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NCI CANCERLIT® Search: Radiotherapy for Breast Cancer - March 2002
National Cancer Institute®
Last Modified: March 1, 2002
Table of Contents
1
UI - 10834870
AU - Kunkler I
TI -
Adjuvant irradiation for breast cancer.
SO - BMJ 2000 Jun 3;320(7248):1485-6
2
UI - 11185588
AU - Whipp E; Candish C
TI -
Adjuvant irradiation for breast cancer. Treatment plans need to be made
with better anatomical information.
SO - BMJ 2000 Nov 11;321(7270):1227
3
UI - 11813149
AU - Vicini F; Baglan K; Kestin L; Chen P; Edmundson G; Martinez A
TI -
The emerging role of brachytherapy in the management of patients with
breast cancer.
SO - Semin Radiat Oncol 2002 Jan;12(1):31-9
AD - Department of Radiation Oncology, William Beaumont Hospital, Royal Oak,
MI, USA. fvicini@beaumont.edu
Brachytherapy remains an important treatment option in the overall
management of patients with breast cancer. In patients treated with
breast conserving therapy (BCT), prospective randomized trials have
established the advantage of a boost in most patients. Interstitial
brachytherapy has consistently been shown to provide an important option
to boost patients, and in certain clinical settings it may provide a
more appropriate means of dose delivery. The concept of delivering
partial breast irradiation with accelerated treatment schedules has now
provided brachytherapy a new and exciting role in the management of
patients treated with BCT. There are now data available from several
phase I/II studies suggesting that brachytherapy alone can be used
safely and reproducibly in this setting in order to reduce the time,
inconvenience, and toxicity associated with traditional radiation
therapy. Although preliminary results with brachytherapy alone are
encouraging, proper patient selection and optimal dosimetric guidelines
must be employed in order to achieve success when used in this setting.
Copyright 2002 by W.B. Saunders Company
4
UI - 11843862
AU - Ampil FL; Burton GV; Li BD
TI -
"Routine" weekly blood counts during breast irradiation for early stage
cancer: are they really necessary?
SO - Breast J 2001 Nov-Dec;7(6):450-2
The present investigation analyzed the weekly blood count assays of 73
women receiving breast irradiation after organ-preserving surgery for
early stage cancer. With regard to leucopenia and anemia, grade 1
toxicity occurred in 26% and 21%, respectively, of the cases.
Thrombocytopenia of any degree and grades 2-4 leucopenia or anemia were
either not seen or were minimally observed. Most of the patients who
experienced grade 1 or grade 2 toxicity had received preirradiation
chemotherapy. We stress the importance of a baseline blood count
recording prior to breast irradiation and the need for further study to
define better the population for whom continuous weekly blood count
determinations might prove to be useful.
5
UI - 11823696
AU - Deutsch M
TI -
Radiotherapy after lumpectomy for breast cancer in very old women.
SO - Am J Clin Oncol 2002 Feb;25(1):48-9
AD - Department of Radiation Oncology, University of Pittsburgh Medical
Center, 200 Lothrop Street, Pittsburgh, PA 15213, U.S.A.
During a 15-year period, 47 women aged 80 to 89 years, with 48 breast
cancers, were treated with postlumpectomy radiotherapy after lumpectomy
alone (31 breast cancers) or lumpectomy and axillary dissection (17
breast cancers). Forty-three breast cancers in 42 women were invasive
carcinomas, and 5 women had ductal carcinoma in situ. Forty-six breasts
were treated with whole breast irradiation with a usual dose of 5,000
cGy in 25 fractions. Six women were treated with accelerated regimens of
250 cGy/d to 300 cGy/d to 4,000 cGy to 4,500 cGy. An additional boost to
the operative area was administered to 34 breasts. Two women were
treated with radiotherapy just to the operative area of the involved
breast with 3,600 cGy and 3,700 cGy in 10 fractions, respectively.
Thirty-four women received adjuvant tamoxifen. Twenty-five women (53.2%)
are alive and free of disease at 21 to 156 months from surgery (median:
43 months). Seventeen women died at 14 to 159 months after surgery
(median: 65.5 months). Twelve of these women survived greater than 5
years from treatment. Distant metastases have developed in only two
women. One died at 68 months after treatment and one is alive with
disease at 34 months. There are no patients with known local-regional
recurrence. Radiotherapy was well tolerated in all patients, and the
majority had a good to excellent cosmetic result. Age alone is not a
contraindication to the administration of postlumpectomy breast
irradiation.
