Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy
(1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Subjects were 2,264 women with pT1–3, any N, M0 i...
Saved in:
| Published in | International journal of radiation oncology, biology, physics Vol. 81; no. 4; pp. e561 - e568 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
15.11.2011
|
| Subjects | |
| Online Access | Get full text |
Cover
Loading…
| Abstract | (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost.
Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed.
Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001).
On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. |
|---|---|
| AbstractList | Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast +/- boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade, 11.3% with lymphovascular invasion (LVI), and 26.3% with greater than or equal to 4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, greater than or equal to 4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). Conclusions: On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade, LVI, and greater than or equal to 4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost.PURPOSE(1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost.Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed.METHODS AND MATERIALSSubjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed.Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001).RESULTSMedian follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001).On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.CONCLUSIONSOn univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast {+-} boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with {>=}4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, {>=}4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). Conclusions: On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and {>=}4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. Purpose ( 1 ) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; ( 2 ) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative ( n = 1,980), close ( n = 222), and positive ( n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively ( p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). Conclusions On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery. |
| Author | Alexander, Cheryl Lupe, Krystine Speers, Caroline Lesperance, Mary Tyldesley, Scott Truong, Pauline T. |
| Author_xml | – sequence: 1 givenname: Krystine surname: Lupe fullname: Lupe, Krystine organization: British Columbia Cancer Agency, Department of Radiation Oncology, Victoria and Vancouver, British Columbia, Canada – sequence: 2 givenname: Pauline T. surname: Truong fullname: Truong, Pauline T. email: ptruong@bccancer.bc.ca organization: British Columbia Cancer Agency, Department of Radiation Oncology, Victoria and Vancouver, British Columbia, Canada – sequence: 3 givenname: Cheryl surname: Alexander fullname: Alexander, Cheryl organization: Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada – sequence: 4 givenname: Mary surname: Lesperance fullname: Lesperance, Mary organization: Department of Mathematics and Statistics, University of Victoria, Victoria, Vancouver, British Columbia, Canada – sequence: 5 givenname: Caroline surname: Speers fullname: Speers, Caroline organization: Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada – sequence: 6 givenname: Scott surname: Tyldesley fullname: Tyldesley, Scott organization: British Columbia Cancer Agency, Department of Radiation Oncology, Victoria and Vancouver, British Columbia, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/21514069$$D View this record in MEDLINE/PubMed https://www.osti.gov/biblio/22054430$$D View this record in Osti.gov |
