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Oral Abstract Presentation Session A General Poster Session B
Abstract No:
146
Author(s):
T. B. Julian, S. R. Land, Y. Wang, F. A. Vicini, D. W. Arthur, N. Wolmark, National Surgical Adjuvant Breast & Bowel Project
Abstract:
Introduction: Whole breast irradiation therapy following lumpectomy for invasive breast cancer (IBC) and non-invasive breast cancer (DCIS) significantly reduces the risk of local recurrence. Boost radiation therapy to the tumor bed has been proven to additionally lower the risk of recurrence for IBC. The benefit of boost therapy in patients with DCIS is less certain. We carried out a review of NSABP B-24 to assess the benefit of boost therapy in this randomized trial. Methods: 1,804 women with DCIS were randomized in NSABP B-24 following lumpectomy and radiation therapy to placebo (902) or tamoxifen (902). Whole breast irradiation therapy (50 Gy) was mandatory. Boost radiation therapy was optional. 1,569 patients (86.97%) were identified as having data for analysis. 692 of these patients received boost therapy ranging from 1 Gy -20 Gy with 81.5% receiving 10 Gy. Mean time on study was 14.2 years for the boost group and 14.3 years for the non- boost group. Results: Patient and tumor characteristics for the boost and non-boost groups are listed in the Table. Patients who received boost radiation therapy were more likely to have positive margins (p=0.002) and were slightly more likely to be white (p=0.006). As previously reported, margin status (HR: 2.12, p<0.001) and age (HR: 0.96, p<0.001) were significant predictors for ipsilateral breast tumor recurrence (IBTR). Boost had no significant impact on IBTR (HR: 0.98, p=0.904); there was also no significant interaction between boost and treatment (HR: l.05, p=0.853) nor between boost and margin status (HR: 0.78, p=0.417). The lack of boost interaction was true for both invasive and non-invasive IBTR. Conclusions: In NSABP B-24, the addition of boost radiation therapy was not found to be of value in reducing the recurrence of invasive or non-invasive breast cancers for patients with DCIS.
B-24 - Patients with Boost and Follow-up Information
Characteristics
Boost
Non-Boost
Chi-Square P Value
Number of Patients
692
877
Mean Time on Study (years)
14.2
14.3
Treatment* Placebo Tamoxifen
49.4 50.6
49.5 50.5
0.98
Age* <49 50-59 >60
36.4 28.8 34.8
31.5 31.1 37.4
0.12
Race* White Black Other Unknown
87.7 6.6 3.3 2.3
85.7 6.3 7.1 0.9
0.006**
Tumor Size* <l.0 cm l.0-2.0 cm >2.1 cm Unknown
84.7 9.4 4.8 1.2
84.4 10.9 3.6 1.0
0.35
Margin Status* Free Involved
79.0 21.0
85.3 14.7
0.002
*Values are percentages of patients with boost data available. ** Unknowns were excluded from p value.
Associated Presentation(s):
1. Is boost therapy necessary in the treatment of DCIS?
Associated Presentation(s):