6
UI - 11857025
AU - Chinje EC; Williams KJ; Telfer BA; Wood PJ; van der Kogel AJ; Stratford
TI -
IJ
17beta-Oestradiol treatment modulates nitric oxide synthase activity in
MDA231 tumour with implications on growth and radiation response.
SO - Br J Cancer 2002 Jan 7;86(1):136-42
AD - Experimental Oncology Group, School of Pharmacy and Pharmaceutical
Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
edwin.chinje@man.ac.uk
The putative oestrogen receptor negative human breast cancer cell line
MDA231, when grown as tumours in mice continually receiving
17beta-oestradiol, showed substantially increased growth rate when
compared to control animals. Further, we observed that 17beta-oestradiol
treatment could both increase the growth rate of established MDA231
tumours as well as decreasing the time taken for initiating tumour
growth. We have also demonstrated that this increase in growth rate is
accompanied by a four-fold increase in nitric oxide synthase activity,
which was predominantly the inducible form. Inducible-nitric oxide
synthase expression in these tumours was confirmed by
immunohistochemical analysis and appeared localized primarily in areas
between viable and necrotic regions of the tumour (an area that is
presumably hypoxic). Prophylactic treatment with the nitric oxide
synthase inhibitor nitro-L-arginine methyl ester resulted in significant
reduction in this apparent 17beta-oestradiol-mediated growth promoting
effect. Tumours derived from mice receiving 17beta-oestradiol-treatment
were characterized by a significantly lower fraction of perfused blood
vessels and an indication of an increased hypoxic fraction. Consistent
with these observations, 17beta-oestradiol-treated tumours were less
radio-responsive compared to control tumours when treated with a single
radiation dose of 15 Gy. Our data suggests that long-term treatment with
oestrogen could significantly alter the tumour oxygenation status during
breast tumour progression, thus affecting response to radiotherapy.
7
UI - 11872286
AU - Galper S; Gelman R; Recht A; Silver B; Kohli A; Wong JS; Van Buren T;
TI -
Baldini EH; Harris JR
Second nonbreast malignancies after conservative surgery and radiation
therapy for early-stage breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):406-14
AD - Department of Radiation Oncology, Brigham and Women's Hospital and
Dana-Farber Cancer Institute, Boston, MA 02115, USA.
sgalper@partners.org
PURPOSE: Breast cancer patients treated with conservative surgery and
radiation therapy are at risk of developing second nonbreast
malignancies (SNBMs). The purpose of this study was to determine the
incidence of all SNBMs and SNBMs by specific location among long-term
survivors and to compare the risk of these events to the age-specific
incidence of malignancies as first cancers in the Surveillance
Epidemiology and End-Results Program (SEER) population. METHODS AND
MATERIALS: We analyzed the likelihood of SNBM development for 1884
patients with clinical Stage I or II breast cancer treated with gross
excision and > or = 60 Gy (median 63) to the breast between 1970 and
1987. Fifty-seven percent received supraclavicular/axillary radiation
(median dose 45 Gy, range 20-60) and 28% received systemic therapy. The
median age at diagnosis was 52 years. The median clinical tumor size was
2 cm. Patients were considered at risk of an SNBM until the development
of the first of distant metastases or contralateral breast cancer or
death or, if alive and disease-free, until the last follow-up visit. The
expected numbers of cancers were obtained from the SEER database, using
the age-specific incidence for white women within 5-year age groups and
5-year calendar intervals. The median time at risk for an SNBM was 10.9
years (range 0.2-27.9). RESULTS: By 8 years of follow-up, 432 patients
(23%) had developed distant metastases, 295 patients (16%) a
local/regional recurrence, and 159 (8%) a contralateral primary. Of the
1884 patients in our cohort, 147 (8%) developed an SNBM compared with
the 127.7 expected from SEER. This corresponds to an absolute excess of
1% of the study population and a relative increase of 15% greater than
that expected from SEER (p = 0.05). Within the first 5 years, the
observed and expected rates of SNBMs were identical (47 vs. 46.9). After
5 years, 24% more SNBMs were observed than expected (100 vs. 80.8, p =
0.02). Among patients <50 years old at breast cancer diagnosis, 43% more
observed SNBMs occurred than expected (40 vs. 28, p = 0.02). For
patients > or = 50 years, 7% more SNBMs were observed than expected (107
vs. 99.7, p = 0.25). Lung SNBMs were observed in 33 women, 52% more than
the 21.67 predicted by SEER (p = 0.01). Most of the lung SNBMs occurred
>5 years after treatment (n = 23) and in women who were >50 years at the
time of their breast cancer diagnosis (n = 27). The observed incidence
of ovarian cancer was significantly greater than expected among patients
<50 years (7 vs. 1.96, p = 0.004) but was not different than expected
for patients > or = 50 years (5 vs. 5.3, p = 0.61). Among the 7
sarcomas, 3 developed in the radiation field. CONCLUSIONS: SNBMs occur
in a substantial minority (8%) of patients treated with conservative
surgery and radiotherapy. However, the absolute excess risk compared
with the general population is very small (1%). This excess risk is only
evident after 5 years. In particular, a slightly increased incidence of
lung SNBMs and a somewhat larger increase in ovarian cancer among
younger patients was found. Our data suggest that preventive strategies
to reduce the incidence of certain cancers (e.g., smoking cessation and
prophylactic oophorectomy) and/or continued monitoring for SNBMs to
increase the likelihood of early detection and treatment may be prudent
in this population.
