The role of radiotherapy in treating small early invasive breast cancer

Varghese, Prabha; Gattuso, J.; Mostafa, A.; Abdel-Rahman, A.T.; Shenton, Karyn; Ryan, D; Jones, J.L.; Wells, Clive; Mair, G.; Kakkar, Ajay K.; Carpenter, R

doi:10.1016/j.ejso.2007.04.008

Cited by 13 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The odds of LR were not associated with whether studies reported no losses or <5% losses 27,31,36,38,41,48,54 to follow-up, or whether they did not provide any information on losses to follow-up (P=0.27; adjusted model). The odds of LR did not differ according to whether or not studies included some subjects treated with quadrantectomy (P=0.58; adjusted model).…”

Section: Resultsmentioning

confidence: 97%

“…Based on the subset of 19 studies 24,25,28,29,31,33,35–37,39–42,47–52 reporting LR in 753 of 13,081 subjects with data on positive, close, and negative margins (from 14,952 subjects), estimates of effect are shown in Table 2. In the unadjusted model, the odds of LR were significantly associated with margin status (P<0.001) but not with negative distance (P= 0.32); however there was weak evidence that LR odds decreased as the distance for negative margins increased (P=0.074 for trend).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis

et al. 2014

View full text Add to dashboard Cite

Purpose. There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. Methods. Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression.

show abstract

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Hazard ratios for the impact of a tumour on inked margin on local recurrence were available for 12 studies (10 studies from adjusted models) 614151721242526272829. Tumour on ink was associated with increased rates of local recurrence (hazard ratio 1.98 (95% confidence interval 1.66 to 2.36), P<0.001; fig 3).…”

Section: Resultsmentioning

confidence: 99%

Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis

Bundred

Michael

Stuart

et al. 2022

BMJ

View full text Add to dashboard Cite

Objective To determine if margin involvement is associated with distant recurrence and to determine the required margin to minimise both local recurrence and distant recurrence in early stage invasive breast cancer. Design Prospectively registered systematic review and meta-analysis of literature. Data sources Medline (PubMed), Embase, and Proquest online databases. Unpublished data were sought from study authors. Eligibility criteria Eligible studies reported on patients undergoing breast conserving surgery (for stages I-III breast cancer), allowed an estimation of outcomes in relation to margin status, and followed up patients for a minimum of 60 months. Patients with ductal carcinoma in situ only or treated with neoadjuvant chemotherapy or by mastectomy were excluded. Where applicable, margins were categorised as tumour on ink (involved), close margins (no tumour on ink but <2 mm), and negative margins (≥2 mm). Results 68 studies from 1 January 1980 to 31 December 2021, comprising 112 140 patients with breast cancer, were included. Across all studies, 9.4% (95% confidence interval 6.8% to 12.8%) of patients had involved (tumour on ink) margins and 17.8% (13.0% to 23.9%) had tumour on ink or a close margin. The rate of distant recurrence was 25.4% (14.5% to 40.6%) in patients with tumour on ink, 8.4% (4.4% to 15.5%) in patients with tumour on ink or close, and 7.4% (3.9% to 13.6%) in patients with negative margins. Compared with negative margins, tumour on ink margins were associated with increased distant recurrence (hazard ratio 2.10, 95% confidence interval 1.65 to 2.69, P<0.001) and local recurrence (1.98, 1.66 to 2.36, P<0.001). Close margins were associated with increased distant recurrence (1.38, 1.13 to 1.69, P<0.001) and local recurrence (2.09, 1.39 to 3.13, P<0.001) compared with negative margins, after adjusting for receipt of adjuvant chemotherapy and radiotherapy. In five studies published since 2010, tumour on ink margins were associated with increased distant recurrence (2.41, 1.81 to 3.21, P<0.001) as were tumour on ink and close margins (1.44, 1.22 to 1.71, P<0.001) compared with negative margins. Conclusions Involved or close pathological margins after breast conserving surgery for early stage, invasive breast cancer are associated with increased distant recurrence and local recurrence. Surgeons should aim to achieve a minimum clear margin of at least 1 mm. On the basis of current evidence, international guidelines should be revised. Systematic review registration CRD42021232115.

show abstract

“…By contrast, there has been limited information about whether select postmenopausal patients younger than 65 years could consider the option of breast conservation without radiotherapy. Local failure rates were similar between patients age 50-60 years, age 60-70 years, or older than 70 years in one retrospective study, 10 and between those age 55-64 years and age 65-75 years in a prospective randomized trial. 11 Another recent prospective study found the 5-year rate of local failure was 4% for patients younger than 65 years, compared with 2% for patients age 65 years and older ( P = .025).…”

Section: Introductionmentioning

confidence: 74%

Omission of Radiotherapy After Breast-Conserving Surgery for Women With Breast Cancer With Low Clinical and Genomic Risk: 5-Year Outcomes of IDEA

Jagsi,

Griffith,

Harris

et al. 2024

JCO

View full text Add to dashboard Cite

PURPOSE Multiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors. METHODS Postmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins ≥2 mm after BCS whose tumors were estrogen receptor–positive, progesterone receptor–positive, and human epidermal growth factor receptor 2–negative with Oncotype DX 21-gene recurrence score ≤18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS. RESULTS Between June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer–specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively. CONCLUSION This trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend.

show abstract

The role of radiotherapy in treating small early invasive breast cancer

Cited by 13 publications

References 32 publications

The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis

The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis

Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis

Omission of Radiotherapy After Breast-Conserving Surgery for Women With Breast Cancer With Low Clinical and Genomic Risk: 5-Year Outcomes of IDEA

Contact Info

Product

Resources

About