Universität zu Köln

Vrieling, Conny, van Werkhoven, Erik ORCID: 0000-0001-7469-7427, Maingon, Philippe, Poortmans, Philip, Weltens, Caroline, Fourquet, Alain, Schinagl, Dominic, Oei, Bing, Rodenhuis, Carla C., Horiot, Jean-Claude, Struikmans, Henk, Van Limbergen, Erik, Kirova, Youlia, Elkhuizen, Paula, Bongartz, Rudolf, Miralbell, Raymond, Morgan, David A. L., Dubois, Jean-Bernard, Remouchamps, Vincent, Mirimanoff, Rene-Olivier, Hart, Guus, Collette, Sandra, Collette, Laurence and Bartelink, Harry (2017). Prognostic Factors for Local Control in Breast Cancer After Long-term Follow-up in the EORTC Boost vs No Boost Trial A Randomized Clinical Trial. JAMA Oncol., 3 (1). S. 42 - 49. CHICAGO: AMER MEDICAL ASSOC. ISSN 2374-2445

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Abstract

IMPORTANCE Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. OBJECTIVE The EORTC boost no boost trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. DESIGN, SETTING, AND PARTICIPANTS Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III boost no boost trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. INTERVENTIONS No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. MAIN OUTCOMES AND MEASURES Time to ipsilateral breast tumor recurrence (IBTR) as first event. RESULTS The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15%(95% CI, 12%-17%). Young age (P <. 001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P =. 001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34%(95% CI, 25%-41%), 14%(95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P <. 001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P <. 001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15%(95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P <. 001) in high-risk patients (<= 50 years with DCIS present). CONCLUSIONS AND RELEVANCE The association of high-grade invasive tumor with IBTR diminished during follow-up, while the effect of DCIS adjacent to invasive tumor seemed to remain stable. Therefore, patients with high-grade invasive tumors should be monitored closely, especially in the first 5 years, while additional DCIS is an indication for longer follow-up, emphasizing the importance of long-term trial follow-up to estimate absolute effects accurately.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Vrieling, Conny UNSPECIFIED UNSPECIFIED UNSPECIFIED van Werkhoven, Erik UNSPECIFIED orcid.org/0000-0001-7469-7427 UNSPECIFIED Maingon, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Poortmans, Philip UNSPECIFIED UNSPECIFIED UNSPECIFIED Weltens, Caroline UNSPECIFIED UNSPECIFIED UNSPECIFIED Fourquet, Alain UNSPECIFIED UNSPECIFIED UNSPECIFIED Schinagl, Dominic UNSPECIFIED UNSPECIFIED UNSPECIFIED Oei, Bing UNSPECIFIED UNSPECIFIED UNSPECIFIED Rodenhuis, Carla C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Horiot, Jean-Claude UNSPECIFIED UNSPECIFIED UNSPECIFIED Struikmans, Henk UNSPECIFIED UNSPECIFIED UNSPECIFIED Van Limbergen, Erik UNSPECIFIED UNSPECIFIED UNSPECIFIED Kirova, Youlia UNSPECIFIED UNSPECIFIED UNSPECIFIED Elkhuizen, Paula UNSPECIFIED UNSPECIFIED UNSPECIFIED Bongartz, Rudolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Miralbell, Raymond UNSPECIFIED UNSPECIFIED UNSPECIFIED Morgan, David A. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dubois, Jean-Bernard UNSPECIFIED UNSPECIFIED UNSPECIFIED Remouchamps, Vincent UNSPECIFIED UNSPECIFIED UNSPECIFIED Mirimanoff, Rene-Olivier UNSPECIFIED UNSPECIFIED UNSPECIFIED Hart, Guus UNSPECIFIED UNSPECIFIED UNSPECIFIED Collette, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Collette, Laurence UNSPECIFIED UNSPECIFIED UNSPECIFIED Bartelink, Harry UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-247053
DOI:	10.1001/jamaoncol.2016.3031
Journal or Publication Title:	JAMA Oncol.
Volume:	3
Number:	1
Page Range:	S. 42 - 49
Date:	2017
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2374-2445
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LUMPECTOMY PLUS TAMOXIFEN; CONSERVING THERAPY; LOCOREGIONAL RECURRENCE; RADIATION ONCOLOGY; STAGE-I; IRRADIATION; WOMEN; RISK; SURGERY; OLDER Multiple languages Oncology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24705