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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.

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.
Nowotwory | Year: 2012

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.

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.
Nowotwory | Year: 2015

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.

Pienkowski T.,Klinika Nowotworow Piersi I Chirurgii Rekonstrukcyjnej | Pikiel J.,Poradnia Onkologiczna | Jagiello-Gruszfeld A.,Klinika Nowotworow Piersi I Chirurgii Rekonstrukcyjnej | Wojtukiewicz M.,University Medyczny | And 6 more authors.
Nowotwory | Year: 2011

Background. The Lapatinib Expanded Access Program (LEAP) was designed to provide access to lapatinib in combination with capecitabine for HER2-positive advanced breast cancer patients, who had progressed after trastuzumabcontaining therapy and had no other treatment option. Material and methods. HER2-positive locally advanced or metastatic breast cancer patients who had previously received anthracyclines, taxanes, and trastuzumab. Patients were assessed for progression-free survival (PFS) and overall survival (OS) and monitored for serious adverse events (SAE). Re s u l t s. As of 30 September 2008, 78 patients were enrolled in LEAP in Poland. The median treatment duration was 24.2 weeks. The median PFSs and OSs were not achieved. Estimated PFS after 24 weeks was 77%, and estimated OS after 30 weeks was 81%. Fourteen SAEs in 13 patients (16.7%) were reported, including decreased left ventricle ejection fraction (LVEF) in 3 patients (3.9%). Conclusions. These results demonstrate that even heavily pre-treated patients with HER2-positive locally advanced or metastatic breast cancer, who had progressed after trastuzumab-containing therapy may benefit from the treatment with lapatinib in combination with capecitabine.

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