International Journal of Radiation Oncology * Biology * Physics
Volume 47, Issue 5 , Pages 1219-1228 , 15 July 2000

A shorter fractionation schedule for postlumpectomy breast cancer patients

Preliminary results of this work were presented in part at the Royal College of Physicians and Surgeons of Canada Annual Meeting (Canadian Association of Radiation Oncology), Toronto, Ontario, September 1998.

  • Wendy Shelley, M.D.

      Affiliations

    • The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada
    • Corresponding Author InformationReprint requests to: Dr. W. E. Shelley, Kingston Regional Cancer Centre, 25 King Street West, Kingston, Ontario K7L 5P9, Canada
    • ,
  • Michael Brundage, M.D.

      Affiliations

    • The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada
    • ,
  • Charles Hayter, M.D.

      Affiliations

    • The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada
    • ,
  • Lawrence Paszat, M.D.

      Affiliations

    • The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada
    • ,
  • Sam Zhou (M.A.)

      Affiliations

    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada
    • ,
  • William Mackillop, M.D.

      Affiliations

    • The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
    • Department of Oncology, Queen’s University, Kingston, Ontario, Canada

,Accepted 3 September 1999.

References 

  1. Forbes JF. The incidence of breast cancer: The global burden, public health considerations. Semin Oncol 1997;24(1 Suppl.1):S1-20–S1-35.
  2. Ries LAG, Kosary CL, Hankey BF, et al., editors. SEER Cancer Statistics Review, 1973–1994 (NIH Publication No. 97-2789). Bethesda, MD: National Cancer Institute; 1997.
  3. Arriagada R, Le MG, Rochard F, et al.  Conservative treatment versus mastectomy in early breast cancer (Patterns of failure with 15 years of follow-up data). J Clin Oncol. 1996;14:1558–1564
  4. Veronesi U, Banfi A, Salvadori B, et al.  Breast conservation is the treatment of choice in small breast cancer (Long-term results of a randomized trial). Eur J Cancer. 1990;26:668–670
  5. Fisher B, Bauer M, Margolese R, et al.  Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–673
  6. Fisher B, Anderson S, Redmond CK, et al.  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. N Engl J Med. 1995;333:1456–1461
  7. Jacobson JA, Danforth DN, Cowan K, et al.  Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332:907–911
  8. van Dongen JA, Bartelink H, Lerut T, et al.  Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr. 1992;11:15–18
  9. Blichert-Toft M, Rose C, Andersen JA, et al.  Danish randomized trial comparing breast conservation therapy with mastectomy (Six years of life table analysis). J Natl Cancer Inst Monogr. 1992;11:19–25
  10. Clark RM, Wilkinson RH, Mahoney LJ, et al.  Breast cancer (A 21 year experience with conservative surgery and radiation). Int J Radiat Biol Phys. 1982;8:967–975
  11. Clark RM, Wilkinson RH, Miceli PN, et al.  Breast cancer (Experiences with conservative therapy). Am J Clin Oncol. 1987;10:461–468
  12. Fourquet A, Campana F, Zafrani B, et al.  Prognostic factors of breast recurrence in the conservative management of early breast cancer (A 25-year follow-up). Int J Radiat Biol Phys. 1989;17:719–725
  13. Ryoo MC, Kagan AR, Wollin M, et al.  Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma. Radiology. 1989;172:555–559
  14. Kurtz JM, Jacquemier J, Amalric R, et al.  Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990;65:1867–1878
  15. Boyages J, Recht A, Connolly J, et al.  Early breast cancer (Predictors of breast recurrence for patients treated with conservative surgery and radiation therapy). Radiother Oncol. 1990;19:29–41
  16. Fowble BL, Solin LJ, Schultz DJ, et al.  Ten-year results of conservative surgery and irradiation for stage I and II breast cancer. Int J Radiat Biol Phys. 1991;21:269–277
  17. Gage I, Recht A, Gelman R, et al.  Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Biol Phys. 1995;33:245–251
