Importance of Radiation Therapy for Breast Cancer Patients Treated With High-dose Chemotherapy and Stem Cell Transplant
Document Type
Article
Publication Title
International Journal of Radiation Oncology, Biology, Physics
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.
DOI
10.1016/s0360-3016(99)00429-0
Publication Date
1-15-2000
Keywords
Breast cancer, High-dose chemotherapy, Transplant, Radiation
ISSN
1879-355X
Recommended Citation
Buchholz TA, Tucker SL, Moore RA, McNeese MD, Strom EA, Jhingrin A, Hortobagyi GN, Singletary S, Champlin RE. Importance of Radiation Therapy for Breast Cancer Patients Treated With High-dose Chemotherapy and Stem Cell Transplant. International Journal of Radiation Oncology, Biology, Physics. 2000; 46(2). doi: 10.1016/s0360-3016(99)00429-0.
