Tamoxifen with or without Breast Irradiation in Women 50 Years of Age or Older with Early Breast Cancer

Fyles, Anthony; McCready, David R.; Manchul, L.; Trudeau, Maureen; Merante, Patricia; Pintilie, Melania; Weir, Lorna; Olivotto, Ivo A.

doi:10.1056/nejmoa040595

Cited by 603 publications

(304 citation statements)

References 19 publications

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“…Several randomized trials have demonstrated that local recurrence rates are significantly higher if RT is omitted after BCS. 2,[4][5][6][7][8][9] In a recent meta-analysis, the EBCTCG estimated that the absolute 5-year local recurrence risk is 19% lower for women who receive RT after BCS, and the absolute benefit was greater in younger women. 10 In our population-based analysis, we observed that the group of women who are most likely to benefit from RT is the same group that had significantly lower rates of RT.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Several randomized trials have demonstrated that local recurrence rates are significantly higher for patients who undergo BCS without RT. 2,[4][5][6][7][8][9] The overview analysis from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) recently reported that breast cancer mortality rates also were significantly higher for patients who did not receive RT after BCS. 10 The patterns of surgical treatment for stage I and II breast cancer changed after the National Institutes of Health Consensus Conference.…”

Section: Introductionmentioning

confidence: 99%

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Omission of radiation therapy after breast‐conserving surgery in the United States

Tuttle

Jarosek

Habermann

et al. 2011

Cancer

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BACKGROUND: Radiation therapy (RT) after breast-conserving surgery (BCS) is associated with a significant reduction in ipsilateral breast tumor recurrence and breast cancer mortality rates in patients with early stage breast cancer. The authors of this report sought to determine which patients with breast cancer do not receive RT after BCS in the United States. METHODS: The Surveillance, Epidemiology, and End Results registry was used to determine the rates of RT after BCS for women with stage I through III breast cancer in the United States from 1992 through 2007. A multivariate analysis was performed to identify independent predictors of omission of RT. RESULTS: In total, 294,254 patients with invasive, nonmetastatic breast cancer were identified who underwent surgery from 1992 through 2007. Most patients (57%) underwent BCS; among those, 21.1% did not receive RT after BCS. The omission of RT increased significantly from 1992 (15.5%) to 2007 (25%). The receipt of RT also decreased significantly for patients with increased cancer stage, age <55 years, high-grade tumors, large tumors, positive or untested lymph node status, African American or Hispanic race, and negative or unknown estrogen receptor status. Significant geographic variation was observed in the rates of RT after BCS. CONCLUSIONS: The omission of RT after BCS was more common in recent years, especially among women who had an increased risk of breast cancer recurrence. This trend represents a serious health care concern because of the potential increased risk of local recurrence and breast cancer mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Omission of radiation therapy after breast‐conserving surgery in the United States

Tuttle

Jarosek

Habermann

et al. 2011

Cancer

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“…32 A Canadian study concluded that radiotherapy combined with tamoxifen reduces the risk of axillary recurrence of breast cancer and axillary recurrence after quadrantectomy in axilla negative and hormone receptor positive women with small tumors. 24 These and other current indications, favor the individualized therapy plan, contributing to increased survival.…”

Section: Resultsmentioning

confidence: 99%

“…The publications originated from 20 countries: Korea (six studies), [8][9][10][11][12][13] Japan (five studies), [14][15][16][17][18] Brazil (four studies), 3,[19][20][21] Canada (three studies), [22][23][24] United States (three studies), [25][26][27] Italy (three studies), [28][29][30] Switzerland (three studies), [31][32][33] France (two studies), 34,35 China (one study), 36 Singapore and Sweden (one study, study performed in both countries), 37 Scotland (one study), 38 Spain (one study), 39 Finland (one study), 40 India (one study), 41 England (two studies), 42,45 Mexico (one study), 43 Poland (one study), 44 and the Netherlands (one study). 46 From the aim established for this study, the variables to be investigated were defined: the study design, study site/country, number of subjects, age of the subjects, five year survival rate, disease-free five year survival rate, factors that contribute to the increase in survival rates.…”

Section: Methodsmentioning

confidence: 99%

Taxa de sobrevida na mulher com câncer de mama: estudo de revisão

Rosa

Radünz

2012

Texto contexto - enferm.

