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Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution

Zeitintervall zwischen brusterhaltender Operation und Strahlentherapie: Ergebnisse eine Analyse von 1393 Patienten

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Abstract

Background

The role of postoperative radiotherapy in breast-conserving therapy is undisputed. However, optimal timing of adjuvant radiotherapy is an issue of ongoing debate. This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery–radiotherapy intervals on local control and overall survival.

Patients and methods

Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period (1990–2006) were analyzed. Patients were assigned to two groups (CT+/CT−) according to chemotherapy status. A delay in the initiation of radiotherapy was defined as > 7 weeks (CT− group) and > 24 weeks (CT+ group).

Results

The 10-year regional recurrence-free survival for the CT− and CT+ groups were 95.6 and 86.0 %, respectively. A significant increase in the median surgery–radiotherapy interval was observed over time (CT− patients: median of 5 weeks in 1990–1992 to a median of 6 weeks in 2005–2006; CT+ patients: median of 5 weeks in 1990–1992 to a median of 21 weeks in 2005–2006). There was no association between a delay in radiotherapy and an increased local recurrence rate (CT− group: p = 0.990 for intervals 0–6 weeks vs. ≥ 7 weeks; CT+ group: p = 0.644 for intervals 0–15 weeks vs. ≥ 24 weeks) or decreased overall survival (CT− group: p = 0.386 for intervals 0–6 weeks vs. ≥ 7 weeks; CT+ group: p = 0.305 for intervals 0–15 weeks vs. ≥ 24 weeks).

Conclusion

In the present cohort, a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups (CT−/CT+). However, in the absence of randomized evidence, delays in the initiation of radiotherapy should be avoided.

Zusammenfassung

Hintergrund

Die zentrale Rolle der postoperativen Strahlentherapie im Rahmen der brusterhaltenden Therapie ist mittlerweile unbestritten. Allerdings ist der optimale Zeitpunkt für den Beginn der adjuvanten Strahlentherapie weiterhin ungewiss. In dieser retrospektiven Kohortenstudie wurde die mögliche Auswirkung einer verzögerten Einleitung der postoperativen Strahlentherapie auf die lokale Kontrolle, sowie auf das Gesamtüberleben untersucht.

Patienten und Methode

Insgesamt wurden Daten von 1393 Patienten über einen 17-Jahres-Zeitraum (1990–2006) analysiert. In Abhängigkeit vom Chemotherapiestatus wurden getrennte Analysen durchgeführt (CT+/CT−). Eine verzögerte Einleitung der Strahlentherapie wurde als ein Intervall von > 7 Wochen (CT−), bzw. > 24 Wochen (CT+) definiert.

Ergebnisse

Das lokale rezidivfreie Überleben für die CT− und CT+ Gruppe lag nach 10 Jahren bei 95,6 % bzw. 86,0 %. Über den gesamten Zeitraum konnte ein signifikanter Anstieg des medianen Intervalls zwischen Operation und Strahlentherapie festgestellt werden (CT−: von median 5 Wochen von 1990–1992 auf median 6 Wochen von 2005–2006; CT+: von median 5 Wochen von 1990–1992 auf median 21 Wochen von 2005–2006). Eine Korrelation zwischen verzögertem Beginn der Strahlentherapie und einer erhöhten lokalen Rezidivrate (CT−: p = 0,990 für Intervalle 0–6 Wochen vs. ≥ 7 Wochen; CT+: p = 0,644 für Intervalle 0–15 Wochen vs. ≥ 24 Wochen) oder einem verringerten Gesamtüberleben (CT−: p = 0,386 für Intervalle 0–6 Wochen vs. ≥ 7 Wochen; CT+: p = 0,305 für Intervalle 0–15 Wochen vs. ≥ 24 Wochen) wurde nicht gefunden.

Schlussfolgerung

In der vorliegenden Kohorte fand sich kein Hinweis auf eine erhöhte Lokalrezidivrate oder ein verringertes Gesamtüberleben bei verzögertem Beginn der Strahlentherapie. Dennoch sollte bei fehlender randomisierter Evidenz eine Verzögerung bei der Initiierung der Strahlentherapie aufgrund radiobiologischer Erwägungen grundsätzlich vermieden werden.

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References

  1. Benk V, Joseph L, Fortin P et al (2004) Effect of delay in initiating radiotherapy for patients with early stage breast cancer. Clin Oncol 16:6–11

    Article  CAS  Google Scholar 

  2. Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107

    Article  CAS  PubMed  Google Scholar 

  3. Blank E, Willich N, Fietkau R et al (2012) Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients. The DEGRO-QUIRO trial. Strahlenther Onkol 188:113–119

    Article  CAS  PubMed  Google Scholar 

  4. Bouche G, Ingrand I, Mathoulin-Pelissier S et al (2010) Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer. Radiother Oncol 97:541–547

    Article  PubMed  Google Scholar 

  5. Brucker SY, Wallwiener M, Kreienberg R et al (2011) Optimizing the quality of breast cancer care at certified German Breast Centers a benchmarking analysis for 2003–2009 with a particular focus on the interdisciplinary specialty of radiation oncology. Strahlenther Onkol 187:89–98

    Article  PubMed  Google Scholar 

  6. Buchholz TA, Austinseymour MM, Moe RE et al (1993) Effect of delay in radiation in the combined modality treatment of breast-cancer. Int J Radiat Oncol Biol Phys 26:23–35

    Article  CAS  PubMed  Google Scholar 

  7. Chen Z, King W, Pearcey R et al (2008) The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol 87:3–16

    Article  PubMed  Google Scholar 

  8. Clarke DH, Le MG, Sarrazin D et al (1985) Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy1985—experience of the institut gustave-roussy. Int J Radiat Oncol Biol Phys 11:137–145

    Article  CAS  PubMed  Google Scholar 

  9. DKG_DGGG (2008) Interdisziplinäre S3-Leitlinie für die Diagnostik und Therapie des Mammakarzinoms der Frau. Zuckschwerdt, Munich

  10. Early Breast Canc Trialists C (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

    Article  Google Scholar 

  11. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  12. Fletcher GH (1986) Implications of the density of clonogenic infestation in radiotherapy. Int J Radiat Oncol Biol Phys 12:1675–1680

    Article  CAS  PubMed  Google Scholar 

  13. Hartsell WF, Recine DC, Griem KL, Murthy AK (1995) Delaying the initiation of intact breast irradiation for patients with lymph-node positive breast-cancer increases the risk of local recurrence. Cancer 76:2497–2503

    Article  CAS  PubMed  Google Scholar 

  14. Henderson IC, Berry DA, Demetri GD et al (2003) Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 21:976–983

    Article  CAS  PubMed  Google Scholar 

  15. Hickey B, Francis D, Lehman M (2006) Sequencing of chemotherapy and radiation therapy for early breast cancer. Cochrane Database Syst Rev

  16. Huang J, Barbera L, Brouwers M et al (2003) Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21:555–563

    Article  PubMed  Google Scholar 

  17. Jatoi I, Proschan MA (2005) Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer—a pooled analysis of updated results. Am J Clin Oncol 28:289–294

    Article  PubMed  Google Scholar 

  18. Kurtz J, Party EW (2002) The curative role of radiotherapy in the treatment of operable breast cancer. Eur J Cancer 38:1961–1974

    Article  CAS  PubMed  Google Scholar 

  19. Kurtz JM, Amalric R, Delouche G et al (1987) The 2nd 10 years—long-term risks of breast conservation in early breast-cancer. Int J Radiat Oncol Biol Phys 13:1327–1332

    Article  CAS  PubMed  Google Scholar 

  20. Leonard CE, Wood ME, Zhen BG et al (1995) Does administration of chemotherapy before radiotherapy in breast-cancer patients treated with conservative surgery negatively impact local-control. J Clin Oncol 13:2906–2915

    CAS  PubMed  Google Scholar 

  21. Livi L, Borghesi S, Saieva C et al (2009) Radiotherapy timing in 4,820 patients with breast cancer: university of florence experience. Int J Radiat Oncol Biol Phys 73:365–369

    Article  PubMed  Google Scholar 

  22. Mackillop WJ, Bates JHT, Osullivan B, Withers HR (1996) The effect of delay in treatment on local control by radiotherapy. Int J Radiat Oncol Biol Phys 34:243–250

