Skip to main content
Erschienen in: Strahlentherapie und Onkologie 1/2016

01.01.2016 | Original Article

Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

verfasst von: Gerd Fastner, MD, Cornelia Hauser-Kronberger, MD, Angelika Moder, PhD, Roland Reitsamer, MD, Franz Zehentmayr, MD, Peter Kopp, PhD, Christoph Fussl, MD, Thorsten Fischer, MD, Heinrich Deutschmann, MSc, Felix Sedlmayer, MD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Abstract

Aim

The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation.

Methods and materials

A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median Dmax) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %).

Results

After a median follow-up of 97 months (range 4–170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03).

Conclusion

Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3.
Fußnoten
1
In-breast and regional recurrences together
 
Literatur
1.
Zurück zum Zitat Goldhirsch A, Winer EP, Coates AS et al (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 24:2206–2223PubMedPubMedCentralCrossRef Goldhirsch A, Winer EP, Coates AS et al (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 24:2206–2223PubMedPubMedCentralCrossRef
2.
Zurück zum Zitat Lowery AJ, Kell MR, Glynn RW et al (2012) Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 133:831–841PubMedCrossRef Lowery AJ, Kell MR, Glynn RW et al (2012) Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 133:831–841PubMedCrossRef
3.
Zurück zum Zitat Lehmann BD, Bauer JA, Chen X et al (2011) Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 121:2750–2767PubMedPubMedCentralCrossRef Lehmann BD, Bauer JA, Chen X et al (2011) Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 121:2750–2767PubMedPubMedCentralCrossRef
4.
Zurück zum Zitat Perou CM (2010) Molecular stratification of triple-negative breast cancers. Oncologist 15:39–48PubMedCrossRef Perou CM (2010) Molecular stratification of triple-negative breast cancers. Oncologist 15:39–48PubMedCrossRef
5.
Zurück zum Zitat Peddi PF, Ellis MJ, Ma C (2012) Molecular basis of triple negative breast cancer and implications for therapy. Int J Breast Cancer 2012:217185. doi:10.1155/2012/217185PubMedPubMedCentralCrossRef Peddi PF, Ellis MJ, Ma C (2012) Molecular basis of triple negative breast cancer and implications for therapy. Int J Breast Cancer 2012:217185. doi:10.1155/2012/217185PubMedPubMedCentralCrossRef
6.
Zurück zum Zitat Cheang MC, Voduc D, Bajdik C et al (2008) Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 14:1368–1376PubMedCrossRef Cheang MC, Voduc D, Bajdik C et al (2008) Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 14:1368–1376PubMedCrossRef
7.
Zurück zum Zitat Cho EY, Chang MH, Choi YL et al (2011) Potential candidate biomarkers for heterogeneity in triple-negative breast cancer (TNBC). Cancer Chemother Pharmacol 68:753–761PubMedCrossRef Cho EY, Chang MH, Choi YL et al (2011) Potential candidate biomarkers for heterogeneity in triple-negative breast cancer (TNBC). Cancer Chemother Pharmacol 68:753–761PubMedCrossRef
8.
Zurück zum Zitat Uhm JE, Park YH, Yi SY et al (2009) Treatment outcomes and clinicopathologic characteristics of triple-negative breast cancer patients who received platinum-containing chemotherapy. Int J Cancer 124:1457–1462PubMedCrossRef Uhm JE, Park YH, Yi SY et al (2009) Treatment outcomes and clinicopathologic characteristics of triple-negative breast cancer patients who received platinum-containing chemotherapy. Int J Cancer 124:1457–1462PubMedCrossRef
9.
Zurück zum Zitat Sedlmayer F, Sautter-Bihl ML, Budach W et al (2013) DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189:825–833PubMedPubMedCentralCrossRef Sedlmayer F, Sautter-Bihl ML, Budach W et al (2013) DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189:825–833PubMedPubMedCentralCrossRef
10.
Zurück zum Zitat Bartelink H, Maingon P, Poortmans P et al (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16:47–56PubMedCrossRef Bartelink H, Maingon P, Poortmans P et al (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16:47–56PubMedCrossRef
11.
Zurück zum Zitat Reitsamer R, Sedlmayer F, Kopp M et al (2006) The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer 118:2882–2887PubMedCrossRef Reitsamer R, Sedlmayer F, Kopp M et al (2006) The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer 118:2882–2887PubMedCrossRef
12.
Zurück zum Zitat Sedlmayer F, Fastner G, Merz F et al (2007) IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis. Strahlenther Onkol 183:32–34PubMedCrossRef Sedlmayer F, Fastner G, Merz F et al (2007) IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis. Strahlenther Onkol 183:32–34PubMedCrossRef
13.
Zurück zum Zitat Krengli M, Calvo FA, Sedlmayer F et al (2013) Clinical and technical characteristics of intraoperative radiotherapy. Analysis of the ISIORT-Europe database. Strahlenther Onkol 189:729–737PubMedCrossRef Krengli M, Calvo FA, Sedlmayer F et al (2013) Clinical and technical characteristics of intraoperative radiotherapy. Analysis of the ISIORT-Europe database. Strahlenther Onkol 189:729–737PubMedCrossRef
14.
Zurück zum Zitat Fastner G, Sedlmayer F, Merz F et al (2013) IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol 108:279–286PubMedCrossRef Fastner G, Sedlmayer F, Merz F et al (2013) IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol 108:279–286PubMedCrossRef
