Evidence Based

1
Evidence Based

• For invasive breast cancer
• BCT is Tumor excision, axillary node dissection,
  whole breast radiation
• Modified mastectomy is total mastectomy and
  axillary node dissection
• BCT Modified Mastectomy, in both Recurrence and
  OS

2
Recurrence

• BCT 1-2/yr - Recurrence is in-breast, 80 in
  primary treated field, 20 new primary or
  regional
• Post mastectomy - Recurrence is chest wall
• The recurrences are different biologies, and
  etiologies
• The type of recurrence for BCT is eliminated by
  mastectomy
• The type of recurrence for mastectomy is
  eliminated by radiation therapy

3
Recurrence

• Since these recurrence rates are approximately
  equal, the treatment successes look the same.
• But if you add radiation to mastectomy then there
  will be a gain in overall survival, i.e.
  MastectomyRad is superior to BCT, most effect
  with node positive. Gain of gt5 at 15 years.

4
Radiation

• Partial breast radiation
• Eliminates treatment of out of field cancers
  known to exist in 20-40
• Provides a shell of inadequate therapeutic
  radiation ideal for induction of cancer.
• It should fail to treat each of the distinct risk
  issues unique to BCT and Mastectomy
• Predicts an increase in late failures

5
Effect of radiotherapy after breast-conserving
surgery (10 trials of BCS ? RT) on local
recurrence and on breast cancer mortality 6097
women with node-negative disease
6
Effect of radiotherapy after breast-conserving
surgery (10 trials of BCS ? RT) on local
recurrence and on breast cancer mortality 1214
women with node-positive disease
7
Effect of radiotherapy after mastectomy and
axillary clearance (25 trials of MastAC ? RT)
on local recurrence and on breast cancer
mortality1428 women with node-negative disease
8
Effect of radiotherapy after mastectomy and
axillary clearance (25 trials of MastAC ? RT)
on local recurrence and on breast cancer
mortality8505 women with node-positive disease
9
Effect of radiotherapy on breast cancer mortality
and on all-cause mortality after mastectomy with
axillary clearance (MastAC?RT)8505 women with
node-positive disease
10
Radiotherapy after mastectomy with axillary
clearance (MastAC?RT) in all women (9933
women, 86 with node-positive disease)
11
Radiotherapy after mastectomy with axillary
clearance (MastAC?RT) in women with
node-negative disease(1428 women)
12
Radiotherapy after mastectomy with axillary
clearance (MastAC?RT) in all women with
node-positive disease (8505 women, many with
the actual number of involved nodes unknown)
13
Radiotherapy after mastectomy with axillary
clearance (MastAC?RT) in women with 1-3
involved lymph nodes (pN1-3) (1890 women)
14
Radiotherapy after mastectomy with axillary
clearance (MastAC?RT) in women with 4 or more
involved lymph nodes (pN4) (1868 women)