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Adjuvant treatments to prevent local reurrence after breast-conserving surgery for early breast cancer: radiation, endocrine- or brachytherapy
Örebro University, School of Medical Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiotherapy after breast-conserving surgery due to breast cancer is an established treatment, known to reduce the incidence of recurrence and even death from the disease. However some women are over-treated with sometimes serious adverse effects. De-escalating the treatment and find alternative adjuvant methods are becoming an important issue. In study I, we present the outcomes from a long-term follow-up trial randomising 381 women with breast cancer to surgery alone or to surgery with the addition of radiotherapy. The incidence of any first breast cancer event was significantly higher without radiotherapy but the protecting effect lasted for only the first five years. In study II, we collected the tissue samples from the tumours in study I to construct tissue micro-arrays. Immuno-histochemical analyses were performed and the tumours were classified into the intrinsic subtypes. The luminal B/HER2 negative subtype was found to be prognostic for ipsilateral breast cancer recurrence (IBTR). The intrinsic subtypes did not interact with radiotherapy. Study III was a multicentre prospective cohort study where the 601 study participants with early breast cancer were treated with surgery and endocrine therapy alone without postoperative radiotherapy. The cumulative incidence of IBTR after five years was low -1.2% and only one woman died of breast cancer. In study IV we evaluated the feasibility and treatment complications when introducing a new method for intraoperative brachytherapy (IOBT) using HDR equipment. We designed a pilot study including fifty women where half of them were treated during primary surgery and the others during a second procedure. The treatment was well tolerated and no logistic problems were reported. No acute adverse effects from IOBT were seen.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 65
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 181
Keywords [en]
Breast-conserving surgery, radiotherapy, endocrine therapy, intraoperative brachytherapy
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-66057ISBN: 978-91-7529-266-3 (print)OAI: oai:DiVA.org:oru-66057DiVA, id: diva2:1193057
Public defence
2018-06-08, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2018-10-03Bibliographically approved
List of papers
1. Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: 20-Year Results of a Randomized Trial
Open this publication in new window or tab >>Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: 20-Year Results of a Randomized Trial
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2014 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 32, no 8, p. 791-797Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate how radiotherapy (XRT) adds to tumor control using a standardized surgical technique with meticulous control of surgical margins in a randomized trial with 20 years of follow-up.

Patients and Methods: Three hundred eighty-one women with pT1N0 breast cancer were randomly assigned to sector resection with (XRT group) or without (non-XRT group) postoperative radiotherapy to the breast. With follow-up through 2010, we estimated cumulative proportion of recurrence, breast cancer death, and all-cause mortality.

Results: The cumulative probability of a first breast cancer event of any type after 20 years was 30.9% in the XRT group and 45.1% in the non-XRT group (hazard ratio [HR], 0.58; 95% CI, 0.41 to 0.82). The benefit of radiotherapy was achieved within the first 5 years. After 20 years, 50.4% of the women in the XRT group died compared with 54.0% in the non-XRT group (HR, 0.92; 95% CI, 0.71 to 1.19). The cumulative probability of contralateral cancer or death as a result of cancer other than breast cancer was 27.1% in the XRT group and 24.9% in the non-XRT group (HR, 1.17; 95% CI, 0.77 to 1.77). In an anticipated low-risk group, the cumulative incidence of first breast cancer of any type was 24.8% in the XRT group and 36.1% in the non-XRT group (HR, 0.61; 95% CI, 0.35 to 1.07).

Conclusion: Radiotherapy protects against recurrences during the first 5 years of follow-up, indicating that XRT mainly eradicates undetected cancer foci present at primary treatment. The similar rate of recurrences beyond 5 years in the two groups indicates that late recurrences are new tumors. There are subgroups with clinically relevant differences in risk.

Place, publisher, year, edition, pages
American Society of Clinical Oncology, 2014
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-56811 (URN)10.1200/JCO.2013.50.6600 (DOI)000332483400016 ()24493730 (PubMedID)2-s2.0-84899626690 (Scopus ID)
Available from: 2017-03-24 Created: 2017-03-24 Last updated: 2018-06-25Bibliographically approved
2. Influence of the subtype on local recurrence risk with or without radiotherapy in a randomized trial
Open this publication in new window or tab >>Influence of the subtype on local recurrence risk with or without radiotherapy in a randomized trial
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-66947 (URN)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-09-18Bibliographically approved
3. Omitting radiotherapy in women ≥ 65 years with low-risk early breast cancer after breast-conserving surgery and adjuvant endocrine therapy is safe
Open this publication in new window or tab >>Omitting radiotherapy in women ≥ 65 years with low-risk early breast cancer after breast-conserving surgery and adjuvant endocrine therapy is safe
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-66948 (URN)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-05-18Bibliographically approved
4. Intraoperative high dose rate brachytherapy during breast-conserving surgery: a prospective pilot study
Open this publication in new window or tab >>Intraoperative high dose rate brachytherapy during breast-conserving surgery: a prospective pilot study
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-66949 (URN)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-05-18Bibliographically approved

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Wickberg, Åsa

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