© 2003 by Oxford University Press
© 2003 Oxford University Press
ARTICLE |
Limited-Field Radiation Therapy in the Management of Early-Stage Breast Cancer
Affiliation of authors: F. A. Vicini, L. Kestin, P. Chen, A. Martinez (Department of Radiation Oncology), P. Benitez (Department of Surgery), N. S. Goldstein (Department of Anatomic Pathology), William Beaumont Hospital, Royal Oak, MI.
Correspondence to: Frank A. Vicini, MD, Department of Radiation Oncology, William Beaumont Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48072 (e-mail: fvicini{at}beaumont.edu).
Background: Several phase III trials have demonstrated equivalent long-term survival between breast conserving surgery plus radiation therapy and mastectomy in patients with early-stage breast cancer but have not provided information on the optimal volume of breast tissue requiring post-lumpectomy radiation therapy. Therefore, we examined the 5-year results of a single institution’s experience with radiation therapy limited to the region of the tumor bed (i.e., limited-field radiation therapy) in selected patients treated with breast-conserving therapy and compared them with results of matched breast-conserving therapy patients who underwent whole-breast radiation therapy. Methods: A total of 199 patients with early-stage breast cancer were treated prospectively with breast-conserving therapy and limited-field radiation therapy using interstitial brachytherapy. To compare potential differences in local recurrence rates based on the volume of breast tissue irradiated, patients in the limited-field radiation therapy group were matched with 199 patients treated with whole-breast radiation therapy. Match criteria included tumor size, lymph-node status, patient age, margins of excision, estrogen receptor status, and use of adjuvant tamoxifen therapy. Local–regional control and disease-free and overall survival were analyzed using the Kaplan–Meier method, and the statistical significance of differences between treatment groups was calculated using the log-rank test. All statistical tests were two-sided. Results: Median follow-up for surviving patients was 65 months (range = 12–115 months). Five ipsilateral breast failures (i.e., recurrences) were observed in patients treated with limited-field radiation therapy. The cumulative incidence of local recurrence was 1% (95% confidence interval [CI] = 0% to 2.8%). On matched-pair analysis, the rate of local recurrence was not statistically significantly different between the patient groups (1% [95% CI = 0% to 2.4%] for the whole-breast radiation therapy patients versus 1% [95% CI = 0% to 2.8%] for the limited-field radiation therapy patients; P = .65). Conclusions: Limited-field radiation therapy administered to the region of the tumor bed has comparable 5-year local control rates to whole-breast radiation therapy in selected patients.
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