The Evolution of the Local and System Therapy of Breast Cancer Stage I: 27-Years’s Data Analysis
The aim of the investigation is to study the dynamics of approaches in surgery, adjuvant radiotherapy and systemic therapy for breast cancer stage I over the past 27 years.
Materials and Methods. In the study included 1341 women (aged 21–88 years) with invasive breast cancer stage I, who had received treatment in N.N. Blokhin Russian Cancer Research Center and Clinic of RMAPE (Moscow) from 1985 to 2012. The first stage of treatment for all the patients included radical surgery (43.5% patients — radical mastectomy; and 56.5% — breast-conserving surgery). More than half of the patients (58.9%) received adjuvant radiotherapy; adjuvant systemic therapy was used in 821 patients (61.0%), endocrine therapy alone — in the third of patients (432 women, 32.1%), chemotherapy alone — in 124 women (9.2%), and 526 patients (19.7%) received a combined systemic therapy (chemotherapy and endocrine therapy). We analyzed the change of approach to the surgical treatment, adjuvant radiotherapy and systemic therapy from 1985 to 2012. A statistical analysis was made by international statistical program SPSS 20.0.
Results. Over the past 27 years local treatment structure of stage I breast cancer has changed: radiotherapy has become an indispensible part of breast conserving therapy, and was added by “boost” (radiotherapy with a dose of 14–16 Gy) on tumor bed by a half of women (50.3%). The part of patients who received radiotherapy after radical mastectomy has decreased (from 14.6 to 4.5%, p < 0.05). Adjuvant systemic therapy has been used by the majority of women (86.7%): a part of patients receiving endocrine therapy has significantly increased (from 20.7 to 44.3%), chemotherapy (from 2.6 to 13.6%), or chemo-hormone therapy (from 8.4 to 28.8%), p < 0.05. Chemotherapy regimens have been changed: non-anthracycline combinations are used instead of anthracycline regimens, and after 2005 — taxanes. HER2-status detection has been used in clinical practice since 2000, and trastuzumab in adjuvant therapy — after 2005; about half of the women with HER2-positive breast cancer stage I (50.8%) have received anti-HER2-therapy by trastuzumab. The proportion of patients receiving endocrine therapy by tamoxifen alone has decreased (from 84.2 to 52.4%, p < 0.05) in favor of other agents (aromatase inhibitors and sequential modes).
- Gatta G., Trama A., Capocaccia R. Variations in cancer survival and patterns of care across Europe: roles of wealth and health-care organization. J Natl Cancer Inst Monogr 2013; 2013(46): 79–87, http://dx.doi.org/10.1093/jncimonographs/lgt004.
- Souza F.H., Polanczyk C.A. Is age-targeted full-field digital mammography screening cost-effective in emerging countries? A micro simulation model. Springerplus 2013 Jul 31; 2: 366, http://dx.doi.org/10.1186/2193-1801-2-366.
- Elkin E.B., Atoria C.L., Leoce N., Bach P.B., Schrag D. Changes in the availability of screening mammography, 2000–2010. Cancer 2013 Aug 13, http://dx.doi.org/10.1002/cncr.28305.
- Abrahamsson L., Humphreys K. A statistical model of breast cancer tumour growth with estimation of screening sensitivity as a function of mammographic density. Stat Methods Med Res 2013 Jul 9, http://dx.doi.org/10.1177/0962280213492843.
- Syed B.M., Green A.R., Paish E.C., Soria D., Garibaldi J., Morgan L., Morgan D.A., Ellis I.O., Cheung K.L. Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts. Br J Cancer 2013 Mar 19; 108(5): 1042–1051, http://dx.doi.org/10.1038/bjc.2012.601.
- Rodríguez-Spiteri Sagredo N., Martínez Regueira F., Olartecoechea Linaje B., Arredondo Chaves J., Cambeiro Vázquez M., Pina Insausti L.J., Elizalde Pérez A., Garíca-Lallana A., Sola Gallego J.J. Accelerated partial breast irradiation with multicatheters during breast conserving surgery for cancer. Cir Esp 2013 Jul 1, http://dx.doi.org/10.1016/j.ciresp.2013.02.016.
- Skandarajah A.R., Bruce Mann G. Selective use of whole breast radiotherapy after breast conserving surgery for invasive breast cancer and DCIS. Surgeon 2013 Apr 27, http://dx.doi.org/10.1016/j.surge.2013.03.005.
- Murphy J.O., Sacchini V.S. New innovative techniques in radiotherapy for breast cancer. Minerva Chir 2013 Apr; 68(2): 139–154.
- Holleczek B., Jansen L., Brenner H. Breast cancer survival in Germany: a population-based high resolution study from saarland. PLoS One 2013 Jul 31; 8(7): e70680, http://dx.doi.org/10.1371/journal.pone.0070680.
- Hernandez-Aya L.F., Gonzalez-Angulo A.M. Adjuvant systemic therapies in breast cancer. Surg Clin North Am 2013 Apr; 93(2): 473–491, http://dx.doi.org/10.1016/j.suc.2012.12.002.
- Hickey B.E., Francis D.P., Lehman M. Sequencing of chemotherapy and radiotherapy for early breast cancer. Cochrane Database Syst Rev 2013 Apr 30; 4: CD005212, http://dx.doi.org/10.1002/14651858.CD005212.pub3.
- Pestalozzi B.C., Holmes E., de Azambuja E., Metzger-Filho O., Hogge L., Scullion M., Láng I., Wardley A., Lichinitser M., Sanchez R.I., Müller V., Dodwell D., Gelber R.D., Piccart-Gebhart M.J., Cameron D. CNS relapses in patients with HER2-positive early breast cancer who have and have not received adjuvant trastuzumab: a retrospective substudy of the HERA trial (BIG 1-01). Lancet Oncol 2013 Mar; 14(3): 244–248, http://dx.doi.org/10.1016/S1470-2045(13)70017-2.
- Kurian A.W., Lichtensztajn D.Y., Keegan T.H., Leung R.W., Shema S.J., Hershman D.L., Kushi L.H., Habel L.A., Kolevska T., Caan B.J., Gomez S.L. Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004–2007. Breast Cancer Res Treat 2013 Jan; 137(1): 247–260, http://dx.doi.org/10.1007/s10549-012-2329-5.
