The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy
Introduction
Nowadays, breast conservative treatment (BCT) is the standard treatment for small breast tumours, stage I and II. Large randomised trials such as the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-06, the European Organization for Research and Treatment of Cancer (EORTC) trial 10801, and other data showed equal results for lumpectomy with irradiation, compared with mastectomy 1, 2, 3, 4.
Women with T1 tumours are an excellent group for BCT. In addition, from a psychological and social point of view, BCT offers women a better treatment compared with mastectomy. In this respect, young women are an important group. Many studies report a higher local recurrence rate in young women, ranging from 8 to 31% in women younger than 45 years of age 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 29.
The identification of patients at an increased risk of local recurrence after BCT continues to generate controversy. Many factors have been identified. Unfortunately, direct comparison of published data is limited because of differences in surgical and radiation techniques, histological evaluations and the use of adjuvant systemic therapy.
In the EORTC trial, investigating the value of the boost dose, which included 5569 patients, young age (<40 years) was again one of the major prognostic factors for worse local control.
This raises the question of whether BCT is the right primary treatment for young women or whether other factors should be considered. To evaluate the importance of young age as a prognostic factor for local recurrence, we analysed a prospective cohort study of breast cancer patients with T1 tumours, all treated with BCT, and all treated with radiotherapy at the Radiotherapy department of the Medisch Spectrum Twente (MST).
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Patients and methods
Between 1984 and 1997, 1085 patients with a pathological T1 breast cancer (pT1), were treated with BCT in the Twente-Achterhoek region, and all had the radiotherapy at the Radiotherapy Department of the MST.
The standard treatment for BCT consisted of lumpectomy with axillary dissection, clearance level I–III, followed by radiotherapy of the whole breast with a boost to the primary tumour area.
The radiotherapy was 50 Gy to the whole breast delivered by tangential technique in 2 Gy fractions,
Results
Of the 1085 women with a pT1 tumour, only 7.8% (85/1085) were 40 years or younger at the time of the primary treatment. The follow-up ranged from 3 to 194 months with a median of 71 months and a mean of 78 months.
Table 1 shows a comparison in terms of clinical, histological and treatment characteristics between the two age groups. The two groups of women defined by age were homogeneous in terms of family history, pN classification, number of positive lymph nodes, margins in the lumpectomy
Discussion
In our analysis, young age was demonstrated to be an important prognostic factor in a failure of local control. In addition, age was a major prognostic factor for survival.
The clinical factors, such as the localisation of the primary in the breast and the family history with respect to first-degree relatives, showed no differences with respect to local recurrence rate, which is in accordance with the literature 6, 14, 15, 16, 27. In contrast to the overall analysis, a separate analysis showed
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