M. Gardner

Breast Cancer With Synchronous Metastases: Survival Impact of Exclusive Locoregional Radiotherapy

PURPOSE Several studies suggest that surgical excision of the primary tumor improves survival among patients with stage IV breast cancer at diagnosis. Exclusive locoregional radiotherapy (LRR) is an alternative form of locoregional treatment (LRT) in this setting. We retrospectively studied the impact of LRT on the survival of breast cancer patients with synchronous metastases. PATIENTS AND METHODS Among 18,753 breast cancer patients treated in our institution between 1980 and 2004, 598 patients (3.2%) had synchronous metastasis at diagnosis. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of LRT on overall survival (OS) was evaluated by multivariate analysis including known prognostic factors. RESULTS Among 581 eligible patients, 320 received LRT (group A), and 261 received no LRT (group B). LRT consisted of exclusive LRR in 249 patients (78%), surgery of the primary tumor with adjuvant LRR in 41 patients (13%), and surgery alone in 30 patients (9%). With a median follow-up time of 39 months, the 3-year OS rates were 43.4% and 26.7% in group A and group B (P =.00002), respectively. The association between LRT and improved survival was particularly marked in women with visceral metastases. LRT was an independent prognostic factor in multivariate analysis (hazard ratio [HR] = 0.70; 95% CI, 0.58 to 0.85; P = .0002). The adjusted HR for late death (>or= 1 year) was 0.76 (95% CI, 0.61 to 0.96; P = .02). CONCLUSION In our experience, LRT, consisting mainly of exclusive LRR, was associated with improved survival in breast cancer patients with synchronous metastases. Exclusive LRR may thus represent an active alternative to surgery.

Is Regional Lymph Node Irradiation Necessary in Stage II to III Breast Cancer Patients With Negative Pathologic Node Status After Neoadjuvant Chemotherapy

PURPOSE Neoadjuvant chemotherapy (NAC) generally induces significant changes in the pathologic extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation (LNI) in breast cancer (BC) patients with pathologic N0 status (pN0) after NAC and breast-conserving surgery (BCS). METHODS AND MATERIALS Among 1,054 BC patients treated with NAC in our institution between 1990 and 2004, 248 patients with clinical N0 or N1 to N2 lymph node status at diagnosis had pN0 status after NAC and BCS. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival (LRR-FS), disease-free survival (DFS), and overall survival (OS). RESULTS All 248 patients underwent breast irradiation, and 158 patients (63.7%) also received LNI. With a median follow-up of 88 months, the 5-year LRR-FS and OS rates were respectively 89.4% and 88.7% with LNI and 86.2% and 92% without LNI (no significant difference). Survival was poorer among patients who did not have a pathologic complete primary tumor response (hazard ratio, 3.05; 95% confidence interval, 1.17-7.99) and in patients with N1 to N2 clinical status at diagnosis (hazard ratio = 2.24; 95% confidence interval, 1.15-4.36). LNI did not significantly affect survival. CONCLUSIONS Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among cN0 to cN2 breast cancer patients with pN0 status after NAC. These results need to be confirmed in a prospective study.

Use of single MRI and 18F-FDG PET-CT scans in both diagnosis and radiotherapy treatment planning in patients with head and neck cancer: Advantage on target volume and critical organ delineation

The use of a single MRI and 18F‐fluoro deoxyglucose positron emission tomography‐CT (18F‐FDG PET‐CT) was evaluated, both in diagnostic procedure and radiotherapy planning, in patients with head and neck cancer.

Adjuvant chemotherapy and lymph node irradiation in breast cancer patients with axillary lymph node micrometastases or isolated tumor cells.

581 Background: To evaluate the influence of loco-regional radiotherapy and adjuvant chemotherapy on the outcome of breast cancer patients with axillary lymph node micrometastases (MMTS) or isolate...

Les nouvelles indications et techniques de radiothérapie dans le cancer du sein

Dans l’approche therapeutique conservatrice du cancer du sein, un des buts de la radiotherapie est celui d’obtenir une dose homogene dans la totalite de la glandemammaire (et dans les aires ganglionnaires, lorsque cela est indique), en evitant les surdosages qui pourraient engendrer des reactions aigues ou tardives, et les sous-dosages qui pourraient etre a l’origine des recidives. Les organes a risque, dont la protection est necessaire, sont les poumons et le cœur (particulierement pour l’irradiation du sein gauche). Les techniques visant a reduire les toxicites cardiaques de la radiotherapie, sont d’autant plus recommandees lorsque d’autres traitements cardiotoxiques lui sont associes (anthracyclines et / ou trastuzumab).