Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Most early-stage breast cancer patients may not need radiation after mastectomy

08.03.2010
No significant increased risk of recurrence for women with spread to 1 lymph node, compared to others without metastasis

Breast cancer patients with early stage disease that has spread to only one lymph node may not benefit from radiation after mastectomy, because of the low present-day risk of recurrence following modern surgery and systemic therapy, a finding that could one day change the course of treatment for thousands of women diagnosed each year, according to researchers at The University of Texas M. D. Anderson Cancer.

The research, presented today in the plenary session of the Society of Surgical Oncology Annual Cancer Symposium, showed that stage I and II patients without spread to axillary lymph nodes or with 1-3 lymph nodes with metastasis who received surgery and adjuvant chemotherapy without radiation to the chestwall post-mastectomy had a low overall risk of locoregional recurrences (LRR).

According to Henry Kuerer, M.D., Ph.D., professor and Training Program Director in M. D. Anderson's Department of Surgical Oncology, 90 percent of patients diagnosed with node-positive disease will present with three or fewer nodes. An estimated 47,000 women are diagnosed annually with breast cancer involving 1- 3 lymph nodes. Of those, 30,000 have only one lymph node involvement.

"There is currently no question that radiotherapy after mastectomy is effective at decreasing the chances of LRR and is indicated in breast cancer patients with lymph node spread in greater than four nodes and where the risk of LRR is higher than 10 to 15 percent. However, the need for post-mastectomy radiation in early stage breast cancer patients has been a topic of great debate within the cancer community for decades," explained Kuerer, the study's senior author.

In the 1990s, two landmark randomized trials demonstrated a survival benefit for early stage breast cancer patients with lymph node metastases who received the therapy post-mastectomy, explained Kuerer. Subsequently, in 2005, a meta-analysis of randomized clinical trials that were conducted in the 1960s to 1980s showed both a survival benefit, and a decreased risk of LRR for women with node positive breast cancer. These study findings shifted clinical practice: the National Comprehensive Cancer Network altered their medical guidelines in 2007 to suggest that stage I and II breast cancer patients with one to three lymph node metastases "strongly consider" radiation post-mastectomy.

"We have entered a new era of breast cancer diagnosis and treatment. Modern day advances in all modalities have been dramatic and, collaboratively, have had a significant impact on recurrence and survival. Given these advances, the goal of our study was to assess the present-day LRR risk in women who present with smaller breast tumors and metastases to fewer lymph nodes," said Kuerer.

Kuerer and his colleagues studied clinical and pathological factors from 1,022 stage I or II breast cancer patients who received a mastectomy at M. D. Anderson between 1997 and 2002. Of those women, 79 percent had no lymph node involvement, 26 percent had 1-3 positive lymph nodes, with the majority having just one positive node. None received post-mastectomy radiation and/or pre-operative chemotherapy; 77 percent received post-operative chemotherapy and/or hormonal therapy. The median age was 54 years and the median follow up time was 7.5 years.

The researchers found that there was no statistical difference in the 10-year risk of LRR in women without lymph node spread versus those with spread to one node - 2.1 percent to 3.3 percent, respectively.

The only independent risk factor for LRR was age; patients age 40 and younger, regardless of node involvement, were at significant increased risk for LRR.

"For these younger women, not less, but more treatment may be needed," said Rajna Sharma, M.D., a fellow in M. D. Anderson's Department of Surgical Oncology, who presented the findings.

"For the overwhelming majority of early-stage breast cancer patients treated with modern surgery and systemic therapies, LRR rates may be too low to justify routine use of post-mastectomy radiation," said Kuerer. "This research will provoke much discussion among those caring for women with early-stage breast disease. Replicating these findings should be a priority to ensure that patients only receive therapy that is medically necessary."

In addition to Kuerer and Sharma, other authors on the all-M.D. Anderson study include: Thomas A. Buchholz, M.D., professor, Department of Radiation Oncology; Funda Meric-Bernstam, M.D., professor, Kelly K. Hunt, M.D., professor, Isabelle Bedrosian, M.D., assistant professor, Gildy V. Babiera, M.D., associate professor, Anthony Lucci, M.D., associate professor, Rosa F. Hwang, M.D., assistant professor, Loren L. Rourke, MD., assistant professor, Elizabeth A. Mittendorf, M.D., assistant professor, all in the Department of Surgical Oncology; Steven J. Kronowitz, M.D., associate professor, Department of Plastic Surgery; 4 Savitri Krishnamurthy, M.D., professor, Department of Pathology; Ana M. Gonzalez-Angulo, M.D., associate professor, Department of Breast Medical Oncology; and Wei Qiao, Department of Biostatistics.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 41 Comprehensive Cancer Centers designated by the National Cancer Institute. For four of the past six years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.

Lindsay Anderson | EurekAlert!
Further information:
http://www.mdanderson.org

More articles from Health and Medicine:

nachricht Researchers release the brakes on the immune system
18.10.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Terahertz spectroscopy goes nano

20.10.2017 | Information Technology

Strange but true: Turning a material upside down can sometimes make it softer

20.10.2017 | Materials Sciences

NRL clarifies valley polarization for electronic and optoelectronic technologies

20.10.2017 | Interdisciplinary Research

VideoLinks
B2B-VideoLinks
More VideoLinks >>>