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Multicenter Study
. 2018 Nov;105(12):1607-1614.
doi: 10.1002/bjs.10889. Epub 2018 Jun 21.

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

J de Boniface  1   2 , J Frisell  1   3 , L Bergkvist  4   5 , Y Andersson  4   5
Affiliations
Multicenter Study

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

J de Boniface et al. Br J Surg. 2018 Nov.

Abstract

Background: The prognostic equivalence between mastectomy and breast-conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking.

Methods: The Swedish Multicentre Cohort Study prospectively included clinically node-negative patients with breast cancer who had planned sentinel node biopsy between 2000 and 2004. Axillary lymph node dissection was undertaken only in patients with sentinel node metastases. For the present investigation, adjusted survival analyses were used to compare patients who underwent BCS and postoperative radiotherapy with those who received mastectomy without radiotherapy.

Results: Of 3518 patients in the Swedish Multicentre Cohort Study, 2767 were included in the present analysis; 2338 had BCS with postoperative radiotherapy and 429 had mastectomy without radiotherapy. Median follow-up was 156 months. BCS followed by whole-breast irradiation was superior to mastectomy without irradiation in terms of both overall survival (79·5 versus 64·3 per cent respectively at 13 years; P < 0·001) and breast cancer-specific survival (90·5 versus 84·0 per cent at 13 years; P < 0·001). The local recurrence rate did not differ between the two groups. The axillary recurrence-free survival rate at 13 years was significantly lower after mastectomy without irradiation (98·3 versus 96·2 per cent; P < 0·001).

Conclusion: The present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model.

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Figures

Figure 1
Figure 1
Flow chart showing the selection of patients for the present analysis. BCS, breast‐conserving surgery; RT, radiotherapy
Figure 2
Figure 2
Kaplan–Meier survival curves showing overall survival in the two local treatment groups. BCS, breast‐conserving surgery; RT, radiotherapy. P < 0·001 (log rank test)
Figure 3
Figure 3
Kaplan–Meier survival curves showing breast cancer‐specific survival in the two local treatment groups. BCS, breast‐conserving surgery; RT, radiotherapy. P < 0·001 (log rank test)
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References

    1. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L et al Eight‐year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989; 320: 822–828. - PubMed
    1. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al Twenty‐year follow‐up of a randomized study comparing breast‐conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–1232. - PubMed
    1. van Maaren MC, de Munck L, de Bock GH, Jobsen JJ, van Dalen T, Linn SC et al 10 year survival after breast‐conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population‐based study. Lancet Oncol 2016; 17: 1158–1170. - PubMed
    1. Hofvind S, Holen Å, Aas T, Roman M, Sebuødegård S, Akslen LA. Women treated with breast conserving surgery do better than those with mastectomy independent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol 2015; 41: 1417–1422. - PubMed
    1. Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of breast conservation therapy vs mastectomy on disease‐specific survival for early‐stage breast cancer. JAMA Surg 2014; 149: 267–274. - PubMed

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