Survival and prognostic factors in patients with early breast cancer after breast conservation therapy: A comparison of two time periods, before and after shortening radiotherapy and increasing the use of adjuvant chemotherapy [Przeżycie i czynniki prognostyczne u chorych na wczesnego raka piersi po leczeniu oszczȩdzaja̧cym w dwóch okresach leczenia: Przed i po wprowadzeniu łagodnej hipofrakcyjnej radioterapii i zintensyfikowanej chemioterapii pooperacyjnej]
Galecki J.,Zaklad Teleradioterapii II |
Nagadowska M.,Klinika Nowotworow Piersi i Chirurgii Rekonstrukcyjnej |
Pienkowski T.,Klinika Nowotworow Piersi i Chirurgii Rekonstrukcyjnej |
Michalski W.,Biuro Badan Klinicznych i Biostatystyki |
And 7 more authors.
Background. In 1999 the routine use of 5 weeks fractionation regime of radiotherapy for early breast cancer patients who had undergone breast conserving surgery was shortened to a 3.5 or 4 weeks fractionation schedule. The aim of the study was to compare treatment efficacy and prognostic factors in patients treated between 1995 and 1998 (Group A - conventional irradiation) and between 1999 and 2002 (Group B - mild hypofractionated irradiation). Material and methods. The retrospective analysis included 552 consecutive patients after breast conservative treatment (BCT) who followed the same protocol. There were no principal differences in clinical or pathological characteristics between groups A (n = 155) and B (n = 397), but systemic treatment was administered to 50% of patients in group A, and to 82% in group B according to the international recommendations. The influence of the potential prognostic factors on disease-free (DFS) and overall survival (OS) was analyzed by means of Cox's proportional hazards model, into which the following prognostic factors were included: age, menopausal status, cancer laterality and location, stage, pT, nodal index, type and grade of histological malignancy, extensive intraductal component (EIC), margins after surgery, and steroid hormone estrogen and progesterone receptors status, period of treatment and regime of irradiation. Median of follow-up for patients in groups A and B were: 104 and 58 months. Results. The 10-year DFS, OS and locoregional recurrence-free survival (LRFS) were 85%, 89% and 93% respectively. The 7-year cumulative locoregional recurrence rate for patients in groups A and B were 7%, and 5% respectively - p = 0.6. The Cox's regression analysis indicated that histological type, grade of malignancy and steroid hormonal receptor status had independent influence on DFS and OS. Neither regimen of irradiation (p = 0.5) nor period of treatment (p = 0.4) were significant predictors for DFS. However, the risk of death for patients in group B was nearly three times higher than for those treated in group A (HR 2.9, CI = 1.1; 7.4). Conclusions. The higher risk of death for patients treated between 1999 and 2002 was probably associated with more advanced breast cancers than in patients treated between 1995 and 1998, but this was not confirmed by comparing the two groups according to the TNM system. We believe that the choice of adjuvant treatment should be based mostly on biological features of cancer such as: histological type and grade of malignancy, steroid hormonal receptor status and other approved prognostic and predictive factors not all of which were analyzed in our study. The shortened method of post-surgical mild hypofractionated irradiation in BCT of 3.5-4 weeks (total dose 42.5 Gy in 17 fractions or 45 Gy in 20 fractions) showed to become a reasonable alternative to 5 weeks of radiotherapy (total dose 50 Gy in 25 fractions). Good results of early breast cancer treatment with BCT confirm that it is appropriate to continue this approach. © Polskie Towarzystwo Onkologiczne. Source
Galecki J.,Zaklad Teleradioterapii |
Kolodziejczyk M.,Zaklad Teleradioterapii |
Olszewski W.P.,Klinika Nowotworow Piersi i Chirurgii Rekonstrukcyjnej |
Michalski W.,Biuro Badan Klinicznych i Biostatystyki |
And 3 more authors.
Background. Among many oncologists the opinion exists, that multitumor breast cancer (MBC) shows greater metastatic dynamics and has worse prognosis comparing to unitumor breast cancer (UBC) in the same TNM stage. Some researchers think that proper evaluation of pT in MBC should be based on combined diameters and not on the largest tumor diameter. The aim of the work is estimation of the treatment results for multiple tumors in breast cancer. Material and methods. The retrospective analysis included 954 consecutive women with breast cancer in stage IA-IIIC after radical mastectomy who were treated between 1995 and 1998 at the Cancer Center-Institute in Warsaw. MBC was diagnosed after mastectomy in 104 (10.9%) of patients. There were no significant differences in characteristics between unicentric and multicentric breast cancer groups according to age, stage, pT, pN, type and grade of histology and methods of adjuvant treatment. Cox's regression model was used to analyse the prognostic factors having influence on disease-free survival (DFS) and overall survival (OS). Median of follow-up was 11 years. Results. There were no significant differences in characteristics between UBC and MBC groups according to age, stage, pT, pN, type and grade of histology and methods of adjuvant treatment. The 10-year actuarial DFS and OS and cumulative rate of locoregional recurrence for patients with UBC and MBC were 51% vs 58% p = 0.1 and 62% vs 72% p = 0.05 and 13% vs 9% p = 0.3.There were no statistical significant differences in frequencies of lymph node metastases among groups with UBC and MBC according to pT, measured as the greatest diameter of tumor. In multivariate logistic regression analyses the following classical prognostic factors had an independent influence on DFS and OS: pN, pT, G, and vascular invasion. MBC did not appeared to be a significant prognostic factor either for DFS or OS. Conclusions. From the present retrospective analysis the results show that MBC does not reduce prognosis compared to UBC and the largest tumor rather than combined diameters of lesions should be used to establish pT. © Polskie Towarzystwo Onkologiczne. Source
Evaluation of early breast cancer treatment effects and prognostic factors with special reference to steroid and HER2 receptors [Ocena skutecznos̈ci leczenia i czynników prognostycznych ze szczególnym uwzględnieniem receptorów steroidowych i HER2 u chorych na wczesnego raka piersi]
Galoecki J.,Zakload Teleradioterapii II |
Olszyna-Serementa M.,Zakload Teleradioterapii II |
Majstrak A.,Klinika Nowotworow Piersi i Chirurgii Rekonstrukcyjnej |
Wisniowska K.,Zakload Teleradioterapii II |
And 2 more authors.
