SAN FRANCISCO ? Multicatheter brachytherapy with accelerated partial breast irradiation (APBI) for early breast cancer provided durable disease control for as long as 15 years, researchers found.
After a median follow-up of 12.1 years, the 100-patient prospective cohort had 3.1% 10-year incidence of in-field recurrence in the breast and a 9.3% incidence of any locoregional recurrence.
The cohort had a 10-year disease-free survival (DFS) of 70% and overall survival of 78%, as reported here at the Multidisciplinary Breast Cancer Symposium.
?It?s important to note that this is not modern brachytherapy. It?s rather Neanderthal,? said invited discussant Robert Kuske, MD, of Arizona Breast Cancer Specialists in Scottsdale, who helped write the protocol for the trial. ?We used two-plane implants without CT guidance, and the selection criteria were rather loose.?
?Despite the Neanderthal techniques, the results have been quite good,? he added.
Several large, ongoing clinical trials are comparing APBI and conventional whole-breast irradiation in women who have undergone breast-conserving surgery for early breast cancer. Results of these trials are still several years away, Julia White, MD, of Ohio State University in Columbus, and colleagues noted in a poster presentation.
Nonetheless, use of APBI has continued to win acceptance in the radiation oncology community in the absence of a large volume of supporting data.
Ongoing follow-up and data collection in the Radiation Therapy Oncology Group (RTOG) 9517 trial afforded an opportunity to examine long-term results of APBI, as administered by one of the earliest techniques: multicatheter brachytherapy.
Investigators in RTOG 9517 enrolled patients during 1997 to 2000, and the primary objective was to demonstrate the reproducibility of APBI technique in a multi-institutional trial. RTOG 9517 had a study population of 100 patients with stage I/II unifocal breast cancer 3 cm in diameter.
Other eligibility criteria included invasive, nonlobular cancer; as many as three involved lymph nodes without extracapsular extension; lumpectomy resulting in negative surgical margins; and use of at least five surgical clips to define the cavity.
White?s group focused on failure in the ipsilateral breast, frequency of contralateral breast cancer, regional and distant failure, DFS, and overall survival at 5 and 10 years.
The patients were randomized 2:1 to high-dose (45 Gy in 3.5 to 5 days) or low-dose (34 Gy in 10 BID fractions over 5 days) interstitial brachytherapy. The surgery consisted of lumpectomy, axillary lymph node dissection, and catheter placement. A third of patients received chemotherapy and two-thirds received hormonal therapy.
The analysis included 98 of the original 100 patients enrolled between 1997 and 2000. The patients had a median age of 62 at enrollment, whites accounted for 87% of the patients, and 80% of the patients were postmenopausal.
White and colleagues reported that 88% of the patients had T1 disease, 81% had negative lymph nodes, 75% had estrogen receptor-positive tumors, 68% had progesterone-receptor positive tumors, and 77% tested positive for estrogen and/or progesterone receptors.
The rate of isolated in-breast recurrence was 3.1% at 5 years and 4.2% at 10 years. The incidence of isolated regional recurrence was 3.1% at 5 and 10 years. The rate of any local-regional recurrence was 7.2% at 5 years and 9.3% at 10 years. The incidence of contralateral breast cancer was 3.1% and 4.2% at 5 and 10 years, respectively.
The patients had a 5-year distant metastasis rate of 7.2%, increasing to 10.3% at 10 years.
DFS was 83.5% and 69.8% at 5 and 10 years, and overall survival was 92.8% and 78% at the 5- and 10-year marks. The patients had a breast cancer specific mortality of 8.2%. Eight women have died of breast cancer and 11 have died of other causes, the authors reported.
The study was supported by the National Cancer Institute.
White, co-investigators, and Kuske reported no conflicts of interest.
Primary source: Multidisclplinary Breast Cancer Symposium
Source reference:
White JR, et al ?Long-term outcome from RTOG 9517: A phase I/II study of accelerated partial breast irradiation (APBI) with multicatheter brachytherapy (MCT) following lumpectomy for early-stage breast cancer? MBCS 2012; Abstract 147.
Add Your Knowledge ? 
Charles Bankhead
Staff Writer
Working from Houston, home to one of the world???s largest medical complexes, Charles Bankhead has more than 20 years of experience as a medical writer and editor. His career began as a science and medical writer at an academic medical center. He later spent almost a decade as a writer and editor for Medical World News, one of the leading medical trade magazines of its era. His byline has appeared in medical publications that have included Cardio, Cosmetic Surgery Times, Dermatology Times, Diagnostic Imaging, Family Practice, Journal of the National Cancer Institute, Medscape, Oncology News International, Oncology Times, Ophthalmology Times, Patient Care, Renal and Urology News, The Medical Post, Urology Times, and the International Medical News Group newspapers. He has a BA in journalism and MA in mass communications, both from Texas Tech University.
Source: http://cancerkick.com/2012/09/16/apbi-tx-durable-in-breast-cancer-over-time/
bachelor jeremy lin espn sassafras mardi gras 2012 the secret world of arrietty cee lo allen iverson
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.