Breast-conserving treatment versus mastectomy in T1-2N0 breast cancer: which one is better for Indonesian women?
Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT) and mastectomy for T1-2N0 breast cancer patients.
Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), and disease-free survival (DFS).
Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 – 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 – 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 – 0.80) and DFS (HR 0.38; 95% CI 0.19 – 0.78).
Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS. (Med J Indones. 2012;21:220-4)
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer incidence and mortality worldwide: IARC Cancer Base No. 10 [Internet]. Lyon,France: International Agency for Research on Cancer 2010[cited 2011 Nov 03]. Available from: http://globocan.iarc.fr
American Cancer Society. Cancer facts & figures 2012. Atlanta: American Cancer Society; 2012. p. 1-28.
National Cancer Institute. PDQ® breast cancer treatment. Bethesda, MD: National Cancer Institute; 2011 [cited 2012 May 03]. Available from: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional.
Ruppel MB, Cole DJ. Symptomatic breast cancer. In: Poston GJ, Beauchamp RD, Ruer TJM, editors. Textbook of surgicaloncology. United Kingdom: Informa UK Ltd; 2007. p. 115. https://doi.org/10.3109/9780203003220-13
Poortmans P. Evidence-based radiation oncology: breast cancer. Radiother Oncol. 2007;84:84-101. https://doi.org/10.1016/j.radonc.2007.06.002
Yang SH, Yang KH, Li YP, Zhang YC, He XD, Song AL, etal. Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials.Ann Oncol. 2008;19:1039-44. https://doi.org/10.1093/annonc/mdm573
Munshi A, Dutta D, Kakkar S, Budrukkar A, Jalali R, Sarin R, et al. Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: a prospective study. Radiother Oncol. 2010;97:288-93. https://doi.org/10.1016/j.radonc.2010.04.008
Struikmans H, Aarts MJ, Jobsen JJ, Koning CC, Merkus JW, Lybeert ML, et al. An increased utilization rate and better compliance to guidelines for primary radiotherapy for breast cancer from 1997 till 2008: a population-based study in the Netherlands. Radiother Oncol. 2011;100:320-5. https://doi.org/10.1016/j.radonc.2011.05.012
Yau TK, Soong IS, Sze H, Choi CW, Yeung MW, Ng WT, et al. Trends and patterns of breast conservation treatment in Hong Kong: 1994-2007. Int J Radiat Oncol Biol Phys. 2009;74:98-103. https://doi.org/10.1016/j.ijrobp.2008.07.066
Keshtgar M, Davidson T, Pigott K, Falzon M, Jones A. Current status and advances in management of early breast cancer. Int J Surg. 2010;8:199-202. https://doi.org/10.1016/j.ijsu.2010.02.004
Leong BDK, Chuah JA, Kumar VM, Rohamini S, SitiZS, Yip CH. Trends of breast cancer treatment in Sabah,Malaysia: a problem with lack of awareness. SingaporeMed J. 2009; 50(8):772-6.
Anderson WF, Reiner AS, Matsuno RK, Pfeiffer RM.Shifting breast cancer trends in the United States. J ClinOncol. 2007;25:3923-9. https://doi.org/10.1200/JCO.2007.11.6079
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233-41. https://doi.org/10.1056/NEJMoa022152 https://doi.org/10.1056/NEJMoa020128
Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in theextent of surgery for early breast cancer on local recurrenceand 15-year survival: an overview of the randomised trials.Lancet. 2005;366:2087-106. https://doi.org/10.1016/S0140-6736(05)67887-7
Simsek F. Five year survival analysis of patients withclinical stages I and IIA breast cancer who received initial treatment at North Carolina Hospital. Center for Health Informatics and Statistics. 2000;123:1-9.
Rapiti E, Fioretta G, Vlastos G, Kurtz J, Schafer P, Sappino AP, et al. Breast-conserving surgery has equivalent effect as mastectomy on stage I breast cancer prognosis only when followed by radiotherapy. Radiother Oncol. 2003;69:277-84. https://doi.org/10.1016/j.radonc.2003.09.003
Noh JM, Park W, Huh SJ, Choi DH, Yang JH, Nam SJ, et al. A comparison of clinical outcomes for breast-conserving treatment and mastectomy for early breast cancer. J Korean soc Ther Radiol Oncol. 2008;26(1):10-6. https://doi.org/10.3857/jkstro.2008.26.1.10
Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst.2000;92:1143-50. https://doi.org/10.1093/jnci/92.14.1143
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-32. https://doi.org/10.1056/NEJMoa020989
Voogd AC, Nielson M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, et al. Differences in risk factor for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol. 2001;19:1688-97. https://doi.org/10.1200/JCO.2001.19.6.1688
Gao X, Fisher SG, Emami B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2003;56(4):1038-45. https://doi.org/10.1016/S0360-3016(03)00203-7
N, Triaspolitica. "Kanker Payudara: Informasi, Penyebab, Gejala, Stadium Dan Pengobatan." Mau Nanya Dong Dok. N.p, 28 June 2017. Web. 30 June 2017. <https://nanyadongdok.blogspot.com/2017/06/kanker-payudara-informasi-penyebab.html>.
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