RESPONSE: Re: Breast-Conserving Surgery With or Without Radiotherapy: Pooled-Analysis for Risks of Ipsilateral Breast Tumor Recurrence and Mortality

Vinh‐Hung, Vincent; Verschraegen, Claire F.; Royce, Melanie; Steene, Jan Van de; Tai, Patricia; Cserni, G.; Storme, Guy; Vlastos, Georges

doi:10.1093/jnci/djh246

Cited by 4 publications

(7 citation statements)

References 3 publications

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“…Despite the limitations and regardless of the modeling, our major finding is that the relationship of age and mortality is biphasic. Such a finding has been described by many other authors [ 16 , 17 , 20 , 26 ]. It is important to remember this biphasic relationship when analyzing the effect of age on patients with breast cancer.…”

Section: Discussionsupporting

confidence: 80%

“…It is important to remember this biphasic relationship when analyzing the effect of age on patients with breast cancer. Otherwise, there is a substantial risk of misinterpreting results when age is inappropriately categorized [ 26 ] or inappropriately modeled. (Table 2 would suggest erroneously almost no effect of age on mortality).…”

Section: Discussionmentioning

confidence: 99%

“…At the other end of the age spectrum, breast cancers in elderly patients have been considered by some authors to exhibit a less aggressive behavior than in younger patients [ 4 , 5 ]. Other authors have argued that breast cancer does not become more indolent as age increases [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Modeling the effect of age in T1-2 breast cancer using the SEER database

et al. 2005

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BackgroundModeling the relationship between age and mortality for breast cancer patients may have important prognostic and therapeutic implications.MethodsData from 9 registries of the Surveillance, Epidemiology, and End Results Program (SEER) of the United States were used. This study employed proportional hazards to model mortality in women with T1-2 breast cancers. The residuals of the model were used to examine the effect of age on mortality. This procedure was applied to node-negative (N0) and node-positive (N+) patients. All causes mortality and breast cancer specific mortality were evaluated.ResultsThe relationship between age and mortality is biphasic. For both N0 and N+ patients among the T1-2 group, the analysis suggested two age components. One component is linear and corresponds to a natural increase of mortality with each year of age. The other component is quasi-quadratic and is centered around age 50. This component contributes to an increased risk of mortality as age increases beyond 50. It suggests a hormonally related process: the farther from menopause in either direction, the more prognosis is adversely influenced by the quasi-quadratic component. There is a complex relationship between hormone receptor status and other prognostic factors, like age.ConclusionThe present analysis confirms the findings of many epidemiological and clinical trials that the relationship between age and mortality is biphasic. Compared with older patients, young women experience an abnormally high risk of death. Among elderly patients, the risk of death from breast cancer does not decrease with increasing age. These facts are important in the discussion of options for adjuvant treatment with breast cancer patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Modeling the effect of age in T1-2 breast cancer using the SEER database

et al. 2005

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“…In order to further improve survival and to reduce the risk of treatment sequelae, more clinical research is needed. Randomized trials have shown the importance of radiotherapy for optimal local control of breast cancer [4]. Yet, despite a 67% reduction in local recurrence rates, the survival benefit for those patients treated with postoperative radiotherapy has been disproportionately modest [4].…”

Section: Introductionmentioning

confidence: 99%

“…Randomized trials have shown the importance of radiotherapy for optimal local control of breast cancer [4]. Yet, despite a 67% reduction in local recurrence rates, the survival benefit for those patients treated with postoperative radiotherapy has been disproportionately modest [4]. There has been concern that local control is offset by an increased risk of heart, vascular, and lung toxicity [5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

et al. 2021

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Purpose The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. Methods Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients’ characteristics and their respective penalty scores. Results Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6–70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). Conclusion Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.

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