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No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT
Lund Univ, Dept Clin Sci, Oncol, Lund, Sweden.;Skane Univ Hosp, Skane Dept Oncol, Lund, Sweden..
Sahlgrens Univ Hosp, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
Dept Clin Sci, Canc Epidemiol, Lund, Sweden..
Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden..
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2016 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 67, p. 57-65Article in journal (Refereed) Published
Abstract [en]

Background: Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. Patients and methods: A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. Results: After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P < 0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P = 0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P = 0.68, nor was breast cancer specific mortality significantly higher. Conclusions: RT after BCS significantly reduced the incidence of IBTR at 15 years of followup. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systeinic therapy are needed to omit RT after BCS.

Place, publisher, year, edition, pages
2016. Vol. 67, p. 57-65
Keyword [en]
Breast cancer, Breast-conserving surgery, Ipsilateral breast tumour recurrence, Whole breast radiation, Contralateral breast cancer, Randomised trial
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-308625DOI: 10.1016/j.ejca.2016.08.001ISI: 000386191700007PubMedID: 27614164OAI: oai:DiVA.org:uu-308625DiVA: diva2:1050925
Funder
Swedish Cancer Society
Available from: 2016-11-30 Created: 2016-11-29 Last updated: 2017-11-29Bibliographically approved

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