Abstract
Purpose
Adding a tumour bed boost to whole-breast irradiation in breast-conserving therapy reduces local recurrence rates. The purpose of the present study was to investigate whether the boost technique influences the magnitude of the effect.
Methods
Patients treated with breast-conserving therapy for invasive breast cancer between 2000 and 2007 were included in the analysis. Three groups were considered according to the applied boost technique: electrons, brachytherapy or photons. The endpoints were local recurrence and any recurrence. Cox regression models were used and correction for the confounders in the association between boost technique and outcome was performed using multivariable models.
Results
1879 tumours were included in the analysis. 1448 tumours (77.1%) were treated with an electron boost, 334 (17.8%) with a brachytherapy boost and 97 (5.2%) with a photon boost. Median follow-up was 13.1 years. The 10-year local recurrence rate was 2.2%. In multivariable analysis with correction for age, pathological Tumour or Node stage (pT, pN), chemotherapy and hormonal therapy, there was no significant difference between the three groups for the local recurrence risk (p = 0.89). 10-year any recurrence rate was 10.8%. In multivariable analysis with correction for age, pT, pN, resection margins, radiotherapy, year of diagnosis, chemotherapy and hormonal therapy, there was no significant difference between the brachytherapy group and the electron group or the photon group (p = 0.11 and p = 0.28, respectively). The photon group had more recurrences compared to the electron group (Hazard Ratio 1.81, 95% Confidence Interval 1.12; 2.92, p = 0.02).
Conclusions
The local recurrence risk reduction of the tumour bed boost in breast-conserving therapy is not influenced by the applied boost technique.
Zusammenfassung
Zielsetzung
Mit einem zusätzlichen Boost auf das Tumorbett wird bei Bestrahlung der ganzen Brust im Rahmen der brusterhaltenden Therapie eine Reduktion der lokalen Rezidivrate erreicht. Das Ziel der vorliegenden Studie war es, zu untersuchen, ob die Boost-Technik das Ausmaß des Effekts beeinflusst.
Methoden
In die Analyse wurden Patientinnen, die zwischen 2000 und 2007 mit brusterhaltender Therapie bei einem invasiven Brustkrebs behandelt wurden, einbezogen. Je nach verwendeter Boost-Technik wurden drei verschiedene Gruppen unterschieden: Elektronen, Brachytherapie oder Photonen. Die Endpunkte waren das Auftreten eines lokalen Rezidivs und jedes Rezidiv. Benutzt wurden Cox-Regressions-Modelle. Eine Korrektur der Störfaktoren in Zusammenhang zwischen Boost-Technik und Outcome erfolgte mit multivariablen Modellen.
Ergebnisse
In die Analyse wurden 1879 Tumoren inkludiert: 1448 Tumoren (77,1 %) wurden mit einem Elektronen-Boost, 334 (17,8 %) mit Brachytherapie und 97 (5,2 %) mit einem Photonen-Boost behandelt. Die mediane Nachbeobachtungszeit betrug 13,1 Jahre. Die 10-Jahres-Lokalrezidivrate lag bei 2,2 %. In multivariablen Analysen unter Berücksichtigung von Alter, pathologisches Tumor oder Lymfknot (pT oder pN), Chemotherapie und hormoneller Therapie gab es keinen signifikanten Unterschied hinsichtlich des Lokalrezidivrisikos (p = 0,89) zwischen den drei verschiedenen Behandlungsgruppen. Die 10-Jahres-Rezidivrate jeglicher Art lag bei 10,8 %. In der multivariablen Analyse unter Berücksichtigung von Alter, pT, pN, Resektionsrändern, Strahlentherapie, Zeitpunkt der Diagnosestellung, Chemotherapie und hormoneller Therapie gab es keinen signifikanten Unterschied zwischen der Brachytherapie- und der Elektronen- oder der Photonentherapie-Gruppe (jeweils p = 0,11 und p = 0,28). In der Photonentherapie-Gruppe traten im Vergleich zur Elektronen-Gruppe mehr Rezidive auf (Hazard Ratio 1,81; 95 %-Konfidenzintervall 1,12; 2,92, p = 0,02).
Schlussfolgerung
Bei Anwendung des Tumorbett-Boosts in der brusterhaltenden Therapie wird die Verringerung des Lokalrezidivrisikos nicht durch die benutzte Boost-Technik beeinflusst.
