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Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC)

Abstract

PURPOSE: To determine whether patients with early-stage SBBC can be safely and effectively treated with bilateral BCT. MATERIALS and METHODS: We retrospectively reviewed records of 26 patients with clinical Stage I-II SBBC treated between 1968-1989 with bilateral BCT. SBBC was defined as tumors diagnosed no more than one month apart, with both sides demonstrating invasive cancer. Maximum (max) clinical stage was based on the more advanced breast tumor. Median age at diagnosis was 56 years (range, 32-85 years); menopausal status was 6 pre-, 16 post-, 3 peri-, and 1 unknown at diagnosis. Median follow-up for surviving pts is 95 months (range, 68-157). Outcome was compared to 1325 pts with unilateral Stage I or II breast cancer, within the same age range, treated during the same time period. There were no significant differences in median age, median total dose, tumor size, estrogen receptor (ER) status, pathologic nodal status, and use of systemic therapy between the study population and the comparison group. Local recurrence (LR) was evaluated as true recurrence (TR, i.e., in the original tumor bed), marginal miss (MM, at the edge of the boost field), or elsewhere (E). Median total dose to the primary was 6100 cGy (range, 5000-7000). Pathology  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CYTOLOGICAL TECHNIQUES; ESTROGENS; LYMPH NODES; MAMMARY GLANDS; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; PATHOLOGICAL CHANGES; RADIATION DOSES; RADIOTHERAPY; RECEPTORS; SIZE; SURVIVAL CURVES; TOXICITY
OSTI ID:
20420660
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1896005065
Submitting Site:
INIS
Size:
page(s) 211
Announcement Date:

Citation Formats

Gollamudi, Smitha V, Gelman, Rebecca S, Peiro, Gloria, Schneider, Lindsey, Connolly, James L, Schnitt, Stuart, Silver, Barbara, and Harris, Jay R. Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC). United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97804-A.
Gollamudi, Smitha V, Gelman, Rebecca S, Peiro, Gloria, Schneider, Lindsey, Connolly, James L, Schnitt, Stuart, Silver, Barbara, & Harris, Jay R. Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC). United States. doi:10.1016/0360-3016(95)97804-A.
Gollamudi, Smitha V, Gelman, Rebecca S, Peiro, Gloria, Schneider, Lindsey, Connolly, James L, Schnitt, Stuart, Silver, Barbara, and Harris, Jay R. 1995. "Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC)." United States. doi:10.1016/0360-3016(95)97804-A. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97804-A.
@misc{etde_20420660,
title = {Breast-conserving therapy (BCT) in stage I-II synchronous bilateral breast cancer (SBBC)}
author = {Gollamudi, Smitha V, Gelman, Rebecca S, Peiro, Gloria, Schneider, Lindsey, Connolly, James L, Schnitt, Stuart, Silver, Barbara, and Harris, Jay R}
abstractNote = {PURPOSE: To determine whether patients with early-stage SBBC can be safely and effectively treated with bilateral BCT. MATERIALS and METHODS: We retrospectively reviewed records of 26 patients with clinical Stage I-II SBBC treated between 1968-1989 with bilateral BCT. SBBC was defined as tumors diagnosed no more than one month apart, with both sides demonstrating invasive cancer. Maximum (max) clinical stage was based on the more advanced breast tumor. Median age at diagnosis was 56 years (range, 32-85 years); menopausal status was 6 pre-, 16 post-, 3 peri-, and 1 unknown at diagnosis. Median follow-up for surviving pts is 95 months (range, 68-157). Outcome was compared to 1325 pts with unilateral Stage I or II breast cancer, within the same age range, treated during the same time period. There were no significant differences in median age, median total dose, tumor size, estrogen receptor (ER) status, pathologic nodal status, and use of systemic therapy between the study population and the comparison group. Local recurrence (LR) was evaluated as true recurrence (TR, i.e., in the original tumor bed), marginal miss (MM, at the edge of the boost field), or elsewhere (E). Median total dose to the primary was 6100 cGy (range, 5000-7000). Pathology was available for review in 19 cases. Cytology (nuclear and cytoplasmic features) was similar in (7(19)) evaluable cases, and architecture (growth pattern, ie, papillary, solid) was similar in (5(19)) cases. The presence of either cytologic or architectural similarity was noted in(9(19)) cases. 7 of 19 pts who had axillary lymph node evaluation on at least one side had pathological confirmation of lymph node metastasis. Stage was the same in both breasts in 13 cases (10 Stage I, 3 Stage II); ER status data was complete in 11 pts, and the same in both primaries in 9 cases. Cosmetic results and complications after BCT were scored. Statistical significance was evaluated by use of the Fisher exact test. RESULTS: The 5-yr actuarial cause-specific survival (CSS) rate of the 26 pts with SBBC was 92%, and the 5-yr disease-free survival (DFS) rate was 68%. At 5 yrs, 22 of 26 pts were alive, and 2 pts died of disease. 5 pts had a LR (1MM, 1 E, 2 TR, and 1 unknown). We compared the 5-yr crude distribution of sites of first failure between SBBC and unilateral breast cancer (Tables 1 and 2) and the differences were not significant (p value=0.28). Table 3 shows the relationship between family history (FH), age, stage and 5-yr crude first failure rates; none of these factors predicted for outcome. A multivariate analysis for DFS and overall survival included the following variables: unilateral vs. bilateral, age, stage, median total dose, ER status, and nodal status; unilateral vs. bilateral did not emerge as a significant factor for DFS (p value=0.16) or overall survival (p value=0.62). Physician assessment of cosmetic outcome was excellent in 57% and good in 43% of SBBC pts evaluated 25 to 48 months after BCT. These cosmetic results were not significantly different from our unilateral comparison group. 3 of 26 pts experienced long-term toxicity. 1 pt who received bilateral RT to internal mammary, supraclavicular and axillary nodes had pneumonitis and pericarditis 16 months after completion of RT which was treated with steroids and pericardial stripping. The same pt experienced a left upper extremity thrombophlebitis 2 yrs after completing RT. 1 pt had persistent left upper extremity edema beginning 6 months after RT and persisting for 9 years. Another pt experienced L'Hermitte's syndrome 9 months after completing RT, which resolved in 6 weeks. 14 of 1325 pts (1%) in the unilateral comparison group had radiation pneumonitis after BCT and 20 pts (2%) experienced arm edema. The toxicity rates were not significantly different between the SBBC and comparison groups. CONCLUSION: Patients with early-stage SBBC can be safely treated with carefully planned, bilateral BCT with outcome that appears to be comparable to patients with early-stage unilateral breast cancer.}
doi = {10.1016/0360-3016(95)97804-A}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}