Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation
Identifieur interne : 007099 ( Istex/Corpus ); précédent : 007098; suivant : 007100Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation
Auteurs : Jos J. Jager ; Lex Volovics ; Leo J. Schouten ; Jos M. A De Jong ; Pierre S. G. J Hupperets ; Maarten F. Von Meyenfeldt ; Bert Schutte ; Geert H. BlijhamSource :
- Radiotherapy and Oncology [ 0167-8140 ] ; 1999.
English descriptors
Abstract
Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated. Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours. Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified. Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.
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DOI: 10.1016/S0167-8140(98)00118-2
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title><author><name sortKey="Jager, Jos J" sort="Jager, Jos J" uniqKey="Jager J" first="Jos J" last="Jager">Jos J. Jager</name><affiliation><mods:affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Volovics, Lex" sort="Volovics, Lex" uniqKey="Volovics L" first="Lex" last="Volovics">Lex Volovics</name><affiliation><mods:affiliation>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Schouten, Leo J" sort="Schouten, Leo J" uniqKey="Schouten L" first="Leo J" last="Schouten">Leo J. Schouten</name><affiliation><mods:affiliation>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="De Jong, Jos M A" sort="De Jong, Jos M A" uniqKey="De Jong J" first="Jos M. A" last="De Jong">Jos M. A De Jong</name><affiliation><mods:affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Hupperets, Pierre S G J" sort="Hupperets, Pierre S G J" uniqKey="Hupperets P" first="Pierre S. G. J" last="Hupperets">Pierre S. G. J Hupperets</name><affiliation><mods:affiliation>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Von Meyenfeldt, Maarten F" sort="Von Meyenfeldt, Maarten F" uniqKey="Von Meyenfeldt M" first="Maarten F" last="Von Meyenfeldt">Maarten F. Von Meyenfeldt</name><affiliation><mods:affiliation>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Schutte, Bert" sort="Schutte, Bert" uniqKey="Schutte B" first="Bert" last="Schutte">Bert Schutte</name><affiliation><mods:affiliation>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Blijham, Geert H" sort="Blijham, Geert H" uniqKey="Blijham G" first="Geert H" last="Blijham">Geert H. Blijham</name><affiliation><mods:affiliation>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F0E5751B378034EDDDC82E5CDCAA9E20972167A1</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1016/S0167-8140(98)00118-2</idno><idno type="url">https://api.istex.fr/document/F0E5751B378034EDDDC82E5CDCAA9E20972167A1/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">007099</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">007099</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title><author><name sortKey="Jager, Jos J" sort="Jager, Jos J" uniqKey="Jager J" first="Jos J" last="Jager">Jos J. Jager</name><affiliation><mods:affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Volovics, Lex" sort="Volovics, Lex" uniqKey="Volovics L" first="Lex" last="Volovics">Lex Volovics</name><affiliation><mods:affiliation>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Schouten, Leo J" sort="Schouten, Leo J" uniqKey="Schouten L" first="Leo J" last="Schouten">Leo J. Schouten</name><affiliation><mods:affiliation>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="De Jong, Jos M A" sort="De Jong, Jos M A" uniqKey="De Jong J" first="Jos M. A" last="De Jong">Jos M. A De Jong</name><affiliation><mods:affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Hupperets, Pierre S G J" sort="Hupperets, Pierre S G J" uniqKey="Hupperets P" first="Pierre S. G. J" last="Hupperets">Pierre S. G. J Hupperets</name><affiliation><mods:affiliation>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Von Meyenfeldt, Maarten F" sort="Von Meyenfeldt, Maarten F" uniqKey="Von Meyenfeldt M" first="Maarten F" last="Von Meyenfeldt">Maarten F. Von Meyenfeldt</name><affiliation><mods:affiliation>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Schutte, Bert" sort="Schutte, Bert" uniqKey="Schutte B" first="Bert" last="Schutte">Bert Schutte</name><affiliation><mods:affiliation>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Blijham, Geert H" sort="Blijham, Geert H" uniqKey="Blijham G" first="Geert H" last="Blijham">Geert H. Blijham</name><affiliation><mods:affiliation>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="ISSN">0167-8140</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">50</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="267">267</biblScope><biblScope unit="page" to="275">275</biblScope></imprint><idno type="ISSN">0167-8140</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0167-8140</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Breast cancer</term><term>Extracapsular tumour extension</term><term>Flow cytometry</term><term>Loco-regional recurrence</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated. Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours. Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified. Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>radiotherapy</json:string><json:string>recurrence</json:string><json:string>node</json:string><json:string>axillary</json:string><json:string>oncol</json:string><json:string>tumour</json:string><json:string>adjuvant</json:string><json:string>breast cancer</json:string><json:string>chemotherapy</json:string><json:string>mastectomy</json:string><json:string>postoperative</json:string><json:string>chest wall</json:string><json:string>adjuvant 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irradiation</json:string><json:string>postoperative radiotherapy</json:string><json:string>chest wall recurrence</json:string><json:string>early breast cancer</json:string><json:string>nodal status</json:string><json:string>jager</json:string><json:string>distant metastases</json:string><json:string>axillary nodes</json:string><json:string>cumulative incidence rate</json:string><json:string>positive axillary nodes</json:string><json:string>cumulative incidence rates</json:string><json:string>decision rule</json:string><json:string>resection margin</json:string><json:string>locoregional recurrence</json:string><json:string>cumulative incidence</json:string><json:string>supraclavicular fossa</json:string><json:string>additional information</json:string><json:string>positive nodes</json:string><json:string>complete axillary dissection</json:string><json:string>cumulative incidences</json:string><json:string>extracapsular tumour extension</json:string><json:string>lymph</json:string><json:string>hazard ratio</json:string><json:string>similar results</json:string><json:string>axillary recurrence</json:string><json:string>local recurrence</json:string><json:string>axillary node</json:string><json:string>regional lymph nodes</json:string><json:string>risk factors</json:string><json:string>flow cytometry</json:string><json:string>prognostic factors</json:string><json:string>additional value</json:string><json:string>axillary recurrences</json:string></teeft></keywords><author><json:item><name>Jos J Jager</name><affiliations><json:string>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</json:string></affiliations></json:item><json:item><name>Lex Volovics</name><affiliations><json:string>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</json:string></affiliations></json:item><json:item><name>Leo J Schouten</name><affiliations><json:string>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</json:string></affiliations></json:item><json:item><name>Jos M.A de Jong</name><affiliations><json:string>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</json:string></affiliations></json:item><json:item><name>Pierre S.G.J Hupperets</name><affiliations><json:string>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</json:string></affiliations></json:item><json:item><name>Maarten F von Meyenfeldt</name><affiliations><json:string>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</json:string></affiliations></json:item><json:item><name>Bert Schutte</name><affiliations><json:string>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</json:string></affiliations></json:item><json:item><name>Geert H Blijham</name><affiliations><json:string>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Breast cancer</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Loco-regional recurrence</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Flow cytometry</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Extracapsular tumour extension</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated. Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours. Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P>0.05) and nodal status (P>0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (>10%) group for LRR could be identified. Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.</abstract><qualityIndicators><score>8</score><pdfVersion>1.2</pdfVersion><pdfPageSize>595 x 794 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1743</abstractCharCount><pdfWordCount>5451</pdfWordCount><pdfCharCount>34749</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>253</abstractWordCount></qualityIndicators><title>Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title><pii><json:string>S0167-8140(98)00118-2</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Radiotherapy and Oncology</title><language><json:string>unknown</json:string></language><publicationDate>1999</publicationDate><issn><json:string>0167-8140</json:string></issn><pii><json:string>S0167-8140(00)X0049-7</json:string></pii><volume>50</volume><issue>3</issue><pages><first>267</first><last>275</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>radiology, nuclear medicine & medical imaging</json:string><json:string>oncology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1016/S0167-8140(98)00118-2</json:string></doi><id>F0E5751B378034EDDDC82E5CDCAA9E20972167A1</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/F0E5751B378034EDDDC82E5CDCAA9E20972167A1/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/F0E5751B378034EDDDC82E5CDCAA9E20972167A1/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/F0E5751B378034EDDDC82E5CDCAA9E20972167A1/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1999 Elsevier Science Ireland Ltd</p></availability><date>1999</date></publicationStmt><notesStmt><note type="content">Fig. 1: Event free survival (efs) and cumulative incidence of loco-regional recurrences of all (ci total Irr) and isolated loco-regional recurrences (ci isolated Irr).</note><note type="content">Fig. 2: Cumulative incidences of loco-regional recurrences according to T-stage. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 3: Cumulative incidences of loco-regional recurrences according to nodal stage. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 4: Cumulative incidences of loco-regional recurrences in node-positive patients according to the presence of extracapsular tumour extension (ECE) of axillary node metastases. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 5: Cumulative incidences of loco-regional recurrences according to high and low risk groups. Numbers of patients at risk are under the curve.</note><note type="content">Table 1: Patient characteristics (n=608)</note><note type="content">Table 2: Loco-regional recurrence (LRR) following modified radical mastectomya</note><note type="content">Table 3: Results of multivariate analysis of all patients</note><note type="content">Table 4: Loco-regional recurrence and DNA flow cytometry after modified radical mastectomy</note><note type="content">Table 5: Results of multivariate analysis of N+ patients (n=353)</note><note type="content">Table 6: LRR rate in relation to T- and N-status and ECE</note><note type="content">Table 7: Multivariate analysis for chest wall recurrence as the endpoint</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title><author xml:id="author-0000"><persName><forename type="first">Jos J</forename><surname>Jager</surname></persName><note type="correspondence"><p>Corresponding author. Department of Radiation Oncology, R.T.I.L., Henri Dunantstr. 5, 6419 PC Heerlen, The Netherlands</p></note><affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Lex</forename><surname>Volovics</surname></persName><affiliation>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Leo J</forename><surname>Schouten</surname></persName><affiliation>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Jos M.A</forename><surname>de Jong</surname></persName><affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Pierre S.G.J</forename><surname>Hupperets</surname></persName><affiliation>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Maarten F</forename><surname>von Meyenfeldt</surname></persName><affiliation>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Bert</forename><surname>Schutte</surname></persName><affiliation>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Geert H</forename><surname>Blijham</surname></persName><affiliation>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</affiliation></author><idno type="istex">F0E5751B378034EDDDC82E5CDCAA9E20972167A1</idno><idno type="DOI">10.1016/S0167-8140(98)00118-2</idno><idno type="PII">S0167-8140(98)00118-2</idno></analytic><monogr><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="pISSN">0167-8140</idno><idno type="PII">S0167-8140(00)X0049-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">50</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="267">267</biblScope><biblScope unit="page" to="275">275</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated. Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours. Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified. Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Breast cancer</term></item><item><term>Loco-regional recurrence</term></item><item><term>Flow cytometry</term></item><item><term>Extracapsular tumour extension</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1998-07-24">Modified</change><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/F0E5751B378034EDDDC82E5CDCAA9E20972167A1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity><istex:entity SYSTEM="gr5" NDATA="IMAGE" name="gr5"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>RADION</jid><aid>2244</aid><ce:pii>S0167-8140(98)00118-2</ce:pii><ce:doi>10.1016/S0167-8140(98)00118-2</ce:doi><ce:copyright type="full-transfer" year="1999">Elsevier Science Ireland Ltd</ce:copyright></item-info><head><ce:title>Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</ce:title><ce:author-group><ce:author><ce:given-name>Jos J</ce:given-name><ce:surname>Jager</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref></ce:author><ce:author><ce:given-name>Lex</ce:given-name><ce:surname>Volovics</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Leo J</ce:given-name><ce:surname>Schouten</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Jos M.A</ce:given-name><ce:surname>de Jong</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Pierre S.G.J</ce:given-name><ce:surname>Hupperets</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Maarten F</ce:given-name><ce:surname>von Meyenfeldt</ce:surname><ce:cross-ref refid="AFF5"><ce:sup>e</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Bert</ce:given-name><ce:surname>Schutte</ce:surname><ce:cross-ref refid="AFF6"><ce:sup>f</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Geert H</ce:given-name><ce:surname>Blijham</ce:surname><ce:cross-ref refid="AFF7"><ce:sup>g</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>d</ce:label><ce:textfn>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF5"><ce:label>e</ce:label><ce:textfn>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF6"><ce:label>f</ce:label><ce:textfn>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="AFF7"><ce:label>g</ce:label><ce:textfn>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Corresponding author. Department of Radiation Oncology, R.T.I.L., Henri Dunantstr. 5, 6419 PC Heerlen, The Netherlands</ce:text></ce:correspondence></ce:author-group><ce:date-received day="31" month="3" year="1998"></ce:date-received><ce:date-revised day="24" month="7" year="1998"></ce:date-revised><ce:date-accepted day="10" month="9" year="1998"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:italic>Purpose</ce:italic>: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated.</ce:simple-para><ce:simple-para><ce:italic>Materials and methods</ce:italic>: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours.