10-Year Results After Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: A Randomized Trial

• Published in: Journal of clinical oncology Vol. 17; no. 8; pp. 2326 - 2333
• Main Authors: LILJEGREN, G, HOLMBERG, L, BERGH, J, LINDGREN, A, TABAR, L, NORDGREN, H, ADAMI, H. O
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.08.1999; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Combined Modality Therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Postmenopause; Postoperative Period; Probability; Risk Factors; Tumors; Human; Relapse; Adjuvant treatment; Early stage; Malignant tumor; Radiotherapy; Mammary gland diseases; Treatment; Exeresis; Follow up study; Surgery; Risk factor; Mammary gland
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/jco.1999.17.8.2326

To study the long-term effectiveness of postoperative radiotherapy after sector resection for breast cancer in a randomized trial in which mammography is a major pathway to diagnosis. Three hundred eighty-one women with a unifocal breast cancer < or = 20 mm in diameter on the preoperative mammogram and without histopathologic signs of axillary metastases were treated by sector resection plus axillary dissection. Of these patients, 184 women were randomized to receive postoperative radiotherapy to the breast (XRT group), and 197 women received no further treatment (non-XRT group). The local recurrence rate was 8.5% (95% confidence interval [CI], 3.9% to 13.1%) in the XRT group and 24.0% (95% CI, 17.6% to 30.4%) in the non-XRT group (P =.0001). Survival free from regional and distant recurrence was 83. 3% in the XRT group (95% CI, 77.5% to 89.1%) and 80.0% in the non-XRT group (95% CI, 73.9% to 86.1%) (P =.23). Overall survival was 77.5% in the XRT group (95% CI, 70.9% to 84.1%) and 78% in the non-XRT group (95% CI, 71.7% to 84.3%) (P =.99). A subgroup analysis suggested that women older than 55 years of age without comedo or lobular carcinomas had a low risk of local recurrence of 6.1% (95% CI, 0.1% to 9.1%) in the XRT-group and 11.0% (4.0% to 18.0%) in the non-XRT group (P =.16). Sector resection plus radiotherapy resulted in an absolute reduction in local recurrence of 16% at 10 years compared with surgery alone. Women older than 55 years of age without comedo or lobular carcinomas may have a low risk of local recurrence. Postoperative radiotherapy was not shown to reduce distant recurrences or improve overall survival.