Breast-conserving therapy with partial or whole breast irradiation: Ten-year results of the Budapest randomized trial

• Published in: Radiotherapy and oncology 2013-08, Vol.108 (2), p.197-202
• Main Authors: Polgár, Csaba, Fodor, János, Major, Tibor, Sulyok, Zoltán, Kásler, Miklós
• Format: Article
• Language: English
• Subjects: Accelerated partial breast irradiation; Adult; Age Factors; Aged; Aged, 80 and over; Brachytherapy; Brachytherapy - methods; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast-conserving therapy; Chi-Square Distribution; Disease-Free Survival; Dose Fractionation; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Hungary; Kaplan-Meier Estimate; Mastectomy, Segmental - methods; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Radiotherapy Dosage; Radiotherapy, Adjuvant; Randomized trial; Risk Assessment; Statistics, Nonparametric; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2013.05.008

Abstract Background and purpose To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Patients and methods Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1–2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI ( n = 130) or PBI ( n = 128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n = 88) or 50 Gy electron beam (EB) irradiation ( n = 40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results. Results After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively ( p = 0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group ( p < 0.01). Conclusions Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI.