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KMID : 0859320080260040204
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2008 Volume.26 No. 4 p.204 ~ p.212
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Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer
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Cho Heung-Lae
Kim Cheol-Jin
Park Sung-Kwang
Oh Min-Kyung
Lee Jin-Yong
Ahn Ki-Jung
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Abstract
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Purpose: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early
breast cancer patients who have undergone breast conserving surgery and radiation therapy.
Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast
conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range 43.8∼129.4 months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for Tis and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had 1∼3 lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (≤2 mm) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy (41.4∼60.4 Gy) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients.
Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of
the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p＜0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome.
Conclusion: The results of this study have shown that breast conservation surgery and radiation therapy in early
breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.
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KEYWORD
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Breast cancer, Breast conserving surgery, Radiation therapy
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