title: Impact of systemic treatment on local control for patients with lymph node-negative breast cancer treated with breast-conservation therapy.
abstract: OBJECTIVE
  To determine the impact of tamoxifen and chemotherapy on local control for breast cancer patients treated with breast-conservation therapy.
  
  
  METHODS
  The data from 484 breast cancer patients who were treated with breast-conserving surgery and radiation were analyzed. Only patients with lymph node-negative disease were studied to provide comparative groups with a similar stage of disease and a similar competing risk for distant metastases. Actuarial local control rates of the 277 patients treated with systemic therapy (128, chemotherapy with or without tamoxifen; 149, tamoxifen alone) were compared with the rates for the 207 patients who received no systemic treatment. Only 10% of the patients had positive (2%), close (3%), or unknown margin status (5%).
  
  
  RESULTS
  Patients treated with systemic therapy had improved 5-year (97.5% v 89.8%) and 8-year (95.6% v 85.2%) local control rates compared with those that did not receive systemic treatment (P =.004, log-rank test). There was no statistical difference in local control between patients treated with chemotherapy and patients treated with tamoxifen alone (P =.219). Systemic treatment, margin status, young patient age, estrogen and progesterone receptor status, and primary tumor size were analyzed in a Cox regression analysis. The use of systemic treatment was the most powerful predictor of local control: patients who did not receive systemic treatment had a relative risk of local recurrence of 3.3 (95% confidence interval, 1.5 to 7.5; P =.004).
  
  
  CONCLUSIONS
  In this retrospective analysis, systemic therapy appears to contribute to long-term local control in patients with lymph node-negative breast cancer treated with breast-conservation therapy.
authors: Departments of Radiation Oncology, Biomathematics, Breast Medical Oncology, and Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. tbuchhol@mdanderson.org
authors: T A
authors: TA
authors: Buchholz
authors: S L
authors: SL
authors: Tucker
authors: J
authors: J
authors: Erwin
authors: D
authors: D
authors: Mathur
authors: E A
authors: EA
authors: Strom
authors: M D
authors: MD
authors: McNeese
authors: G N
authors: GN
authors: Hortobagyi
authors: M
authors: M
authors: Cristofanilli
authors: F J
authors: FJ
authors: Esteva
authors: L
authors: L
authors: Newman
authors: S E
authors: SE
authors: Singletary
authors: A U
authors: AU
authors: Buzdar
authors: K K
authors: KK
authors: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen