Adjuvant Radiotherapy and Chemotherapy in Node-Positive Premenopausal Women with Breast Cancer
Joseph Ragaz, Stewart M. Jackson, Nhu Le, Ian H. Plenderleith, John J. Spinelli, Vivian E. Basco, Kenneth S. Wilson, Margaret A. Knowling, Christopher M.L. Coppin, Marilyn Paradis, Andrew J. Coldman, and Ivo A. Olivotto
Background Radiotherapy after mastectomy to treat early breastcancer has been known since the 1940s to reduce rates of localrelapse. However, the routine use of postoperative radiotherapybegan to decline in the 1980s because it failed to improve overallsurvival. We prospectively tested the efficacy of combiningradiotherapy with chemotherapy.
Methods From 1978 through 1986, 318 premenopausal women withnode-positive breast cancer were randomly assigned, after modifiedradical mastectomy, to receive chemotherapy plus radiotherapyor chemotherapy alone. Radiotherapy was given to the chest walland locoregional lymph nodes between the fourth and fifth cyclesof cyclophosphamide, methotrexate, and fluorouracil.
Results After 15 years of follow-up, the women assigned to chemotherapyplus radiotherapy had a 33 percent reduction in the rate ofrecurrence (relative risk, 0.67; 95 percent confidence interval,0.50 to 0.90) and a 29 percent reduction in mortality from breastcancer (relative risk, 0.71; 95 percent confidence interval,0.51 to 0.99), as compared with the women treated with chemotherapyalone.
Conclusions Radiotherapy combined with chemotherapy after modifiedradical mastectomy decreases rates of locoregional and systemicrelapse and reduces mortality from breast cancer.
Trials of postoperative radiotherapy for breast cancer conductedduring the 1960s and 1970s showed significant reductions inrates of locoregional recurrence but no improvement in overallsurvival.1,2 This result has been attributed to micrometastases,which determine prognosis regardless of the effect of the locoregionaltherapy. Additional concern was raised by data suggesting thatirradiated patients have reduced survival rates, due to eitherimmune suppression3 or cardiac complications.2,4,5
In the late 1970s, adjuvant chemotherapy became a standard treatmentfor high-risk premenopausal patients with breast cancer.6,7,8The use of adjuvant radiation subsequently declined, becauseit did not appear to prolong survival. Nevertheless, there arereasons to reconsider radiotherapy, including the limited valueof adjuvant chemotherapy for bulky disease,9,10,11 a synergisticeffect of chemotherapy plus radiation on residual locoregionaltumor,12,13,14 and the possibility that eliminating bulky diseasewith radiation may improve the effect of chemotherapy, becausechemotherapy may be more effective when the overall diseaseburden is low.9,10,11,12,15 To test the hypothesis that addingradiation to adjuvant systemic therapy improves the outcomein patients with breast cancer, we designed a randomized trialin 1978 in British Columbia. This report presents our findingsafter 15 years of follow-up.
Methods
From 1979 through 1986, 318 premenopausal women with newly diagnosedstage I or II breast cancer were enrolled in the study afterundergoing modified radical mastectomy if, after axillary-nodedissection, one or more level I or II lymph nodes were foundto be positive on pathological examination. The mastectomy wasperformed according to standard surgical practice between 1979and 1986. After written informed consent was obtained, the patientswere randomly assigned to one of two groups: those receivingadjuvant chemotherapy plus locoregional radiotherapy in fivefields (the chemotherapy–radiotherapy group, with 164patients) and those receiving chemotherapy alone (the chemotherapygroup, with 154 patients). The characteristics of the patientswere evenly balanced, as Table 1 shows.
Table 1. Prognostic Variables at Base Line in the Two Study Groups.
Surgery
All the patients underwent modified radical mastectomy, withdissection of level I and II axillary lymph nodes. The surgerywas performed by specialists who referred all the patients tothe British Columbia Cancer Agency, the provincial cancer institute,for registration, randomization, and the planning of the chemotherapyand radiation treatments.
Chemotherapy
The chemotherapy consisted of cyclophosphamide (600 mg per squaremeter of body-surface area), methotrexate (40 mg per squaremeter), and fluorouracil (600 mg per square meter) (the CMFregimen), given intravenously every 21 days as described byBonadonna et al.,7 initially for 12 months (80 patients), andin the case of patients randomized after 1981, for 6 months.
Radiation
The radiation therapy was administered between the fourth andfifth cycles of chemotherapy. Sixteen daily treatments weredelivered over a period of three to four weeks. The postmastectomychest wall received a dose of 37.5 Gy through two tangentialfields. The mid-axilla received a dose of 35 Gy through an anteriorsupraclavicular–axillary field with a posterior axillaryboost. A direct internal mammary field delivered a dose of 35Gy at a depth of 3 cm. All the fields were treated with cobalt-60.The interval between the fourth and fifth cycles of chemotherapywas five to six weeks. Also, as part of a second randomization,68 patients with estrogen-positive tumors were treated withradiation-induced ovarian ablation that included 20 Gy overa period of five days plus prednisone (7.5 mg per day) for twoyears, as described by Meakin et al.16 Among these 68 patients,33 were assigned to chemotherapy and 35 were assigned to chemotherapyand radiotherapy.
Statistical Analysis
In the various analyses, we studied the following end points:any relapse of breast cancer (or death without a known relapseof breast cancer), for the analysis of disease-free survival;locoregional recurrence as a first event, before a systemicrecurrence (in the ipsilateral chest wall or an axillary, internalmammary, or supraclavicular node), for the analysis of survivalfree of locoregional disease; any systemic relapse, with orwithout a locoregional relapse (or death without a known systemicrelapse), for the analysis of survival free of systemic disease;death from breast cancer, for the analysis of breast-cancer–specificsurvival; and any death, for the analysis of overall survival.
Survival curves were estimated by the Kaplan–Meier method.17Significance levels, estimates of relative risk, and 95 percentconfidence intervals were calculated with a proportional-hazardsregression model.18 Two-sided P values of less than 0.05 wereconsidered to represent statistical significance. The analysiswas done for the whole group of 318 patients and also for subgroupswith involvement in either one to three axillary nodes or fouror more nodes. Differences between these subgroups with respectto the relative risk associated with the radiation were studiedby testing for significant interactions with the proportional-hazardsregression model. In the survival analysis, the time to theend points associated with each event was calculated from thedate of the tissue diagnosis of breast cancer. Eleven patients(3.5 percent) were lost to follow-up — three (1.9 percent)from the chemotherapy group and eight (4.9 percent) from thechemotherapy–radiotherapy group. All 11 patients werealive and had no recurrences at their last known follow-up.In all the analyses, the data were censored as of the date ofthat follow-up. Of the 164 patients randomly assigned to chemotherapyand radiotherapy, 12 did not receive radiotherapy and were treatedwith chemotherapy alone (7 declined radiotherapy, 3 had metastasesbefore radiotherapy, and 2 had postsurgical complications).Eight patients randomly assigned to chemotherapy had radiotherapyat their own request or that of their physicians. All the analysespresented were performed on an intention-to-treat basis (accordingto the initial randomization).
Results
All Patients
A total of 318 patients were randomized, and among the survivorsthe median follow-up was 150 months (150 months in the chemotherapygroup and 150 in the chemotherapy–radiotherapy group).During the 15 years of follow-up, breast cancer had recurredin 176 patients and 144 patients died. Of the 176 patients withrecurrences, the disease returned locoregionally as a firstevent in 55 and systemically in 169; 14 additional patientshad locoregional recurrences after a systemic recurrence. Therewas no difference with regard to any survival end point betweenthe patients who had 12 months of chemotherapy and those whohad only 6 months (P = 0.60 for disease-free survival at 15years; P = 0.70 for overall survival).
Study Groups
Table 2 and Figure 1 through 4 show the results in the two groupsof patients. In the group treated with chemotherapy plus radiotherapy,79 of 164 patients had recurrences — locoregional, systemic,or both — as compared with 97 of 154 patients in the groupgiven chemotherapy alone. These values translate into an overallreduction of 33 percent in the rate of recurrence of breastcancer (relative risk, 0.67; 95 percent confidence interval,0.50 to 0.90; P = 0.007), with an improvement of 17 percentagepoints in disease-free survival at the 15-year follow-up (Figure 1).There was an overall reduction of 34 percent in the rateof systemic recurrence (relative risk, 0.66; 95 percent confidenceinterval, 0.49 to 0.89; P = 0.006) in the group treated withcombined therapy (75 of 164 patients vs. 94 of 154 patientsin the group treated only with chemotherapy), and a 17-percentage-pointimprovement in systemic disease-free survival (Figure 2). Therate of locoregional recurrence was reduced by 56 percent (relativerisk, 0.44; 95 percent confidence interval, 0.26 to 0.77; P= 0.003) in the group given chemotherapy plus radiotherapy (19events, vs. 36 events in the group treated with chemotherapyonly), for an absolute improvement of 20 percent in survivalfree of local disease. Mortality from breast cancer was reducedby 29 percent in the chemotherapy–radiotherapy group (relativerisk, 0.71; 95 percent confidence interval, 0.51 to 0.99; P= 0.05), with 62 deaths, as compared with 76 in the chemotherapy-onlygroup, which represented an improvement of 10 percentage pointsin breast-cancer–specific survival (Figure 3). There were66 deaths in the group given the combined treatment and 78 deathsin the chemotherapy group, for a 26 percent reduction in overallmortality at 15 years (relative risk, 0.74; 95 percent confidenceinterval, 0.53 to 1.02; P = 0.07) and an 8 percent improvementin overall survival (Table 2 and Figure 4).
Figure 1. Disease-free Survival in the Study Groups.
In the group receiving chemotherapy combined with radiotherapy, 79 of 164 patients had relapses. The ratio of observed events to expected events was 0.82. In the group receiving chemotherapy alone, 97 of 154 patients had relapses. The ratio of observed events to expected events was 1.20. The relative risk of relapse when the former group was compared with the latter was 0.67 (P = 0.007).
Figure 2. Survival Free of Systemic Disease in the Study Groups.
The top panel shows an analysis of all 318 study patients. In the group receiving chemotherapy combined with radiotherapy, 75 of 164 patients had systemic recurrences or died. The ratio of observed events to expected events was 0.81. In the group receiving chemotherapy alone, 94 of 154 patients had systemic recurrences or died. The ratio of observed events to expected events was 1.23. The relative risk of a systemic recurrence or death when the former group was compared with the latter was 0.66 (P = 0.006).
The middle panel shows an analysis of the 183 study patients with one to three involved lymph nodes each. In the group receiving chemotherapy combined with radiotherapy, 32 of 91 patients had systemic recurrences or died. The ratio of observed events to expected events was 0.79. In the group receiving chemotherapy alone, 45 of 92 patients had systemic recurrences or died. The ratio of observed events to expected events was 1.23. The relative risk of a systemic recurrence or death when the former group was compared with the latter was 0.65 (P = 0.06).
The bottom panel shows an analysis of the 112 study patients with four or more involved lymph nodes each. In the group receiving chemotherapy combined with radiotherapy, 35 of 58 patients had systemic recurrences or died. The ratio of observed events to expected events was 0.8. In the group receiving chemotherapy alone, 43 of 54 patients had systemic recurrences or died. The ratio of observed events to expected events was 1.25. The relative risk of systemic recurrences or death when the former group was compared with the latter was 0.64 (P = 0.05).
Figure 3. Breast-Cancer–Specific Survival in the Study Groups.
In the group receiving chemotherapy combined with radiotherapy, 62 of 164 patients died of metastatic breast cancer. The ratio of observed events to expected events was 0.84. In the group receiving chemotherapy alone, 76 of 154 patients had metastatic breast cancer or died. The ratio of observed events to expected events was 1.18. The relative risk of death from metastatic breast cancer when the former group was compared with the latter was 0.71 (P = 0.05).
In the group receiving chemotherapy combined with radiotherapy, 66 of 164 patients died. The ratio of observed deaths to expected deaths was 0.86. In the group receiving chemotherapy alone, 78 of 154 patients died. The ratio of observed deaths to expected deaths was 1.16. The relative risk of death when the former group was compared with the latter was 0.74 (P = 0.07).
Among the 94 patients who had systemic relapses after chemotherapyalone, 19 were alive at the time of the 15-year analysis, ascompared with 9 of the 75 patients with such relapses in thechemotherapy–radiotherapy group. Radiation also improvedoutcome in the 68 patients randomly assigned to ovarian ablation,in regard to disease-free survival (relative risk, 0.72), survivalfree of systemic disease (relative risk, 0.76), and overallsurvival (relative risk, 0.88).
Subgroups Based on Nodal Involvement
The reduction in the relative risk of a recurrence that wasobtained by adding radiation to chemotherapy was similar inthe subgroup with one to three positive nodes and the subgroupwith four or more positive nodes (Table 3). There were no statisticallysignificant differences between these subgroups with regardto either survival free of systemic disease (P for interaction= 0.9) or rates of locoregional recurrence (P = 0.73).
Table 3. Rates of Survival Free of Systemic and Locoregional Disease, According to the Number of Positive Lymph Nodes.
Side Effects of Radiation
Arm edema developed in 15 of the 154 irradiated patients. Interventionswere required in six (an elastic sleeve in four, a pump in one,and physiotherapy in one), as compared with five patients inthe chemotherapy group, one of whom required physiotherapy.Limited apical lung fibrosis developed in most of the irradiatedpatients, but only one had interstitial pneumonitis requiringcorticosteroids, with full resolution on chest radiography severalweeks later. In one patient with a right-sided breast lesion,congestive heart failure developed 14 years after radiotherapy,at the age of 63. We considered this event related not to theadjuvant radiation but rather to treatment with doxorubicin,which was given at a cumulative dose of 540 mg for metastasesto the lung and pleura. There were no cases of brachial plexopathy.The incidence of second cancers and the associated mortalitywere distributed evenly between the two groups (Table 4).
Table 4. Incidence of Second Cancers and Side Effects of Treatment.
Discussion
This study of premenopausal women with breast cancer demonstratesthat locoregional radiotherapy reduces the rates of locoregionaland systemic relapses and the chance of dying from breast cancer.There was no excess mortality we could attribute to the long-termside effects of radiotherapy. Our trial did not stratify thepatients according to nodal status, but a test for interactionshowed no significant difference in the magnitude of the benefitfrom radiotherapy between the subgroup with three or fewer positivenodes and the subgroup with four or more positive nodes. Thesedata based on a 15-year follow-up indicate that radiation canoffer substantial protection from systemic relapse to node-positivepatients. It is possible that we will see additional benefitin overall survival, because at this writing 19 patients inthe chemotherapy group remain alive with systemic recurrence,as compared with only 9 in the combined-treatment group; mostof these 28 patients are expected to die of breast cancer.