  18. Smitt MC, Nowels KW, Zdeblick MJ, et al.  The importance of the lumpectomy surgical margin status in long term results of breast conservation. Cancer. 1995;76:259–261
  19. Vujovic O, Perera F, Sar AR, et al.  Does delay in breast irradiation following conservative breast surgery in node-negative breast cancer patients have an impact on risk of recurrence?. Int J Radiat Biol Phys. 1998;40:869–874
  20. Elkhuizen PHM, van de Vuver MJ, Hermans J, et al.  Local recurrence after breast-conserving therapy for invasive breast cancer (High incidence in young patients and association with poor survival). Int J Radiat Biol Phys. 1998;40:859–867
  21. Touboul E, Buffat L, Belkacemi Y, et al.  Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Biol Phys. 1999;43:25–38
  22. Clark RM, McCulloch PB, Levine MN, et al.  Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84:683–689
  23. Clark RM, Whelan T, Levine M, et al.  Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer (An update). J Natl Cancer Inst. 1996;88:1659–1664
  24. Uppsala-Orebro Breast Cancer Study Group Liljegren GG, Holmberg L, Adami HO. Sector resection with or without postoperative radiotherapy for Stage I breast cancer (Five year results of a randomized trial). J Natl Cancer Inst. 1994;86:717–722
  25. Veronesi U, Luini A, Del Vecchio M, et al.  Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993;328:1587–1591
  26. Forrest AP, Stewart HJ, Everington D, et al.  Randomized controlled trial of conservation therapy for breast cancer (6-year analysis of the Scottish trial). Lancet. 1996;348:708–713
  27. Harris JR, Levene MB, Svensson G, et al.  Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–261
  28. Beadle GF, Silver B, Botnick L, et al.  Cosmetic results following primary radiation therapy for early breast cancer. Cancer. 1984;54:2911–2918
  29. Patterson MP, Pezner RD, Hill HR, et al.  Patient self-evaluation of cosmetic outcome of breast-preserving cancer treatment. Int J Radiat Oncol Biol Phys. 1985;11:1849–1852
  30. Dewar JA, Benhamou S, Arriagada R, et al.  Cosmetic results following lumpectomy, axillary dissection and radiotherapy for small breast cancer. Radiother Oncol. 1988;12:273–280
  31. Olivitto IA, Rose MA, Osteen RT, et al.  Late cosmetic outcome after conservative surgery and radiotherapy (Analysis of causes of cosmetic failure). Int J Rad Oncol Biol Phys. 1989;17:747–753
  32. Van Limbergen E, Rijnders A, van der Schueren E, et al.  Cosmetic evaluation of breast conserving treatment for mammary cancer. 2. A quantitative analysis of the influence of radiation dose, fractionation schedules and surgical treatment techniques on cosmetic results. Radiother Oncol. 1989;16:253–267
  33. Hamilton CS, Nield JM, Adler GF, et al.  Breast appearance and function after breast conserving surgery and radiotherapy. Acta Oncol. 1990;29:291–295
  34. Wagar DE, DiPetrillo T, Schmidt-Ulrich R, et al.  Factors influencing cosmetic outcome and complication risk after conservation surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–363
  35. Sneeuw KCA, Aaronson NK, Yarnold JR, et al.  Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients’ ratings, observers’ ratings and objective assessments. Radiat Oncol. 1992;25:153–159
  36. Sarin R, Sinshaw KA, Shrivastava SK, et al.  Therapeutic factors influencing the cosmetic outcome and late complications in the conservative management of early breast cancer. Int J Radiat Oncol Biol Phys. 1993;27:285–292
  37. Taylor ME, Perez CA, Halverson KJ, et al.  Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–764
  38. Olivotto IA, Weir LM, Kim-Sing C, et al.  Late cosmetic results of short fractionation for breast conservation. Radiat Oncol. 1996;41:7–13
  39. Priestman TJ, Bullimore JA, Godden TP, et al.  The Royal College of Radiologists’ fractionation survey. Clin Oncol. 1989;1:39–46
  40. Whelan T, Marcellus D, Clark R, et al.  Adjuvant radiotherapy for early breast cancer (Patterns of practice in Ontario). Can Med Assoc J. 1993;149:1273–1277
  41. Yarnold JR, Price P, Steel GG. Non-surgical management of early breast cancer in the United Kingdom (Radiotherapy fractionation practices). Clin Oncol. 1995;7:223–226
  42. Olivotto A, Kim-Sing C, Bajdik CD, et al.  Effect of acetylsalicylic acid on radiation and cosmetic results after conservative surgery for early breast cancer (A randomized trial). Radiat Oncol. 1996;41:1–6
  43. Goy JCM, Dobbs HJ. Variations in postoperative radiotherapy delivery for patients with screen-detected breast cancer in the South Thames (East) region. Clin Oncol. 1998;10:30–34
  44. Mackillop WJ, Fu J, Quirt CF, et al.  Waiting for radiotherapy in Ontario. Int J Radiat Oncol Biol Phys. 1994;30:221–228
  45. Olivotto IA, Kim-Sing C, Doll C; et al. Breast conservation: Possible role for shorter fractionation (Abstr.). Clin Invest Med 1992(Suppl.):824.
  46. Pezner RD, Lipsett JA, Desai K, et al.  To boost or not to boost (decreasing radiation therapy in conservative breast cancer treatment when “inked” tumor resection margins are pathologically free of cancer). Int J Radiat Oncol Biol Phys. 1988;14:873–877
  47. Schmidt-Ullrich R, Wazer DE, Tercilla O, et al.  Tumor margin assessment as a guide to optimal conservation surgery and irradiation in early stage breast carcinoma. Int J Radiat Oncol Biol Phys. 1989;17:733–738
  48. Fisher ER, Anderson S, Redmond C, et al.  Ipsilateral breast tumor recurrence and survival following lumpectony and irradiation (pathological findings from NSABP Protocol B-06). Semin Surg Oncol. 1992;8:161–166
  49. Lichter AS, Fraass A, Van de Geijn J, Padikal TN. A technique for field matching in primary breast irradiation. Int J Radiat Oncol Biol Phys. 1983;9:263–270
  50. Brundage MD, Dixon PF, Mackillop WJ, et al.  A real-time audit of radiation therapy in a regional cancer center. Int J Radiat Oncol Biol Phys. 1999;43:115–124
  51. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481
  52. Cox DR. Regression models and life tables. J R Stat Soc. 1972;34:187–220
  53. Veronesi U, Marubini E, Del Vecchio M, et al.  Local recurrence and distant metastases after conservative breast cancer treatments (Partly independent events). J Natl Cancer Inst. 1995;87:19–27
  54. Wazer SE, Schmidt-Ullrich RK, Ruthazer R, et al.  Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed. Int J Radiat Oncol Biol Phys. 1998;40:851–858
  55. Spivack B, Khanna MM, Tafra L, et al.  Margin status and local recurrence after breast-conserving surgery. Arch Surg. 1994;129:952–957
  56. Solin LJ, Fowble BL, Schultz DJ, et al.  The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys. 1991;21:279–287
  57. Schnitt SJ, Abner A, Gelman R, et al.  The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast-conserving surgery and radiation therapy. Cancer. 1994;74:1746–1751
  58. Heimann R, Powers C, Halpern HJ, et al.  Breast preservation in stage I and II carcinoma of the breast. The University of Chicago experience. Cancer. 1996;78:1722–1730
  59. Zafrani B, Viehl P, Fourquet A, et al.  Conservative treatment of early breast cancer (Prognostic value of the ductal in situ component and other pathological variables on local control and survival). Eur J Cancer Clin Oncol. 1989;11:1645–1650
  60. Ghossein NA, Alpert S, Barba J, et al.  Importance of adequate excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively. Arch Surg. 1992;127:411–415
  61. Anscher MS, Jones P, Prosnitz LR, et al.  Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy. Ann Surg. 1993;218:22–28
  62. Park C, Mitsumori M, Recht A, et al.  The relationship between pathologic margin status and outcome after breast-conserving therapy. (Abstr.) Int J Radiat Oncol Biol Phys. 1998;42(Suppl.):1
  63. Cowen D, Largillier R, Bardou VJ, et al.  Positive margins after conservative treatments impacts local control and possibly survival in node-negative breast cancer. (Abstr.) Int J Radiat Oncol Biol Phys. 1998;42(Suppl.):3
  64. Veronesi U, Volterrani F, Luini A, et al.  Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer. 1990;6:671–673
