Impact of radiotherapy technique on the outcome of early breast cancer treated with conservative surgery: A multicenter observational study on 1,176 patients.
OBJECTIVE
To quantify the impact of radiotherapy technique on cosmetic outcome and on 5-year local control rate of early breast cancer treated with conservative surgery and adjuvant radiation.


METHODS
A total of 1,176 patients irradiated to the breast in 1997 were entered by eight centers into a prospective, observational study. Surgical procedure was quadrantectomy in 97% of patients, with axillary dissection performed in 96%; pT-stage was T1 in 81% and T2 in 19% of cases; pN-stage was N0 in 71%, N + (1-3) in 21%, and N + (>3) in 8% of cases. An immobilization device was used in 17% of patients; external contour-based and computed tomography-based treatment planning were performed in 20% and 72% of cases, respectively; 37% of patients were treated with a telecobalt unit and 63% with a linear accelerator; portal verification was used in 55% of patients; a boost dose to the tumor bed was delivered in 60% of cases.


RESULTS
With a median follow-up of 6.2 years, local, regional, and distant control rates at 5 years are 98%, 99%, and 92%, respectively. Use of less sophisticated treatment technique was associated with a less favorable cosmetic outcome. Local control was comparable between centers despite substantial technical differences. In a multivariate analysis including clinical and technical factors, only older age and prescription of medical adjuvant treatment significantly predicted for better local control, whereas use of portal verification was of borderline significance.


CONCLUSIONS
Radiation technical factors impacted negatively on cosmetic outcome, but had relatively small effects on local control compared with other clinical factors.
Palazzi
Mauro
M
Istituto Nazionale Tumori, Milan, Italy. mauro.palazzi@istitutotumori.mi.it
Tomatis
Stefano
S
Valli
Maria Carla
MC
Guzzetti
Renata
R
Tonoli
Sandro
S
Bertoni
Filippo
F
Magrini
Stefano Maria
SM
Meregalli
Sofia
S
Asnaghi
Diego
D
Arienti
Virginia
V
Pradella
Renato
R
Cafaro
Ines
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000379:methods / Q000401:mortality; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D015996:Survival Rate