Factors affecting recurrence in lumpectomy without irradiation for breast cancer

Article Abstract:

Conservative surgery has become more common in the treatment of breast cancer. While previously radical mastectomy was the standard treatment in virtually all cases, it has become common, particularly in women with very small tumors, to excise the primary lesion and remove the lymph nodes from the armpit (axilla), but to conserve most of the breast tissue. Usually, the affected breast is irradiated to help prevent the growth of any small remaining foci of tumor cells. However, irradiation was instituted as a cautionary measure, and it is uncertain that radiotherapy is actually necessary or provides any benefit. The authors reviewed the cases of 122 women with breast cancer who underwent conservative surgery without receiving radiation treatment to determine if omitting this treatment had adverse consequences. All the patients had invasive breast cancer that was treated with wide excision and the removal of the axillary lymph nodes. During the follow-up period, which varied from one to eight years, 22 patients had breast cancer recurrences and one had a recurrence of tumor in the armpit. When the researchers looked for factors which correlated with recurrence, they found that none of the 20 patients whose primary tumors were smaller than 1 centimeter suffered relapse. The likelihood of relapse seemed to be directly dependent upon the size of the primary tumor before surgery. The presence or absence of tumor cells in the lymph nodes of the armpit seemed to have no influence on relapse. Furthermore, it was observed that the likelihood of relapse was dependent upon age, as well. In the group of 122 women, 31 were over 70 years of age, and only one relapse was observed among these elderly women. The results of this study indicate that for some women, irradiation is an important aspect of treatment for breast cancer. However, for women with primary tumors smaller than one centimeter, and for patients over the age of 70, preventative irradiation may serve little purpose and the patient may no need this treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Irradiation, Irradiation (Radiation exposure)

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Impact of radiation therapy and/or chemotherapy on the risk for a second malignancy after breast cancer

Article Abstract:

Since the risk of developing a second breast cancer is high among breast cancer patients, most patients now receive adjuvant therapy in addition to breast surgery. This adjuvant therapy may take the form of chemotherapy, radiotherapy, or a combination of the two. Since the number of treated women is quite high, it becomes important to determine the long-term risks associated with adjuvant therapy. Since any cancer-causing effects of adjuvant therapy may take a decade or more to express themselves, only a long-term study involving a relatively large number of patients can provide answers to these questions. Such a study was conducted on 1,081 women, who were treated for primary breast cancer between 1970 and 1981. No patients included in the study had signs of distant cancer spread at the time of treatment. Of the 1,081 patients, 407 received only surgical treatment, 226 received adjuvant chemotherapy, 140 received adjuvant radiotherapy, and 308 received a combination of radiotherapy and chemotherapy in addition to surgery. Consistent with previous reports, the rate of new breast cancer developing in the other breast was elevated for all patients, but was highest among the patients who received only surgical treatment. There was no apparent elevation in the rate of solid nonbreast tumors developing in the patients, regardless of treatment. The rate of development of leukemia, however, was elevated among patients receiving surgery only, chemotherapy only, or chemotherapy in combination with radiotherapy. It should be emphasized that this elevation represents a total of four cases of leukemia in the patient population of 1,081, and the elevation was statistically significant for only the surgery group. The overall findings suggest that there is little or no negative impact of adjuvant therapy for breast cancer patients. Adjuvant chemotherapy and chemotherapy with radiation therapy appear to reduce the risk of breast cancer in the contralateral breast. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery

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Impact of second malignancy risk of the combined use of radiation and chemotherapy for lymphomas

Article Abstract:

Unfortunately, many treatments are not without their own risks; this is especially true for cancer therapies, which can cause particularly harsh effects. The cases of 999 patients treated for lymphomas, both Hodgkin's and non-Hodgkin's, were evaluated to determine to what degree the anticancer treatments increased the risk of a second cancer. The use of combined radiotherapy and chemotherapy produces improved survival rates, but it is not certain if combined therapy might also cause increased risk of a second cancer. For the 313 patients with Hodgkin's disease, the relative risk of acute leukemia was 51.3 overall, and the relative risk of solid tumors was 6.5. (A relative risk of 1.0 suggests the same risk as the normal population.) For patients with non-Hodgkin's lymphomas, the relative risk of leukemia was 8.3, and the relative risk of solid tumors was less than 1.0. The radiotherapy conferred greater relative risk than chemotherapy for Hodgkin's disease patients; among non-Hodgkin's patients the increased relative risk of leukemia was due entirely to chemotherapy, not radiation. When the incidence of second tumors in patients receiving both treatment modalities was analyzed, it was found that there was no statistically significant difference between combined modality therapy and either radiotherapy or chemotherapy alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Hodgkin's disease, Risk factors, Non-Hodgkin's lymphomas, Leukemia, Leukemia, Radiation-induced, Radiation induced leukemia

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