15.
Zurück zum Zitat Kaplan EL, Meier P (1958) Nonparametric-Estimation from Incomplete Observations. J Am Stat Assoc 53:457–481CrossRef Kaplan EL, Meier P (1958) Nonparametric-Estimation from Incomplete Observations. J Am Stat Assoc 53:457–481CrossRef
16.
Zurück zum Zitat Voduc KD, Cheang MC, Tyldesley S et al (2010) Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 28:1684–1691PubMedCrossRef Voduc KD, Cheang MC, Tyldesley S et al (2010) Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 28:1684–1691PubMedCrossRef
17.
Zurück zum Zitat Millar EK, Graham PH, O’Toole SA et al (2009) Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol 27:4701–4708PubMedCrossRef Millar EK, Graham PH, O’Toole SA et al (2009) Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol 27:4701–4708PubMedCrossRef
18.
Zurück zum Zitat Elsawaf Z, Sinn HP, Rom J et al (2013) Biological subtypes of triple-negative breast cancer are associated with distinct morphological changes and clinical behaviour. Breast 22:986–992PubMedCrossRef Elsawaf Z, Sinn HP, Rom J et al (2013) Biological subtypes of triple-negative breast cancer are associated with distinct morphological changes and clinical behaviour. Breast 22:986–992PubMedCrossRef
19.
Zurück zum Zitat Luporsi E, Andre F, Spyratos F et al (2012) Ki-67: level of evidence and methodological considerations for its role in the clinical management of breast cancer: analytical and critical review. Breast Cancer Res Treat 132:895–915PubMedPubMedCentralCrossRef Luporsi E, Andre F, Spyratos F et al (2012) Ki-67: level of evidence and methodological considerations for its role in the clinical management of breast cancer: analytical and critical review. Breast Cancer Res Treat 132:895–915PubMedPubMedCentralCrossRef
20.
Zurück zum Zitat Vaidya JS, Baldassarre G, Massarut S (2009) Beneficial effects of intraoperative radiotherapy on tumor microenvironment could improve outcomes (Int J Radiat Oncol Biol Phys 2008;72:1575–1581). Int J Radiat Oncol Biol Phys 74:976PubMedCrossRef Vaidya JS, Baldassarre G, Massarut S (2009) Beneficial effects of intraoperative radiotherapy on tumor microenvironment could improve outcomes (Int J Radiat Oncol Biol Phys 2008;72:1575–1581). Int J Radiat Oncol Biol Phys 74:976PubMedCrossRef
21.
Zurück zum Zitat Belletti B, Vaidya JS, D’Andrea S et al (2008) Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 14:1325–1332PubMedCrossRef Belletti B, Vaidya JS, D’Andrea S et al (2008) Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 14:1325–1332PubMedCrossRef
22.
Zurück zum Zitat Herskind C, Griebel J, Kraus-Tiefenbacher U et al (2008) Sphere of equivalence—a novel target volume concept for intraoperative radiotherapy using low-energy X rays. Int J Radiat Oncol Biol Phys 72:1575–1581PubMedCrossRef Herskind C, Griebel J, Kraus-Tiefenbacher U et al (2008) Sphere of equivalence—a novel target volume concept for intraoperative radiotherapy using low-energy X rays. Int J Radiat Oncol Biol Phys 72:1575–1581PubMedCrossRef
23.
Zurück zum Zitat Pogoda K, Niwinska A, Murawska M et al (2013) Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol 30:388PubMedPubMedCentralCrossRef Pogoda K, Niwinska A, Murawska M et al (2013) Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol 30:388PubMedPubMedCentralCrossRef
24.
Zurück zum Zitat Montagna E, Bagnardi V, Rotmensz N et al (2012) Breast cancer subtypes and outcome after local and regional relapse. Ann Oncol 23:324–331PubMedCrossRef Montagna E, Bagnardi V, Rotmensz N et al (2012) Breast cancer subtypes and outcome after local and regional relapse. Ann Oncol 23:324–331PubMedCrossRef
25.
Zurück zum Zitat Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence afte breast-conserving therapy. J Clin Oncol 26:2373–2378PubMedCrossRef Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence afte breast-conserving therapy. J Clin Oncol 26:2373–2378PubMedCrossRef
26.
Zurück zum Zitat Moran MS (2015) Radiation therapy in the locoregional treatment of triple-negative breast cancer. Lancet Oncol 16:e113–e122CrossRef Moran MS (2015) Radiation therapy in the locoregional treatment of triple-negative breast cancer. Lancet Oncol 16:e113–e122CrossRef
27.
Zurück zum Zitat Zaky SS, Lund M, May KA et al (2011) The negative effect of triple-negative breast cancer on outcome after breast-conserving therapy. Ann Surg Oncol 18:2858–2865PubMedCrossRef Zaky SS, Lund M, May KA et al (2011) The negative effect of triple-negative breast cancer on outcome after breast-conserving therapy. Ann Surg Oncol 18:2858–2865PubMedCrossRef
28.
Zurück zum Zitat Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384:164–172PubMedCrossRef Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384:164–172PubMedCrossRef
Metadaten
Titel
Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery
verfasst von
Gerd Fastner, MD
Cornelia Hauser-Kronberger, MD
Angelika Moder, PhD
Roland Reitsamer, MD
Franz Zehentmayr, MD
Peter Kopp, PhD
Christoph Fussl, MD
Thorsten Fischer, MD
Heinrich Deutschmann, MSc
Felix Sedlmayer, MD
Publikationsdatum
01.01.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 1/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0895-2

Weitere Artikel der Ausgabe 1/2016

Strahlentherapie und Onkologie 1/2016 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.