By John Otrompke
CHICAGO -- November 5, 2009 -- Despite improvements in breast cancer treatment, young women with breast cancer are at increased risk for poor outcomes, particularly after breast-conserving surgery, researchers noted at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting.
"The younger the patient, the more local recurrences they have, the more distant metastases, and the more malignant the disease is," stated Josef Hammer, MD, Barmherzige Schwestern Hospital, Linz, Austria, speaking here at an oral presentation on November 3.
The literature indicates that a newly diagnosed 30-year-old woman has a 10-year survival rate between 20% and 30%. Dr. Hammer said that many young patients opt for breast-sparing surgery, because they would lose some quality of life if they had mastectomies.
"Many of these patients know from cancer groups and survivors that reconstruction by tram flap, for example, which is not associated with an increased risk for recurrence, is associated with reports of pain, so they have breast-sparing surgery instead. This is associated with more local recurrence, side effects, complications, and infections," Dr. Hammer explained.
In this study, Dr. Hammer and his fellow researchers gathered data from 2,207 patients who had breast-conserving surgery with systemic chemotherapy, and were referred for radiation therapy.
Analysis was performed for local recurrence; 2,162 patients were evaluable. Local recurrence was 5.8% at 119 months, and disease-free survival, which was 80.8%. Age was the most important cut point for local recurrence, while node ratio, tumour size, and other factors were the most important predictors of disease-free survival. If the tumour was progesterone-negative, that was a negative factor for survival in the fourth level of analysis, and tumour location was relevant in the fifth level, with centrally and medially located tumours carrying increased risk.
Risk was determined mostly by age (average age of patients was 65 years) and the ratio between positive nodes and all excised nodes, not the number of positive nodes, as has sometimes been hypothesised, said Dr. Hammer. "Most [patients] were older, postmenopausal women, which means they have better survival," he explained. The relevant age point was 52 years, he added.
This study confirms medical beliefs that have been validated throughout the decade, Dr. Hammer concluded. "If a patient is found to have medial-tumour or progesterone-negative cancer at the beginning of treatment, it is valid to decide that the patient should be treated in a more aggressive manner," he said.
[Presentation title: Which Risk Parameters Gain in Importance After Breast Conserving Surgery (BCS), Systemic Therapy (ST) and Radiation Therapy (RT)? An Analysis From 2,162 Patients. Abstract 114]
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