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Impact of young age on local control after partial breast irradiation in Japanese patients with early stage breast cancer

Breast Cancer volume 24, pages 79–85 (2017)Cite this article

Abstract

Background

Partial breast irradiation (PBI) is an alternative to whole breast irradiation (WBI) for breast-conserving therapy (BCT). A randomised phase 3 trial demonstrated that PBI using multicatheter brachytherapy had an equivalent rate of local recurrence, disease-free survival, and overall survival as compared to WBI. However, limited data are available on PBI efficacy for young patients with breast cancer.

Methods

We evaluated consecutive patients with Tis-2 (≤ 3 cm) N0-1 breast cancer who underwent BCT. For PBI, patients received radiotherapy using multicatheter brachytherapy in an accelerated manner with a dose of 32 Gy in eight fractions over 5–6 days. For WBI, patients received an external beam radiation therapy that was applied to the entire breast with a total dose of 50 Gy in fractions of 2 Gy for 5 weeks. Two hundred seventy-four patients with 278 lesions received PBI; 190 patients with 193 lesions received WBI.

Results

Patients aged <50 years including 98 women with 99 lesions receiving PBI and 85 women with 85 lesions receiving WBI were selected. Ipsilateral breast tumor recurrence rate was 3.0 and 2.4 % by PBI and WBI, respectively (P = 0.99). There was no significant difference in 4-year probability of disease-free survival (97.6 and 91.4 % for PBI and WBI, respectively; P = 0.87).

Conclusions

This is the first report of PBI efficacy in young patients in Asia. Although it is a nonrandomized retrospective chart review of a small cohort of patients with a relatively short follow-up period, PBI may be a better option than WBI following BCS in some young patients with breast cancer.

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References

  1. Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med. 2014;11:101–15. doi:10.7497/j.issn.2095-3941.2014.02.005.

    PubMed  PubMed Central  Google Scholar 

  2. Kurebayashi J, Miyoshi Y, Ishikawa T, Saji S, Sugie T, Suzuki T, et al. Clinicopathological characteristics of breast cancer and trends in the management of breast cancer patients in Japan: based on the Breast Cancer Registry of the Japanese Breast Cancer Society between 2004 and 2011. Breast Cancer. 2015;22:235–44. doi:10.1007/s12282-015-0599-6.

    Article  PubMed  Google Scholar 

  3. Kim Z, Min SY, Yoon CS, Jung KW, Ko BS, Kang E, et al. The basic facts of Korean Breast Cancer in 2012: results from a Nationwide Survey and Breast Cancer Registry Database. J Breast Cancer. 2015;18:103–11. doi:10.4048/jbc.2015.18.2.103.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. 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. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  5. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

    Article  PubMed  Google Scholar 

  6. Fisher CM, Rabinovitch R. Frontiers in radiotherapy for early-stage invasive breast cancer. J Clin Oncol. 2014;32:2894–901. doi:10.1200/JCO.2014.55.1184.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tuttle TM, Jarosek S, Habermann EB, Yee D, Yuan J, Virnig BA. Omission of radiation therapy after breast-conserving surgery in the United States: a population-based analysis of clinicopathologic factors. Cancer. 2012;118:2004–13. doi:10.1002/cncr.26505.

    Article  PubMed  Google Scholar 

  8. Saji S, Hiraoka M, Tokuda Y, Fukui N, Ikeda T. Trends in local therapy application for early breast cancer patients in the Japanese Breast Cancer Society Breast Cancer Registry during 2004–2009. Breast Cancer. 2012;19:1–3. doi:10.1007/s12282-011-0308-z.

    Article  PubMed  Google Scholar 

  9. Skandarajah AR, Mann GB. Do all patients require radiotherapy after breast-conserving surgery? Cancers. 2010;2:740–51. doi:10.3390/cancers2020740.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7. doi:10.1200/JCO.2012.45.2615.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM, PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16:266–73. doi:10.1016/S1470-2045(14)71221-5.