The benefits of radiotherapy found in our study, but not inmost earlier studies, merit comment. The meta-analysis performedby the Early Breast Cancer Trialists' Collaborative Group,1which analyzed all the randomized radiation trials begun before1985, found a 67 percent reduction in rates of locoregionalrelapse (P<0.001) and a 6 percent reduction in mortalityfrom breast cancer (P = 0.03), but no improvement in overallsurvival. There was an important increase in the number of deathsnot due to breast cancer among the irradiated patients (P =0.002). A previous meta-analysis and several individual trialsfound that the latter was due to a substantial increase in mortalityfrom cardiac causes.2,4,19 These studies, however, includedall the radiation trials started in the 1960s, using older equipmentand radiation techniques and considered obsolete by presentstandards. Also, in various past trials different areas wereencompassed in the irradiated volume, and the trials differedin techniques of radiation, treatment planning, age, nodal status,and the use of adjuvant chemotherapy. Therefore, the meta-analysesof previous studies may not be relevant to current practice.
There are at least nine reported randomized trials comparingthe combined treatment with chemotherapy alone.20,21,22,23,24,25,26Of these, only the Danish study20 found that radiotherapy hada benefit of a magnitude similar to that in our trial, and therewas a significant survival benefit in favor of radiotherapy(P = 0.001). The patients in that study were similar to thosein our cohort; there was a large and homogeneous group of premenopausal,node-positive patients treated with chemotherapy and five-fieldradiotherapy.20 The other eight studies were not similar toours or the Danish trial, either because the number of randomizedpremenopausal patients was small or because the radiotherapytechniques or the chemotherapy schedules were heterogeneous.
Our data suggest that locoregional disease is not only a markerof systemic disease but also, in some patients, a potentialsource for its future dissemination. The Stockholm trial27 alsoprovides evidence that locoregional radiotherapy in node-positivepatients decreases the risk of systemic metastases. In thiscontext, the interaction with adjuvant chemotherapy may be important,because chemotherapy is expected to eliminate systemic micrometastasesmore effectively than locoregional disease.9,10,11,15 In node-positivepatients, adding locoregional radiotherapy may be essentialto prevent secondary dissemination from the residual locoregionalmetastatic disease, and it could increase the potential forcure.
Because all our patients were uniformly treated with chest-walland nodal radiation, our results may not apply to patients treatedwith breast irradiation alone after conservative surgery. Fourrandomized trials comparing breast irradiation with no irradiationin patients who underwent conservative surgery28,29,30,31 showedsignificant reductions in the rate of relapse in the breastbut no effect on systemic recurrences or overall survival. Therefore,it may be necessary to add nodal radiation to breast irradiationin premenopausal node-positive patients who are treated withpartial mastectomy and adjuvant chemotherapy.
Locoregional radiation is not routinely used at present in patientswith node-positive breast cancer, although it is coming intouse to treat patients with 10 or more positive nodes32,33 andoccasionally those with 4 or more positive nodes. The routineuse of radiation in all node-positive patients would representa substantial shift in treatment for breast cancer. Our dataindicate that locoregional disease remaining after definitivesurgery may be an important source of systemic disease. Theelimination of locoregional cancer cells by radiotherapy addedto adjuvant chemotherapy may reduce mortality in selected patientswith breast cancer.
We are indebted to the following colleagues at the British ColumbiaCancer Agency: Dr. Ann Worth, for assistance with the conductof the study; and Mr. David Noble, Dr. Ralph Durand, Dr. JoeConnors, and Dr. Nevine Murray, for their review of the manuscript.
Source Information
From the Departments of Medical Oncology (J.R., I.H.P., M.A.K., C.M.L.C.) and Radiation Oncology (S.M.J., V.E.B., M.P., I.A.O.), the Cancer Control Research Unit (N.L.), and the Cancer Control Strategy Process (A.J.C.), British Columbia Cancer Agency, Vancouver; the Department of Health Care and Epidemiology, University of British Columbia, Vancouver (J.J.S.); the Health Research Centre, St. Paul's Hospital, Vancouver (J.J.S.); and the Department of Medical Oncology, British Columbia Cancer Agency, Victoria (K.S.W.) — all in British Columbia, Canada.
Address reprint requests to Dr. Ragaz at Medical Oncology, British Columbia Cancer Agency, 600 W. 10th Ave., Vancouver, BC V5Z 4E6, Canada.
References
Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Engl J Med 1995;333:1444-1455. [Erratum, N Engl J Med 1996;334:1003.] [Free Full Text]
Cuzick J, Stewart H, Rutqvist L, et al. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 1994;12:447-453. [Abstract]
Stjernsward J. Can survival be decreased by post-operative irradiation? Int J Radiat Oncol Biol Phys 1977;2:1171-1175. [Medline]
Rutqvist LE, Lax I, Fornander T, Johansson H. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 1992;22:887-896. [Medline]
Fuller SA, Haybittle JL, Smith RE, Dobbs HJ. Cardiac doses in post-operative breast irradiation. Radiother Oncol 1992;25:19-24. [CrossRef][Medline]
Fisher B, Carbone P, Economou SG, et al. l-Phenylalanine mustard (L-PAM) in the management of primary breast cancer: a report of early findings. N Engl J Med 1975;292:117-122. [Abstract]
Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 1976;294:405-410. [Abstract]
Nissen-Meyer R, Kjellgren K, Malmio K, Mansson B, Norin T. Surgical adjuvant chemotherapy: results with one short course with cyclophosphamide after mastectomy for breast cancer. Cancer 1978;41:2088-2098. [CrossRef][Medline]
Schabel FM Jr. Concepts for treatment of micrometastases developed in murine systems. AJR Am J Roentgenol 1976;126:500-511. [Abstract]
Skipper HE, Schabel FM Jr, Mellett LB, et al. Implications of bio-chemical, cytokinetic, pharmacologic, and toxicologic relationships in the design of optimal therapeutic schedules. Cancer Chemother Rep 1970;54:431-450. [Medline]
Durand RE. Chemosensitivity testing in V79 spheroids: drug delivery and cellular microenvironment. J Natl Cancer Inst 1986;77:247-252.
Tubiana M, Arrigada R, Cosset JM. Sequencing of drugs and radiation: the integrated alternating regimen. Cancer 1985;55:2131-2139. [Medline]
Fu KK. Biological basis for the interaction of chemotherapeutic agents and radiation therapy. Cancer 1985;55:Suppl:2123-2130. [CrossRef][Medline]
Vokes EE, Weichselbaum PR. Concomitant chemoradiotherapy: rationale and clinical experience in patients with solid tumors. J Clin Oncol 1990;8:911-934. [Erratum, J Clin Oncol 1990;8:1447.] [Abstract]
Goldie JH, Coldman AJ. A mathematical model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 1979;63:1727-1733. [Medline]
Meakin JW, Alt WEC, Beale FA, et al. Ovarian irradiation and prednisone following surgery for carcinoma of the breast. Can Med Assoc J 1979;120:1221-1229. [Abstract]
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81.
Cox DR. Regression models and life-tables. J R Stat Soc [B] 1972;34:187-220.
