CHICAGOBreast conservation followed by radiotherapy is an
effective treatment approach for invasive breast cancer in medically
indigent black women, but prompt initiation of the radiotherapy and
adequate radiation dose are necessary to achieve optimal results,
according to a study presented at the 85th Annual Meeting
of the Radiological Society of North America (RSNA).
In this study, women who received radiotherapy within 30 days of
lumpec-tomy had superior disease-free survival, compared with those
in whom radiotherapy was delayed. Women who received a dose of at
least 50 Gy achieved a greater degree of local control as well as
longer disease-free and overall survival than those given lower
doses, said Stuart H. Burri, MD, chief resident in Radiation
Oncology, Emory University.
Dr. Burri and his colleagues reviewed the records of 88 black women
who underwent breast-conservation therapy between 1980 and 1996 at
Emorys Grady Memorial Hospital. Most were uninsured or
receiving Medicaid. Of these 88 women, 72 had invasive cancer: 56%
stage I disease; 37.5% stage II; 5.6% stage III; and 33% had positive
Following lumpectomy, radiotherapy was delivered to the involved
breast by means of opposed tangents. The dose ranged from 45 to 55 Gy
(median, 50 Gy), and 70% received a radiation boost (median dose, 10
Gy). Radiotherapy was delivered between 9 and 312 days after
lumpectomy (median, 69 days). The average follow-up was 55.4 months.
The proportion of women with invasive breast cancer who had local
control of their disease was 95% at 5 years and 88% at 10 years.
Disease-free survival was 85% at 5 years and 65% at 10 years, and
overall survival was 77% at 5 years and 43% at 10 years.
Local control, disease-free survival, and overall survival were
inferior among women who received a radiotherapy dose to the tumor
bed of less than 50 Gy (P < .0001). Treatment failure was
more likely if radiotherapy was delayed for more than 30 days after
lumpectomy (P = .0479).
Dr. Burri explained that the method of notifying patients of the need
for radiotherapy was most likely responsible for the extended
intervals between surgery and further treatment experienced by some
patients. Patients typically were notified by mail to return for
further therapy after lumpectomy, but indigent patients can be
difficult to contact by mail, because they tend to move frequently or
do not have a mailing address.
Mailings also have been delayed by inefficiencies in the hospital
mailing system. We have made efforts in recent years to
decrease that time, and it has improved recently, Dr. Burri