8
UI - 11870524
AU - Buchholz TA; Singletary SE
TI -
Radiotherapy for early stage favourable breast cancers.
SO - Br J Cancer 2002 Jan 21;86(2):309-11
9
UI - 10856100
AU - Obedian E; Fischer DB; Haffty BG
TI -
Second malignancies after treatment of early-stage breast cancer:
lumpectomy and radiation therapy versus mastectomy.
SO - J Clin Oncol 2000 Jun;18(12):2406-12
AD - Department of Therapeutic Radiology, Yale University School of Medicine,
New Haven, CT 06520-8040, USA.
PURPOSE: To determine the risk of second malignancies after lumpectomy
and radiation therapy (LRT), and to compare it with that in a similar
cohort of early-stage breast cancer patients undergoing mastectomy
LRT. A cohort of 1,387 breast cancer patients who underwent surgical
treatment by mastectomy (MAST), and who did not receive postoperative
radiation during the same time period, served as a comparison group.
Second malignancies were categorized as contralateral breast versus
nonbreast. In the cohort of patients undergoing LRT, a detailed analysis
was carried out with respect to age, disease stage, smoking history,
radiation therapy technique, dose, the use of chemotherapy or hormone
therapy, and other clinical and/or pathologic characteristics. RESULTS:
and 16 years for the MAST group. The 15-year risk of any second
malignancy was nearly identical for both cohorts (17.5% v 19%,
respectively). The second breast malignancy rate at 15 years was 10% for
both the MAST and LRT groups. The 15-year risk of a second nonbreast
malignancy was 11% for the LRT and 10% for the MAST group. In the subset
of patients 45 years of age or younger at the time of treatment, the
second breast and nonbreast malignancy rates at 15 years were 10% and 5%
for patients undergoing LRT versus 7% and 4% for patients undergoing
mastectomy (P, not statistically significant). In the detailed analysis
of LRT patients, second lung malignancies were associated with a history
of tobacco use. There were fewer contralateral breast tumors in patients
undergoing adjuvant hormone therapy, although this did not reach
statistical significance. The adjuvant use of chemotherapy did not
significantly affect the risk of second malignancies. CONCLUSION: There
seems to be no increased risk of second malignancies in patients
undergoing LRT using modern techniques, compared with MAST. Continued
monitoring of these patient cohorts will be required in order to
document that these findings are maintained with even longer follow-up
periods. With nearly 15 years median follow-up periods, however, these
data should be reassuring to women who are considering LRT as a
treatment option.
10
UI - 11099332
AU - Unnithian J; Macklis R
TI -
Breast cancer radiotherapy: safe for all?
SO - J Clin Oncol 2000 Dec 1;18(23):4000-1
11
UI - 11550486
AU - Fodor J; Sulyok Z; Polgar C; Major T; Toth J; Nemeth G
TI -
[Breast-conserving treatment for early invasive lobular breast cancer:
15 years results]
SO - Magy Seb 2001 Aug;54(4):209-14
AD - Orszagos Onkologiai Intezet Sugarterapias Osztaly, 1122 Budapest, Rath
Gyorgy u. 7-9. fodor@oncol.hu
BACKGROUND: Infiltrating lobular cancer is biologically different from
invasive ductal cancer and there is disagreement regarding appropriate
local management of this disease. PURPOSE: To examine treatment outcomes
after breast-saving surgery for patients with invasive lobular breast
cancer. MATERIAL AND METHODS: Between 1983 and 1987, 77 women with
early, stage I-II invasive lobular breast cancer were treated with
complete gross excision of the tumour and axillary dissection.