Haybittle JL, Brinkley D, Houghton J, A'Hern RP, Baum M. Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer. BMJ 1989;298:1611-1614.
Overgaard M, Hansen PS, Rose C, et al. Postmastectomy radiotherapy and adjuvant systemic treatment in high-risk breast cancer patients. Eur J Cancer 1994;30:Suppl 2:S28-S28.abstract
McArdle CS, Crawford D, Dykes EH, et al. Adjuvant radiotherapy and chemotherapy in breast cancer. Br J Surg 1986;73:264-266. [Medline]
Muss HB, Cooper MR, Brockschmidt JK, et al. A randomized trial of chemotherapy (L-PAM vs CMF) and irradiation for node positive breast cancer: eleven year follow-up of a Piedmont Oncology Association trial. Breast Cancer Res Treat 1991;19:77-84. [CrossRef][Medline]
Griem KL, Henderson IC, Gelman R, et al. The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. J Clin Oncol 1987;5:1546-1555. [Free Full Text]
Blomqvist C, Tiusanen K, Elomaa I, et al. The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer: long-term follow-up results of a randomised trial. Br J Cancer 1992;66:1171-1176. [Medline]
Velez-Garcia E, Carpenter JT Jr, Moore M, et al. Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a South-Eastern Cancer Study Group (SEG) Trial. Eur J Cancer 1992;28:1833-1837.
Buzdar AU, Blumenschein GR, Smith TL, et al. Adjuvant chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide, with or without Bacillus Calmette-Guerin and with or without irradiation in operable breast cancer: a prospective randomized trial. Cancer 1984;53:384-389. [CrossRef][Medline]
Arriagada R, Rutqvist LE, Mattsson A, Kramar A, Rotstein S. Adequate locoregional treatment for early breast cancer may prevent secondary dissemination. J Clin Oncol 1995;13:2869-2878. [Abstract]
Fisher B, Redmond C. Lumpectomy for breast cancer: an update of the NSABP experience. In: Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Journal of the National Cancer Institute monographs. No. 11. Washington, D.C.: Government Printing Office, 1992:7-13. (NIH publication no. 90-3187.)
Hermann RE, Esselstyn CB Jr, Grundfest-Broniatowski S, et al. Partial mastectomy without radiation is adequate treatment for patients with stages 0 and I carcinoma of the breast. Surg Gynecol Obstet 1993;177:247-253. [Medline]
Clark RM, McCulloch PB, Levine MN, et al. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst 1992;84:683-689. [Free Full Text]
Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N EnglJ Med 1993;328:1587-91.
Marks LB, Halperin EC, Prosnitz LR, et al. Post-mastectomy radiotherapy following adjuvant chemotherapy and autologous bone marrow transplantation for breast cancer patients with greater than or equal to 10 positive axillary lymph nodes: Cancer and Leukemia Group B. Int J Radiat Oncol Biol Phys 1992;23:1021-1026. [Medline]
Diab SG, deMoor CA, Clark GM, Osborne CK, Ravdin PM, Elledge RM. Radiation therapy improves survival by decreasing local failure in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy. Proc Am Soc Clin Oncol 1997;16:130a. abstract.
Radiotherapy and Chemotherapy in High-Risk Breast Cancer
El-Tamer M., Homel P., Braverman A. S., Wolberg W. H., Robins H. I., Goldhirsch A., Coates A. S., Colleoni M., Gelber R. D., Raffle A.E., Evans R. A., Overgaard M., Rose C., Mouridsen H., Ragaz J., Jackson S. M., Spinelli J. J., Hellman S.
Extract |
Full Text
N Engl J Med 1998;
338:329-333, Jan 29, 1998.
Correspondence
This article has been cited by other articles:
Gruber, G., Cole, B. F., Castiglione-Gertsch, M., Holmberg, S. B., Lindtner, J., Golouh, R., Collins, J., Crivellari, D., Thurlimann, B., Simoncini, E., Fey, M. F., Gelber, R. D., Coates, A. S., Price, K. N., Goldhirsch, A., Viale, G., Gusterson, B. A., for the International Breast Cancer Study Group,
(2008). Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer. Ann Oncol
19: 1393-1401
[Abstract][Full Text]
MUNSHI, A, MALLICK, I, BUDRUKKAR, A, JALALI, R, BADWE, R, DINSHAW, K A, SARIN, R
(2008). A novel method for CT-scan-based localization of the internal mammary chain by internal mammary catheterization: an aid in breast cancer radiation therapy planning. Br. J. Radiol.
81: 485-489
[Abstract][Full Text]
Glatstein, E., Glick, J., Kaiser, L., Hahn, S. M.
(2008). Should Randomized Clinical Trials Be Required for Proton Radiotherapy? An Alternative View. JCO
26: 2438-2439
[Full Text]
Marks, L. B., Zeng, J., Prosnitz, L. R.
(2008). One to Three Versus Four or More Positive Nodes and Postmastectomy Radiotherapy: Time to End the Debate. JCO
26: 2075-2077
[Full Text]
Becker, T. E., Ellsworth, R. E., Deyarmin, B., Patney, H. L., Jordan, R. M., Hooke, J. A., Shriver, C. D., Ellsworth, D. L.
(2008). The Genomic Heritage of Lymph Node Metastases: Implications for Clinical Management of Patients with Breast Cancer. Ann. Surg. Oncol.
15: 1056-1063
[Abstract][Full Text]
Thomson, H. J., Potter, S., Greenwood, R. J., Bahl, A., Barker, J., Cawthorn, S. J., Winters, Z. E.
(2008). A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy. Ann. Surg. Oncol.
15: 1081-1091
[Abstract][Full Text]
Kyndi, M., Sorensen, F. B., Knudsen, H., Overgaard, M., Nielsen, H. M., Overgaard, J.
(2008). Estrogen Receptor, Progesterone Receptor, HER-2, and Response to Postmastectomy Radiotherapy in High-Risk Breast Cancer: The Danish Breast Cancer Cooperative Group. JCO
26: 1419-1426
[Abstract][Full Text]
Morrogh, M., Borgen, P. I., King, T. A.
(2007). The Importance of Local Control in Early-Stage Breast Cancer: A Historical Review and a Discussion of Ongoing Issues. Ann. Surg. Oncol.
14: 3310-3320
[Full Text]
Yao, M. S., Kurland, B. F., Smith, A. H., Schubert, E. K., Dunnwald, L. K., Byrd, D. R., Mankoff, D. A.
(2007). Internal Mammary Nodal Chain Drainage Is a Prognostic Indicator in Axillary Node-Positive Breast Cancer. Ann. Surg. Oncol.
14: 2985-2993
[Abstract][Full Text]
Punglia, R. S., Morrow, M., Winer, E. P., Harris, J. R.
(2007). Local Therapy and Survival in Breast Cancer. NEJM
356: 2399-2405
[Full Text]
Le Pechoux, C., Dunant, A., Pignon, J.-P., De Ruysscher, D., Mornex, F., Senan, S., Casas, F., Price, A., Milleron, B.
(2007). Need for a New Trial to Evaluate Adjuvant Postoperative Radiotherapy in Non-Small-Cell Lung Cancer Patients With N2 Mediastinal Involvement. JCO
25: e10-e11
[Full Text]
Smith, B. D., Haffty, B. G., Hurria, A., Galusha, D. H., Gross, C. P.