Introduction. Choice of adjuvant systemic therapy in early breast cancer patients followed breast conserving surgery depends on many prognostic factors especially from steroid (estrogen receptor \- ER; progesterone receptor \- PR) and HER-2 receptor status. Purpose. To evaluate the treatment we determined disease free survival (DFS) and the risk of local recurrence and examined the influence of classical prognostic factors with special consideration of the biological subtype of breast cancer on DFS before the era of trastuzumab treatment. Patients and methods. Consecutively 615 female patients with early invasive breast cancer received breast conservative treatment between 2003 and 2006 in the Oncological Center in Warsaw. Data were prospectively collected. Adjuvant systemic therapy of second and third generation in 40% of patients had been given and in 28% of patients hormonotherapy was applied. After surgery and chemotherapy, irradiation with mild hypofractionation during 3 or 4 weeks was used. The following prognostic factors were included in the study: age, menopausal status, breast laterality, pT, pN, histology, grade, EIC, margins, and four biological subtypes: Luminal (ER positive and/or PR positive) HER-2 negative, Luminal (ER positive and/or PR positive) HER-2 positive, Triple-Negative, Non-Luminal (ER positive and/or PR positive) HER-2 positive. Survival curves were obtained using the Kaplan Maier method. To analyse time to recurrence, the competing risk method was performed. To study the influence of prognostic factors on DFS the proportional hazards model of Cox was used. The median follow-up time was 8 years. Results. The 8-year DFS and cumulative loco-regional recurrence (CLRR) rate were 89% and 4.6% respectively. The significant factors influencing DFS were: young age of patients, number of involved nodes above three and grade 3 histological malignancy. Biological subtypes of breast cancer were not significant predictors for DFS in the univariate or multivariate analysis \- logrank test: p = 0.19. It was shown, however, the probability of occurrence of the negative trend DFS for biological subtypes in the following order: Luminal HER2 (negative), Luminal HER2 (positive), Triple-negative and Nonluminal HER2 (positive) \- logrank test for trend: p = 0.03. The analysis examined the distribution of prognostic factors and confirmed that in biological subtype Triple-negative and Nonluminal HER2 (positive) significantly more often than in the types of Luminal HER2 (negative) and Luminal HER2 (positive), were younger patients, with larger tumour, with more than 3 involved nodes and grade 3 histological malignancy. Conclusions. 1. High probability of 8-year DFS and low CLRR rate of breast cancer indicated a positive assessment of conserving therapy at the Cancer Center in Warsaw between 2003-2006. 2. Despite aggressive treatment the strongest prognostic factors still remain: the young age of patients, the number of involved lymph node in the axillary fossa greater than three and low differentiation of cancer G3. 3. The worst prognosis is for patients diagnosed with breast cancer in subtype Nonluminal HER2 (positive), and this justifies the introduction of molecular targeted therapies aimed at HER2. © Polskie Towarzystwo Onkologiczne. Source
Skowronska-Gardas A.,Zaklad Teleradioterapii |
Chojnacka M.,Zaklad Teleradioterapii |
Pedziwiatr K.,Zaklad Teleradioterapii |
Sloniewska A.,Zaklad Teleradioterapii |
And 5 more authors.
Results. 1, 2 and 3-year overall survival and recurrence free survival rates were 63%, 52%, 39% and 54, 38%, 31%, respectively. Failure was found in 36 patients, only in 4 cases as an isolated local recurrence. The microscopic radicality of the resection and the type of gastrectomy performed had significant influence on overall and progression free survival. Additionally, progression free survival rates were significantly longer in the group at stage I and II versus III and IV acc. to AJCC. Conclusions. 1. Adjuvant chemoradiotherapy of gastric cancer patients appears to be effective, but the failure ratio remains high. 2. Potential toxicity of this treatment can be reduced with 3D conformal radiotherapy. 3. RSR is the independent prognostic factor that could be used in referring patients for studies with more aggressive therapy. Source