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672Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: An indication for radiotherapy?
S171 670
671
L O C O R E G I O N A L R E C U R R E N T BREAST C A N C E R P R O G N O S T I C FACTORS FOR DISTANT METASTASES C. Kamby, L. Sengelov Finsen Centre, Rigshospitalet and Department of Oncology Copenhagen University Hospital in Herlev, Denmark. We evaluated clinico-pathological and biochemical factors at primary diagnosis and at first recurrence in 140 patients (pts) with Iocoregional recurrence (52 local and 88 regional). All pts entered a staging protocol in the period of 1983-85. The aim was to define subbroups of pts at different risk of developing metastases in specific anatomical sites. Median follow-up was 10.4 years; 78 pts had distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 53 months. The actuarial rate of dissemination was 72% after 10 years. Median time to dissemination was 44 months for pts recurrence in the regional nodes compared to 78 months for pts with local recurrence only, p=0.05. There was no specific time sequence (temporal pattern) in the anatomical distribution of metastases. The location of recurrence (local vs regional) was tested together with 31 potential prognostic factors of distant metastases. Most significant (p<0.20) variables were selected for Cox analyses. Regional recurrence and level of S-lactate dehydrogenase were the most significant prognostic factors for distant metastases irrespective of site. Prognostic factors for bone metastases were presence of residual cancer in mastectomy specimen and presence of regional recurrence. There were no significant prognostic factors of soft tissue and visceral recurrence.
CONSERVATIVE THERAPY OF BREAST CANCER
F.Sanchiz, *6,. Milld, N.Artola, J.C.Juli~, L.M.Moya y J.Tornet. Centro de Radioterapia y Oncologia - C / Platon, 21 08006 - BARCELONA (Spain) From 1/1982 to 1/1995 a totdi of 714 patients with primary breast carcinoma (size less than 3 cm) were treated with tumarectomy or quadrontectomy and uxlllary dissection. After surgery putients received complementary Radiotherapy (Co60 photons) on the breast volume (50 Gy-25 froctlons, tangential fields) plus a boost on the tumoural bed (16 Gy-8 fractions).lpsilateral oxilosuprodovicular areas were irrodiated when axillusy involvement was above 4 + nodes (50 Gy, 25 froctions, anterior and posterior portals). Simultaneous adjuvant CMF (6 cycles) were opplied when oxlllary involvement was present. RESULTS:Patients chusocteristius were as follows: Age roge " ~ > 6 y.o. premenopousol 302, pustmenopuusal 412; tumourectomy 217, quodrontectomy 497; T1 512, T2 202; N+ 2 1 1 . Ranging follow-up was from 12 to 156 months (mean 61,3 months); 149 (21%) patients with recurrence (39 local) were detected. CONCLUSIONS:Conservative strategy for breast cancer is an usseful alternative to rnustectomy that should be advised to women with early-stage breast cancer.
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RADIOTHERAPy?
SECOND PRIMARY TUMOURS IN CHILDREN TREATED" FOR RETINOBLASTOMA WITH MEGAVOLTAGE EXTERNAL BEAM IRRADIATION
B.J. Fisher', F.E. ~erera', A.L. Cooke j, A. Opeitum j, A.R. Dar i, V.M. Venkatesan I, L. Stitt, I IDept. of Radiatlon Oncology, London Regional Cancer Centre and University of Western Ontario, London, Ontarlo, Canada
*P.Hofman,**S.M.Imhof,**K.E.W.P.Tan. * dept.of radiotherapy, University Hosp.Utrecht, Netherlands **dept.of ophthalmology, Free Univ.Hosp., A'dam, Netherlands
Purpose: To retrospectively review the failure patterns of 82 patients with Stage II or III breast cancer who had axillary node extracapsular extenslon (ECE} and who received systemic therapy without locoreglonal radiation. Methods and Materials: Of the 82 patients 45 had the gross extracapsular extension and 37 microscopic. The ErE-positive group was compared to a subgroup of 172 patients who did not have extracapsular axillary node extension. Results: Median age of the 82 ECE-poeitive patients was 56 years. Twenty-flve patients had segmental mastectomy, the remainder modified radical mastectomy. Median survival was 60 months, with a median disease-free and Iocoreglonal failure-free survival of 38 months. Seventy-eight percent of patients developed recurrence, which was Iocoreglonal in 66% (27% local, 27% reglonal, 3% 1ocoregional and 9% locoregional and metastatic}. There was a 36% recurrence rate in the intact breast, 14% recurred on the chest wall, 7% in the axilla, 12% in supraclavicular nodes and 1% in the IMC nodes. Unlvariate analysis of the entire 2 5 4 node-positive patient group revealed extracapsular extension to be prognostically significant for actuarial and disease-free survival and for locoregional failure. Comparison of the 82 ErE-positive patients with a group of 172 ECE-negatlve patients determined that there was a statistically significant d l f f e r e n c e b e t w e e n the two groups in terms of survlval (overall and disease-free) and locoreglonal recurrence. Segmental mastectomy and ER negative statue increased the risk of locoreglonal recurrence within the ErE-positive group. Conclumions: Extracapsulsr axillary node extension is a prognostically significant factor fo r actuarial survival, dlsease-free survival and locoregional failure, however the risk of axillary relapse in patients who have had an adequate axillary dissection is low {7%). We recoaDend iocoregional radiation for all patients with extranodal extension. Ax£11ary irradiation may b e omitted in patients who have had an adequate axillary dissection.