(2006). Postmastectomy Radiation and Survival in Older Women With Breast Cancer. JCO
24: 4901-4907
[Abstract][Full Text]
Cheng, S. H., Horng, C.-F., West, M., Huang, E., Pittman, J., Tsou, M.-H., Dressman, H., Chen, C.-M., Tsai, S. Y., Jian, J. J., Liu, M.-C., Nevins, J. R., Huang, A. T.
(2006). Genomic Prediction of Locoregional Recurrence After Mastectomy in Breast Cancer. JCO
24: 4594-4602
[Abstract][Full Text]
Taghian, A. G., Jeong, J.-H., Mamounas, E. P., Parda, D. S., Deutsch, M., Costantino, J. P., Wolmark, N.
(2006). Low Locoregional Recurrence Rate Among Node-Negative Breast Cancer Patients With Tumors 5 cm or Larger Treated by Mastectomy, With or Without Adjuvant Systemic Therapy and Without Radiotherapy: Results From Five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials. JCO
24: 3927-3932
[Abstract][Full Text]
Shikama, N., Mitsumori, M., Yamauchi, C., Takekawa, H., Arakawa, K., Sasaki, S., Teshima, T.
(2006). Patterns of Care Study for Postmastectomy Radiotherapy in Japan: Its Role in Monitoring the Patterns of Changes in Practice. Jpn J Clin Oncol
36: 499-503
[Abstract][Full Text]
Punglia, R. S., Weeks, J. C., Neville, B. A., Earle, C. C.
(2006). Radiation Therapy After Mastectomy Between 1991 and 1999 in Elderly Women: Response to Clinical Trial Information. JCO
24: 3474-3482
[Abstract][Full Text]
Morrow, M., Goldstein, L.
(2006). Surgery of the Primary Tumor in Metastatic Breast Cancer: Closing the Barn Door After the Horse Has Bolted?. JCO
24: 2694-2696
[Full Text]
Nielsen, H. M., Overgaard, M., Grau, C., Jensen, A. R., Overgaard, J.
(2006). Study of Failure Pattern Among High-Risk Breast Cancer Patients With or Without Postmastectomy Radiotherapy in Addition to Adjuvant Systemic Therapy: Long-Term Results From the Danish Breast Cancer Cooperative Group DBCG 82 b and c Randomized Studies. JCO
24: 2268-2275
[Abstract][Full Text]
Bear, H. D., Anderson, S., Smith, R. E., Geyer, C. E. Jr, Mamounas, E. P., Fisher, B., Brown, A. M., Robidoux, A., Margolese, R., Kahlenberg, M. S., Paik, S., Soran, A., Wickerham, D. L., Wolmark, N.
(2006). Sequential Preoperative or Postoperative Docetaxel Added to Preoperative Doxorubicin Plus Cyclophosphamide for Operable Breast Cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. JCO
24: 2019-2027
[Abstract][Full Text]
Callagy, G. M., Pharoah, P. D., Pinder, S. E., Hsu, F. D., Nielsen, T. O., Ragaz, J., Ellis, I. O., Huntsman, D., Caldas, C.
(2006). Bcl-2 Is a Prognostic Marker in Breast Cancer Independently of the Nottingham Prognostic Index. Clin. Cancer Res.
12: 2468-2475
[Abstract][Full Text]
International Breast Cancer Study Group,
(2006). Multicycle Dose-Intensive Chemotherapy for Women With High-Risk Primary Breast Cancer: Results of International Breast Cancer Study Group Trial 15-95. JCO
24: 370-378
[Abstract][Full Text]
Gebski, V., Lagleva, M., Keech, A., Simes, J., Langlands, A. O.
(2006). Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical Perspective. JNCI J Natl Cancer Inst
98: 26-38
[Abstract][Full Text]
Patt, D. A., Goodwin, J. S., Kuo, Y.-F., Freeman, J. L., Zhang, D. D., Buchholz, T. A., Hortobagyi, G. N., Giordano, S. H.
(2005). Cardiac Morbidity of Adjuvant Radiotherapy for Breast Cancer. JCO
23: 7475-7482
[Abstract][Full Text]
Peoples, G. E., Gurney, J. M., Hueman, M. T., Woll, M. M., Ryan, G. B., Storrer, C. E., Fisher, C., Shriver, C. D., Ioannides, C. G., Ponniah, S.
(2005). Clinical Trial Results of a HER2/neu (E75) Vaccine to Prevent Recurrence in High-Risk Breast Cancer Patients. JCO
23: 7536-7545
[Abstract][Full Text]
Gruber, G., Bonetti, M., Nasi, M. L., Price, K. N., Castiglione-Gertsch, M., Rudenstam, C.-M., Holmberg, S. B., Lindtner, J., Golouh, R., Collins, J., Crivellari, D., Carbone, A., Thurlimann, B., Simoncini, E., Fey, M. F., Gelber, R. D., Coates, A. S., Goldhirsch, A.
(2005). Prognostic Value of Extracapsular Tumor Spread for Locoregional Control in Premenopausal Patients With Node-Positive Breast Cancer Treated With Classical Cyclophosphamide, Methotrexate, and Fluorouracil: Long-Term Observations From International Breast Cancer Study Group Trial VI. JCO
23: 7089-7097
[Abstract][Full Text]
Kunkler, I.
(2005). Re: Locoregional Radiation Therapy in Patients With High-Risk Breast Cancer Receiving Adjuvant Chemotherapy: 20-Year Results of the British Columbia Randomized Trial. JNCI J Natl Cancer Inst
97: 1162-1163
[Full Text]
Truong, P T, Berthelet, E, Patenaude, V, Bishop, J, Sandwith, B, Moravan, V, Beckham, W, Mitchell, T, Olivotto, I A
(2005). Setup variations in locoregional radiotherapy for breast cancer: an electronic portal imaging study. Br. J. Radiol.
78: 742-745
[Abstract][Full Text]
Peters, W. P., Rosner, G. L., Vredenburgh, J. J., Shpall, E. J., Crump, M., Richardson, P. G., Schuster, M. W., Marks, L. B., Cirrincione, C., Norton, L., Henderson, I.C., Schilsky, R. L., Hurd, D. D.
(2005). Prospective, Randomized Comparison of High-Dose Chemotherapy With Stem-Cell Support Versus Intermediate-Dose Chemotherapy After Surgery and Adjuvant Chemotherapy in Women With High-Risk Primary Breast Cancer: A Report of CALGB 9082, SWOG 9114, and NCIC MA-13. JCO
23: 2191-2200
[Abstract][Full Text]
Giordano, S. H., Kuo, Y.-F., Freeman, J. L., Buchholz, T. A., Hortobagyi, G. N., Goodwin, J. S.
(2005). Risk of Cardiac Death After Adjuvant Radiotherapy for Breast Cancer. JNCI J Natl Cancer Inst
97: 419-424
[Abstract][Full Text]
Whelan, T. J.
(2005). Use of Conventional Radiation Therapy As Part of Breast-Conserving Treatment. JCO
23: 1718-1725
[Full Text]
Colleoni, M., Zahrieh, D., Gelber, R. D., Holmberg, S. B., Mattsson, J. E., Rudenstam, C.-M., Lindtner, J., Erzen, D., Snyder, R., Collins, J., Fey, M. F., Thurlimann, B., Crivellari, D., Murray, E., Mendiola, C., Pagani, O., Castiglione-Gertsch, M., Coates, A. S., Price, K., Goldhirsch, A.
