[Correlation of risk factors with the efficacy of applied therapies by breast conserving procedure in breast cancer].
1007 cases of female breast cancer patients treated with breast conserving surgery and subsequently irradiation with a median dose of 66 (50-80) Gy including boost with tangential high voltage photon beams. 34.6% (348/1007) received no further therapies, 53.4% (538/1007) Tamoxifen, 26% (262/1007) an adjuvant chemotherapy +/- Tamoxifen. All tumors were classified on the basis of the pathologic-anatomical spreading: 70.7% (712/1007) pT1a-c, 27.4% (276/1007) pT2. 1.9% (19/1007) pT3-4 due to the refusal of mastectomy or an error in the preoperative diagnosis. 32.5% (327/1007) showed proven axillary metastases, of which 26.3% (86/327) > or = 4 LN+. Median age 56 (23-92) years. The local relapse rate after a median follow-up of 70 (12-264) months amounted to 5.9% (59/1007). Distant metastases were registered in 11.5% (116/1007). A total of 8.8% (89/1007) died as consequence of breast cancer, 3.2% (32/1007) of other causes. In 82.6% (816/988) of the pT1/pT2 tumors the resection area had been described. In 29.8% (156/524) in the resected parts there were found rests of tumors. The LRFS falls from 94% to 82% and by remained R1 (26/524) to 47%. Correlation likewise the DMFS, which sanks from 81% to 68% respectively to 63%. We expect a second wave of metastases like the situation by local relapses. Often the R1-resection was connected with other histological high risk factors as multifocality/-centricity, necrosis or vascular invasion. If one divides the patient case sample into a first group with special risk factors (< or = 40 years of age, > or = 4 positive axillary lymph nodes, vascular invasion), and a second which exhibited none of these components, the first group had a 23-26% lower disease free survival rate. Amazing is the fact that, subsequent to a lumpectomy and irradiation, the use or non use of Tamoxifen and/or cytostatics was without proven statistical significance. The evaluation was conceived and implemented more than 20 years ago, and documentation was continuously collected ever since. We're aware of the lack of randomization, but there are less the randomized studies than rather its transformations respectively the daily routine who will decide about life and death. However, evaluations of this data by medical oncologists would, on the one hand, make it possible to better assess the importance of the available data and our results, and, on the other hand, clarify the clinical value of partially and/or completely applied medical treatments.
Kantonsspital Aarau.
N
N
Schwegler
E
E
Puric
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen