J Breast Cancer.  2015 Mar;18(1):50-56. 10.4048/jbc.2015.18.1.50.

Proportion and Clinical Outcomes of Postoperative Radiotherapy Omission after Breast-Conserving Surgery in Women with Breast Cancer

• Yu JI
• Choi DH
• Huh SJ
• Park W
• Nam SJ
• Kim SW
• Lee JE
• Kil WH
• Im YH
• Ahn JS
• Park YH

• KMID: 2286337
• DOI: http://doi.org/10.4048/jbc.2015.18.1.50

Abstract

PURPOSE
The present study was conducted to investigate the proportion and clinical outcomes of breast cancer patients who did not receive postoperative radiotherapy (PORT) after breast-conserving surgery (BCS).
METHODS
This retrospective study included all breast cancer patients received curative BCS without PORT between 2003 and 2013. In the PORT omission group, characteristics and local recurrence differences were compared between the recommended group and the refused group. To compare the local recurrence-free survival (LRFS) of the PORT omission group and the control group who received PORT, subjects were selected by using the pooled data of patients treated between 1994 and 2007.
RESULTS
During the study period, 96 patients did not receive PORT among a total of 6,680 patients who underwent BCS. Therefore, the overall rate of PORT omission was 1.4%. Among the 96 patients, 20 were recommended for PORT omission (recommended group) and 76 refused PORT (refused group). The median follow-up period of all study participants was 19.3 months (range, 0.3-115.1 months). Patients in the recommended group were older (p=0.004), were more likely to be postmenopausal (p=0.013), and had more number of positive prognostic factors compared with the refused group. Overall, 12 cases of disease recurrence, including 11 cases of local recurrence, developed in the PORT-refused group. The LRFS of the PORT-omission group was significantly inferior to that of patients who received PORT after BCS (p<0.001). In the PORT-omission group, significant favorable prognostic factors for LRFS were having histologic grade 1 or 2 disease (p=0.023), having no axillary lymph node metastasis (p=0.039), receiving adjuvant endocrine therapy (p=0.046), and being in the recommended group (p=0.026).
CONCLUSION
The rate of PORT omission in the present study is very low among women who underwent surgery compared to that of other studies worldwide. PORT omission is significantly related to a high local recurrence rate.

Keyword

Adjuvant radiotherapy; Breast neoplasms; Local neoplasm recurrence; Proportion; Segmental mastectomy

MeSH Terms

Breast Neoplasms*
Female
Follow-Up Studies
Humans
Lymph Nodes
Mastectomy, Segmental*
Neoplasm Metastasis
Neoplasm Recurrence, Local
Radiotherapy*
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies

Figure

• 

  Figure 1 CONSORT diagram. BCS=breast-conserving surgery; PORT=postoperative radiotherapy; SMC=Samsung Medical Center; r/o=rule out.

• 

  Figure 2 Annual proportion of postoperative radiotherapy (PORT) omission after breast-conserving surgery (BCS). The rate increased slightly to approximately 1.5% after 2006, when physicians started to recommend PORT omission.

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  Figure 3 Kaplan-Meyer curves of local recurrence-free survival (LRFS) according to the postoperative radiotherapy (PORT) or omission. When compared with patients who received PORT after breast-conserving surgery (BCS) in 1994 to 2007 at Samsung Medical Center, LRFS was clearly inferior in PORT omission group.

• 

  Figure 4 Kaplan-Meyer curves of local recurrence-free survival (LRFS) according to prognostic factors. Significantly higher LRFS was detected for patients with histologic grade (HG) 1 or 2 (A), no axillary lymph node (LN) metastasis (B), endocrine therapy (Tx) (C), and the recommended group (D).

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