Fifty-eight of these patients were treated with 50 Gy ipsilateral breast
irradiation, and 19 did not receive radiotherapy. During 176 month
median follow-up local-regional recurrences, distant metastases,
contralateral breast cancers, breast cancer deaths and deaths caused by
other disease were scored. The probability of survival was estimated by
Kaplan-Meier method. In uni- and multivariate analysis the Cox-model was
used. Relative risk (RR) and associated confidence intervals (CI) were
calculated from the regression coefficients. Statistical differences in
proportions and means were assessed by log rank and Fisher exact-tests.
RESULTS: In the saved breast, the actual rate of local recurrence at 15
years was 13% for irradiated and 53% for non-irradiated patients (RR:
0.1; 95% CI: 0.03-0.31; p: < 0.0001). The incidence of total breast
cancer relapses (local-regional recurrences and distant metastases) was
also higher for non-irradiated than for irradiated patients (74% vs.
40%; p: 0.0168). In multivariate analysis irradiation (no vs. yes)
showed a significant effect on local tumour control (RR: 0.08: 95% CI:
0.02-0.28; p: 0.0001), but menopausal (pre vs. post), T-(T1 vs. T2) and
N-(N0 vs. N1) status did not. The breast cancer specific survival at 15
years was 74% without and 62% with local recurrence (RR: 1.45; 95% CI:
0.53-3.96; p: 0.4697). The majority of local recurrences (9 of 14) were
curable by salvage surgery. For all patients the rate of contralateral
breast cancer was 6.5%. CONCLUSION: Results of long-term follow-up
confirmed that breast-conserving surgery and radiotherapy is a
reasonable treatment for patients with early invasive lobular breast
cancer. The majority of local recurrences are curable by salvage
surgery.
12
UI - 11727957
AU - Lind PA; Wennberg B; Gagliardi G; Fornander T
TI -
Pulmonary complications following different radiotherapy techniques for
breast cancer, and the association to irradiated lung volume and dose.
SO - Breast Cancer Res Treat 2001 Aug;68(3):199-210
AD - Department of Radiotherapy, Huddinge University Hospital, Stockholm,
Sweden. Pehr.Lind@abc.se
PURPOSE: This study investigates the incidence of short-term pulmonary
complications following radiotherapy (RT) for breast cancer (BC) with
different treatment techniques/incidentally irradiated lung volumes and
the importance of confounding factors on RT-induced pulmonary
complications. PATIENTS AND METHODS: Prospectively, 475 patients with BC
were followed for pulmonary complications 1, 4 and 7 months post-RT.
Mean lung dose volume histograms (MDVH) were constructed and compared
for the different RT-techniques. Among a subset of the mastectomized
patients treated with loco-regional (LR-) RT, who had undergone complete
three-dimensional (3-D) dose planning (n = 43), MDVH for asymptomatic
patients was compared with MDVH for patients experiencing both
radiological and clinical pulmonary side-effects. RESULTS: Moderate
pulmonary complications, that is requiring treatment with
corticosteroids, were rare following local RT (< 1%), but were diagnosed
among 11% of the patients treated with LR-RT. A correlation between
increasing irradiated lung volumes at the >20 Gy-level (V20), based on
MDVH for the RT-techniques, and pulmonary complications was found (P <
0.001). Furthermore, increasing age and reduced pre-RT functional level
were independently associated with a higher rate of pulmonary
complications (P = 0.005 and P = 0.018). Among the subgroup of
mastectomized patients treated with LR-RT, who had undergone complete
3-D dose planning, a difference in mean V20 was found between patients
experiencing both clinical and radiological pulmonary side-effects
compared to patients experiencing neither of the two side-effects (P =
0.007). CONCLUSION: Moderate pulmonary complications following local RT
for BC are rare. The incidence of short-term moderate pulmonary
complications in LR-RT is, however, clinically significant and to define
quality assurance guidelines for these RT-techniques, 3-D RT planning
can be used.