    Article  PubMed  Google Scholar 

  12. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    CAS  Article  PubMed  Google Scholar 

  13. Pan IW, Smith BD, Shih YC. Factors contributing to underuse of radiation among younger women with breast cancer. J Natl Cancer Inst. 2014;106:340. doi:10.1093/jnci/djt340.

    Article  Google Scholar 

  14. Lautner M, Lin H, Shen Y, Parker C, Kuerer H, Shaitelman S, et al. Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer. JAMA Surg. 2015;150:778–86. doi:10.1001/jamasurg.2015.1102.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Strnad V, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 2015;S0140–6736(15):00471–7. doi:10.1016/S0140-6736(15)00471-7.

    Google Scholar 

  16. Sato K, Mizuno Y, Kato M, Shimo T, Kubota J, Takeda N, et al. Intraoperative open-cavity implant for accelerated partial breast irradiation using high-dose rate multicatheter brachytherapy in Japanese breast cancer patients: a single-institution registry study. J Cancer Ther. 2012;3:822–30. doi:10.4236/jct.2012.325104.

    Article  Google Scholar 

  17. Recht A, Silver B, Schnitt S, Connolly J, Hellman S, Harris JR. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys. 1985;11:1271–6. doi:10.1016/0360-3016(85)90241-X.

    CAS  Article  PubMed  Google Scholar 

  18. Saika K, Sobue T. Epidemiology of breast cancer in Japan and the USA. JMAJ. 2009;52:39–44.

    Google Scholar 

  19. American Society of Breast surgeons: Consensus Statements. Accelerated partial breast irradiation. In: American Society of Breast surgeons Web site. 2015. https://www.breastsurgeons.org/statements/PDF_Statements/APBI.pdf. Accessed 1 Sep 2015.

  20. Shah C, Vicini F, Wazer DE, Arthur D, Patel RR. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12:267–77. doi:10.1016/j.brachy.2013.02.001.

    Article  PubMed  Google Scholar 

  21. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001. doi:10.1016/j.ijrobp.2009.02.031.

    Article  PubMed  Google Scholar 

  22. Polgár C, Van Limbergen E, Pötter R, Kovács G, Polo A, Lyczek J, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol. 2010;94:264–73. doi:10.1016/j.radonc.2010.01.014.

    Article  PubMed  Google Scholar 

  23. Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, Hammond ME, Lyman GH, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32:1502–6. doi:10.1200/JCO.2014.55.1572.

    Article  PubMed  Google Scholar 

  24. King TA. Selecting local therapy in the young breast cancer patient. J Surg Oncol. 2011;103:330–6. doi:10.1002/jso.21697.

    Article  PubMed  Google Scholar 

  25. Stull TS, Catherine Goodwin M, Chernick MR, Carella RJ, Frazier TG, et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology. Ann Surg Oncol. 2012;19:553–9. doi:10.1245/s10434-011-1941-7.

    Article  PubMed  Google Scholar 

  26. Sato K, Mizuno Y, Fuchikami H, Kato M, Shimo T, Kubota J, et al. Single-institution comparison of accelerated partial breast irradiation and whole breast irradiation in breast cancer patients with unfavorable parameters by the American Society for Radiation Oncology guidelines. J Tumor. 2014;2:129–33.

    Google Scholar 

  27. Sedlmayer F, Zehentmayr F, Fastner G. Partial breast re-irradiation for local recurrence of breast carcinoma: benefit and long term side effects. Breast. 2013;22(Suppl 2):S141–6. doi:10.1016/j.breast.2013.07.026.

    Article  PubMed  Google Scholar 

  28. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98. doi:10.1056/NEJMoa1209825.