Introduction: Between 1970 and 1990 one-hundred-six patients with rethnoblastoma received external beam irradiation. The purpose of this study is to investigate the influence of irradiation on the occurrence of second primary tumors. Materials: Eighty-seven patients (group I) had the hereditary type, 19 patients (group If) a non-hereditary unilateral type. The follow-up ranged from 4 to 23 years. Methods: All patients were treated, with a uni- or bilateral Dshaped 6 MV linac field (26x32 mm), covering the emile retina of the affected eye(s). Results: In group I we found outside the irradiated volume 5 pineoblastomas and one malignant histiocytoma of the mandible. Inside the irradiated volume we found 2 rhabdomyosarcomas and one ostensarcoma. The latent period between the retinoblastoma and the development of a second primary ranged from 1.5 to 18 years. All patients with pJneoblastoma were seen within 3 years. In group II no second primary tumors were observed. For group I + I I the chance of being free from second tumors at l 0 years was 92 %, the actarially calculated survival was 90 %. Conclusions: -second primaries develop in patients with the hereditary type and are therefore not necessarily linked to the possible tumor inducing effect of irradiation. -as well the relatively short latent time between irradiation and the development of a pineob|astoma as the location outside the irradiated volume militate against a radiation induced tumor origin.
671
L O C O R E G I O N A L R E C U R R E N T BREAST C A N C E R P R O G N O S T I C FACTORS FOR DISTANT METASTASES C. Kamby, L. Sengelov Finsen Centre, Rigshospitalet and Department of Oncology Copenhagen University Hospital in Herlev, Denmark. We evaluated clinico-pathological and biochemical factors at primary diagnosis and at first recurrence in 140 patients (pts) with Iocoregional recurrence (52 local and 88 regional). All pts entered a staging protocol in the period of 1983-85. The aim was to define subbroups of pts at different risk of developing metastases in specific anatomical sites. Median follow-up was 10.4 years; 78 pts had distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 53 months. The actuarial rate of dissemination was 72% after 10 years. Median time to dissemination was 44 months for pts recurrence in the regional nodes compared to 78 months for pts with local recurrence only, p=0.05. There was no specific time sequence (temporal pattern) in the anatomical distribution of metastases. The location of recurrence (local vs regional) was tested together with 31 potential prognostic factors of distant metastases. Most significant (p<0.20) variables were selected for Cox analyses. Regional recurrence and level of S-lactate dehydrogenase were the most significant prognostic factors for distant metastases irrespective of site. Prognostic factors for bone metastases were presence of residual cancer in mastectomy specimen and presence of regional recurrence. There were no significant prognostic factors of soft tissue and visceral recurrence.
CONSERVATIVE THERAPY OF BREAST CANCER
F.Sanchiz, *6,. Milld, N.Artola, J.C.Juli~, L.M.Moya y J.Tornet. Centro de Radioterapia y Oncologia - C / Platon, 21 08006 - BARCELONA (Spain) From 1/1982 to 1/1995 a totdi of 714 patients with primary breast carcinoma (size less than 3 cm) were treated with tumarectomy or quadrontectomy and uxlllary dissection. After surgery putients received complementary Radiotherapy (Co60 photons) on the breast volume (50 Gy-25 froctlons, tangential fields) plus a boost on the tumoural bed (16 Gy-8 fractions).lpsilateral oxilosuprodovicular areas were irrodiated when axillusy involvement was above 4 + nodes (50 Gy, 25 froctions, anterior and posterior portals). Simultaneous adjuvant CMF (6 cycles) were opplied when oxlllary involvement was present. RESULTS:Patients chusocteristius were as follows: Age roge " ~ > 6 y.o. premenopousol 302, pustmenopuusal 412; tumourectomy 217, quodrontectomy 497; T1 512, T2 202; N+ 2 1 1 . Ranging follow-up was from 12 to 156 months (mean 61,3 months); 149 (21%) patients with recurrence (39 local) were detected. CONCLUSIONS:Conservative strategy for breast cancer is an usseful alternative to rnustectomy that should be advised to women with early-stage breast cancer.
