The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival

Marissa C. van Maaren*, Reini W. Bretveld, Jan J. Jobsen, Renske K. Veenstra, Catharina G.M. Groothuis-Oudshoorn, Hendrik Struikmans, John H. Maduro, Luc J.A. Strobbe, Philip M.P. Poortmans, Sabine Siesling

*Corresponding author for this work

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Abstract

Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort.

Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes.

Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38-0.94)) and 42-55 days (HR 0.64 (95% CI: 0.45-0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42-55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days.

Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.

Original languageEnglish
Pages (from-to)179-188
Number of pages10
JournalBritish journal of cancer
Volume117
Issue number2
DOIs
Publication statusPublished - 11 Jul 2017

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Segmental Mastectomy
Disease-Free Survival
Radiotherapy
Drug Therapy
Survival
Population
Confidence Intervals
Neoplasm Metastasis
Guidelines
Breast Neoplasms
Recurrence

Keywords

  • 10-year disease-free survival
  • Breast cancer
  • Breast-conserving surgery
  • Radiation therapy
  • Time interval

Cite this

van Maaren, Marissa C. ; Bretveld, Reini W. ; Jobsen, Jan J. ; Veenstra, Renske K. ; Groothuis-Oudshoorn, Catharina G.M. ; Struikmans, Hendrik ; Maduro, John H. ; Strobbe, Luc J.A. ; Poortmans, Philip M.P. ; Siesling, Sabine. / The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. In: British journal of cancer. 2017 ; Vol. 117, No. 2. pp. 179-188.
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title = "The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival",
abstract = "Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort.Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes.Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95{\%} confidence interval (CI): 0.38-0.94)) and 42-55 days (HR 0.64 (95{\%} CI: 0.45-0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42-55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days.Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.",
keywords = "10-year disease-free survival, Breast cancer, Breast-conserving surgery, Radiation therapy, Time interval",
author = "{van Maaren}, {Marissa C.} and Bretveld, {Reini W.} and Jobsen, {Jan J.} and Veenstra, {Renske K.} and Groothuis-Oudshoorn, {Catharina G.M.} and Hendrik Struikmans and Maduro, {John H.} and Strobbe, {Luc J.A.} and Poortmans, {Philip M.P.} and Sabine Siesling",
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The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. / van Maaren, Marissa C.; Bretveld, Reini W.; Jobsen, Jan J.; Veenstra, Renske K.; Groothuis-Oudshoorn, Catharina G.M.; Struikmans, Hendrik; Maduro, John H.; Strobbe, Luc J.A.; Poortmans, Philip M.P.; Siesling, Sabine.

In: British journal of cancer, Vol. 117, No. 2, 11.07.2017, p. 179-188.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival

AU - van Maaren, Marissa C.

AU - Bretveld, Reini W.

AU - Jobsen, Jan J.

AU - Veenstra, Renske K.

AU - Groothuis-Oudshoorn, Catharina G.M.

AU - Struikmans, Hendrik

AU - Maduro, John H.

AU - Strobbe, Luc J.A.

AU - Poortmans, Philip M.P.

AU - Siesling, Sabine

PY - 2017/7/11

Y1 - 2017/7/11

N2 - Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort.Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes.Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38-0.94)) and 42-55 days (HR 0.64 (95% CI: 0.45-0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42-55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days.Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.

AB - Background: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort.Methods: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes.Results: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38-0.94)) and 42-55 days (HR 0.64 (95% CI: 0.45-0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42-55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days.Conclusions: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned.

KW - 10-year disease-free survival

KW - Breast cancer

KW - Breast-conserving surgery

KW - Radiation therapy

KW - Time interval

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