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4–31 Malignant Breast Tumors After Radiotherapy for a First Cancer During Childhood
RADIATION THERAPY 4–31
Malignant Breast Tumors After Radiotherapy for a First Cancer During Childhood Guibout C, Adjadj E, Rubino C, et al (Institut Gustave Roussy, Villejuif, France) J Clin Oncol 23:197-204, 2005
Background.—Breast tissue is one of the most radiosensitive organs in the body, particularly in children. Significant improvements in cancer therapies have enabled children with cancer to become long-term survivors, with 70% surviving for at least 5 years; among pediatric patients with Hodgkin’s disease, the rate of survival for at least 5 years is 94%. Patients who undergo radiotherapy or other cancer therapies in childhood are thought to be at significant risk of developing late sequelae. The purpose of this study was to clarify the role of specific treatment and type of first cancer in
4–32
The Management of Elderly Patients With T1-T2 Breast Cancer Treated With or Without Radiotherapy Livi L, Paiar F, Meldolesi E, et al (Univ of Florence, Italy; Centro per lo Studio e la Prevenzione Oncologia, Florence, Italy) Eur J Surg Oncol 31:473-478, 2005
Aim.—The aim of the current study is to identify a subgroup of patients with breast cancer who have a low risk of local recurrence after conservative surgery in order to avoid radiotherapy treatment.
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the long-term risk of subsequent breast cancer among childhood cancer survivors. Methods.—Data on chemotherapy and radiotherapy regimens were collected for a group of 1,814 3-year female cancer survivors treated between 1946 and 1986 at 8 French or English centers. Individual estimation of Radiation doses to each breast were estimated for the 1,258 patients given external-beam radiotherapy. The mean dose to the breast was 5.06 Gy (range, 0.0-88.0 Gy) delivered in a mean of 20 fractions. Findings.—During a mean followup period of 16 years (range, 3-46 years), 16 patients developed a clinical breast cancer (0.95 cases expected), 13 after having had radiotherapy. The cumulative incidence of breast cancer was 2.8% at 30 years after the first cancer (95% confidence interval [CI], 1.0% to 4.5%) and 10.7% after 40 years (95% CI, 1.4% to 19.9%). The annual excess incidence in-
creased with age, whereas the standardized incidence ratio decreased. On average, each Gray received by any breast increased the excess relative risk of breast cancer by 0.13 (range, < 0 to 0.75; P = 0.06). After adjustment for castration, age at first cancer, attained age, radiation dose to the breast, and chemotherapy vs no chemotherapy, the risk of developing a subsequent breast cancer was highest among patients treated for Hodgkin’s disease (relative risk, 7.01; 95% CI, 1.430.9). Conclusions.—The high risk of developing breast cancer after treatment for Hodgkin’s disease in childhood seems to be attributable not only to high radiation doses to the breast but also to a specific susceptibility.
Methods.—A group of 472 patients underwent conservative surgery without radiotherapy, and it was compared to a second group of 755 patients with similar characteristics, but who had received radiotherapy treatment (RT) after conservative surgery. Results.—Breast relapse’s univariate analysis demonstrated statistical significance for the following factors: radiotherapy treatment, clinical stage, pathological stage, positive axillary nodes and tumour grading. Different results were obtained studying breast relapse. In the no-RT group breast relapse was 10.6% while in
the irradiated group it was 3.4%. The breast relapse incidence decreases as the age of the patients increases especially over 75 years of age. Conclusions.—In conclusion, there is clinical evidence of avoiding adjuvant radiotherapy for patients over 75 years with T1-T2 cancer treated with quadrantectomy with a clear excision margin.
Breast Diseases: A Year Book Quarterly Vol 16 No 4 2006
See the Expert Perspective by Mansur in this issue.
Identifying subgroups of patients who do not need adjuvant therapy is critical to improving the standard of care in breast cancer treatment. In this article, Livi and colleagues tackled an important aspect of this issue by exam-
Malignant Breast Tumors After Radiotherapy for a First Cancer During Childhood Guibout C, Adjadj E, Rubino C, et al (Institut Gustave Roussy, Villejuif, France) J Clin Oncol 23:197-204, 2005
Background.—Breast tissue is one of the most radiosensitive organs in the body, particularly in children. Significant improvements in cancer therapies have enabled children with cancer to become long-term survivors, with 70% surviving for at least 5 years; among pediatric patients with Hodgkin’s disease, the rate of survival for at least 5 years is 94%. Patients who undergo radiotherapy or other cancer therapies in childhood are thought to be at significant risk of developing late sequelae. The purpose of this study was to clarify the role of specific treatment and type of first cancer in
4–32
The Management of Elderly Patients With T1-T2 Breast Cancer Treated With or Without Radiotherapy Livi L, Paiar F, Meldolesi E, et al (Univ of Florence, Italy; Centro per lo Studio e la Prevenzione Oncologia, Florence, Italy) Eur J Surg Oncol 31:473-478, 2005
Aim.—The aim of the current study is to identify a subgroup of patients with breast cancer who have a low risk of local recurrence after conservative surgery in order to avoid radiotherapy treatment.
368 368
®
the long-term risk of subsequent breast cancer among childhood cancer survivors. Methods.—Data on chemotherapy and radiotherapy regimens were collected for a group of 1,814 3-year female cancer survivors treated between 1946 and 1986 at 8 French or English centers. Individual estimation of Radiation doses to each breast were estimated for the 1,258 patients given external-beam radiotherapy. The mean dose to the breast was 5.06 Gy (range, 0.0-88.0 Gy) delivered in a mean of 20 fractions. Findings.—During a mean followup period of 16 years (range, 3-46 years), 16 patients developed a clinical breast cancer (0.95 cases expected), 13 after having had radiotherapy. The cumulative incidence of breast cancer was 2.8% at 30 years after the first cancer (95% confidence interval [CI], 1.0% to 4.5%) and 10.7% after 40 years (95% CI, 1.4% to 19.9%). The annual excess incidence in-
creased with age, whereas the standardized incidence ratio decreased. On average, each Gray received by any breast increased the excess relative risk of breast cancer by 0.13 (range, < 0 to 0.75; P = 0.06). After adjustment for castration, age at first cancer, attained age, radiation dose to the breast, and chemotherapy vs no chemotherapy, the risk of developing a subsequent breast cancer was highest among patients treated for Hodgkin’s disease (relative risk, 7.01; 95% CI, 1.430.9). Conclusions.—The high risk of developing breast cancer after treatment for Hodgkin’s disease in childhood seems to be attributable not only to high radiation doses to the breast but also to a specific susceptibility.
Methods.—A group of 472 patients underwent conservative surgery without radiotherapy, and it was compared to a second group of 755 patients with similar characteristics, but who had received radiotherapy treatment (RT) after conservative surgery. Results.—Breast relapse’s univariate analysis demonstrated statistical significance for the following factors: radiotherapy treatment, clinical stage, pathological stage, positive axillary nodes and tumour grading. Different results were obtained studying breast relapse. In the no-RT group breast relapse was 10.6% while in
the irradiated group it was 3.4%. The breast relapse incidence decreases as the age of the patients increases especially over 75 years of age. Conclusions.—In conclusion, there is clinical evidence of avoiding adjuvant radiotherapy for patients over 75 years with T1-T2 cancer treated with quadrantectomy with a clear excision margin.
Breast Diseases: A Year Book Quarterly Vol 16 No 4 2006
See the Expert Perspective by Mansur in this issue.
Identifying subgroups of patients who do not need adjuvant therapy is critical to improving the standard of care in breast cancer treatment. In this article, Livi and colleagues tackled an important aspect of this issue by exam-