(2005). Site of Primary Tumor Has a Prognostic Role in Operable Breast Cancer: The International Breast Cancer Study Group Experience. JCO
23: 1390-1400
[Abstract][Full Text]
Smith, B. D., Smith, G. L., Haffty, B. G.
(2005). Postmastectomy Radiation and Mortality in Women With T1-2 Node-Positive Breast Cancer. JCO
23: 1409-1419
[Abstract][Full Text]
Neri, A., Marrelli, D., Roviello, F., De Stefano, A., Guarnieri, A., Pallucca, E., Pinto, E.
(2005). Prognostic Value of Extracapsular Extension of Axillary Lymph Node Metastases in T1 to T3 Breast Cancer. Ann. Surg. Oncol.
12: 246-253
[Abstract][Full Text]
Whelan, T., Levine, M.
(2005). More Evidence That Locoregional Radiation Therapy Improves Survival: What Should We Do?. JNCI J Natl Cancer Inst
97: 82-84
[Full Text]
Ragaz, J., Olivotto, I. A., Spinelli, J. J., Phillips, N., Jackson, S. M., Wilson, Kenneth. S., Knowling, M. A., Coppin, C. M. L., Weir, L., Gelmon, K., Le, N., Durand, R., Coldman, A. J., Manji, M.
(2005). Locoregional Radiation Therapy in Patients With High-Risk Breast Cancer Receiving Adjuvant Chemotherapy: 20-Year Results of the British Columbia Randomized Trial. JNCI J Natl Cancer Inst
97: 116-126
[Abstract][Full Text]
Truong, P. T., Olivotto, I. A., Whelan, T. J., Levine, M.
(2005). Outcomes of postmastectomy radiotherapy. CMAJ
172: 19-19
[Full Text]
Sartor, C. I., Peterson, B. L., Woolf, S., FitzGerald, T. J., Laurie, F., Turrisi, A. J., Bogart, J., Henderson, I. C., Norton, L.
(2005). Effect of Addition of Adjuvant Paclitaxel on Radiotherapy Delivery and Locoregional Control of Node-Positive Breast Cancer: Cancer and Leukemia Group B 9344. JCO
23: 30-40
[Abstract][Full Text]
Huang, E. H., Tucker, S. L., Strom, E. A., McNeese, M. D., Kuerer, H. M., Buzdar, A. U., Valero, V., Perkins, G. H., Schechter, N. R., Hunt, K. K., Sahin, A. A., Hortobagyi, G. N., Buchholz, T. A.
(2004). Postmastectomy Radiation Improves Local-Regional Control and Survival for Selected Patients With Locally Advanced Breast Cancer Treated With Neoadjuvant Chemotherapy and Mastectomy. JCO
22: 4691-4699
[Abstract][Full Text]
Taghian, A., Jeong, J.-H., Mamounas, E., Anderson, S., Bryant, J., Deutsch, M., Wolmark, N.
(2004). Patterns of Locoregional Failure in Patients With Operable Breast Cancer Treated by Mastectomy and Adjuvant Chemotherapy With or Without Tamoxifen and Without Radiotherapy: Results From Five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials. JCO
22: 4247-4254
[Abstract][Full Text]
Olivotto, I. A., Truong, P. T., Chua, B.
(2004). Postmastectomy Radiation Therapy: Who Needs It?. JCO
22: 4237-4239
[Full Text]
Violet, J A, Harmer, C
(2004). Breast cancer: improving outcome following adjuvant radiotherapy. Br. J. Radiol.
77: 811-820
[Abstract][Full Text]
Nielsen, T. O., Hsu, F. D., Jensen, K., Cheang, M., Karaca, G., Hu, Z., Hernandez-Boussard, T., Livasy, C., Cowan, D., Dressler, L., Akslen, L. A., Ragaz, J., Gown, A. M., Gilks, C. B., van de Rijn, M., Perou, C. M.
(2004). Immunohistochemical and Clinical Characterization of the Basal-Like Subtype of Invasive Breast Carcinoma. Clin. Cancer Res.
10: 5367-5374
[Abstract][Full Text]
Hinrichs, C. S., Watroba, N. L., Rezaishiraz, H., Giese, W., Hurd, T., Fassl, K. A., Edge, S. B.
(2004). Lymphedema Secondary to Postmastectomy Radiation: Incidence and Risk Factors. Ann. Surg. Oncol.
11: 573-580
[Abstract][Full Text]
Truong, P. T., Olivotto, I. A., Whelan, T. J., Levine, M.
(2004). Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ
170: 1263-1273
[Abstract][Full Text]
Shenkier, T., Weir, L., Levine, M., Olivotto, I., Whelan, T., Reyno, L.
(2004). Clinical practice guidelines for the care and treatment of breast cancer: 15. Treatment for women with stage III or locally advanced breast cancer. CMAJ
170: 983-994
[Abstract][Full Text]
Guerrero Urbano, M T, Nutting, C M
(2004). Clinical use of intensity-modulated radiotherapy: part II. Br. J. Radiol.
77: 177-182
[Abstract][Full Text]
Vallis, K. A., Tannock, I. F.
(2004). Postoperative Radiotherapy for Breast Cancer: Growing Evidence for an Impact on Survival. JNCI J Natl Cancer Inst
96: 88-89
[Full Text]
Manders, P., Sweep, F. C. G. J., Tjan-Heijnen, V. C. G., Geurts-Moespot, A., van Tienoven, D. T. H., Foekens, J. A., Span, P. N., Bussink, J., Beex, L. V. A. M.
(2003). Vascular Endothelial Growth Factor Independently Predicts the Efficacy of Postoperative Radiotherapy in Node-Negative Breast Cancer Patients. Clin. Cancer Res.
9: 6363-6370
[Abstract][Full Text]
Dodwell, D, Horgan, K
(2003). Locoregional treatment for breast cancer. BMJ
327: 1062-1063
[Full Text]
Cakir, S., Gursel, B., Meydan, D., Yildiz, L.
(2003). The Sequencing of Radiation Therapy and Chemotherapy after Mastectomy in Premenopausal Women with Breast Cancer. Jpn J Clin Oncol
33: 563-569
[Abstract][Full Text]
Shikama, N., Nishikawa, A., Mitsumori, M., Hiraoka, M., Yamamoto, T., Teshima, T., Inoue, T., Wilson, F., Owen, J.
(2003). Patterns of Care Study: Comparison of Process of Post-mastectomy Radiotherapy (PMRT) in Japan and the USA. Jpn J Clin Oncol
33: 518-521
[Abstract][Full Text]
Mamounas, E. P.
(2003). NSABP Breast Cancer Clinical Trials: Recent Results and Future Directions. Clin Med Res
1: 309-326
[Abstract][Full Text]
Zippel, D., Papa, M.
(2003). Patients With Breast Cancer and Positive Sentinel Nodes: Axillary Dissection or Axillary Radiotherapy?. Arch Surg
138: 1159-1159
[Full Text]
Shikama, N., Sasaki, S., Mitsumori, M., Hiraoka, M., Yamauchi, C., Yamamoto, T., Teshima, T., Inoue, T.