| BookMark | eNqFkl2LEzEUhoOsuN3VfyAS8EJvpuYk89EBEXbrxwoVl1ZZ70Imc6bN7DSpyUyhf8Tfa8bWOz_gQEJ4zpuXc94LcmadRUKeApsCg_xVOzWtd9VuyhnAlPFY8IBMYFaUiciyb2dkwkTOEhHhc3IRQstYJIv0ETnnkEHK8nJCfqyGKmAfqGvonduipXem39B55wJS5-mtC6Y3e6SflF8bG-hV06On1x5V6JO5swH93tg1XQ1-jf5wbL8x6w1dOK06ukQ9eI9WI12acE_fYtiZHk8K9LYbAr12Ll6Xqjau36BXu8Nj8rBRXcAnp_OSfH3_7sv8Jll8_vBxfrVIMBVpn8yYrpq8yfKmUVBojaziLBNQzyqB8UGUtYJKcYCs4bzQmchr3pQZS8uMQ5OKS_L8qBsNGBl0dKY32lmLupc8aqWpYJF6caR23n0fMPRya4LGrlMW3RBkyUCwNIeRfPlPEvJZkedCgIjosxM6VFus5c6brfIH-Xs3EXhzBDAOYG_Qj_7GQdbGj_ZqZyQwOYZBtvIYBjmGQTIeC_4goDtjTdzKPR4wtG7wNg5XggyxQa7GuIxpAWBM8F8Cr_8u8P__fwIXcdMO |
| ContentType | Journal Article |
| Copyright | 2011 Elsevier Inc. Elsevier Inc. Copyright © 2011 Elsevier Inc. All rights reserved. |
| Copyright_xml | – notice: 2011 Elsevier Inc. – notice: Elsevier Inc. – notice: Copyright © 2011 Elsevier Inc. All rights reserved. |
| DBID | CGR CUY CVF ECM EIF NPM 7U7 C1K 7X8 OTOTI |
| DOI | 10.1016/j.ijrobp.2011.02.021 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed Toxicology Abstracts Environmental Sciences and Pollution Management MEDLINE - Academic OSTI.GOV |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) Toxicology Abstracts Environmental Sciences and Pollution Management MEDLINE - Academic |
| DatabaseTitleList | Toxicology Abstracts MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1879-355X |
| EndPage | e568 |
| ExternalDocumentID | 22054430 21514069 S0360301611003221 1_s2_0_S0360301611003221 |
| Genre | Journal Article |
| GeographicLocations | British Columbia |
| GeographicLocations_xml | – name: British Columbia |
| GroupedDBID | --- --K .1- .FO 0R~ 1B1 1P~ 1RT 1~5 4.4 457 4G. 53G 5RE 5VS 7-5 AAEDT AAEDW AAQFI AAQQT AAWTL AAXUO ABJNI ABLJU ABNEU ABOCM ABUDA ACGFS ACIUM ACVFH ADBBV ADCNI ADVLN AENEX AEUPX AEVXI AFPUW AFRHN AFTJW AGCQF AHHHB AIGII AITUG AJUYK AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ BELOY DU5 EBS EFKBS EJD F5P FDB GBLVA HED HMO HZ~ IHE J1W KOM LX3 M41 MO0 O9- OC~ OO- RNS ROL RPZ SDG SEL SES SSZ UV1 XH2 Z5R ~S- .55 .GJ 29J AALRI AAQXK ABEFU ABWVN ACRPL ADMUD ADNMO ADPAM AFCTW AFFNX AFJKZ AGRDE ASPBG AVWKF AZFZN EFJIC FEDTE FGOYB FIRID G-2 HMK HVGLF HX~ NQ- R2- RIG SAE SEW UDS X7M XPP ZGI AAIAV AGZHU ALXNB ZA5 CGR CUY CVF ECM EIF NPM 7U7 C1K 7X8 ABPTK OTOTI |
| ID | FETCH-LOGICAL-e434t-80cbf6f56ffa17cce0b20531d8b3e17c39da1ba2115f227c536d2f95049521f43 |
| ISSN | 0360-3016 1879-355X |
| IngestDate | Fri May 19 00:47:20 EDT 2023 Fri Jul 11 15:16:41 EDT 2025 Tue Aug 05 10:36:07 EDT 2025 Thu Apr 03 06:49:48 EDT 2025 Fri Feb 23 02:26:53 EST 2024 Sun Feb 23 10:19:01 EST 2025 Tue Aug 26 16:31:55 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 4 |
| Keywords | Surgical margins Breast cancer Breast-conserving therapy Radiotherapy boost Local recurrence |
| Language | English |
| License | Copyright © 2011 Elsevier Inc. All rights reserved. |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-e434t-80cbf6f56ffa17cce0b20531d8b3e17c39da1ba2115f227c536d2f95049521f43 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 21514069 |
| PQID | 1687663313 |
| PQPubID | 23462 |
| ParticipantIDs | osti_scitechconnect_22054430 proquest_miscellaneous_901304610 proquest_miscellaneous_1687663313 pubmed_primary_21514069 elsevier_sciencedirect_doi_10_1016_j_ijrobp_2011_02_021 elsevier_clinicalkeyesjournals_1_s2_0_S0360301611003221 elsevier_clinicalkey_doi_10_1016_j_ijrobp_2011_02_021 |
| PublicationCentury | 2000 |
| PublicationDate | 2011-11-15 |
