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Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy.
- Source :
-
Cancer [Cancer] 2003 Jan 01; Vol. 97 (1), pp. 30-9. - Publication Year :
- 2003
-
Abstract
- Background: A prospectively applied treatment policy for breast-conserving therapy used margin assessment as the exclusive guide to the intensity of radiation therapy directed at the tumor bed.<br />Methods: From 1982 to 1994, 498 women with 509 Stage I/II breast carcinomas with a median follow-up of 121 months were treated. Final margin status (FMS) categories were defined as greater than 5 mm, greater than 2-5 mm, greater than 0-2 mm, and positive. For margins less than or equal to 2 mm or indeterminate, reexcisions were performed if feasible. All patients received whole breast irradiation to 50.0-50.4 Gy. Final tumor bed boosts as a function of FMS were as follows: no residual on reexcision, no boost performed; FMS greater than 5 mm, boost of 10 Gy; FMS greater than 2-5 mm, boost of 14 Gy; FMS greater than 0-2 mm or positive, boost of 20 Gy. Cases were analyzed for local failure with respect to histology, age, tumor size, excision volume, reexcision, and total dose.<br />Results: FMS was positive, greater than 0-2 mm, greater than 2-5 mm, and greater than 5 mm, and no residual tumor on reexcision in 21%, 20%, 17%, 14%, and 28% of cases, respectively. At 12 years, Kaplan-Meier local failure rates were 17% for FMS positive, 9% for FMS greater than 0-2 mm, 5% for FMS greater than 2-5 mm, 0% for FMS greater than 5 mm, and 6% for specimens without evidence of residuum on reexcision (P = 0.009). Patients 45 years old and younger had a 12-year local failure rate of 15% whereas patients older than 45 years had a 12-year local failure rate of 6% (P = 0.01). On multivariate analysis, young age (P = 0.03) predicted increased local failure rate, whereas margins that were less than or equal to 2 mm or positive predicted late (> 5 years) but not early (< or = 5 years) recurrence (P = 0.003).<br />Conclusions: Graded tumor bed dose escalation in response to FMS results in very low rates of local failure over the first 5 years for all FMS categories. However, tumors with close/positive margins have significantly increased local failure rates after 5 years of follow-up even with increased radiation boost dose. In addition, graded tumor bed dose escalation does not fully overcome the adverse influence of young age.<br /> (Copyright 2003 American Cancer Society.DOI 10.1002/cncr.10981)
- Subjects :
- Adult
Aged
Aged, 80 and over
Breast Neoplasms surgery
Carcinoma, Ductal, Breast surgery
Carcinoma, Lobular surgery
Chemotherapy, Adjuvant
Cohort Studies
Combined Modality Therapy
Dose-Response Relationship, Radiation
Female
Follow-Up Studies
Humans
Middle Aged
Prospective Studies
Radiation Dosage
Breast Neoplasms radiotherapy
Carcinoma, Ductal, Breast radiotherapy
Carcinoma, Lobular radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 0008-543X
- Volume :
- 97
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 12491502
- Full Text :
- https://doi.org/10.1002/cncr.10981