© 1994 by Oxford University Press
Journal of the National Cancer Institute, Vol. 86, No. 9, 717-722,
May 4, 1994
© 1994 Oxford University Press
Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: Five-Year Results of a Randomized Trial1
Department of Surgery
Department of Oncology, Orebro Medical Center Hospital Sweden
Department of Surgery and Cancer Epidemiology Unit
Department of Oncology, University Hospital Uppsala, Sweden
Cancer Epidemiology Unit, University Hospital, Uppsala; and Department of Epidemiology, Harvard School of Public Health Boston, Mass
Department of Oncology, University Hospital Lund, Sweden
Uppsala-Örebro Breast Cancer Study Group
Correspondence to: Lars Holmberg, M.D., Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden.
BACKGROUND:: The effectiveness of routine postoperative irradiation following breast-conserving treatment of breast cancer has not previously been assessed in randomized clinical trials that have taken place in settings where mammography has been a major pathway to diagnosis or that have followed patients treated surgically by sector resection. Purpose: The aim of this study was to determine if treatment of stage I breast cancer by strictly standardized surgical technique with meticulous confirmation of a complete excision can reduce the local recurrence rate to an acceptable level without routine adjuvant radiotherapy. Methods: In this trial conducted in Sweden, 381 women with stage I breast cancer were surgically treated by sector resection plus axillary dissection; then 184 women were randomly selected to receive postoperative radiotherapy to the breast (XRT group), and 197 women received no further treatment (non-XRT group). Patient accrual started in October 1981 and ended in September 1988. Criteria for eligibility were a unifocal cancer 20 mm or less in diameter (visible on mammogram) and radical excision and no histopathologic signs of axillary metastases. Results: After median follow-up times of 65 and 63 months, the 5-year local recurrence rate was 2.3% (95% confidence interval [CI] = 0.1%-4.3%) in the XRT group and 18.4% (95% CI = 12.5%-24.2%) in the non-XRT group, respectively. The life-table curves were significantly different (P = .0001). The two treatment groups did not differ in overall survival: For the XRT group, the value was 91.0% (95% CI = 86.4%-95.4%); for the non-XRT group, it was 90.3% (95% CI = 85.8%-94.8%). The same was true for survival free from regional and distant recurrence: XRT group, 90.0% (95% CI = 85.3%-94.5%); non-XRT group, 87.1% (95% CI = 82.3%-92.0%). The rate of local recurrences was significantly higher in patients treated more recently (P. = 003). Conclusions: Sector resection plus radiotherapy to the breast very effectively achieves local tumor control. Surgery alone results in similar survival prospects, but the probability of local recurrence approaches 20% at 5 years. Implications: The increase in recurrence rate observed over time suggests that surgical technique and patient selection should be improved. The benefits of reduced cost and patient inconvenience that would result from the elimination of postoperative radiotherapy must be carefully weighed against the disadvantages of local recurrence. Longer term follow-up must be done to estimate the risk of cancer recurrence in these women 10 and 15 years later, and methods must be developed to identify those women who have a higher risk of recurrence. Finally, economic analyses of this and similar trials are needed to give empirical underpinnings for optimal use of radiotherapy. [J Natl Cancer Inst 86: 717–722, 1994]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. SPYROPOULOU, M. LEOTSINIDIS, M. TSIAMITA, K. SPIROPOULOS, and D. KARDAMAKIS Pulmonary Function Testing in Women with Breast Cancer Treated with Radiotherapy and Chemotherapy In Vivo, September 1, 2009; 23(5): 867 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Zellars, V. Stearns, D. Frassica, F. Asrari, T. Tsangaris, L. Myers, S. DiPasquale, J. R. Lange, L. K. Jacobs, L. A. Emens, et al. Feasibility Trial of Partial Breast Irradiation With Concurrent Dose-Dense Doxorubicin and Cyclophosphamide in Early-Stage Breast Cancer J. Clin. Oncol., June 10, 2009; 27(17): 2816 - 2822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Godinez, E. C. Gombos, S. A. Chikarmane, G. K. Griffin, and R. L. Birdwell Breast MRI in the Evaluation of Eligibility for Accelerated Partial Breast Irradiation Am. J. Roentgenol., July 1, 2008; 191(1): 272 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Sanders, T. Scroggins, F. L. Ampil, and B. D. Li Accelerated Partial Breast Irradiation in Early-Stage Breast Cancer J. Clin. Oncol., March 10, 2007; 25(8): 996 - 1002. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. P. McCarthy, L. H. Ngo, R. G. Roetzheim, T. N. Chirikos, D. Li, R. E. Drews, and L. I. Iezzoni Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med, November 7, 2006; 145(9): 637 - 645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Dowlatshahi, H. C. Snider, M. A. Gittleman, C. Nguyen, P. M. Vigneri, and R. L. Franklin Early Experience With Balloon Brachytherapy for Breast Cancer Arch Surg, June 1, 2004; 139(6): 603 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Punglia, K. M. Kuntz, J. H. Lee, and A. Recht Radiation Therapy Plus Tamoxifen Versus Tamoxifen Alone After Breast-Conserving Surgery in Postmenopausal Women With Stage I Breast Cancer: A Decision Analysis J. Clin. Oncol., June 15, 2003; 21(12): 2260 - 2267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Fisher, J. Bryant, J. J. Dignam, D. L. Wickerham, E. P. Mamounas, E. R. Fisher, R. G. Margolese, L. Nesbitt, S. Paik, T. M. Pisansky, et al. Tamoxifen, Radiation Therapy, or Both for Prevention of Ipsilateral Breast Tumor Recurrence After Lumpectomy in Women With Invasive Breast Cancers of One Centimeter or Less J. Clin. Oncol., October 15, 2002; 20(20): 4141 - 4149. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Nattinger, R. T. Kneusel, R. G. Hoffmann, and M. A. Gilligan Relationship of Distance From a Radiotherapy Facility and Initial Breast Cancer Treatment J Natl Cancer Inst, September 5, 2001; 93(17): 1344 - 1346. [Full Text] [PDF]
|
|
|
|
|
|
M. Morrow, J. White, J. Moughan, J. Owen, T. Pajack, J. Sylvester, J. Frank Wilson, and D. Winchester Factors Predicting the Use of Breast-Conserving Therapy in Stage I and II Breast Carcinoma J. Clin. Oncol., April 15, 2001; 19(8): 2254 - 2262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Vicini, K. L. Baglan, L. L. Kestin, C. Mitchell, P. Y. Chen, R. C. Frazier, G. Edmundson, N. S. Goldstein, P. Benitez, R. R. Huang, et al. Accelerated Treatment of Breast Cancer J. Clin. Oncol., April 1, 2001; 19(7): 1993 - 2001. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. K. Linderholm, T. Lindahl, L. Holmberg, S. Klaar, J. Lennerstrand, R. Henriksson, and J. Bergh The Expression of Vascular Endothelial Growth Factor Correlates with Mutant p53 and Poor Prognosis in Human Breast Cancer Cancer Res., March 1, 2001; 61(5): 2256 - 2260. [Abstract] [Full Text]
|
|
|
|
|
|
F. Ponten, H. Lindman, A. Bostrom, B. Berne, and J. Bergh Induction of p53 Expression in Skin by Radiotherapy and UV Radiation: a Randomized Study J Natl Cancer Inst, January 17, 2001; 93(2): 128 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Hayman, B. E. Hillner, J. R. Harris, L. J. Pierce, and J. C. Weeks Cost-Effectiveness of Adding an Electron-Beam Boost to Tangential Radiation Therapy in Patients With Negative Margins After Conservative Surgery for Early-Stage Breast Cancer J. Clin. Oncol., January 14, 2000; 18(2): 287 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. K.F. Temple, E. E.L. Wang, and R. S. McLeod Preventive health care, 1999 update: 3. Follow-up after breast cancer Can. Med. Assoc. J., October 1, 1999; 161(8): 1001 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Liljegren, L. Holmberg, J. Bergh, A. Lindgren, L. Tabar, H. Nordgren, and H.O. Adami 10-Year Results After Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: A Randomized Trial J. Clin. Oncol., August 1, 1999; 17(8): 2326 - 2326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Moritz, T Bates, S M Henderson, S Humphreys, and M J Michell Variation in management of small invasive breast cancers detected on screening in the former South East Thames region: observational study BMJ, November 15, 1997; 315(7118): 1266 - 1272. [Abstract] [Full Text]
|
|
|
|
 |
|
 I. C. Henderson Paradigmatic Shifts in the Management of Breast Cancer N. Engl. J. Med., April 6, 1995; 332(14): 951 - 952. [Full Text]
|
|
|
|
 |
|
 S. C. Formenti, B. Rosenstein, K. A. Skinner, and G. Jozsef T1 Stage Breast Cancer: Adjuvant Hypofractionated Conformal Radiation Therapy to Tumor Bed in Selected Postmenopausal Breast Cancer Patients—Pilot Feasibility Study Radiology, January 1, 2002; 222(1): 171 - 178. [Abstract] [Full Text] [PDF]
|
|