| PublicationDateYYYYMMDD | 2011-11-15 |
| PublicationDate_xml | – month: 11 year: 2011 text: 2011-11-15 day: 15 |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | International journal of radiation oncology, biology, physics |
| PublicationTitleAlternate | Int J Radiat Oncol Biol Phys |
| PublicationYear | 2011 |
| Publisher | Elsevier Inc |
| Publisher_xml | – name: Elsevier Inc |
| References | Forrest, Stewart, Everington (bib5) 1996; 348 BC Cancer Agency. 02 Stage 1 or Stage II invasive Cancer (T1, T2; N0, N1, M0). Updated November 2004. Available at Touboul, Buffat, Belkacémi (bib30) 1999; 43 Jones, Antonini, Hart (bib42) 2009; 27 Whelan, Clark, Roberts (bib46) 1994; 30 Borger, Kemperman, Hart (bib10) 1994; 12 DiBiase, Komarnicky, Heron (bib13) 2002; 53 Peterson, Schultz, Reynolds (bib19) 1999; 43 Harrell (bib35) 2001 Heimann, Powers, Halpem (bib12) 1996; 78 Gage, Schnitt, Nixon (bib21) 1996; 78 Clark, Whelan, Levine (bib4) 1996; 88 Spivack, Khanna, Tafra (bib11) 1994; 129 Anscher, Jones, Prosnitz (bib9) 1993; 218 Jobsen, van der Palen, Ong (bib14) 2003; 57 Kunos, Latson, Overmoyer (bib28) 2006; 12 Ryoo, Kagan, Wollin (bib31) 1989; 172 Jobsen, Van Der Palen, Ong (bib32) 2007; 46 Kaufmann, Morrow, von Minckwitz (bib7) 2010; 116 Freedman, Fowble, Hanlon (bib16) 1999; 44 Poortmans, Collette, Horiot (bib25) 2009; 90 Liljegren, Holmberg, Adami (bib3) 1994; 86 Judd, McClelland (bib36) 1989 Neuschatz, DiPetrillo, Safaii (bib18) 2003; 97 McIntosh, Freedman, Eisenberg (bib33) 2007; 30 Altman PG, Anderson PK.Stat Med 1989;8:771–783. Recht, Come, Henderson (bib26) 1996; 334 Kreike, Hart, van de Velde (bib23) 2008; 71 Bartelink, Horiot, Poortmans (bib41) 2007; 25 Smitt, Nowels, Carlson (bib17) 2003; 57 Buccholz, Tucker, Erwin (bib39) 2001; 19 Besana-Ciani, Greenall (bib15) 2008; 5 Wazer, Schmidt-Ullrich, Ruthazer (bib27) 1998; 40 Solin, Fowble, Schultz (bib29) 1991; 21 . Fisher, Anderson, Redmond (bib1) 1995; 333 Azu, Abrahamse, Katz (bib43) 2001; 17 Malmström, Holmberg, Anderson (bib6) 2003; 39 Arriagada, Le, Contesso (bib40) 2002; 13 Renton, Gazet, Ford (bib24) 1996; 22 Obedian, Haffty (bib20) 2000; 6 Anderson, Wapnir, Dignam (bib45) 2009; 27 Taghian, Mohiuddin, Jagsi (bib8) 2005; 241 Park, Mitsumori, Nixon (bib22) 2000; 18 Sanghani, Truong, Raad (bib38) 2010; 28 Veronesi, Marubini, Mariani (bib2) 2001; 12 Chism, Freedman, Li (bib44) 2006; 65 |
| References_xml | – volume: 78 start-page: 1921 year: 1996 end-page: 1928 ident: bib21 article-title: Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy publication-title: Cancer – volume: 39 start-page: 1690 year: 2003 end-page: 1697 ident: bib6 article-title: Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: A randomised clinical trial in a population with access to public mammography screening publication-title: Eur J Cancer – volume: 86 start-page: 717 year: 1994 end-page: 722 ident: bib3 article-title: Sector resection with or without postoperative radiotherapy for stage I breast cancer: Five-year results of a randomized trial. Uppsala-Orebro Breast Cancer Study Group publication-title: J Natl Cancer Inst – volume: 43 start-page: 25 year: 1999 end-page: 38 ident: bib30 article-title: Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer publication-title: Int J Radiat Oncol Biol Phys – volume: 97 start-page: 30 year: 2003 end-page: 39 ident: bib18 article-title: Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy publication-title: Cancer – volume: 30 start-page: 146 year: 2007 end-page: 151 ident: bib33 article-title: Recurrence rates and analysis of close or positive margins in patients treated without re-excision before radiation for breast