Skip to main content
Top
Published in: Annals of Surgical Oncology 6/2009

01-06-2009 | Breast Oncology

Local Control, Toxicity, and Cosmesis in Women Younger Than 50 Enrolled Onto the American Society of Breast Surgeons MammoSite Radiation Therapy System Registry Trial

Authors: A. J. Khan, MD, F. Vicini, MD, P. Beitsch, MD, B. Haffty, MD, C. Quiet, MD, A. Keleher, MD, D. Garcia, MD, H. Snider, MD, M. Gittleman, MD, V. Zannis, MD, H. Kuerer, MD, PhD, E. Whitacre, MD, P. Whitworth Jr, MD, R. Fine, MD

Published in: Annals of Surgical Oncology | Issue 6/2009

Login to get access

Background

The American Society of Breast Surgeons enrolled women onto a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System (RTS) breast brachytherapy device. This report examines local recurrence (LR), toxicity, and cosmesis as a function of age in women enrolled onto the trial.

Methods

A total of 1449 primary early-stage breast cancers were treated in 1440 women. Of these, 130 occurred in women younger than 50 years of age. Fisher’s exact test was performed to correlate age (<50 vs. ≥ 50 years) with toxicity and with cosmesis. The association of age with LR failure times was investigated by fitting a parametric model.

Results

Women younger than 50 were more likely to develop fat necrosis: 4.6% (6 of 130) vs. 1.8% (24 of 1319) (P = .0456). Other toxicities were comparable. At 2 years, cosmesis was excellent or good in 87% of assessable women aged <50 years (n = 74) and in 94% of assessable older women (n = 751) (P = .0197). At 3 years, this difference disappeared: excellent or good in 90% (56 of 62) of younger women vs. 93% (573 of 614) of older women (P = .2902). The crude LR rate for the group was 1.7% (25 of 1449). There was no statistically significant difference in LR as a function of age. In women <50, 3.1% (4 of 130) developed a LR; in the older patients, 1.6% (21 of 1319) developed LR (3-year actuarial LR rates, 2.9% vs. 1.7%, respectively; P = .2284).

