Outcome of breast-conservative therapy for early-stage breast cancer: a retrospective analysis / 中华放射肿瘤学杂志

ABSTRACT

Objective To analyze the results of survival and local regional control of early-stage breast cancer patients treated with breast-conserving surgery and whole breast radiation therapy, and to explore the factors influencing local control. Methods From October 1995 to September 2005,335 patients with early-stage breast cancer were treated with breast conservative therapy, including 25 with post-operative radiotherapy alone( group A), 194 with sequential chemo-radiotherapy( group B) ,80 with concurrent chemoradiotherapy( group C), and 36 with chemo-radio-chemotherapy (group D). Axillary dissection was performed in 312 patients and sentinel node biopsy in 2. Adjuvant chemotherapy was given to 310 patients. Radiation of 50 Gy in 25 fractions was delivered to the whole breast in 256 patients,and to the breast and regional nodes in 79. Another 10 Gy in 5 fractions was boosted to the tumor bed. The proportion of patients with surgery-radiation interval of less than 4 weeks,4-8 weeks,8-20 weeks and over 20 weeks was 16.4%, 23.6% ,37.3% and 22.7% ,respectively. Concurrent chemo-radiation and" sandwich" modality were delivered in 80 and 36 patients,respectively. Results The median follow-up was 48(25.3-146.7) months. The 5-year local-regional control and ipsilateral breast control rates were 94.5% and 95.6%, respectively. The 5-year disease-free survival,metastasis-free survival and overall survival rates were 88.6% ,93.2% and 98.8% ,respectively. Lymph-vascular invasion and neural invasion were significant factors influencing local control in univariate analysis. No significant differences were found in local control rates among different surgery-radiation intervals or different sequencing of radiotherapy and chemotherapy. Multivariate analysis showed that lymph-vascular invasion and reexcision for positive or unknown margin were independent prognostic factors influencing local control. In group A + B, C and D, the frequency of grade Ⅲ skin toxicity was4.5%.80.0%.and 77.0%,respectively(χ2=226.00,P=0.000).Conclusiom Breast conservative therapy for early-stage breast eancer results in good local-regional control and overall survival.Lymph-vascular invasion and reexcision are independent prognostic factors for local control.Surgery-radiation interval and sequencing of radiotherapy and chemotherapy have no impact on local contr01.Grade Ⅲ skin toxicity of the concurTent radio.chemotherapy and the chemo.radio.chemotherapy group is significantly higher than that of the sequential chemotherapy-radiotherapy plus radiotherapy alone group.