    Article  CAS  PubMed  Google Scholar 

  23. Mackillop WJ, Fu H, Quirt CF et al (1994) Waiting for radiotherapy in ontario. Int J Radiat Oncol Biol Phys 30:221–228

    Article  CAS  PubMed  Google Scholar 

  24. Mikeljevic JS, Haward R, Johnston C et al (2004) Trends in postoperative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery. Br J Cancer 90:1343–1348

    Article  PubMed Central  PubMed  Google Scholar 

  25. Munich Cancer Registry. http://www.tumorregister-muenchen.de/. Accessed 28 Jan 2014

  26. Nixon AJ, Recht A, Neuberg D et al (1994) The relation between the surgery-radiotherapy interval and treatment outcome in patients treated with breast-conserving surgery and radiation-therapy without systemic therapy. Int J Radiat Oncol Biol Phys 30:17–21

    Article  CAS  PubMed  Google Scholar 

  27. Recht A, Come SE, Henderson IC et al (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 334:1356–1361

    Article  CAS  PubMed  Google Scholar 

  28. Sautter-Bihl ML, Sedlmayer F, Budach W et al (2012) One life saved by four prevented recurrences? Update of the Early Breast Cancer Trialists confirms: postoperative radiotherapy improves survival after breast conserving surgery. Strahlenther Onkol 188:461–463

    Article  CAS  PubMed  Google Scholar 

  29. Scorsetti M, Alongi F, Fogliata A et al (2012) Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments. Radiat Oncol 7:145

    Article  PubMed Central  PubMed  Google Scholar 

  30. Selby P, Gillis C, Haward R (1996) Benefits from specialised cancer care. Lancet 348:313–318

    Article  CAS  PubMed  Google Scholar 

  31. Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer (1998) Clinical practice guidelines for the care and treatment of breast cancer. CMAJ 158:S1–S83

    Google Scholar 

  32. Van Parijs H, Miedema G, Vinh-Hung V et al (2012) Short course radiotherapy with simultaneous integrated boost for stage I–II breast cancer, early toxicities of a randomized clinical trial. Radiat Oncol 7:80

    Article  Google Scholar 

  33. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  34. Vujovic O, Perera F, Dar AR et al (1998) Does delay in breast irradiation following conservative breast surgery in node-negative breast cancer patients have an impact on risk of recurrence? Int J Radiat Oncol Biol Phys 40:869–874

    Article  CAS  PubMed  Google Scholar 

  35. Whelan TJ, Clark RM, Levine MN et al (1996) The effect of delay in initiating radiotherapy post-lumpectomy on local breast recurrence. Int J Radiat Oncol Biol Phys 36:280

    Article  Google Scholar 

  36. Winzer KJ, Gruber C, Badakhshi H et al (2012) Compliance of patients concerning recommended radiotherapy in breast cancer. Association with recurrence, age, and hormonal therapy. Strahlenther Onkol 188:788–794

    Article  PubMed  Google Scholar 

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Compliance with ethical guidelines

Conflict of interest. S. Corradini, O.M. Niemoeller, M. Niyazi, F. Manapov, M. Haerting, N. Harbeck, C. Belka, and S. Kahlert state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    S. Corradini, O.M. Niemoeller, M. Niyazi, F. Manapov & C. Belka

  2. Breast Center, Department of Obstetrics and Gynecology, University of Munich, Munich, Germany

    M. Haerting, N. Harbeck & S. Kahlert

  3. Comprehensive Cancer Center (CCC-LMU), University of Munich, Munich, Germany

    N. Harbeck

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  1. S. Corradini
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  2. O.M. Niemoeller
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  3. M. Niyazi
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Correspondence to S. Corradini.

Additional information

Stefanie Corradini and Olivier M Niemoeller contributed equally.

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Corradini, S., Niemoeller, O., Niyazi, M. et al. Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution. Strahlenther Onkol 190, 352–357 (2014). https://doi.org/10.1007/s00066-013-0540-x

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  • DOI: https://doi.org/10.1007/s00066-013-0540-x

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