13
UI - 11849780
AU - Iannuzzi CM; Atencio DP; Green S; Stock RG; Rosenstein BS
TI -
ATM mutations in female breast cancer patients predict for an increase
in radiation-induced late effects.
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):606-13
AD - Department of Radiation Oncology, Mount Sinai School of Medicine, New
York, NY 10029, USA. christopher.iannuzzi@mountsinai.org
PURPOSE: Mutation of the ATM gene may be associated with enhanced
radiosensitivity and increased radiation-induced morbidity. Denaturing
high performance liquid chromatography (DHPLC) is a powerful new
technique proven to be sensitive and accurate in the detection of
missense mutations, as well as small deletions and insertions. We
screened female breast cancer patients for evidence of ATM gene
alterations using DHPLC. This study attempted to determine whether
breast cancer patients who develop severe radiotherapy (RT)-induced
effects are more likely to possess ATM mutations than patients who
display normal radiation responses. METHODS AND MATERIALS: Forty-six
patients with early-stage breast carcinoma underwent limited surgery and
adjuvant RT. DNA was isolated from blood lymphocytes, and each coding
exon of the ATM gene was amplified using polymerase chain reaction.
Genetic variants were identified using DHPLC by comparing test patterns
with a known wild-type pattern. All variants were subjected to DNA
sequencing and compared with wild-type sequences for evidence of a
mutation. A retrospective review was performed, and the Radiation
Therapy Oncology Group/European Organization for Research and Treatment
of Cancer acute and late morbidity scoring schemes for skin and
subcutaneous normal tissues were applied to quantify the
radiation-induced effects. RESULTS: Nine ATM mutations were identified
in 6 patients (8 novel and 1 rare). The median follow-up was 3.2 years
(range 1.3-10.3). A significant correlation between ATM mutation status
and the development of Grade 3-4 subcutaneous late effects was found.
All 3 of the patients (100%) who manifested Grade 3-4 subcutaneous late
sequelae possessed ATM mutations, whereas only 3 (7%) of the 43 patients
who did not develop this form of severe toxicity harbored an ATM
mutation (p = 0.001). One ATM mutation carrier developed Grade 4 soft
tissue necrosis after RT and required hyperbaric oxygen. All 3 patients
manifesting Grade 3-4 late subcutaneous responses in fact harbored 2 ATM
mutations. In contrast, none of the 3 ATM carriers who had a single
mutation developed a severe subcutaneous reaction. ATM mutation status
did not predict for a significant increase in early effects. Of the 23
patients with Grade 2-3 moist desquamation, 4 (17%) had an ATM mutation
compared with 2 (9%) of 23 patients without desquamation (p = 0.7).
CONCLUSION: Possession of an ATM mutation, particularly when 2 are
present, may be predictive of an increase in subcutaneous late tissue
effects after RT for breast cancer and may subsequently prove to be a
relative contraindication to standard management. These patients may be
better served with reduced doses of radiation. Equivalent local control
remains to be tested, but this germline alteration may radiosensitize
normal tissues, as well as the tumor itself. DHPLC is effective in the
identification of these patients. A larger study is required to confirm
these findings.
14
UI - 11849781
AU - Chen SC; Chen MF; Hwang TL; Chao TC; Lo YF; Hsueh S; Chang JT; Leung WM
TI -
Prediction of supraclavicular lymph node metastasis in breast carcinoma.
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):614-9
AD - Department of Surgery, Chang Gung Memorial Hospital, Chang Gung
University College of Medicine, Taoyuan, Taiwan. chensc@adm.cgmh.org.tw
PURPOSE: Supraclavicular lymph node metastasis in breast cancer patients
has a poor prognosis, and aggressive local treatment has usually
resulted in severe morbidity. The purpose of this study was to select
high-risk neck metastasis patients for prophylactic radiotherapy.