</ce:simple-para><ce:simple-para><ce:italic>Results</ce:italic>: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (<ce:italic>n</ce:italic>=93), either with (<ce:italic>n</ce:italic>=30) or without (<ce:italic>n</ce:italic>=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (<ce:italic>P</ce:italic><0.05) and nodal status (<ce:italic>P</ce:italic><0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified.</ce:simple-para><ce:simple-para><ce:italic>Conclusions</ce:italic>: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Breast cancer</ce:text></ce:keyword><ce:keyword><ce:text>Loco-regional recurrence</ce:text></ce:keyword><ce:keyword><ce:text>Flow cytometry</ce:text></ce:keyword><ce:keyword><ce:text>Extracapsular tumour extension</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation</title></titleInfo><name type="personal"><namePart type="given">Jos J</namePart><namePart type="family">Jager</namePart><affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</affiliation><description>Corresponding author. Department of Radiation Oncology, R.T.I.L., Henri Dunantstr. 5, 6419 PC Heerlen, The Netherlands</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lex</namePart><namePart type="family">Volovics</namePart><affiliation>Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Leo J</namePart><namePart type="family">Schouten</namePart><affiliation>Department of Registration and Epidemiology, Comprehensive Cancer Centre Limburg, Maastricht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jos M.A</namePart><namePart type="family">de Jong</namePart><affiliation>Institute for Radiation Oncology Limburg, Heerlen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pierre S.G.J</namePart><namePart type="family">Hupperets</namePart><affiliation>Department of Internal Medicine, Section of Hematology–Oncology, University Hospital Maastricht, Maastricht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maarten F</namePart><namePart type="family">von Meyenfeldt</namePart><affiliation>Department of Surgery, Section of Surgical Oncology, University Hospital Maastricht, Maastricht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bert</namePart><namePart type="family">Schutte</namePart><affiliation>Department of Molecular Cell Biology & Genetics, University of Maastricht, Maastricht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Geert H</namePart><namePart type="family">Blijham</namePart><affiliation>Department of Internal Medicine, University Hospital Utrecht, Utrecht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><dateModified encoding="w3cdtf">1998-07-24</dateModified><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated. Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours. Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified. Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.</abstract><note type="content">Fig. 1: Event free survival (efs) and cumulative incidence of loco-regional recurrences of all (ci total Irr) and isolated loco-regional recurrences (ci isolated Irr).</note><note type="content">Fig. 2: Cumulative incidences of loco-regional recurrences according to T-stage. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 3: Cumulative incidences of loco-regional recurrences according to nodal stage. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 4: Cumulative incidences of loco-regional recurrences in node-positive patients according to the presence of extracapsular tumour extension (ECE) of axillary node metastases. Numbers of patients at risk are under the curve.</note><note type="content">Fig. 5: Cumulative incidences of loco-regional recurrences according to high and low risk groups. Numbers of patients at risk are under the curve.</note><note type="content">Table 1: Patient characteristics (n=608)</note><note type="content">Table 2: Loco-regional recurrence (LRR) following modified radical mastectomya</note><note type="content">Table 3: Results of multivariate analysis of all patients</note><note type="content">Table 4: Loco-regional recurrence and DNA flow cytometry after modified radical mastectomy</note><note type="content">Table 5: Results of multivariate analysis of N+ patients (n=353)</note><note type="content">Table 6: LRR rate in relation to T- and N-status and ECE</note><note type="content">Table 7: Multivariate analysis for chest wall recurrence as the endpoint</note><subject lang="en"><genre>Keywords</genre><topic>Breast cancer</topic><topic>Loco-regional recurrence</topic><topic>Flow cytometry</topic><topic>Extracapsular tumour extension</topic></subject><relatedItem type="host"><titleInfo><title>Radiotherapy and Oncology</title></titleInfo><titleInfo type="abbreviated"><title>RADION</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19990301</dateIssued></originInfo><identifier type="ISSN">0167-8140</identifier><identifier type="PII">S0167-8140(00)X0049-7</identifier><part><date>19990301</date><detail type="volume"><number>50</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>247</start><end>378</end></extent><extent unit="pages"><start>267</start><end>275</end></extent></part></relatedItem><identifier type="istex">F0E5751B378034EDDDC82E5CDCAA9E20972167A1</identifier><identifier type="DOI">10.1016/S0167-8140(98)00118-2</identifier><identifier type="PII">S0167-8140(98)00118-2</identifier><accessCondition type="use and reproduction" contentType="copyright">©1999 Elsevier Science Ireland Ltd</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Ireland Ltd, ©1999</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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