Importance of radiation therapy for breast cancer patients treated with high-dose chemotherapy and stem cell transplant.

Abstract

PURPOSE:

To determine local-regional failure rates in breast cancer patients treated with surgery and high-dose chemotherapy with stem cell transplant and to relate local-regional failure to the use and timing of radiation treatment.

METHODS AND MATERIALS:

We retrospectively reviewed the records of 165 breast cancer patients treated on institutional protocols with surgery and high-dose chemotherapy with stem cell transplant. All patients had either Stage III disease, 10 or more positive axillary lymph nodes, or 4 or more positive axillary lymph nodes following neoadjuvant chemotherapy. Twelve patients had inflammatory breast cancer. Thirteen patients treated with breast preservation and 5 patients who died from toxicity within 30 days of transplant were excluded from the analyses of local-regional recurrences. In the remaining 147 patients, 108 were treated with adjuvant radiation and 39 were not. The disease stage distribution for these two groups was comparable. The median follow-up for surviving patients was 35 months.

RESULTS:

The 3- and 5-year actuarial disease-free survival (DFS) for the entire group was 60% and 51%, respectively. The 5-year rates of freedom from isolated local-regional recurrence were 95% in the patients treated with adjuvant radiation and 86% in the patients who did not receive radiation (p = 0.014, log rank comparison). The 5-year rates of any local-regional recurrence as a first event (isolated recurrences plus those with simultaneous local-regional and distant recurrences) were 92% versus 82%, respectively for patients whose treatment did and did not include radiation (p = 0.038). We could not demonstrate a correlation of the timing of radiation with the risk of local-regional recurrence.

CONCLUSIONS:

These data indicate that high-dose chemotherapy does not negate the importance of radiation in optimizing local-regional control in patients with high-risk breast cancer. Given the results of recent randomized trials studying postmastectomy radiation, which show that improving local-regional control improves overall survival (OS), we believe that all breast cancer patients with high-risk primary breast cancer who are treated with high-dose chemotherapy with stem cell transplant should receive radiation as a component of their treatment.

• Authors: T A Buchholz, S L Tucker, R A Moore, M D McNeese, E A Strom, A Jhingrin, G N Hortobagyi, S E Singletary, R E Champlin
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 46 Issue 2 Pg. 337-43 (Jan 15 2000) ISSN: 0360-3016 [Print] United States
• PMID: 10661340 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Breast Neoplasms (chemistry, drug therapy, radiotherapy)
• Combined Modality Therapy
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Mastectomy
• Multivariate Analysis
• Neoplasm Recurrence, Local (chemistry, prevention & control)
• Neoplasm Staging
• Retrospective Studies
• Survival Analysis