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Master Thesis

Traitement conservateur d'un second événement intra-mammaire homolatéral : intérêt de la classification d'irradiation partielle de GEC-ESTRO

Abstract : AIM:
Second ipsilateral breast tumor event (2ndIBTE) occurring after primary radio-surgical treatment can be treated by either salvage mastectomy or 2nd conservative treatment (2ndCT) including an accelerated partial breast re-irradiation (APBrI). We analyzed the impact of the GEC-ESTRO APBI classification (GAC) on the oncological outcome after APBrI.
MATERIALS AND METHODS:
Between 2000 and 2016, 159 patients (pts) underwent a 2ndCT. After lumpectomy, APBrI was performed using either low-dose (30-55 Gy reference isodose) or high-dose rate brachytherapy (28-34 Gy). Oncological outcome including 3rdIBTE, regional (RFS) or metastasis-free survival (MFS), specific (SS) and overall survival (OS) was analyzed according to GAC. Univariate (UVA) and multivariate analyses (MVA) were conducted to identify significant prognostic factors for 3rdIBTE.
RESULTS:
With a median follow-up of 71 months (range 62-85 months), 60 pts (42%), 61 pts (42.7%) and 22 pts (15.4%) were classified as low-risk (LR), intermediate-risk (IR) and high-risk (HR), respectively. For the whole cohort, 6-year 3rdIBTE-free survival, RFS, MFS, SS and OS rates were 97.4, 96.4, 90.3, 92.9 and 91.2%, respectively. Six-year 3rdIBTE-free survival rates for LR, IR and HR were 100, 95.8 and 92.9%, respectively (p = 0.003), while no significant differences were found between the three GAC groups for RFS, MFS, SS. In UVA, lympho-vascular invasion (p = 0.009), positive margins (p = 0.0001) and GAC high-risk group (p = 0.001) were considered as significant prognostic factors for 3rdIBTE, while, in MVA, high-risk group (p = 0.009) was the only prognostic factor.
CONCLUSION:
In case of 2ndIBTE, GAC could be used as a decision helping tool to discuss conservative or radical treatment options. Patient information remains crucial in order to accurately define the salvage therapy modalities.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02436910
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Monday, January 13, 2020 - 2:35:12 PM
Last modification on : Thursday, January 7, 2021 - 12:50:02 PM
Long-term archiving on: : Tuesday, April 14, 2020 - 4:56:50 PM

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  • HAL Id : dumas-02436910, version 1

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Lucile Montagne. Traitement conservateur d'un second événement intra-mammaire homolatéral : intérêt de la classification d'irradiation partielle de GEC-ESTRO. Human health and pathology. 2019. ⟨dumas-02436910⟩

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