Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer.

Haybittle, J. L.; Brinkley, Diana; Houghton, J; A’Hern, Roger; Baum, Michael

doi:10.1136/bmj.298.6688.1611

Cited by 175 publications

(59 citation statements)

References 9 publications

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“…Tumour size, determined by clinical examination, was recorded in all 2455 patients. As the primary operation was a simple mastectomy, pathological A factor influencing non-breast cancer mortality in this trial after 5 years' follow-up was the choice of initial treatment, patients in the DXT arm having a higher risk of dying from causes other than breast cancer (Haybittle et al, 1989: Houghton et al, 1994. Treatment allocation was therefore adjusted for in the analyses.…”

Section: Methodsmentioning

confidence: 99%

Social class and weight as prognostic factors in early breast cancer

Haybittle¹,

Houghton²,

Baum³

1997

Br J Cancer

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Summary Data from the Cancer Research Campaign trial for early breast cancer have been used to study the effect of social class and weight on prognosis after primary treatment either by a simple mastectomy plus post-operative radiotherapy or by a simple mastectomy followed by a watch policy. There were 2455 patients for whom both social class could be determined and weight was recorded. These patients presented in clinical stages and 11 and were recruited between June 1970 and April 1975. The cut-off date for the analysis was 31 December 1991. When the survival curves of patients in manual classes were compared with those in non-manual classes, there was a tendency for the latter to do better, but the difference was not statistically significant (P = 0.12). By contrast, there was a highly significant difference (P = 0.002) in survival favouring patients weighing less than or equal to 60 kg compared with those weighing greater than 60 kg. The difference was confined to post-menopausal patients and was still highly significant when included in a multivariate analysis with social class, age, tumour size, clinical stage and tumour grade. The effect of weight was to increase the mortality due to breast cancer rather than other causes.Keywords: breast cancer mortality; social class; weightThe effect of social class on overall mortality is well recognized (Blane et al, 1990), manual workers tending to have higher rates than non-manual. Most studies of the effect of socioeconomic factors on survival after treatment for breast cancer have suggested a similar trend, namely a worse prognosis in lower socioeconomic classes. A recent review by Schrijvers and Mackenbach (1994) of six studies found in four of them a statistically significant increased relative risk (RR) of dying for patients with the lowest socioeconomic status. A paper published subsequent to this review also found a clear gradient by deprivation category, with better survival for women from more affluent areas (Schrijvers et al, 1995).There have also been numerous studies on the effect of weight on prognosis in patients treated for breast cancer. Goodwin and Boyd (1990) reviewed 14 such studies before 1990 and identified a modest effect of body size on prognosis (smaller women doing better), the effect being greatest in post-menopausal women and in those with little or no involvement of axillary nodes. Nevertheless, some more recent reports (Ewertz et al, 1991;Gordon et al, 1992;Katoh et al, 1994) have been unable to show convincingly an improvement of prognosis with decreasing weight or some index of obesity.These studies vary considerably in patient numbers and in whether or not adjustments have been made for other prognostic factors. In addition, their conclusions have often been based on follow-up periods of 5 years or less, so that the considerable number of deaths from breast cancer that occur more than 5 years after first treatment have not always played a part in the analyses.

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Section: Methodsmentioning

confidence: 99%

Social class and weight as prognostic factors in early breast cancer

Haybittle¹,

Houghton²,

Baum³

1997

Br J Cancer

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“…The correspondents ask why this small difference, detectable in modern trials, was not seen before. As previously suggested 12 , in older trials over 50% patients died from breast cancer in the first 5 years 13 and a 1-2% difference wouldn't be detectable until breast-cancer mortality reduced in the later years. On the other hand, in these modern trials, <5% patients die -more than half of these from causes other than breast cancer.…”

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confidence: 78%

In Reply to Park et al

Vaidya

Bulsara

Wenz

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Increased non-breast-cancer mortality including cardiac events in post-surgically irradiated women [17,18] is thought to be related to involvement of these normal organs. The incidence of adverse radiation effects is higher in meta-analyses on older trials with larger fields [15,19] . Thus, older radiation techniques with deep tangents or direct fields on IMLN have been abandoned from the current standard.…”

Section: Imlnm and Radiotherapymentioning

confidence: 99%

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

Kishi

Tanino²,

Sonomura³

et al. 2012

WJR

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AIM:To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS:We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS:All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10: EQ�2, α/β = 10, cumulative total was 101.9 Gy EQ�10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQ�2, α/β = 3 which was 98.7 Gy EQ�2, α/β = 3 without spacer. No procedure related-or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION:We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.

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Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer.

Cited by 175 publications

References 9 publications

Social class and weight as prognostic factors in early breast cancer

Social class and weight as prognostic factors in early breast cancer

In Reply to Park et al

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

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