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J Korean Soc Ther Radiol Oncol > Volume 20(4); 2002 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2002;20(4): 309-315.
Radiation Therapy for Operable Breast Cancer after Conservative Surgery
Myung Za Lee, Ha Chung Chun
Department of Radiation Therapy, College of Medicine, Hanyang University, Seoul, Korea. RT3580@hanyang.ac.kr
To evaluate the result of conservative management on recurrence, survival and prognostic factors of patient with operable breast cancer.
Fifty three patients, treated for localized breast cancer by lumpectomy or quadrantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years (range 24~72). The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2. Thirty-eight patients had negative and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobular, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were the outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of 46~50 Gy were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas.
The overall five and 10 year actuarial and disease free survivals were 94.3 % and 92.4%, 91.2 and 81%, respectively. The overall five year survivals were 100% in stage I and IIa, and 66.7% in stage IIb and IIIa tumors. Seven patients failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were 7.5% and 5.7%, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 (26.6%). A high incidence in the axillary node was noted at a young age with 7 out of 12 (58.3%) and in T2 lesions with 8 out of 21 (38.4%). A young age, positive axillary node and large tumor size were all related with poor survival.
Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival.
Key Words: Breast cancer, Conservative surgery and radiation
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