672 sx~e.~Oz~
673 ~'~i~;L~y
NDns
ZX'm,SZO,
RECEIVING ADo-UVR~FT SYSTEMIC ~musuJ~PY:
z,,
~,~m~es
AN I N D I C A T I O N F O R
RADIOTHERAPy?
SECOND PRIMARY TUMOURS IN CHILDREN TREATED" FOR RETINOBLASTOMA WITH MEGAVOLTAGE EXTERNAL BEAM IRRADIATION
B.J. Fisher', F.E. ~erera', A.L. Cooke j, A. Opeitum j, A.R. Dar i, V.M. Venkatesan I, L. Stitt, I IDept. of Radiatlon Oncology, London Regional Cancer Centre and University of Western Ontario, London, Ontarlo, Canada
*P.Hofman,**S.M.Imhof,**K.E.W.P.Tan. * dept.of radiotherapy, University Hosp.Utrecht, Netherlands **dept.of ophthalmology, Free Univ.Hosp., A'dam, Netherlands
Purpose: To retrospectively review the failure patterns of 82 patients with Stage II or III breast cancer who had axillary node extracapsular extenslon (ECE} and who received systemic therapy without locoreglonal radiation. Methods and Materials: Of the 82 patients 45 had the gross extracapsular extension and 37 microscopic. The ErE-positive group was compared to a subgroup of 172 patients who did not have extracapsular axillary node extension. Results: Median age of the 82 ECE-poeitive patients was 56 years. Twenty-flve patients had segmental mastectomy, the remainder modified radical mastectomy. Median survival was 60 months, with a median disease-free and Iocoreglonal failure-free survival of 38 months. Seventy-eight percent of patients developed recurrence, which was Iocoreglonal in 66% (27% local, 27% reglonal, 3% 1ocoregional and 9% locoregional and metastatic}. There was a 36% recurrence rate in the intact breast, 14% recurred on the chest wall, 7% in the axilla, 12% in supraclavicular nodes and 1% in the IMC nodes. Unlvariate analysis of the entire 2 5 4 node-positive patient group revealed extracapsular extension to be prognostically significant for actuarial and disease-free survival and for locoregional failure. Comparison of the 82 ErE-positive patients with a group of 172 ECE-negatlve patients determined that there was a statistically significant d l f f e r e n c e b e t w e e n the two groups in terms of survlval (overall and disease-free) and locoreglonal recurrence. Segmental mastectomy and ER negative statue increased the risk of locoreglonal recurrence within the ErE-positive group. Conclumions: Extracapsulsr axillary node extension is a prognostically significant factor fo r actuarial survival, dlsease-free survival and locoregional failure, however the risk of axillary relapse in patients who have had an adequate axillary dissection is low {7%). We recoaDend iocoregional radiation for all patients with extranodal extension. Ax£11ary irradiation may b e omitted in patients who have had an adequate axillary dissection.
Introduction: Between 1970 and 1990 one-hundred-six patients with rethnoblastoma received external beam irradiation. The purpose of this study is to investigate the influence of irradiation on the occurrence of second primary tumors. Materials: Eighty-seven patients (group I) had the hereditary type, 19 patients (group If) a non-hereditary unilateral type. The follow-up ranged from 4 to 23 years. Methods: All patients were treated, with a uni- or bilateral Dshaped 6 MV linac field (26x32 mm), covering the emile retina of the affected eye(s). Results: In group I we found outside the irradiated volume 5 pineoblastomas and one malignant histiocytoma of the mandible. Inside the irradiated volume we found 2 rhabdomyosarcomas and one ostensarcoma. The latent period between the retinoblastoma and the development of a second primary ranged from 1.5 to 18 years. All patients with pJneoblastoma were seen within 3 years. In group II no second primary tumors were observed. For group I + I I the chance of being free from second tumors at l 0 years was 92 %, the actarially calculated survival was 90 %. Conclusions: -second primaries develop in patients with the hereditary type and are therefore not necessarily linked to the possible tumor inducing effect of irradiation. -as well the relatively short latent time between irradiation and the development of a pineob|astoma as the location outside the irradiated volume militate against a radiation induced tumor origin.