Surgery in early stage breast cancer should be followed by radiotherapy
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《英国医生杂志》
Omission of radiotherapy after breast conserving surgery for early stage breast cancer is associated with higher rates of relapse and slightly higher mortality from the disease, a new study has found (Journal of the National Cancer Institute 2004;96:115-21).
The researchers, led by Dr Vincent Vinh-Hung of the Oncology Center at Academic Hospital in Jette, Belgium, and colleagues did a pooled analysis of 15 published randomised clinical trials of women with early stage breast cancer who had breast conserving surgery alone or surgery followed by radiotherapy. They analysed recurrence of ipsilateral breast tumour and death from any cause.
Recurrence rates, based on information from 9422 women, and mortality information was available for 8206 women. The authors calculated that the women who received breast conserving surgery alone were three times more likely to have a relapse than women who had breast conserving surgery followed by radiotherapy (95% confidence interval 2.65 to 3.40). In clinical trials that had five or more years of follow up information, the relapse rate ranged from 0.4% to 2.1% a year for women who had breast conserving surgery plus radiotherapy, compared with 1.4% to 5.7% a year for women who had only surgery. The authors also found that the relative risk of mortality for those not receiving radiotherapy was 1.09, which corresponded to a 8.6% relative excess mortality if radiotherapy were omitted (95% confidence interval = 0.3% to 17.5%).
"The present study confirms that radiotherapy should not be omitted after breast-conserving surgery, except for medical contraindications such as systemic vascular disease or a previous history of irradiation," the authors wrote. "Although the mortality risk may seem small, in daily practice in the general population it may translate into a considerable survival disadvantage."
In an accompanying editorial in the same journal (p 89), Katherine Vallis and Ian Tannock of Princess Margaret Hospital, Toronto, Canada, say that, although there may be a small subset of women with good prognostic factors who do not need to have radiotherapy after surgery, this analysis "reinforces the view that the large majority of patients undergoing breast conserving surgery should also receive radiotherapy.
"The most likely explanation for improved survival from use of radiotherapy after breast-conserving surgery is that local failure may result in secondary dissemination of disease."(New York Scott Gottlieb)
The researchers, led by Dr Vincent Vinh-Hung of the Oncology Center at Academic Hospital in Jette, Belgium, and colleagues did a pooled analysis of 15 published randomised clinical trials of women with early stage breast cancer who had breast conserving surgery alone or surgery followed by radiotherapy. They analysed recurrence of ipsilateral breast tumour and death from any cause.
Recurrence rates, based on information from 9422 women, and mortality information was available for 8206 women. The authors calculated that the women who received breast conserving surgery alone were three times more likely to have a relapse than women who had breast conserving surgery followed by radiotherapy (95% confidence interval 2.65 to 3.40). In clinical trials that had five or more years of follow up information, the relapse rate ranged from 0.4% to 2.1% a year for women who had breast conserving surgery plus radiotherapy, compared with 1.4% to 5.7% a year for women who had only surgery. The authors also found that the relative risk of mortality for those not receiving radiotherapy was 1.09, which corresponded to a 8.6% relative excess mortality if radiotherapy were omitted (95% confidence interval = 0.3% to 17.5%).
"The present study confirms that radiotherapy should not be omitted after breast-conserving surgery, except for medical contraindications such as systemic vascular disease or a previous history of irradiation," the authors wrote. "Although the mortality risk may seem small, in daily practice in the general population it may translate into a considerable survival disadvantage."
In an accompanying editorial in the same journal (p 89), Katherine Vallis and Ian Tannock of Princess Margaret Hospital, Toronto, Canada, say that, although there may be a small subset of women with good prognostic factors who do not need to have radiotherapy after surgery, this analysis "reinforces the view that the large majority of patients undergoing breast conserving surgery should also receive radiotherapy.
"The most likely explanation for improved survival from use of radiotherapy after breast-conserving surgery is that local failure may result in secondary dissemination of disease."(New York Scott Gottlieb)