Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial

Overgaard, Marie; Jensen, Maj‐Britt; Overgaard, Jens; Hansen, Per Krogh; Rose, Carsten; Andersson, Michael; Kamby, Claus; Kjær, Mogens; Gadeberg, C.; Rasmussen, Birgitte; Blichert-Toft, M; Mouridsen, Henning T.

doi:10.1016/s0140-6736(98)09201-0

Cited by 1,482 publications

(748 citation statements)

References 23 publications

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“…We note that 3 of the 4 cases that relapsed underwent intraoperative radiotherapy. Locoregional therapy has been demonstrated to improve not only disease-free survival, but also overall survival rates (21,22). A short-term follow-up study suggested that the rate of regional recurrence may be very low (0.12%) for patients considered to be SLN-negative on the basis of H&E and IHC sections and for those who do not undergo axillary dissection (14).…”

Section: Discussionmentioning

confidence: 99%

Sentinel node biopsy in breast cancer: results in a large series

Carvalho

Netto

Lima

et al. 2010

Braz J Med Biol Res

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Section: Discussionmentioning

confidence: 99%

Sentinel node biopsy in breast cancer: results in a large series

Carvalho

Netto

Lima

et al. 2010

Braz J Med Biol Res

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“…In two randomized trials of PMRT that were conducted by the Danish Breast Cancer Cooperative Group, LRR rates in patients with 1-3 positive lymph nodes who received systemic therapy but did not receive radiotherapy were approximately 30% at 10 years. 4,5 These risks were considerably greater compared with the rates observed in the British Columbia Cancer Agency (BCCA) randomized trial (16% at 10 years and 33% at 15 years) 6 and in retrospective studies of patients who were enrolled in systemic therapy trials (12-20% at 10 years). [7][8][9][10] This inconsistency has been attributed to variations in the extent of axillary lymph node staging, resulting in different numbers of dissected axillary lymph nodes.…”

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confidence: 94%

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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BACKGROUNDAdjuvant therapy for women with T1–T2 breast carcinoma and 1–3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODSThe study cohort was comprised of 542 women with pathologic T1–T2 breast carcinoma who had 1–3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten‐year Kaplan–Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut‐off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTSThe median follow‐up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut‐off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10‐year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONSThe presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1–3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. Cancer 2005. © 2005 American Cancer Society.

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“…Adjuvant radiotherapy (RT) for breast cancer is a standard treatment used to improve local tumor control and overall survival 1, 2, 3, 4. Volumetric modulated arc therapy (VMAT) has been evaluated for breast treatment in several publications as attested in a recent review 5.…”

Section: Introductionmentioning

confidence: 99%

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Tyran

Tallet

Resbeut

et al. 2018

J Applied Clin Med Phys

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PurposeThis study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment.MethodsTen files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT).ResultsUsing a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1).ConclusionThis study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.

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Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial

Cited by 1,482 publications

References 23 publications

Sentinel node biopsy in breast cancer: results in a large series

Sentinel node biopsy in breast cancer: results in a large series

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

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