TY - JOUR
T1 - Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery
T2 - 2093 Patients treated with a prospective margin-directed policy
AU - Livi, Lorenzo
AU - Meattini, Icro
AU - Franceschini, Davide
AU - Saieva, Calogero
AU - Meacci, Fiammetta
AU - Marrazzo, Livia
AU - Gerlain, Elena
AU - Desideri, Isacco
AU - Scotti, Vieri
AU - Nori, Jacopo
AU - Sanchez, Luis Jose
AU - Orzalesi, Lorenzo
AU - Bonomo, Pierluigi
AU - Greto, Daniela
AU - Bianchi, Simonetta
AU - Biti, Giampaolo
PY - 2013/8
Y1 - 2013/8
N2 - Purpose: To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). Methods and materials: A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS <2 mm or positive. Results: After a median follow up of 5.2 years, we recorded 41 local relapse (LR, 2%). Concerning LR free survival, age at diagnosis, nuclear grade, hormonal status, T-stage, adjuvant hormonal therapy and adjuvant chemotherapy emerged as significant parameters (p-values from log rank test 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence. Conclusions: Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype.
AB - Purpose: To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). Methods and materials: A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS <2 mm or positive. Results: After a median follow up of 5.2 years, we recorded 41 local relapse (LR, 2%). Concerning LR free survival, age at diagnosis, nuclear grade, hormonal status, T-stage, adjuvant hormonal therapy and adjuvant chemotherapy emerged as significant parameters (p-values from log rank test 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence. Conclusions: Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype.
KW - Breast-conserving surgery
KW - Dose escalation
KW - Invasive breast cancer
KW - Radiotherapy boost
KW - Tumor margins
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U2 - 10.1016/j.radonc.2013.02.009
DO - 10.1016/j.radonc.2013.02.009
M3 - Article
C2 - 23490271
AN - SCOPUS:84885377374
VL - 108
SP - 273
EP - 278
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
SN - 0167-8140
IS - 2
ER -