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Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry

  • Gynecologic Oncology
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According to German S3 guidelines, radiotherapy (RT) is indicated in patients with invasive breast cancer after breast-conserving therapy (BCT). The aim of this analysis was to assess adherence to guidelines, long-term survival, recurrence rates, and recurrence-free survival after adjuvant RT in patients with BCT in daily clinical practice.


This retrospective cohort study comprised data from the population-based clinical cancer registry of the Tumor Centre Regensburg (Bavaria, Germany). 6370 patients with non-metastatic invasive breast cancer and UICC tumor stages I, II, and III who were treated in certified breast cancer centers by BCT and diagnosed between 2003 and 2013 were included in the study.


6184 (97.1%) breast cancer patients received guideline concordant RT and showed a 3-year overall survival (OAS) of 96.8% in contrast to 90.9% in patients without RT (5-year OAS of 93.1% vs. 79.0%, p < 0.001). In multivariable Cox regression models, better overall survival was confirmed for the RT group (HR 0.64, 95% CI 0.46–0.88, p = 0.007). The 5-year local recurrence-free survival rate (RFS) in the irradiated patients was 92.1% vs. 62.0% in the comparison group (p < 0.001). The 10-year RFS was 80.5% vs. 36.0% (p < 0.001). This difference persisted after adjusting in multivariable analysis (HR 0.20, 95% CI 0.16–0.26, p < 0.001).


This population-based analysis showed that the implementation of German guidelines in clinical routine was successful and guideline concordant adjuvant radiotherapy after BCT leads to better overall and recurrence-free survival and lower local recurrence rates.

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Breast-conserving therapy


Overall survival


Hazard ratio


Accelerated partial breast irradiation


Standard deviation


Confidence interval


Recurrence-free survival


German Cancer Society, “Deutsche Krebsgesellschaft”


Estrogen receptor


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Authors and Affiliations



TW: project development, data collection, data analysis, and manuscript writing. OO: project development and manuscript editing. MG: project development, data collection, data analysis, and manuscript editing. MK: project development and manuscript editing. OK: manuscript editing. ECI: project development and manuscript editing.

Corresponding author

Correspondence to Monika Klinkhammer-Schalke.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human and/or animal participants

This article is a retrospective study and does not contain any studies with human participants or animals performed by any of the authors.

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Wimmer, T., Ortmann, O., Gerken, M. et al. Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry. Arch Gynecol Obstet 299, 1131–1140 (2019).

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