  65. Sastre-Garau X, Jouve M, Asselain B, et al.  Infiltrating lobular carcinoma of the breast, Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 1996;77:113–120
  66. Silverstein MJ, Lewinsky BS, Waisman JR, et al.  Infiltrating lobular carcinoma (Is it different from infiltrating duct carcinoma?). Cancer. 1994;73:1673–1677
  67. Weiss MC, Fowble Bl, Solin LJ, et al.  Outcome of conservative therapy for invasive breast cancer by histologic subtype. Int J Radiat Oncol Biol Phys. 1992;23:941–947
  68. Clarke D, Le M, Sarrazin D, et al.  Analysis of local-regional relapses in patients with early breast cancer treated by excision and radiotherapy (Experience of the Institute Gustave-Roussy). Int J Radiat Oncol Biol Phys. 1985;11:137–145
  69. Kurtz JM, Jacquemier J, Amalric R, et al.  Breast conserving therapy for macroscopically multiple cancers. Ann Surg. 1991;212:38–44
  70. Leopold KA, Recht A, Schnitt SJ, et al.  Results of conservative surgery and radiation therapy for multiple synchronous cancers of one breast. Int J Radiat Oncol Biol Phys. 1989;16:11–16
  71. Wilson LD, Bienfield M, McKhann CF, et al.  Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer. 1993;72:137–142
  72. Van Limbergen E, Van den Bogaert W, van der Schueren E, et al.  Tumor excision and radiotherapy as primary treatment of breast cancer. Analysis of patient and treatment parameters and local control. Radiat Oncol. 1987;8:1–9
  73. Fisher ER, Sass R, Fisher B, et al.  Pathologic findings from the national surgical adjuvant breast project ( Protocol 6 ) II. Relation of local breast recurrence to multicentricity. Cancer. 1986;57:1717–1724
  74. van Tienhoven G, van Bree NAM, Mijnheer BJ, et al.  Quality assurance of the EORTC trial 22881/10882 (Assessment of the role of the booster dose in breast conserving therapy: The Dummy Run). Radiother Oncol. 1991;22:290–298
  75. Romestaing P, Lehingue Y, Carrie C, et al.  Role of 10-Gy boost in the conservative treatment of early breast cancer (Results of a randomized clinical trial in Lyon, France). J Clin Oncol. 1997;15:963–968
  76. Yamada Y, Ackerman I, Frannssen E, et al.  Does the dose fractionation schedule influence local control of adjuvant radiotherapy for early stage breast cancer?. Int J Radiat Oncol Biol Phys. 1999;44:99–104
  77. Thames HD, Withers HR, Peters LJ, et al.  Changes in early and late radiation responses with altered dose fractionation (Implications for dose–survival relationships). Int J Radiat Oncol Biol Phys. 1982;8:219–226
  78. Dodwell DJ, Povall J, Gerrard G, et al.  Skin Telangiectasia (The influence of radiation dose delivery parameters in the conservative management of early breast cancer). Clin Oncol. 1995;7:248–250
  79. Das IJ, Cheng CW, Fein DA, et al.  Patterns of dose variability in radiation prescription of breast cancer. Radiother Oncol. 1997;44:83–99
  80. Owen J, Yarnold LJ, Regan J; et al. Randomized comparison of a 13-fraction schedule with conventional 25-fraction schedule of radiotherapy after local excision of early breast cancer (Abstr.). Royal College of Radiologists Annual Scientific Meeting and Exhibition. Sep. 22–25,1992; Southampton. 1992. p. 175.
  81. Wallace L, Priestman S, Dunn J, et al.  The quality of life of early breast cancer patients treated by two different radiotherapy regimens. Clin Oncol. 1993;5:228–233
  82. Whelan TJ, Mackenzie KG, Levine M; et al. A randomized trial comparing two fractionation schedules for breast irradiation postlumpectomy in node-neagative breast cancer (Abstr.). J Clin Oncol 2000;19:5.
  83. The steering committee on clinical practice guidelines for the care and treatment of breast cancer. Breast radiotherapy after breast-conserving surgery. Can Med Assoc J 1998;158(Suppl. 3):S35–S42.

☆ Supported in part by a grant from Cancer Care Ontario.

PII: S0360-3016(00)00567-8

doi: 10.1016/S0360-3016(00)00567-8

International Journal of Radiation Oncology * Biology * Physics
Volume 47, Issue 5 , Pages 1219-1228 , 15 July 2000

Article Tools

* Image Usage & Resolution