title: Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients.
abstract: BACKGROUND
  Postoperative radiotherapy after breast-conserving surgery (BCS) is the standard in the management of breast cancer. The optimal timing for starting postoperative radiation therapy has not yet been well defined. In this study, we aimed to evaluate if the time interval between BCS and postoperative radiotherapy is related to the incidence of local and distant relapse in women with early node-negative breast cancer not receiving chemotherapy.
  
  
  METHODS
  We retrospectively analyzed clinical data concerning 615 women treated from 1984 to 2010, divided into three groups according to the timing of radiotherapy: ≤60, 61-120, and >120 days. To estimate the presence of imbalanced distribution of prognostic and treatment factors among the three groups, the χ2 test or the Fisher exact test were performed. Local relapse-free survival, distant metastasis-free survival (DMFS), and disease-free survival (DFS) were estimated with the Kaplan-Meier method, and multivariate Cox regression was used to test for the independent effect of timing of RT after adjusting for known confounding factors. The median follow-up time was 65.8 months.
  
  
  RESULTS
  Differences in distribution of age, type of hormone therapy, and year of diagnosis were statistically significant. At 15-year follow-up, we failed to detect a significant correlation between time interval and the risk of local relapse (p = 0.09) both at the univariate and the multivariate analysis. The DMFS and the DFS univariate analysis showed a decreased outcome when radiotherapy was started early (p = 0.041 and p = 0.046), but this was not confirmed at the multivariate analysis (p = 0.406 and p = 0.102, respectively).
  
  
  CONCLUSIONS
  Our results show that no correlation exists between the timing of postoperative radiotherapy and the risk of local relapse or distant metastasis development in a particular subgroup of women with node-negative early breast cancer.
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy. cap.ra@libero.it.
authors: Raffaella
authors: R
authors: Caponio
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Maria Paola
authors: MP
authors: Ciliberti
authors: Direzione Scientifica, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy.
authors: Giusi
authors: G
authors: Graziano
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Rocco
authors: R
authors: Necchia
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Giovanni
authors: G
authors: Scognamillo
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Antonio
authors: A
authors: Pascali
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Sabino
authors: S
authors: Bonaduce
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Anna
authors: A
authors: Milella
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Gabriele
authors: G
authors: Matichecchia
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Cristian
authors: C
authors: Cristofaro
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Davide
authors: D
authors: Di Fatta
authors: U.O. Fisica Sanitaria, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Bari, Italy.
authors: Pasquale
authors: P
authors: Tamborra
authors: U.O. Radioterapia, National Cancer Research Centre Istituto Tumori "Giovanni Paolo II", Via O. Flacco, 65, Bari, Italy.
authors: Marco
authors: M
authors: Lioce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000706:statistics & numerical data*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D011878:Radiotherapy / Q000706:statistics & numerical data; D016019:Survival Analysis
keywords: Distant metastases; Early-stage breast cancer; Local relapse; Radiotherapy; Survival; Timing