METHODS: Between 1990 and 1998, 2658 consecutive invasive breast cancer
patients underwent surgery and adjuvant therapy in the hospital. The
median age was 47 years (range 22-92). The median follow-up period was
39 months. The following factors were analyzed: age, tumor size, tumor
location, histologic type, histologic grade, estrogen and progesterone
receptor status, DNA flow cytometry study results, number of positive
axillary lymph nodes, use of chemotherapy, radiotherapy, and/or hormonal
therapy, and level of involved axillary nodes. RESULTS: Of the 2658
patients, 113 (4.3%) developed supraclavicular lymph node metastasis
during this period. Young age (< or =40 years), tumor size >3 cm, high
histologic grade, angiolymphatic invasion, negative estrogen receptor
status, synthetic phase fraction >4%, >4 positive nodes, and level II or
III involved nodes were all significant for predicting neck metastasis
in the univariate analysis. Three predictive factors were significant
after multivariate analysis: high histologic grade, >4 positive nodes,
and axillary level II or III involved nodes. In patients with axillary
level I involved nodes and < or =4 positive nodes, the incidence was
4.4%. If axillary level III was involved, the rate of supraclavicular
lymph node metastasis was 15.1%. CONCLUSION: The incidence of
supraclavicular lymph node metastasis was higher in the groups with >4
positive nodes and in those with axillary level II or III involved
nodes. Selective use of comprehensive radiotherapy for these high-risk
patients will achieve good locoregional control.
15
UI - 11849807
AU - Gupta A; Yang LX; Chen L
TI -
Study of the G2/M cell cycle checkpoint in irradiated mammary epithelial
cells overexpressing Cul-4A gene.
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):822-30
AD - Geraldine Brush Cancer Research Institute, California Pacific Medical
Center, San Francisco, CA 94115, USA.
PURPOSE: Members of the cullin gene family are known to be involved in
cell cycle control. One of the cullin genes, Cul-4A, is amplified and
overexpressed in breast cancer cells. This study investigates the effect
of Cul-4A overexpression upon G2/M cell cycle checkpoint after DNA
damage induced by either ionizing or nonionizing radiation. METHODS AND
MATERIALS: The normal mammary epithelial cell line MCF10A was stably
transfected with full-length Cul-4A cDNA. Independent clones of MCF10A
cells that overexpress Cul-4A proteins were selected and treated with
either 8 Gy of ionizing radiation or 7 J/M(2) of UV radiation. The
profile of cell cycle progression and the accumulation of several cell
cycle proteins were analyzed. RESULTS: We found that overexpression of
Cul-4A in MCF10A cells abrogated the G2/M cell cycle checkpoint in
response to DNA damage induced by ionizing irradiation, but not to DNA
damage induced by nonionizing radiation. Analysis of cell cycle proteins
showed that after ionizing irradiation, p53 accumulated in the
mock-transfected MCF10A cells, but not in the Cul-4A transfectants.
CONCLUSION: Our results suggest a role for Cul-4A in tumorigenesis
and/or tumor progression, possibly through disruption of cell cycle
control.
16
UI - 10951419
AU - Majeski J; Austin RM; Fitzgerald RH
TI -
Cutaneous angiosarcoma in an irradiated breast after breast conservation
therapy for cancer: association with chronic breast lymphedema.
SO - J Surg Oncol 2000 Jul;74(3):208-12; discussion 212-3
AD - Department of Surgery, East Cooper Regional Medical Center, Mt.
Pleasant, South Carolina, USA.
The authors report a rare case of cutaneous angiosarcoma arising more
than 5 years after excision of a 1.5 cm invasive ductal cancer of the
breast. All lymph nodes were negative for metastatic breast cancer in
this 68-year-old female. The patient had postoperative therapy
consisting of 5040 cGy over a 5 week period using a 6 Megavolt linear
accelerator. After radiation therapy to the breast and axillae, the
patient developed chronic hard, taut edema of the irradiated right
breast. Tamoxifen was administered for 5 years and then stopped. Three
months after the cessation of tamoxifen, cutaneous angiosarcoma was
found by skin biopsy. A complete mastectomy removed all tumor with clear
margins. There are less than 60 cases of radiation associated breast
angiosarcoma found in the literature. The presence of chronic lymphedema
in the breast after radiation therapy possibly contributes to the
development and is an early warning sign for later development of
secondary angiosarcoma. The characteristic purple nodules and
discoloration of the irradiated skin is the hallmark to suspect the
diagnosis. The authors recommend long-term clinical surveillance for
this tumor for all patients who have received breast conservative
surgical therapy with concomitant radiation therapy for primary breast
cancer.
17
UI - 11844827
AU - Vallis KA; Pintilie M; Chong N; Holowaty E; Douglas PS; Kirkbride P;
TI -
Wielgosz A
Assessment of coronary heart disease morbidity and mortality after
radiation therapy for early breast cancer.
SO - J Clin Oncol 2002 Feb 15;20(4):1036-42
AD - Department of Radiation Oncology, Princess Margaret Hospital/University
Health Network and University of Toronto, Canada.
katherine.vallis@rmp.uhn.on.ca
PURPOSE: To assess the risk of fatal and nonfatal myocardial infarction
(MI) after breast-conserving surgery (BCS) and radiation therapy (RT)
for left-sided breast cancer. PATIENTS AND METHODS: A hospital-based
retrospective cohort linkage study of all breast cancer patients
registered at the Princess Margaret Hospital (PMH), Toronto, Canada,
between 1982 and 1988 who were treated with postlumpectomy RT was
performed. Available identifiers for the study cohort were linked to two
province-wide health files: the Canadian Institute for Health
Information Hospitalization File and the Ontario Mortality Database.
Admissions to hospital for MI and deaths attributable to MI were
identified. The relevant original health records were abstracted to
verify the diagnosis of MI according to diagnostic criteria used in the
World Health Organization multinational monitoring of trends and
determinants in cardiovascular disease (MONICA) project. We compared
incidence of MI in the study cohort with the general population and
incidence of MI after therapy for left- versus right-sided breast
cancer. RESULTS: A cohort of 2,128 patients was identified. The median
length of follow-up was 10.2 years. The incidence of MI in the study
cohort was comparable to that in an age-matched general population of
women in Ontario. There were 70 coronary events among 56 patients after
breast irradiation. According to MONICA criteria, 53 and six events were
characterized as definite and possible MIs, respectively. Eleven events
did not satisfy MONICA criteria for MI. Twenty-six patients treated for
left-sided and 23 patients treated for right-sided breast cancer
experienced at least one definite or possible MI (log-rank test, P
=.66). There were eight fatal MIs among the left-sided group and six
among the right-sided group. There was no excess of other cardiac
diseases among patients who received left-sided radiotherapy compared to
the right-sided group. CONCLUSION: We have found no evidence for excess
morbidity and mortality from coronary artery disease among women treated
with RT to the left breast after BCS at 10.2 years of follow-up. Longer
follow-up is required to confirm that excess cardiac disease has been
completely avoided.
18
UI - 11794170
AU - Bartelink H; Horiot JC; Poortmans P; Struikmans H; Van den Bogaert W;
TI -
Barillot I; Fourquet A; Borger J; Jager J; Hoogenraad W; Collette L;
Pierart M; European Organization for Research and Treatment of Cancer
Radiotherapy and Breast Cancer Groups
Recurrence rates after treatment of breast cancer with standard
radiotherapy with or without additional radiation.
SO - N Engl J Med 2001 Nov 8;345(19):1378-87
AD - Department of Radiation Oncology, the Netherlands Cancer Institute,
Amsterdam. h.bartelink@nki.nl
BACKGROUND: Radiotherapy prevents local recurrence of breast cancer
after breast-conserving surgery. We evaluated the effect of a
supplementary dose of radiation to the tumor bed on the rates of local
recurrence among patients who received radiotherapy after
breast-conserving surgery for early breast cancer. METHODS: After
lumpectomy and axillary dissection, patients with stage I or II breast
cancer received 50 Gy of radiation to the whole breast in 2-Gy fractions
over a five-week period. Patients with a microscopically complete
excision were randomly assigned to receive either no further local
treatment (2657 patients) or an additional localized dose of 16 Gy,
usually given in eight fractions by means of an external electron beam
(2661 patients). RESULTS: During a median follow-up period of 5.1 years,
local recurrences were observed in 182 of the 2657 patients in the
standard-treatment group and 109 of the 2661 patients in the
additional-radiation group. The five-year actuarial rates of local
recurrence were 7.3 percent (95 percent confidence interval, 6.8 to 7.6
percent) and 4.3 percent (95 percent confidence interval, 3.8 to 4.7
percent), respectively (P<0.001), yielding a hazard ratio for local
recurrence of 0.59 (99 percent confidence interval, 0.43 to 0.81)
associated with an additional dose. Patients 40 years old or younger
benefited most; at five years, their rate of local recurrence was 19.5
percent with standard treatment and 10.2 percent with additional
radiation (hazard ratio, 0.46 [99 percent confidence interval, 0.23 to
0.89]; P=0.002). At five years in the age group 41 to 50 years old, no
differences were found in rates of metastasis or overall survival (which
were 87 and 91 percent, respectively). CONCLUSIONS: In patients with
early breast cancer who undergo breast-conserving surgery and receive 50
Gy of radiation to the whole breast, an additional dose of 16 Gy of
radiation to the tumor bed reduces the risk of local recurrence,
especially in patients younger than 50 years of age.
19
UI - 11893803
AU - Whelan T; Julian J; Levine M
TI -
Radiotherapy for breast cancer.
SO - N Engl J Med 2002 Mar 14;346(11):862-4
20
UI - 11898811
AU - Arriagada R
TI -
Radiotherapy for breast cancer.
SO - N Engl J Med 2002 Mar 14;346(11):862-4
21
UI - 11898812
AU - Kunkler I
TI -
Radiotherapy for breast cancer.
SO - N Engl J Med 2002 Mar 14;346(11):862-4
22
UI - 11165739
AU - Berberich W; Schnabel K; Berg D; Lamprecht E
TI -
Boost irradiation of breast carcinoma: teletherapy vs. brachytherapy.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Feb;94(2):276-82
AD - Institute for Radiotherapy, St. Mary's Hospital, D-92224 Amberg,
Germany.
BACKGROUND: The results of adjuvant radiotherapy including a boost dose
after breast-conserving surgery of mamma carcinoma were retrospectively
analysed to relate local tumor control, survival, and cosmetic results
to the boost technique. MATERIAL AND METHODS: The study included 229
female patients who were treated in the period 1986--1997. Group A
consisted of patients where the primary irradiation was
hyperfractionated (two fractions per day) and the boost was applied by
reduced portals, also at two fractions per day. In group B the 'boost'
was applied interstitially intraoperatively and the 'primary'
irradiation followed at one fraction per day. The cosmetic results and
the late changes to the mamma were the subjects of follow-up
examinations and were assessed using the EORTC score. RESULTS: 129
patients formed group A, median follow-up 4.2 years, and 100 patients
with median follow-up of 9.4 years formed group B. 59% of group A and
60% of group B were in stage pT1, 38% and 39% were in pT2, and 25% and
39% were in stage N1 or N2 (no significant differences). Tumors were
mostly poorly to moderately differentiated. The upper outer quadrant was
most afflicted. Local recurrence occurred in two and five cases,
lymph-node recurrence in two cases each, while there were ten and 12
cases of distant metastases. There were no deaths in group A and in
group B six with obvious distant metastases and eight with other causes
of death. The cosmetic results and late side-effects (induration,
teleangiectasis, ulcers) were significantly worse in the interstitial
group B. Multivariate analysis revealed that only the total applied dose
significantly affected the severity of late radiation side-effects. The
cosmetic results worsened with time, the tendency for lymph edemas in
the irradiated side increased. Induration decreased continuously after
pure teletherapy but increased continuously after interstitial therapy.
These trends did not change in either group. CONCLUSIONS: Both therapy
schemes resulted in successful local tumor control with good cosmetic
results and few side effects, but the interstitial boost therapy was
clearly less favourable. Longer-term follow-up is required to compare
the late side-effects even further.
23
UI - 11750976
AU - Polgar C; Fodor J; Major T; Nemeth G
TI -
Is boost irradiation with interstitial brachytherapy less favourable
than with teletherapy after breast conserving surgery?
SO - Eur J Obstet Gynecol Reprod Biol 2002 Jan 10;100(2):255-6
24
UI - 11821473
AU - Morkas M; Fleming D; Hahl M
TI -
Challenges in oncology. Case 2. Radiation recall associated with
docetaxel.
SO - J Clin Oncol 2002 Feb 1;20(3):867-9
AD - James Graham Brown Cancer Center, University of Louisville, Louisville,
KY, USA.
25
UI - 11692927
AU - Marinova L
TI -
[Local treatment of axillae and its impact on survival in patients with
early breast cancer (EBC) after breast conservative surgery (BCS)]
SO - Khirurgiia (Sofiia) 2000;56(5-6):21-4
Following a shut survey showing the influence of the local therapeutic
approaches (operative and radiation) for axillaries region on the
distant survival, dissemination and lethality in patients with early BC
after BCS, the author presents her treatment results. It is pointed out
that BC is a systemic disease in some criteria taking in a
consideration. In this aspect no significant influence of the local
therapeutic methods is found. Furthermore a long-term follow up is still
met to prove that a less extensive local treatment methods lead to
irreversible consequences: increasing the local recurrences, distant
dissemination and lethality.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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