(2003). Patterns of Care Study in Japan: Analysis of Patients Subjected to Mastectomy Followed by Radiotherapy. Jpn J Clin Oncol
33: 456-462
[Abstract][Full Text]
Stemmer, S. M., Rizel, S., Hardan, I., Adamo, A., Neumann, A., Goffman, J., Brenner, H. J., Pfeffer, M. R.
(2003). The Role of Irradiation of the Internal Mammary Lymph Nodes in High-Risk Stage II to IIIA Breast Cancer Patients After High-Dose Chemotherapy: A Prospective Sequential Nonrandomized Study. JCO
21: 2713-2718
[Abstract][Full Text]
Copeland, E. M. III
(2003). Breast Cancer: Specialists Do Make a Difference. Ann. Surg. Oncol.
10: 589-590
[Full Text]
Roach, M. III, DeSilvio, M., Lawton, C., Uhl, V., Machtay, M., Seider, M.J., Rotman, M., Jones, C., Asbell, S.O., Valicenti, R.K., Han, S., Thomas, C.R. Jr, Shipley, W.S.
(2003). Phase III Trial Comparing Whole-Pelvic Versus Prostate-Only Radiotherapy and Neoadjuvant Versus Adjuvant Combined Androgen Suppression: Radiation Therapy Oncology Group 9413. JCO
21: 1904-1911
[Abstract][Full Text]
Kunkler, I. H, Harnett, A. N
(2003). Cardiovascular mortality after radiotherapy for breast cancer. BMJ
326: 983-983
[Full Text]
Smith, R. E., Bryant, J., DeCillis, A., Anderson, S.
(2003). Acute Myeloid Leukemia and Myelodysplastic Syndrome After Doxorubicin-Cyclophosphamide Adjuvant Therapy for Operable Breast Cancer: The National Surgical Adjuvant Breast and Bowel Project Experience. JCO
21: 1195-1204
[Abstract][Full Text]
Wallgren, A., Bonetti, M., Gelber, R.D., Goldhirsch, A., Castiglione-Gertsch, M., Holmberg, S.B., Lindtner, J., Thurlimann, B., Fey, M., Werner, I.D., Forbes, J.F., Price, K., Coates, A.S., Collins, J.
(2003). Risk Factors for Locoregional Recurrence Among Breast Cancer Patients: Results From International Breast Cancer Study Group Trials I Through VII. JCO
21: 1205-1213
[Abstract][Full Text]
Foster, R. S. Jr
(2003). Breast Cancer Detection and Treatment: A Personal and Historical Perspective. Arch Surg
138: 397-408
[Full Text]
Sigurdson, E. R.
(2003). Lymph Node Dissection: Is It Diagnostic or Therapeutic?. JCO
21: 965-967
[Full Text]
Sharkis, D. H., Recht, A., Sonpavde, G., Veronesi, U., Mariani, L., Fisher, B., Anderson, S., Bryant, J.
(2003). Breast-Conserving Surgery for Breast Cancer. NEJM
348: 657-660
[Full Text]
Gaffney, D. K., Tsodikov, A., Wiggins, C. L.
(2003). Diminished Survival in Patients With Inner Versus Outer Quadrant Breast Cancers. JCO
21: 467-472
[Abstract][Full Text]
Guenther, J. M., Hansen, N. M., DiFronzo, L. A., Giuliano, A. E., Collins, J. C., Grube, B. L., O'Connell, T. X.
(2003). Axillary Dissection Is Not Required for All Patients With Breast Cancer and Positive Sentinel Nodes. Arch Surg
138: 52-56
[Abstract][Full Text]
Buchholz, T. A., Strom, E. A., Perkins, G. H., McNeese, M. D.
(2002). Controversies Regarding the Use of Radiation After Mastectomy in Breast Cancer. The Oncologist
7: 539-546
[Abstract][Full Text]
Kwan, W., Jackson, J., Weir, L. M., Dingee, C., McGregor, G., Olivotto, I. A.
(2002). Chronic Arm Morbidity After Curative Breast Cancer Treatment: Prevalence and Impact on Quality of Life. JCO
20: 4242-4248
[Abstract][Full Text]
Buchholz, T. A., Kronowitz, S. J., Kuerer, H. M.
(2002). Immediate Breast Reconstruction after Skin-Sparing Mastectomy for the Treatment of Advanced Breast Cancer: Radiation Oncology Considerations. Ann. Surg. Oncol.
9: 820-821
[Full Text]
Chen, H. H. W., Su, W.-C., Guo, H.-R., Chang, T.-W., Lee, W.-Y.
(2002). p53 and c-erbB-2 but Not bcl-2 are Predictive of Metastasis-free Survival in Breast Cancer Patients Receiving Post-mastectomy Adjuvant Radiotherapy in Taiwan. Jpn J Clin Oncol
32: 332-339
[Abstract][Full Text]
Arriagada, R., Le, M. G., Contesso, G., Guinebretiere, J. M., Rochard, F., Spielmann, M.
(2002). Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol
13: 1404-1413
[Abstract][Full Text]
Fisher, B., Jeong, J.-H., Anderson, S., Bryant, J., Fisher, E. R., Wolmark, N.
(2002). Twenty-Five-Year Follow-up of a Randomized Trial Comparing Radical Mastectomy, Total Mastectomy, and Total Mastectomy Followed by Irradiation. NEJM
347: 567-575
[Abstract][Full Text]
Stathopoulou, A., Vlachonikolis, I., Mavroudis, D., Perraki, M., Kouroussis, Ch., Apostolaki, S., Malamos, N., Kakolyris, S., Kotsakis, A., Xenidis, N., Reppa, D., Georgoulias, V.
(2002). Molecular Detection of Cytokeratin-19-Positive Cells in the Peripheral Blood of Patients With Operable Breast Cancer: Evaluation of Their Prognostic Significance. JCO
20: 3404-3412
[Abstract][Full Text]
Lee, J. H., Glick, H. A., Hayman, J. A., Solin, L. J.
(2002). Decision-Analytic Model and Cost-Effectiveness Evaluation of Postmastectomy Radiation Therapy in High-Risk Premenopausal Breast Cancer Patients. JCO
20: 2713-2725
[Abstract][Full Text]
Vallis, K. A., Pintilie, M., Chong, N., Holowaty, E., Douglas, P. S., Kirkbride, P., Wielgosz, A.
(2002). Assessment of Coronary Heart Disease Morbidity and Mortality After Radiation Therapy for Early Breast Cancer. JCO
20: 1036-1042
[Abstract][Full Text]
Buchholz, T. A., Tucker, S. L., Masullo, L., Kuerer, H. M., Erwin, J., Salas, J., Frye, D., Strom, E. A., McNeese, M. D., Perkins, G., Katz, A., Singletary, S. E., Hunt, K. K., Buzdar, A. U., Hortobagyi, G. N.
(2002). Predictors of Local-Regional Recurrence After Neoadjuvant Chemotherapy and Mastectomy Without Radiation. JCO
20: 17-23
[Abstract][Full Text]
Eubank, W. B., Mankoff, D. A., Vesselle, H. J., Eary, J. F., Schubert, E. K., Dunnwald, L. K., Lindsley, S. K., Gralow, J. R., Austin-Seymour, M. M., Ellis, G. K., Livingston, R. B.
