title: Effect of local therapy on locoregional recurrence in postmenopausal women with breast cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial.
abstract: OBJECTIVE
  The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of either exemestane or the sequence of tamoxifen followed by exemestane in postmenopausal hormone-sensitive breast cancer. The present analyses explored the association between locoregional therapy and recurrence (LRR) in this population.
  
  
  METHODS
  Between 2001 and 2006, 9779 patients were randomized. Local treatment was breast conserving surgery plus radiotherapy (BCS+RT), mastectomy without radiotherapy (MST-only), or mastectomy plus radiotherapy (MST+RT). Patients with unknown data on surgery, radiotherapy, tumor or nodal stage (n=199), and patients treated by lumpectomy without radiotherapy (n=349) were excluded.
  
  
  RESULTS
  After a median follow-up of 5.2 years, 270 LRRs occurred (2.9%) among 9231 patients. The 5-years actuarial incidence of LRR was 4.2% (95% CI 3.3-4.9%) for MST-only, 3.4% (95% CI 2.4-4.2%) for MST+RT and 1.9% (95% CI 1.5-2.3%) for BCS+RT. After adjustment for prognostic factors, the hazard ratio (HR, reference BCS+RT) for LRR remained significantly higher for MST-only (HR 1.53; 95% CI 1.10-2.11), not for MST+RT (HR 0.78; 95% CI 0.50-1.22).
  
  
  CONCLUSIONS
  This explorative analysis showed a higher LRR risk after MST-only than after BCS+RT, even after adjustment for prognostic factors. As this effect was not seen for MST+RT versus BCS+RT, it might be explained by the beneficial effects of radiation treatment.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, The Netherlands. Electronic address: m.van_hezewijk@lumc.nl.
authors.forename: Marjan
authors.initials: M
authors.lastname: van Hezewijk
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Astrid N
authors.initials: AN
authors.lastname: Scholten
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Liefers
authors.forename: Daniel
authors.initials: D
authors.lastname: Rea
authors.forename: Annette
authors.initials: A
authors.lastname: Hasenburg
authors.forename: Robert
authors.initials: R
authors.lastname: Paridaens
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hozumi
authors.forename: Christos
authors.initials: C
authors.lastname: Markopoulos
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Jones
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007391:International Cooperation; D015412:Mastectomy, Segmental / Q000379:methods; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D017698:Postmenopause; D011379:Prognosis; D011960:Receptors, Estrogen / Q000235:genetics / Q000378:metabolism; D011980:Receptors, Progesterone / Q000235:genetics / Q000378:metabolism; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D013629:Tamoxifen / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D013629:Tamoxifen; C056516:exemestane
keywords: Breast cancer; Breast conserving surgery; Locoregional recurrence; Mastectomy; Postmenopausal women; Radiation