cancer publication-title: Am J Clin Oncol – volume: 218 start-page: 22 year: 1993 end-page: 28 ident: bib9 article-title: Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy publication-title: Ann Surg – volume: 18 start-page: 1668 year: 2000 end-page: 1675 ident: bib22 article-title: Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: Influence of margin status and systemic therapy on local recurrence publication-title: J Clin Oncol – volume: 25 start-page: 3259 year: 2007 end-page: 3265 ident: bib41 article-title: Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial publication-title: J Clin Oncol – volume: 129 start-page: 952 year: 1994 end-page: 956 ident: bib11 article-title: Margin status and local recurrence after breast-conserving surgery publication-title: Arch Surg – volume: 241 start-page: 629 year: 2005 end-page: 639 ident: bib8 article-title: Current perceptions regarding surgical margin status after breast-conserving therapy: Results of a survey publication-title: Ann Surg – volume: 334 start-page: 1356 year: 1996 end-page: 1361 ident: bib26 article-title: The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer publication-title: N Engl J Med – year: 2001 ident: bib35 article-title: Regression modeling strategies – year: 1989 ident: bib36 article-title: Data analysis: A model comparison approach – volume: 90 start-page: 80 year: 2009 end-page: 85 ident: bib25 article-title: Impact of the boost dose of 10 Gy versus 26 Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomised EORTC boost trial publication-title: Radiother Oncol – volume: 333 start-page: 1456 year: 1995 end-page: 1461 ident: bib1 article-title: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer publication-title: N Engl J Med – volume: 6 start-page: 28 year: 2000 end-page: 33 ident: bib20 article-title: Negative margin status improves local control in conservatively managed breast cancer patients publication-title: Cancer J Sci Am – volume: 12 start-page: 997 year: 2001 end-page: 1003 ident: bib2 article-title: Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial publication-title: Ann Oncol – volume: 40 start-page: 851 year: 1998 end-page: 858 ident: bib27 article-title: Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed publication-title: Int J Radiat Oncol Biol Phys – volume: 12 start-page: 653 year: 1994 end-page: 660 ident: bib10 article-title: Risk factors in breast-conservation therapy publication-title: J Clin Oncol – volume: 65 start-page: 1416 year: 2006 end-page: 1421 ident: bib44 article-title: Re-excision of margins before breast radiation-diagnostic or therapeutic? publication-title: Int J Radiat Oncol Biol Phys – volume: 78 start-page: 1722 year: 1996 end-page: 1730 ident: bib12 article-title: Breast preservation in Stage I and II carcinoma of the breast. The University of Chicago experience publication-title: Cancer – volume: 5 start-page: 13 year: 2008 ident: bib15 article-title: The importance of margins status after breast conservative surgery and radiotherapy in node positive patients: A follow-up of 10–15 years publication-title: Int Semin Surg Oncol – volume: 21 start-page: 279 year: 1991 end-page: 287 ident: bib29 article-title: The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer publication-title: Int J Radiat Oncol Biol Phys – volume: 348 start-page: 708 year: 1996 end-page: 713 ident: bib5 article-title: Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group publication-title: Lancet – volume: 116 start-page: 1184 year: 2010 end-page: 1191 ident: bib7 article-title: Locoregional treatment of primary breast cancer: Consensus recommendations from an International Expert Panel publication-title: Cancer – volume: 12 start-page: 28 year: 2006 end-page: 36 ident: bib28 article-title: Breast conservation surgery achieving > or = 2 mm tumor-free margins results in decreased local-regional recurrence rates publication-title: Breast J – volume: 172 start-page: 555 year: 1989 end-page: 559 ident: bib31 article-title: Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma publication-title: Radiology – volume: 17 start-page: 558 year: 2001 end-page: 563 ident: bib43 article-title: What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates publication-title: Ann Surg Oncol – volume: 28 start-page: 718 year: 2010 end-page: 722 ident: bib38 article-title: Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy publication-title: J Clin Oncol – volume: 88 start-page: 1659 year: 1996 end-page: 1664 ident: bib4 article-title: Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: An update. Ontario Clinical Oncology Group publication-title: J Natl Cancer Inst – reference: Altman PG, Anderson PK.Stat Med 1989;8:771–783. – volume: 46 start-page: 172 year: 2007 end-page: 180 ident: bib32 article-title: Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy publication-title: Acta Oncol – volume: 44 start-page: 1005 year: 1999 end-page: 1015 ident: bib16 article-title: Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy publication-title: Int J Radiat Oncol Biol Phys – reference: . – volume: 30 start-page: 11 year: 1994 end-page: 16 ident: bib46 article-title: Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group publication-title: Int J Radiat Oncol Biol Phys – volume: 57 start-page: 979 year: 2003 end-page: 985 ident: bib17 article-title: Predictors of re-excision findings and recurrence after breast conservation publication-title: Int J Radiat Oncol Biol Phys – volume: 22 start-page: 17 year: 1996 end-page: 22 ident: bib24 article-title: The importance of the resection margin in conservative surgery for breast cancer publication-title: Eur J Surg Oncol – volume: 27 start-page: 4939 year: 2009 end-page: 4947 ident: bib42 article-title: Impact of pathological characteristics on local relapse after breast-conserving therapy: A subgroup analysis of the EORTC boost versus no boost trial publication-title: J Clin Oncol – volume: 27 start-page: 2466 year: 2009 end-page: 2473 ident: bib45 article-title: Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer publication-title: J Clin Oncol – volume: 43 start-page: 1029 year: 1999 end-page: 1035 ident: bib19 article-title: Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: The University of Pennsylvania experience publication-title: Int J Radiat Oncol Biol Phys – volume: 13 start-page: 1404 year: 2002 end-page: 1413 ident: bib40 article-title: Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer publication-title: Ann Oncol – volume: 71 start-page: 1014 year: 2008 end-page: 1021 ident: bib23 article-title: Continuing risk of ipsilateral breast relapse after breast-conserving therapy at long-term follow-up publication-title: Int J Radiat Oncol Biol Phys – volume: 19 start-page: 2240 year: 2001 end-page: 2246 ident: bib39 article-title: Impact of systemic treatment on local control for patients with lymph node-negative breast cancer treated with breast-conservation therapy publication-title: J Clin Oncol – reference: BC Cancer Agency. 02 Stage 1 or Stage II invasive Cancer (T1, T2; N0, N1, M0). Updated November 2004. Available at – volume: 57 start-page: 724 year: 2003 end-page: 731 ident: bib14 article-title: The value of a positive margin for invasive carcinoma in breast-conservative treatment in relation to local recurrence is limited to young women only publication-title: Int J Radiat Oncol Biol Phys – volume: 53 start-page: 680 year: 2002 end-page: 686 ident: bib13 article-title: Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy publication-title: Int J Radiat Oncol Biol Phys |
