The influence of surgical margins The influence of surgical margins on local control after breast on local control after breast conserving surgery and conserving surgery and postoperative radiotherapy postoperative radiotherapy Danijela Scepanovic, Martina Lukacovicova, Andrea Hurakova, Marg Danijela Scepanovic, Martina Lukacovicova, Andrea Hurakova, Marg ita Pobijakova ita Pobijakova National Cancer Institute of Slovakia, Bratislava National Cancer Institute of Slovakia, Bratislava ESTRO 29, September 12 – 16 2010, Barcelona, Spain
21
Embed
The influence of surgical margins on local control after breast conserving surgery and postoperative radiotherapy
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
The influence of surgical margins The influence of surgical margins on local control after breast on local control after breast
conserving surgery and conserving surgery and postoperative radiotherapypostoperative radiotherapy
Danijela Scepanovic, Martina Lukacovicova, Andrea Hurakova, MargDanijela Scepanovic, Martina Lukacovicova, Andrea Hurakova, Margita Pobijakovaita Pobijakova
National Cancer Institute of Slovakia, BratislavaNational Cancer Institute of Slovakia, Bratislava
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
BackgroundBackgroundRadiotherapy prevents local Radiotherapy prevents local
recurrence of breast cancer after recurrence of breast cancer after breastbreast--conserving surgery. conserving surgery.
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
PurposePurposeTo evaluate the influence of a surgical To evaluate the influence of a surgical
margins on local control, who underwent margins on local control, who underwent lumpectomy and whole breast irradiation lumpectomy and whole breast irradiation
with or without boost as part of their breast with or without boost as part of their breast conserving therapy (BCT) for early stage conserving therapy (BCT) for early stage
breast cancer (I and II stage).breast cancer (I and II stage).
Materials and methods, Materials and methods, from 2000 till 2004from 2000 till 2004
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Materials and methods, Materials and methods, from 2000 till 2004from 2000 till 2004
RadiotherapyRadiotherapy
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
• All of patients were operated by lumpectomy of a breast tumor and axillary dissection, followed by whole breast irradiation to 50Gy in 5
weeks, with two tangential fields, 6MVX energy.
• They were randomly assigned to receive either no extra irradiation or a boost dose of 10 - 16Gy to the original tumor bed.
• There were 328 pts (73%) with microscopically complete excision (more than 5mm) and 121 pts (27%) with a microscopically incomplete excision (less or equal than 5mm). Patients with
microscopically complete excision who did not receive boost were 159 (48%). However, boost was not applied in 33 pts (27%) with a
microscopically incomplete excision.
Technique of boost (N = 259)Dose of boost (N = 259)
Materials and methods, Materials and methods, from 2000 till 2004from 2000 till 2004
BoostBoost
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Materials and methods, Materials and methods, from 2000 till 2004from 2000 till 2004
ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Surgical margins were used to assess risk of local recurrence.
Also, we evaluated influence of• age
• menstrual status • histological type of cancer
• size of tumor • presence of axillar lymph nodes metastases
• presence of lymph–angioinvasion• histological grade
• presence of c-erb-B2/neu • application of boost and
• technique of boost (electrons or iridium 192 implant, high dose rate - HDR) on rate of local recurrence.
Surgical margins (N = 449)
Negative surgical margins were associated with statistically significant influenceon low risk of local recurrence (p < 0,001). However, there was not statistically
significant influence of boost in patients with microscopically incompleteexcision (p = 0,181).
Boost in patients with microscopicallyincomplete excision (N = 121)
SurgicalSurgicalmarginsmargins
NN 55--yearsyearsDFSDFS
betabeta RR (95% RR (95% CCI)I)
<5 mm<5 mm 121121 0,920,92 1,001,00>5 mm>5 mm 328328 0,990,99 --2,842,84 0,06 (0,01 0,06 (0,01 –– 0,26)0,26)
IV. IV. ResultsResults ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Axillar lymph nodes (N = 449)
Cox regression model could not be applicated on lymph nodes status. However, there was very statistically significant influence of negative lymph-angioinvasion
V. V. ResultsResults ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Grade (N = 393)
There was not local recurrence in patients with grade 1 of tumor. Influence ofHER2 status was not statistically significant to risk of local recurrence (p = 0,304).
ESTRO 29, September 12 – 16 2010, Barcelona, Spain VI. ResultsVI. Results
Application of boost (N = 449)
Application of boost had higher risk of local recurrence because the boost was applied in patients with positive surgical margins more often (p = 0,031).
Technique of boost had not influence on risk of local recurrence (p = 0,112).
VII. ResultsVII. Results ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Dose of boost (N = 259)
Dose <9 Gy was applied in 2 patients and >17 Gy in 3 patients. There was not any local recurrence in these two groups of patients. Risk of local recurrence has not
VIII. ResultsVIII. Results ESTRO 29, September 12 – 16 2010, Barcelona, Spain
Multivariable analysis
Patients with negative surgical margins had strongly statistically significant influence (p < 0,001) and patients with negative lymph/angioinvasion had
statistically significant influence on low risk of local recurrence (p = 0,007).
N = 44N = 4499 BetaBeta RR (95% RR (95% CCI)I) p p -- valuevalue