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References
Ferlay J, Soerjomataram I, Ervik M et al (2014) GLOBOCAN 2012 v1.1, cancer incidence, mortality and prevalence. Lyon, France: International Agency for Research on Cancer. http://globocan.iarc.fr. Accessed 8 Mar 2018
Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716
Holland R, Veling SH, Mravunac M, Hendriks JH (1985) Histologic multifocality of Tis, T1-T2 breast carcinomas implications for clinical trials of breast-conserving surgery. Cancer 56:979–990
Bartelink H, Horiot JC, Poortmans PM et al (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy for early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 25:3259–3265
Kuerer HM, Julian TB, Strom EA et al (2004) Accelerated partial breast irradiation after conservative surgery for breast cancer. Ann Surg 239:338–351
Vaidya JS, Joseph DJ, Tobias JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376:91–102
ESMO Guidelines Committee, Senkus E, Kyriakides S, Ohno S et al (2015) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl5):v8–v30
van Tienhoven G, van Bree N, Mijnheer B, Bartelink H (1991) Quality assurance of the EORTC trial 22881/10882: “assessment of the role of the booster dose in breast conserving therapy”: the Dummy Run. EORTC radiotherapy cooperative group. Radiother Oncol 22:290–298
Bartelink H, Maingon P, Poortmans P et al (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16:47–56
Kindts I, Laenen A, Depuydt T, Weltens C (2017) Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd011987.pub2
Fourquet A, Campana F, Mosseri V et al (1995) Iridium-192 versus cobalt-60 boost in 3‑7 cm breast cancer treated by irradiation alone: final results of a randomized trial. Radiother Oncol 34:114–120
Touboul E, Belkacemi Y, Lefranc JP et al (1995) Early breast cancer: influence of type of boost (electrons vs iridium-192 implant) on local control and cosmesis after conservative surgery and radiation therapy. Radiother Oncol 34:105–113
Mansfield CM, Komarnicky LT, Schwartz GF et al (1995) Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy. Cancer 75:2328–2336
Wazer DE, Kramer B, Schmid C et al (1997) Factors determining outcome in patients treated with interstitial implantation as a radiation boost for breast conserving therapy. Int J Radiat Oncol Biol Phys 39:381–393
Hill-Kayser C, Chacko D, Hwang WT et al (2011) Long-term clinical and cosmetic outcomes after breast conservation treatment for women with early-stage breast carcinoma according to the type of breast boost. Int J Radiat Oncol Biol Phys 79:1048–1054
Perez CA, Taylor ME, Halverson K et al (1996) Brachytherapy or electron beam boost in conservation therapy of carcinoma of the breast: a nonrandomized comparison. Int J Radiat Oncol Biol Phys 34:995–1007
Frazier R, Kestin L, Kini V et al (2001) Impact of boost technique on outcome in early-stage breast cancer patients treated with breast-conserving therapy. Am J Clin Oncol 24:26–32
Poortmans P, Bartelink H, Horiot JC et al (2004) The influence of the boost technique on local control in breast conserving treatment in the EORTC ‘boost versus no boost’ randomised trial. Radiother Oncol 72:25–33
Knauerhase H, Strietzel M, Gerber B, Reimer T, Fietkau R (2008) Tumor location, interval between surgery and radiotherapy, and boost technique influence local control after breast-conserving surgery and radiation: retrospective analysis of monoinstitutional long-term results. Int J Radiat Oncol Biol Phys 72:1048–1055
Deore S, Sarin R, Dinshaw K, Shrivastava S (1993) Influence of dose-rate and dose per fraction on clinical outcome of breast cancer treated by external beam irradiation plus Iridium-192 implants: analysis of 289 cases. Int J Radiat Oncol Biol Phys 26:601–606
Verhoeven K, Kindts I, Laenen A et al (2015) A comparison of three different radiotherapy boost techniques after breast conserving therapy for breast cancer. Breast 24:391–396
Verhoeven K, Peeters S, Erven K et al (2016) Boost delineation in breast radiation therapy: Isotropic versus anisotropic margin expansion. Pract Radiat Oncol 6:e243–e248
Hammer J, Mazeron J, Van Limbergen E (1999) Breast boost-why, how, when …? Strahlenther Onkol 175:478–483
Van Limbergen E, Reynders A, Van den Bogaert W (1998) The useful boost range concept judges the ballistic selectivity of electron beams versus brachytherapy in the boost techniques of breast conserving therapy. Eur J Cancer 34(Suppl 5):S57
Poortmans P, Aznar M, Bartelink H (2012) Quality indicators for breast cancer: revisiting historical evidence in the context of technology changes. Semin Radiat Oncol 22:29–39
Vrieling C, Van Werkhoven E, Maingon P et al (2017) Prognostic factors for local control in breast cancer after long-term follow-up in the EORTC boost vs no boost trial. JAMA Oncol 3:42–48
Sanghani M, Truong P, Raad R et al (2010) Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy. J Clin Oncol 28:718–722
Park S, Kim J (2013) Comparison of electron and X‑ray beams for tumor bed boost irradiation in breast-conserving treatment. J Breast Cancer 16:300–307
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I. Kindts, K. Verhoeven, A. Laenen, M. Christiaens, H. Janssen, A. Van der Vorst, E. Van Limbergen and C. Weltens declare that they have no competing interests.
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Kindts, I., Verhoeven, K., Laenen, A. et al. A comparison of a brachytherapy and an external beam radiotherapy boost in breast-conserving therapy for breast cancer: local and any recurrences. Strahlenther Onkol 195, 310–317 (2019). https://doi.org/10.1007/s00066-018-1413-0
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DOI: https://doi.org/10.1007/s00066-018-1413-0