| SSID | ssj0001174 |
| Score | 2.1989932 |
| Snippet | (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with... Purpose ( 1 ) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; ( 2 ) To identify... Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets... |
| SourceID | osti proquest pubmed elsevier |
| SourceType | Open Access Repository Aggregation Database Index Database Publisher |
| StartPage | e561 |
| SubjectTerms | Adult Age Factors Analysis of Variance Breast cancer Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Breast-conserving therapy British Columbia Female Follow-Up Studies HAZARDS Hematology, Oncology and Palliative Medicine HISTOLOGY Humans Local recurrence Lymphatic Metastasis MAMMARY GLANDS Mastectomy, Segmental Middle Aged Neoplasm Recurrence, Local - mortality Neoplasm Staging Neoplasm, Residual NEOPLASMS PATIENTS Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy boost Radiotherapy Planning, Computer-Assisted REGRESSION ANALYSIS Retreatment SIMULATION SURGERY Surgical margins WOMEN |
| Title | Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0360301611003221 https://www.clinicalkey.es/playcontent/1-s2.0-S0360301611003221 https://dx.doi.org/10.1016/j.ijrobp.2011.02.021 https://www.ncbi.nlm.nih.gov/pubmed/21514069 https://www.proquest.com/docview/1687663313 https://www.proquest.com/docview/901304610 https://www.osti.gov/biblio/22054430 |
| Volume | 81 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3dj9JAEN_ccYnxxfgtepo1Mb5c2rS729I-Ip5BAWOQi_e26cc2Qi6UQPugf4h_rzPdbSkCyXkJaaDsli3z29nZ6W9mCHnHHKEyESSWzxxlCRirFaexYwUqzEQSpSxL0TUw-eoPr8SXa-_65PR9i7VUFrGd_D4YV3IXqcI5kCtGyf6HZJuLwgl4D_KFI0gYjreSMc56pckYVSVKmOMYUnSTV-WasBCvZgZhNVukwvSrguAfkIdeWFiqExUFZuTWsdG6OzI_Lsa4xKFNWaVvgrk_RQr6R3wuXyhzhYtvN-UGgyXg7TRK5yaWa-c58a7DsZWmYo05EbS1ukyaiJl4GzyjXS6NxT8uV0orpV-glLQbdmI3dOXZujTcYqQ6ouU8s00Te2A33qUmnEczDeCeKw_4wB7an7etxgrTp-N0MNFM2l350_xc2jh98eW1VCn3YbVxdFRnrfd1qRiDb9FS4srT-eGNQQAfg4OLjfZ7LOz5Yp3HK5MOlsHL3S6uNaHgcjByrQ18aX3HweBYMFkfqNN_Guudmdww6ci9pqfkjMF2iHXIWX80_TFqbA7X5Buv77MOEq2YjPvj27G8OgCT-fENVmVozR6SB2aHRPsa7o_IiVo-JvcmhgPyhPwxqKd5RivUU4QtrVBP8zWtUU8N6mmFerqHempQr7sj6mmFerpFPUXUU4N6cwWKqKcV6mkb9U_J1afL2WBomeoilhJcFGCaJXHmZ56fZZHbSxLlxAxXpDSIuYITPEwjN44YbJkyxnqJx33QXKEHW2oweTPBn5HOMl-qF4RGSewGGQ-5UlyoMArCLAkTHjnCjXtRwLrEq_9uWQc8wxItAUiyZlkupBaTRDFJB8TP3C7pHeqnNma6buQxoLR7GlNam8i3-M1zxAP2wizSCdLtoBvG4wvBnS55W-NEwkKETxejpcpLGIoPhpXPucu7hB5pEyJPAis8dMlzjTG50kl1JG49MAr_5Z3v-RW5v53756RTrEv1GnYMRfzGTJe_LCQWMQ |
| linkProvider | Library Specific Holdings |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Subsets+of+Women+With+Close+or+Positive+Margins+After+Breast-Conserving+Surgery+With+High+Local+Recurrence+Risk+Despite+Breast+Plus+Boost+Radiotherapy&rft.jtitle=International+journal+of+radiation+oncology%2C+biology%2C+physics&rft.au=Lupe%2C+Krystine%2C+M.D&rft.au=Truong%2C+Pauline+T.%2C+M.D.C.M&rft.au=Alexander%2C+Cheryl%2C+C.H.I.M&rft.au=Lesperance%2C+Mary%2C+Ph.D&rft.date=2011-11-15&rft.issn=0360-3016&rft.volume=81&rft.issue=4&rft.spage=e561&rft.epage=e568&rft_id=info:doi/10.1016%2Fj.ijrobp.2011.02.021&rft.externalDBID=ECK1-s2.0-S0360301611003221&rft.externalDocID=1_s2_0_S0360301611003221 |
| thumbnail_m | http://utb.summon.serialssolutions.com/2.0.0/image/custom?url=https%3A%2F%2Fcdn.clinicalkey.com%2Fck-thumbnails%2F03603016%2FS0360301611X00135%2Fcov150h.gif |