(2002). Detection of Locoregional and Distant Recurrences in Breast Cancer Patients by Using FDG PET. RadioGraphics
22: 5-17
[Abstract][Full Text]
National Institutes of Health Consensus Developmen,
(2001). National Institutes of Health Consensus Development Conference Statement: Adjuvant Therapy for Breast Cancer, November 1-3, 2000. J Natl Cancer Inst Monogr
2001: 5-15
[Abstract][Full Text]
Pierce, L. J.
(2001). Treatment Guidelines and Techniques in Delivery of Postmastectomy Radiotherapy in Management of Operable Breast Cancer. J Natl Cancer Inst Monogr
2001: 117-124
[Abstract][Full Text]
Bartelink, H., Horiot, J.-C., Poortmans, P., Struikmans, H., Van den Bogaert, W., Barillot, I., Fourquet, A., Borger, J., Jager, J., Hoogenraad, W., Collette, L., Pierart, M., the European Organization for Research and Treatme,
(2001). Recurrence Rates after Treatment of Breast Cancer with Standard Radiotherapy with or without Additional Radiation. NEJM
345: 1378-1387
[Abstract][Full Text]
Leonard, R., Hardy, J., van Tienhoven, G., Houston, S., Simmonds, P., David, M., Mansi, J.
(2001). Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial of 6% Miltefosine Solution, a Topical Chemotherapy in Cutaneous Metastases From Breast Cancer. JCO
19: 4150-4159
[Abstract][Full Text]
Lin, K. Y., Johns, F. R., Gibson, J., Long, M., Drake, D. B., Moore, M. M.
(2001). An Outcome Study of Breast Reconstruction: Presurgical Identification of Risk Factors for Complications. Ann. Surg. Oncol.
8: 586-591
[Abstract][Full Text]
Eubank, W. B., Mankoff, D. A., Takasugi, J., Vesselle, H., Eary, J. F., Shanley, T. J., Gralow, J. R., Charlop, A., Ellis, G. K., Lindsley, K. L., Austin-Seymour, M. M., Funkhouser, C. P., Livingston, R. B.
(2001). 18Fluorodeoxyglucose Positron Emission Tomography to Detect Mediastinal or Internal Mammary Metastases in Breast Cancer. JCO
19: 3516-3523
[Abstract][Full Text]
Redmond, K. C., Wang, J. H., Austin, K. K., Relihan, N., McGreal, G., Kirwan, W. O., Richardson, D., Kelly, J., Redmond, H. P., Braun, S., Harbeck, N., Pantel, K.
(2001). Is Immunohistochemical Analysis an Appropriate Diagnostic Technique for Bone Marrow Micrometastases?. JCO
19: 3589-3592
[Full Text]
(2001). National Institutes of Health Consensus Development Conference Statement: Adjuvant Therapy for Breast Cancer, November 1-3, 2000. JNCI J Natl Cancer Inst
93: 979-989
[Abstract][Full Text]
Cantin, J., Scarth, H., Levine, M., Hugi, M.
(2001). Clinical practice guidelines for the care and treatment of breast cancer: 13. Sentinel lymph node biopsy. CMAJ
165: 166-173
[Abstract][Full Text]
Hortobagyi, G. N.
(2001). Adjuvant Systemic Therapy for Early Breast Cancer: Progress and Controversies. Clin. Cancer Res.
7: 1839-1842
[Full Text]
Shapiro, C. L., Recht, A.
(2001). Side Effects of Adjuvant Treatment of Breast Cancer. NEJM
344: 1997-2008
[Full Text]
Howe, H. L., Wingo, P. A., Thun, M. J., Ries, L. A. G., Rosenberg, H. M., Feigal, E. G., Edwards, B. K.
(2001). Annual Report to the Nation on the Status of Cancer (1973 Through 1998), Featuring Cancers With Recent Increasing Trends. JNCI J Natl Cancer Inst
93: 824-842
[Abstract][Full Text]
Ozsahin, M., Colleoni, M., Goldhirsch, A., Coates, A., Gelber, R., Castiglione-Gertsch, M.
(2001). Bone Metastases in Breast Cancer: How to Prevent?. JCO
19: 2764-2765
[Full Text]
Byrd, D. R., Dunnwald, L. K., Mankoff, D. A., Anderson, B. O., Moe, R. E., Yeung, R. S., Schubert, E. K., Eary, J. F.
(2001). Internal Mammary Lymph Node Drainage Patterns in Patients With Breast Cancer Documented by Breast Lymphoscintigraphy. Ann. Surg. Oncol.
8: 234-240
[Abstract][Full Text]
Du, X., Goodwin, J. S.
(2001). Patterns of Use of Chemotherapy for Breast Cancer in Older Women: Findings From Medicare Claims Data. JCO
19: 1455-1461
[Abstract][Full Text]
Braun, S., Cevatli, B. S., Assemi, C., Janni, W., Kentenich, C. R.M., Schindlbeck, C., Rjosk, D., Hepp, F.
(2001). Comparative Analysis of Micrometastasis to the Bone Marrow and Lymph Nodes of Node-Negative Breast Cancer Patients Receiving No Adjuvant Therapy. JCO
19: 1468-1475
[Abstract][Full Text]
Recht, A., Edge, S. B., Solin, L. J., Robinson, D. S., Estabrook, A., Fine, R. E., Fleming, G. F., Formenti, S., Hudis, C., Kirshner, J. J., Krause, D. A., Kuske, R. R., Langer, A. S., Sledge, G. W. Jr, Whelan, T. J., Pfister, D. G.
(2001). Postmastectomy Radiotherapy: Clinical Practice Guidelines of the American Society of Clinical Oncology. JCO
19: 1539-1569
[Abstract][Full Text]
Harris, S. R., Hugi, M. R., Olivotto, I. A., Levine, M.
(2001). Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ
164: 191-199
[Abstract][Full Text]
Katz, A., Strom, E. A., Buchholz, T. A., Thames, H. D., Smith, C. D., Jhingran, A., Hortobagyi, G., Buzdar, A. U., Theriault, R., Singletary, S. E., McNeese, M. D.
(2000). Locoregional Recurrence Patterns After Mastectomy and Doxorubicin-Based Chemotherapy: Implications for Postoperative Irradiation. JCO
18: 2817-2827
[Abstract][Full Text]
Lohrisch, C., Jackson, J., Jones, A., Mates, D., Olivotto, I. A.
(2000). Relationship Between Tumor Location and Relapse in 6,781 Women With Early Invasive Breast Cancer. JCO
18: 2828-2835
[Abstract][Full Text]
van Dongen, J. A., Voogd, A. C., Fentiman, I. S., Legrand, C., Sylvester, R. J., Tong, D., van der Schueren, E., Helle, P. A., van Zijl, K., Bartelink, H.
(2000). Long-Term Results of a Randomized Trial Comparing Breast-Conserving Therapy With Mastectomy: European Organization for Research and Treatment of Cancer 10801 Trial. JNCI J Natl Cancer Inst
92: 1143-1150
[Abstract][Full Text]
McMasters, K. M., Tuttle, T. M., Carlson, D. J., Brown, C. M., Noyes, R. D., Glaser, R. L., Vennekotter, D. J., Turk, P. S., Tate, P. S., Sardi, A., Cerrito, P. B., Edwards, M. J.
(2000). Sentinel Lymph Node Biopsy for Breast Cancer: A Suitable Alternative to Routine Axillary Dissection in Multi-Institutional Practice When Optimal Technique Is Used. JCO
18: 2560-2566
[Abstract][Full Text]
Previous