Conclusions

Accelerated partial breast irradiation with the MammoSite RTS results in low toxicity and produces similar cosmesis and local control at 3 years in women younger than 50 when compared with older women.
Literature
1.
go back to reference Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–32.PubMedCrossRef Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–32.PubMedCrossRef
2.
go back to reference Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;341:1233–41.CrossRef Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;341:1233–41.CrossRef
3.
go back to reference Leljegren G, Holmberg L, Bergh J, et al. 10-year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol 1999;17:2326–33. Leljegren G, Holmberg L, Bergh J, et al. 10-year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol 1999;17:2326–33.
4.
go back to reference 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. Ontario Clinical Oncology Group. J Natl Cancer Inst 1996;88:1659–64.PubMedCrossRef 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. Ontario Clinical Oncology Group. J Natl Cancer Inst 1996;88:1659–64.PubMedCrossRef
5.
go back to reference Vicini F, Kini VR, Chen P, et al. Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy. J Surg Oncol 1999;70:33–40.PubMedCrossRef Vicini F, Kini VR, Chen P, et al. Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy. J Surg Oncol 1999;70:33–40.PubMedCrossRef
6.
go back to reference Baglan KL, Martinez AA, Frazier RC, et al. The use of high-dose rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2001;50:1003–11.PubMedCrossRef Baglan KL, Martinez AA, Frazier RC, et al. The use of high-dose rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2001;50:1003–11.PubMedCrossRef
7.
go back to reference Vicini FA, Kestin L, Chen P, et al. Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst 2003;95:1205–11.PubMedCrossRef Vicini FA, Kestin L, Chen P, et al. Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst 2003;95:1205–11.PubMedCrossRef
8.
go back to reference Arthur DW, Winter K, Kuske RR, et al. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 9517. Int J Radiat Oncol Biol Phys 2008;72:467–73.PubMed Arthur DW, Winter K, Kuske RR, et al. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 9517. Int J Radiat Oncol Biol Phys 2008;72:467–73.PubMed
9.
go back to reference Edmundson G, Vicini F, Chen P, et al. Dosimetric characteristics of the MammoSite RTS, a new breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 2002;52:1132–9.PubMed Edmundson G, Vicini F, Chen P, et al. Dosimetric characteristics of the MammoSite RTS, a new breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 2002;52:1132–9.PubMed
10.
go back to reference De la Rochefordiere A, Asselain B, Campana F, et al. Age as a prognostic factor in premenopausal breast carcinoma. Lancet 1993;341:1039–43.PubMedCrossRef De la Rochefordiere A, Asselain B, Campana F, et al. Age as a prognostic factor in premenopausal breast carcinoma. Lancet 1993;341:1039–43.PubMedCrossRef
11.
go back to reference Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12:888–94.PubMed Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12:888–94.PubMed
12.
go back to reference Haffty BG, McKhann C, Beinfeld M, et al. Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data. J Clin Oncol 1991;9:997–1003.PubMed Haffty BG, McKhann C, Beinfeld M, et al. Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data. J Clin Oncol 1991;9:997–1003.PubMed
13.
go back to reference Kurtz JM, Spitalier JM, Amalric R, et al. Mammary recurrences in women younger than forty. Int J Radiat Oncol Biol Phys 1988;15:271–6.PubMedCrossRef Kurtz JM, Spitalier JM, Amalric R, et al. Mammary recurrences in women younger than forty. Int J Radiat Oncol Biol Phys 1988;15:271–6.PubMedCrossRef
14.
go back to reference Fowble BL, Schultz DJ, Overmoyer B, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys 1994;30:23–33.PubMed Fowble BL, Schultz DJ, Overmoyer B, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys 1994;30:23–33.PubMed
15.
go back to reference Kini VR, Vicini FA, Frazier R, et al. Mammographic, pathologic, and treatment-related factors associated with local recurrence in patients with early-stage breast cancer treated with breast conserving therapy. Int J Radiat Oncol Biol Phys 1999;43:341–6.PubMed Kini VR, Vicini FA, Frazier R, et al. Mammographic, pathologic, and treatment-related factors associated with local recurrence in patients with early-stage breast cancer treated with breast conserving therapy. Int J Radiat Oncol Biol Phys 1999;43:341–6.PubMed
16.
go back to reference Veronesi U, Salvadori B, Luini A, et al. Conservative treatment of early breast cancer Long-term results of 1232 cases treated with quadrantectomy axillary dissection and radiotherapy. Ann Surg 1990;211:250–9.PubMed Veronesi U, Salvadori B, Luini A, et al. Conservative treatment of early breast cancer Long-term results of 1232 cases treated with quadrantectomy axillary dissection and radiotherapy. Ann Surg 1990;211:250–9.PubMed
17.
go back to reference Vicini F, Beitsch PD, Quiet CA, et al. Three-year analysis of treatment efficacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer 2008;112:758–66.PubMedCrossRef Vicini F, Beitsch PD, Quiet CA, et al. Three-year analysis of treatment efficacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer 2008;112:758–66.PubMedCrossRef
18.
go back to reference Jeruss JS, Vicini FA, Beitsch PD, et al. Initial outcomes for patients treated on the American Society of Breast Surgeons MammoSite clinical trial for ductal carcinoma-in situ of the breast. Ann Surg Oncol 2006;13:967–76.PubMedCrossRef Jeruss JS, Vicini FA, Beitsch PD, et al. Initial outcomes for patients treated on the American Society of Breast Surgeons MammoSite clinical trial for ductal carcinoma-in situ of the breast. Ann Surg Oncol 2006;13:967–76.PubMedCrossRef
19.
go back to reference Arthur DW, Vicini FA, Kuske RR, Wazer DE, Nag S; American Brachytherapy Society. Accelerated partial breast irradiation: an updated report from the American Brachytherapy Society. Brachytherapy 2003;2:124–30.PubMedCrossRef Arthur DW, Vicini FA, Kuske RR, Wazer DE, Nag S; American Brachytherapy Society. Accelerated partial breast irradiation: an updated report from the American Brachytherapy Society. Brachytherapy 2003;2:124–30.PubMedCrossRef
21.
go back to reference Chao KK, Vicini FA, Wallace M, et al. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: the William Beaumont hospital experience. Int J Radiat Oncol Biol Phys 2007;69:32–40.PubMed Chao KK, Vicini FA, Wallace M, et al. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: the William Beaumont hospital experience. Int J Radiat Oncol Biol Phys 2007;69:32–40.PubMed
22.
go back to reference Patel RR, Christensen ME, Hodge CW, et al. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial: five-year results. Int J Radiat Oncol Biol Phys 2008;70:970–3.PubMed Patel RR, Christensen ME, Hodge CW, et al. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial: five-year results. Int J Radiat Oncol Biol Phys 2008;70:970–3.PubMed
Metadata
Title
Local Control, Toxicity, and Cosmesis in Women Younger Than 50 Enrolled Onto the American Society of Breast Surgeons MammoSite Radiation Therapy System Registry Trial
Authors
A. J. Khan, MD
F. Vicini, MD
P. Beitsch, MD
B. Haffty, MD
C. Quiet, MD
A. Keleher, MD
D. Garcia, MD
H. Snider, MD
M. Gittleman, MD
V. Zannis, MD
H. Kuerer, MD, PhD
E. Whitacre, MD
P. Whitworth Jr, MD
R. Fine, MD
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0406-8

Other articles of this Issue 6/2009

Annals of Surgical Oncology 6/2009 Go to the issue