auch zur Frage der zeitlichen Relation der Anwendung adjuvanter systemischer und lokaler Therapie legt das Modell einen sofortigen Beginn nahe [5,32,60]. Unter anderem ist ein Warten bis zum Lokalrezidiv als Indikator für die systemische Therapie nicht indiziert, ja Warten verursacht zusätzliche Sterbefälle [18].…”