Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer

초기 유방암의 유방보존수술과 방사선치료의 장기추적결과

  • Kim, Jin-Hee (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Byun, Sang-Jun (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine)
  • 김진희 (계명대학교 의과대학 동산의료원 방사선종양학교실) ;
  • 변상준 (계명대학교 의과대학 동산의료원 방사선종양학교실)
  • Received : 2009.08.25
  • Accepted : 2009.09.09
  • Published : 2009.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. Materials and Methods: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. Results: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ($\leq$6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conclusion: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

목 적: 초기 유방암에서 유방 보존 수술과 방사선치료 후 실패양상과 생존율 및 미용효과를 알아보고자 하였다. 대상 및 방법: 1992년 1월부터 2002년 12월까지 계명대학교 동산의료원에서 유방보존수술과 방사선치료를 받은 초기 유방암환자 154명을 대상으로 하였다. TNM 병기는 1기 90명, IIa기 50명, IIb기 11명이었다. 모든 환자는 유방의 부분절제술과 동측 액와림프절 곽청술을 시행하고 방사선치료를 하였다. 유방의 방사선치료는 동측 전체 유방에 6 MV 광자선으로 50~54 Gy를 5주에서 6주간에 조사하였고 원발병소에 추가 방사선은 전자선으로 10~16 Gy를 조사하였다. 항암화학요법은 75명에서 방사선치료 전후에 시행하였고 호르몬치료는 92명에서 Tamoxifen을 사용하였다. 추적관찰기간은 13개월에서 179개월로 중앙값이 92.5개월이었다. 결 과: 전체환자의 5년, 10년 생존율은 97.3%, 94.5%이었다. 5년, 10년 무병생존율은 92.5%, 88.9%이었고 구제 치료후 5년, 10년 무병생존율은 93.9%, 90.2%이었다. 다변량 분석상 수술 후 방사선치료까지의 기간이($\leq$6 weeks vs. >6 weeks, p=0.017) 무병생존율에 있어서 통계적으로 유의한 예후 인자였다. 주된 실패양상은 원격전이였고 다발성으로 치료 후 중앙값 55.5개월에 전이를 하였다. 원격전이의 호발부위는 폐였다. 미용결과는 80.7%에서 좋음에서 매우 좋음으로 나타났다. 결 론: 초기 유방암에서 유방보존수술과 방사선치료는 우수한 생존율과 미용결과를 보인다고 생각된다. 또한 유방 보존수술 후 방사선치료는 가능한 한 빨리, 6주 이내에 시행되는 것이 좋을 것으로 생각된다.