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ABSTRACT:Integrative research that aimed to identify results in the publications available through the databases LILACS, SciELO and PubMed, period 2004-2009, the contributing factors to the increment of the survival rates in five years and the disease-free survival rate in five years in women with breast cancer. The results in 40 publications showed a higher incidence of the disease for the age groups between 50-60 years and 40-49 years. Screening programs, genetic, immunohistochemical and cytological diagnostic methods, increment of the education and socioeconomic patterns, associations of conventional therapies with new therapies contribute to the increase of survival rates, quality of life and care for women with breast cancer. DESCRIPTORS: TASA DE SUPERVIVENCIA EN MUJER CON CÁNCER DE MAMA: ESTUDIO DE REVISIÓN RESUMEN:Investigación integrativa que identificó en las publicaciones de LILACS, SciELO y PubMed en el período 2004-2009, los factores contribuyentes para la elevación de las tasas de supervivencia en cinco años y supervivencia libre de enfermedades en cinco años de las mujeres con cáncer de mama. Los resultados de 40 publicaciones, demuestran que la mayor incidencia de la enfermedad se dio entre los 50-60 años y 40-49 años. Programas de rastreo, elevación de la escolaridad, del patrón socioeconómico, estudios genéticos, inmunohistoquímicos y citológicos además de las terapéuticas convencionales favorecen a la elevación de las tasas de supervivencia, la calidad de vida y de los cuidados de la mujer con cáncer de mama. DESCRIPTORES:Tasa de supervivência. Neoplasias de la mama. Diagnóstico precoz.

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“…Additionally, some elderly patients tend to have more transportation, social, and other healthrelated issues that may affect their ability to receive daily radiation therapy. The Canadian trial [31] and the Cancer and Leukemia Group B (CALGB/Radiation Therapy Oncology Group (RTOG)/Eastern Cooperative Oncology Group (ECOG) trial [36,65,31] both randomized older women with estrogen-receptor-positive early breast cancer following breast-conserving surgery to tamoxifen with or without radiation therapy. Although both trials showed absolute benefits to women receiving radiation therapy, the benefits overall were small.…”

Section: External Beam Radiation Therapymentioning

confidence: 99%

Radiation Therapy in Early-Stage Invasive Breast Cancer

Lin

Tripuraneni

2011

Indian J Surg Oncol

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The treatment of breast cancer involves a multi-disciplinary approach with radiation therapy playing a key role. Breast-conserving surgery has been an option for women with early-stage breast cancer for over two decades now. Multiple randomized trials now have demonstrated the efficacy of breast-conserving surgery followed by radiation therapy. With the advancements in breast imaging and the successful campaign for early detection of breast cancer, more women today are found to have early-stage small breast cancers. Patient factors (breast size, tumor location, history of prior radiation therapy, preexisting conditions such as collagen vascular disease, age, having prosthetically augmented breasts), pathological factors (margin status, tumor size, presence of extensive intraductal component requiring multiple surgical excisions), as well as patient preference are all taken into consideration prior to surgical management of breast cancer. Whole-breast fractionated radiation therapy between 5 and 7 weeks is considered as the standard of care treatment following breast-conserving surgery. However, new radiation treatment strategies have been developed in recent years to provide alternatives to the conventional 5-7 week whole-breast radiation therapy for some patients. Accelerated partial breast radiation therapy (APBI) was introduced because the frequency of breast recurrences outside of the surgical cavity has been shown to be low. This technique allows treatments to be delivered quicker (usually 1 week, twice daily) to a limited volume. Often times, this treatment involves the use of a brachytherapy applicator to be placed into the surgical cavity following breast-conserving surgery. Accelerated hypofractionated whole-breast irradiation may be another faster way to deliver radiation therapy following breast-conserving surgery. This journal article reviews the role of radiation therapy in women with early-stage breast cancer addressing patient selection in breast-conserving therapy, a review of pertinent trials in breast-conserving therapy, as well as the different treatment techniques available to women following breast-conserving surgery.Keywords Accelerated partial breast irradiation . Breast brachytherapy . Breast-conserving surgery and radiation . Hypofractionated whole-breast radiation . Breast irradiation in early-stage breast cancer

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Tamoxifen with or without Breast Irradiation in Women 50 Years of Age or Older with Early Breast Cancer

Abstract: As compared with tamoxifen alone, radiotherapy plus tamoxifen significantly reduces the risk of breast and axillary recurrence after lumpectomy in women with small, node-negative, hormone-receptor-positive breast cancers.

Cited by 603 publications

References 19 publications

Omission of radiation therapy after breast‐conserving surgery in the United States

Omission of radiation therapy after breast‐conserving surgery in the United States

Taxa de sobrevida na mulher com câncer de mama: estudo de revisão

Radiation Therapy in Early-Stage Invasive Breast Cancer

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