Postlumpectomy Radiotherapy: RESULTS

Patient and Tumor Characteristics

The median age of the patients was 55 years with a mean age of 56.3 years. Other important patient characteristics are summarized in Table 1. The table includes only black and white patients, since only 2.2% of the patients in the study were nonblack, nonwhite. The data was analyzed both with and without the nonblack, nonwhite patients and there was no significant difference in the results. The data presented here will only be for the black and white patients for clarity.

Several characteristics other than those listed in Table 1 were reviewed, including days from lumpectomy to initiation of radiotherapy, as well as dose of radiation, number of involved nodes, and extracapsular extension of lymph nodes metastases. There were no statistical differences in the other categories reviewed.
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Table 1. Patients Characteristics

	Black	White	p Value
Stage* 1 II III	54.9% 43.1% 2.0%	67.9% 32.1% 0%	0.0308
T Stage* Tla Tib Tic T2 T3	10.8% 20.6% 36.3% 29.4% 2.9%	8.0% 30.9% 37.0% 24.1% 0%	0.0767
Final Margins Negative Positive Close (<2 mm) Unknown	78.4% 5.9% 15.7% 0%	69.8% 9.9% 16.0% 4.3%	NS
Re-excision	45.1%	28.4%	0.0136
Grade 1 II III Unknown	12.7% 40.2% 35.3% 11.8%	27.2% 27.2% 24.1% 9.3%	0.002554
Positive Nodes	29.4%	14.8%	0.0083
Estrogen Receptor Positive Negative Unknown	56.9% 31.4% 11.8%	59.9% 25.0% 15.4%	NS
Progesterone Receptor Positive Negative Unknown	51.0% 37.3% 11.8%	52.5% 32.1% 15.4%	NS
Vascular/Lymphatic Invasion	15.7%	14.2%	NS
Received Chemotherapy	39.2%	28.4%	0.0677
Age <45	24.5%	13.0%	0.016
>49 Elapsed Days	18.6%	4.3%	0.000138
# Stage 1: T1N0M0, Stage II: T1N1M0J2N0M0J2N1M0J3N0M0, Stage III: T0N2M0, T1N2M0, T2N2M0, T3N1M0, T3N2M0, T4anyNM0/anyTN3M0; * Tla: Tumor more than 0.1 but not more than 0.5 cm in greatest dimension; Tib: Tumor more than 0.5 cm but not more than 1 cm in greatest dimension; Tic: Tumor more than 1 cm but not more than 2 cm in greatest dimension; T2: Tumor more than 2 cm but not more than 5 cm in greatest dimension; T3: Tumor more than 5 cm in greatest dimension31

Treatment Characteristics

All of the patients were treated with opposed tangential fields. The median dose of the tangential fields was 50 Gy. 80.4% of the patients had a boost with a median boost dose of 10 Gy. The median total dose was 60 Gy with a range of 35.08 Gy-65 Gy. The patient who received 35.08 Gy stopped her treatment against the advice of her physicians. 11.9% of the patients had a supraclavicular field. A posterior axillary boost was included in 2.2% of the patients and a separate internal mammary field in only one patient.
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Table 2

	Black	White	p Value
Five-year local/regional control	95.5%	94.8%	0.9121
Five-year disease-free survival	90.3%	91.7%	0.8026

The median follow-up was 49 months with an average follow-up of 49 months. 15.6% of the patients had been lost to follow-up. There were no differences statistically in either follow-up or patients lost between the blacks and whites.

Treatment Results

The local control and disease-free survival are summarized in Table 2. Actuarial Kaplan-Meier curves for local control and disease-free survival for black and white patients are displayed in Figures 1 and 2, respectively. The actuarial local control was 95.5% at five years in the black patients and 94.8% in the white patients. At five years, the actuarial disease-free survival was 90.3% and 91.7% in the black and white patients, respectively. Both the local control and disease-free survival were statistically indistinguishable for the black and white patients. Similarly, the data were analyzed by stage in both races. In stage-I and -II patients, there was no statistical difference between local control, disease-free survival, or overall survival of the black and white patients.
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Figure 1 Local/regional control in black and white patients treated with postlumpectomy radiotherapy. At five years, the actuarial local/regional control in black patients was 95.5% and 94.8% in white patients (p=0.9121).

There was no statistical difference for either local control or disease-free survival by institution.

Not surprisingly, patients with higher-stage as well as higher-grade disease were more likely to fail on univariate analysis. Also, patients who were ER-positive and PR-positive were less likely to fail. tadalis sx

Figure 2 Disease-free survival in black and white patients treated with postlumpectomy radiotherapy. The actuarial five year disease-free survival was 90.3% in the black patients and 91.7% in the white patients (p=0.8026).

The factors included in the multivariate analysis were age, race, stage, tumor grade, margin status, ER status, PR status, vascular/lymphatic invasion, nodal status, number of positive lymph nodes, elapsed days under treatment, chemotherapy, and days from lumpectomy to initiation of radiation treatment. Race was not a statistically significant factor on multivariate analysis for both local control and disease-free survival. The only independent significant factors for local control on multivariate analysis were ER positivity and elapsed days from lumpectomy. Patients who were ER-positive were less likely to fail locally (RR=0.038), and those that had longer elapsed days from lumpectomy to initiation of radiation treatments were more likely to fail (RR=1.014). The intriguing finding of a greater likelihood of local failure in those patients treated with postlumpectomy radiotherapy, with a delay in the initiation of treatment, merits further study. Interestingly, and almost certainly a result of the small numbers with few overall failures, there were no independent statistically significant factors for disease-free survival on the multivariate analysis.
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