Keywords

References

  1. Fisher B, Bauer M, Margolese R, et al. Five year result of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665-673 https://doi.org/10.1056/NEJM198503143121101
  2. Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol 1989;14:177-184 https://doi.org/10.1016/0167-8140(89)90165-5
  3. Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe methods in patients with small cancer of the breast long-term results of three randomized trials on 1,973 patients. Eur J Cancer 1995;31A:1574-1579
  4. National Institutes of Health Consensus Development Panel. Consensus statement: treatment of early-stage breast cancer. J Natl Cancer Inst Monogr 1992;11:1-5
  5. National Cancer Center. Cancer Prevalence Statistics: 23rd Korean Central Registry Report. Goyang; National Cancer Center, 2002
  6. Ahn SH, Yoo KY. The breast cancer society: chronological changes of clinical characteristics in 31115 new breast cancer patients among Koreans during 1996∼2004. Breast Cancer Res Treat 2006;99:209-214 https://doi.org/10.1007/s10549-006-9188-x
  7. Kim JH, Kim OB, Kim YS. Breast conserving operation and radiation therapy in early breast cancer: interim analysis. J Korean Soc Ther Radiol Oncol 2001;19:27-33
  8. Bland KI, Menck HR, Scott-Conner CE, Morrow M, Winchester DJ, Winchester DP. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer 1998;83:1262-1273 https://doi.org/10.1002/(SICI)1097-0142(19980915)83:6<1262::AID-CNCR28>3.0.CO;2-2
  9. Dubois JB, Gary-Bobo J, Pourquier H, et al. Tumorectomy and radiotherapy in early breast cancer: a report on 392 patients. Int J Radiat Oncol Biol Phys 1988;15:1275-1282 https://doi.org/10.1016/0360-3016(88)90221-0
  10. Fowble B, Solin LJ, Schultz DJ, et al. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys 1990;19:833-842 https://doi.org/10.1016/0360-3016(90)90002-2
  11. Kurtz JM, Amalric R, Brandone H, et al. Local recurrence after breast-conserving surgery and radiotherapy: frequency, time course, and prognosis. Cancer 1989;63:1912-1917 https://doi.org/10.1002/1097-0142(19890515)63:10<1912::AID-CNCR2820631007>3.0.CO;2-Y
  12. Pierquin B, Huart J, Raynal M, et al. Conservative treatment for breast cancer: long-term results (15 years). Radiother Oncol 1991;20:16-23 https://doi.org/10.1016/0167-8140(91)90107-R
  13. Solin LJ, Fowble B, Martz KL, et al. Definitive irradiation for early stage breast cancer: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 1988;14:235-242 https://doi.org/10.1016/0360-3016(88)90426-9
  14. Chie EK, Kim K, Choi JH, et al. Results of breast conserving surgery and subsequent postoperative radiotherapy for cases of breast cancer. J Korean Soc Ther Radiol Oncol 2008;26:142-148 https://doi.org/10.3857/jkstro.2008.26.3.142
  15. Kim KJ, Huh SJ, Yang JH, et al. Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol 2005;35:126-133 https://doi.org/10.1093/jjco/hyi039
  16. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-1241 https://doi.org/10.1056/NEJMoa022152
  17. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-1232 https://doi.org/10.1056/NEJMoa020989
  18. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003;98:697-702 https://doi.org/10.1002/cncr.11580
  19. Van Dongen JA, Voogd AC, Fentiman IS, et al. Longterm results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143-1145 https://doi.org/10.1093/jnci/92.14.1143
  20. Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992;11:19-25
  21. Veronesi U, Volterrani F, Luini A, et al. Quadrantectomy vs. lumpectomy for small size breast cancer. Eur J Cancer 1990;26:671-673 https://doi.org/10.1016/0277-5379(90)90114-9
  22. Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 2000;18:1668-1675 https://doi.org/10.1200/JCO.2000.18.8.1668
  23. Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999;44:1005-1015 https://doi.org/10.1016/S0360-3016(99)00112-1
  24. Leong C, Boyages J, Jayasinghe UW, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer 2004;100:1823-1832 https://doi.org/10.1002/cncr.20153
  25. Fowble BL, Schultz DJ, Overmoyer B, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys 1994;30:23-33 https://doi.org/10.1016/0360-3016(94)90515-0
  26. Zhou P, Reht A. Young age and outcome for women with early stage invasive breast carcinoma. Cancer 2004;101:1264-1274 https://doi.org/10.1002/cncr.20523
  27. Hankey BF, Miller B, Curtis R, Kosary C. Trends in breast cancer in younger women in contrast to older women. J Natl cancer Inst Monogr 1994;16:7-14
  28. Olivotto IA, Lesperance ML, Truong PT, et al. Intervals longer than 20 weeks from breast-conserving surgery to radiation therapy are associated with inferior outcome for women with early-stage breast cancer who are not receiving chemotherapy. J Clin Oncol 2009;27:16-23 https://doi.org/10.1200/JCO.2008.18.1891
  29. Huang J, Barbera L, Brouwers M, et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555-563 https://doi.org/10.1200/JCO.2003.04.171
  30. Chen Z, King W, Pearcey R, et al. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol 2008;87:3-16 https://doi.org/10.1016/j.radonc.2007.11.016
  31. H\acute{e}bert-Croteau N, Freeman CR, Latreille J, et al. Delay in adjuvant radiation treatment and outcomes of breast cancer: a review. Breast Cancer Res Treat 2002;74:77-94 https://doi.org/10.1023/A:1016089215070
  32. Powell SN, Taghian AG, Kachnic LA, Coen JJ, Assaad S. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys 2003;55:1209-1215 https://doi.org/10.1016/S0360-3016(02)04273-6
  33. Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, Harris EE. Time course of mild arm lymphedema after breast conservation treatment for early-stage breast cancer. Int J Radiat Oncol Biol Phys Epub 2009 May 8
  34. Dewar JA, Benhamou S, Benhamou E, et al. Cosmetic results following lumpectomy, axillary dissection and radiotherapy for small breast cancer. Radiother Oncol 1988;12:273-280 https://doi.org/10.1016/0167-8140(88)90016-3
  35. Beadle GF, Silver B, Botnick L, Hellman S, Harris JR. Cosmetic results following primary radiation therapy for early breast cancer. Cancer 1984;54:2911-2918 https://doi.org/10.1002/1097-0142(19841215)54:12<2911::AID-CNCR2820541216>3.0.CO;2-V
  36. Fowble B, Solin LJ, Schultz DJ, Goodman RL. Ten year results of conservative surgery and irradiation for stage I and II breast cancer. Int J Radiat Oncol Biol Phys 1991;21:269-277 https://doi.org/10.1016/0360-3016(91)90771-U
  37. Arenas M, Sabater S, Hernandez V, et al. Cosmetic outcome of breast conservative treatment for early stage breast cancer. Clin Transl Oncol 2006;8:334-338 https://doi.org/10.1007/s12094-006-0179-5
  38. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 2005;16:1569-1583 https://doi.org/10.1093/annonc/mdi326
  39. Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast conserving surgery in small breast carcinoma: long term results of a randomized trial. Ann Oncol 2001;12:997-1003 https://doi.org/10.1023/A:1011136326943
  40. Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 2004;351:971-977 https://doi.org/10.1056/NEJMoa040587
  41. Arthur D. Accelerated partial breast irradiation: a change in treatment paradigm for early stage breast cancer. J Surg Oncol 2003;84:185-191 https://doi.org/10.1002/jso.10318

Cited by

  1. Evaluations and Comparisons of Body Surface Doses during Breast Cancer Treatment by Tomotherapy and LINAC Radiotherapy Devices vol.28, pp.4, 2009, https://doi.org/10.14316/pmp.2017.28.4.218
  2. 유방암 환자의 Field-in-Field Technique 치료 시 호흡의 움직임에 따른 선량 평가 vol.41, pp.6, 2009, https://doi.org/10.17946/jrst.2018.41.6.561