    CAS  Article  PubMed  Google Scholar 

  29. Sato K, Mizuno Y, Fuchikami H, Kato M, Shimo T, Kubota J, et al. Comparison of radiation dose to the left anterior descending artery by whole and partial breast irradiation in breast cancer patients. J Contemp Brachytherapy. 2015;7:23–8. doi:10.5114/jcb.2014.47891.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Amin M, Gabram S, Bumpers H, Landry J, Jani AB, Diaz R, et al. Feasibility of accelerated partial breast irradiation in a large inner-city public hospital. Ann Surg Oncol. 2012;19:4094–8. doi:10.1245/s10434-012-2444-x.

    Article  PubMed  Google Scholar 

  31. Pasko J, Schray M, Lee M, Johnson N. Experience with partial breast irradiation for treatment of breast cancer at a community-based cancer center. Am J Surg. 2014;207:682–5. doi:10.1016/j.amjsurg.2013.12.025.

    Article  PubMed  Google Scholar 

  32. Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14:1269–77. doi:10.1016/S1470-2045(13)70497-2.

    Article  PubMed  Google Scholar 

  33. Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014;383:603–13. doi:10.1016/S0140-6736(13)61950-9.

    Article  PubMed  Google Scholar 

  34. Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: 10-year results of the Budapest randomized trial. Radiother Oncol. 2013;108:197–202. doi:10.1016/j.radonc.2013.05.008.

    Article  PubMed  Google Scholar 

  35. Kamrava M, Kuske RR, Anderson B, Chen P, Hayes J, Quiet C, et al. Outcomes of breast cancer patients treated with accelerated partial breast irradiation via multicatheter interstitial brachytherapy: the pooled registry of multicatheter interstitial sites (PROMIS) experience. Ann Surg Oncol. 2015;22:404–11. doi:10.1245/s10434-015-4563-7.

    Article  Google Scholar 

  36. Chen PY, Shah C, Wilkinson JB, et al. Efficacy of young patients treated with accelerated partial breast irradiation for early-stage breast cancer. Radiother Oncol. 2012;103(Suppl 2):S36–7. doi:10.1016/S0167-8140(12)72057.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Enago (http://www.enago.jp) for the English language review.

Author information

Affiliations

  1. Department of Breast Oncology, Tokyo-West Tokushukai Hospital, 3-1-1 Matsubara, Akishima, Tokyo, 196-0003, Japan

    Kazuhiko Sato, Yoshio Mizuno, Hiromi Fuchikami & Naoko Takeda

  2. Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, 3-1-1 Matsubara, Akishima, Tokyo, 196-0003, Japan

    Masahiro Kato, Takahiro Shimo & Jun Kubota

  3. Inoue Ladies Clinic, 1-26-9 Fujimi, Tachikawa, Tokyo, 190-0013, Japan

    Naoko Takeda & Yuko Inoue

  4. Seto Hospital, 8-6 Kanayama, Tokorozawa, Saitama, 359-1128, Japan

    Hiroshi Seto

  5. Health Evaluation Center, Utsunomiya Memorial Hospital, 1-3-16 Odori, Utsunomiya, Tochigi, 320-0811, Japan

    Tomohiko Okawa

Authors
  1. Kazuhiko Sato
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  2. Yoshio Mizuno
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  3. Hiromi Fuchikami
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  4. Masahiro Kato
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  5. Takahiro Shimo
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  6. Jun Kubota
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  7. Naoko Takeda
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  8. Yuko Inoue
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  9. Hiroshi Seto
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  10. Tomohiko Okawa
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Correspondence to Kazuhiko Sato.

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Cite this article

Sato, K., Mizuno, Y., Fuchikami, H. et al. Impact of young age on local control after partial breast irradiation in Japanese patients with early stage breast cancer. Breast Cancer 24, 79–85 (2017). https://doi.org/10.1007/s12282-016-0669-4

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  • DOI: https://doi.org/10.1007/s12282-016-0669-4

Keywords

  • Breast cancer
  • Young
  • Brachytherapy
  • Partial breast irradiation