title: Radiotherapy timing in 4,820 patients with breast cancer: university of florence experience.
abstract: OBJECTIVE
  To analyze the relationship between a delay in radiotherapy (RT) after breast-conserving surgery and ipsilateral breast recurrence (BR).
  
  
  METHODS
  We included in our analysis 4,820 breast cancer patients who had undergone postoperative RT at the University of Florence. The patients were categorized into four groups according to the interval between surgery and RT (T1, <60 days; T2, 61-120 days; T3, 121-180 days; and T4, >180 days).
  
  
  RESULTS
  On multivariate analysis, the timing of RT did not reach statistical significance in patients who received only postoperative RT (n = 1,935) or RT and hormonal therapy (HT) (n = 1,684) or RT, chemotherapy (CHT), and HT (n = 529). In the postoperative RT-only group, age at presentation, surgical margin status, and a boost to the tumor bed were independent prognostic factors for BR. In the RT plus HT group, age at presentation and boost emerged as independent prognostic factors for BR (p = 0.006 and p = 0.049, respectively). Finally, in the RT, CHT, and HT group, only multifocality was an independent BR predictor (p = 0.01). Only in the group of patients treated with RT and CHT (n = 672) did multivariate analysis with stepwise selection show RT timing as an independent prognostic factor (hazard ratio, 1.59; 95% confidence interval, 1.01-2.52; p = 0.045). Analyzing this group of patients, we found that most patients included had worse prognostic factors and had received CHT consisting of cyclophosphamide, methotrexate, and 5-fluorouracil before undergoing RT.
  
  
  CONCLUSIONS
  The results of our study have shown that the timing of RT itself does not affect local recurrence, which is mainly related to prognostic factors. Thus, the "waiting list" should be thought of as a "programming list," with patients scheduled for RT according to their prognostic factors.
authors: Radiotherapy Unit, University of Florence, Florence, Italy.
authors: Lorenzo
authors: L
authors: Livi
authors: Simona
authors: S
authors: Borghesi
authors: Calogero
authors: C
authors: Saieva
authors: Icro
authors: I
authors: Meattini
authors: Andrea
authors: A
authors: Rampini
authors: Alessia
authors: A
authors: Petrucci
authors: Beatrice
authors: B
authors: Detti
authors: Alessio
authors: A
authors: Bruni
authors: Fabiola
authors: F
authors: Paiar
authors: Monica
authors: M
authors: Mangoni
authors: Livia
authors: L
authors: Marrazzo
authors: Benedetta
authors: B
authors: Agresti
authors: Luigi
authors: L
authors: Cataliotti
authors: Simonetta
authors: S
authors: Bianchi
authors: Giampaolo
authors: G
authors: Biti
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016609:Neoplasms, Second Primary; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists