Radiation recovery
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Response to Radiotherapy After Breast-Conserving Surgery in Different Breast Cancer Subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial
Martin Sjöström, Dan Lundstedt, Linda Hartman, Erik Holmberg, Fredrika Killander, Anikó Kovács, ...Show MoreCreative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/
PurposeTo evaluate the effect of adjuvant radiotherapy (RT) after breast conservation surgery in different breast cancer subtypes in a large, randomized clinical trial with long-term follow-up.
Patients and MethodsTumor tissue was collected from 1,003 patients with node-negative, stage I and II breast cancer who were randomly assigned in the Swedish Breast Cancer Group 91 Radiotherapy trial between 1991 and 1997 to breast conservation surgery with or without RT. Systemic adjuvant treatment was sparsely used (8%). Subtyping was performed with immunohistochemistry and in situ hybridization on tissue microarrays for 958 tumors.
ResultsRT reduced the cumulative incidence of ipsilateral breast tumor recurrence (IBTR) as a first event within 10 years for luminal A–like tumors (19% v 9%; P = .001), luminal B–like tumors (24% v 8%; P < .001), and triple-negative tumors (21% v 6%; P = .08), but not for human epidermal growth factor receptor 2–positive (luminal and nonluminal) tumors (15% v 19%; P = .6); however, evidence of an overall difference in RT effect between subtypes was weak (P = .21). RT reduced the rate of death from breast cancer (BCD) for triple-negative tumors (hazard ratio, 0.35; P = .06), but not for other subtypes. Death from any cause was not improved by RT in any subtype. A hypothesized clinical low-risk group did not have a low risk of IBTR without RT, and RT reduced the rate of IBTR as a first event after 10 years (20% v 6%; P = .008), but had no effect on BCD or death from any cause.
ConclusionSubtype was not predictive of response to RT, although, in our study, human epidermal growth factor receptor 2–positive tumors seemed to be most radioresistant, whereas triple-negative tumors had the largest effect on BCD. The effect of RT in the presumed low-risk luminal A–like tumors was excellent.
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story of the week
Published in Oncology
Journal Scan / Research · August 10, 2017
Noninferiority of Partial-Breast and Reduced-Dose Radiotherapy After Breast Conservation Surgery for Patients With Early Breast Cancer
- The Lancet
TAKE-HOME MESSAGE
- This phase III noninferiority trial enrolled 2016 women who had undergone breast-conserving surgery for grade 1–3 unifocal invasive ductal adenocarcinoma. They were randomized 1:1:1 to receive 40 Gy whole-breast radiotherapy (control; n = 674), 36 Gy whole-breast radiotherapy and 40 Gy restricted to the vicinity of the original tumor (reduced-dose group; n = 673), or 40 Gy restricted to the vicinity of the original tumor only (partial-breast group; n = 669) to evaluate the balance of beneficial versus adverse effects among treatment groups. Compared with the control group, estimated 5-year differences in local relapse were −0.73% and −0.38% in the reduced-dose and partial-breast groups, respectively. Both the reduced-dose group and the partial-breast group exhibited noninferiority. Similar adverse events were reported among treatment groups, with significantly fewer reports of change in breast appearance (partial-breast group) and breast harder or firmer (partial-breast and reduced-dose groups).
- These data demonstrate the noninferiority of reduced-dose and partial-breast radiotherapy compared with standard radiotherapy, approaches that can be implemented globally.
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My hubby took me out for an early birthday dinner at Applebee's!!0 -
Happy B-Day Josie!
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Happy Birthday Josie! I love Applebees!
Diane
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Thanks Fran and Diane. My birthday is actually August 24 but it's a Thursday so my DH decided to take me out last night. Tomorrow is my BIL Matts birthday he is my DH mentality disabled brother. And my DH other brother is a week older than me and his was August 17. So this evening we will do birthdays at my in-laws house.
Hope everyone is doing well. Fran you are amazing getting all that work done. Hope you can rest. Next year my brother-in-law will put a garden in at my In-laws house. It's already fenced in and I'm excited to be a part of it. But I will be able to relate even more next year at this time and may need some tips from you Fran.😍
I've been noticing my wrists are stiff and sore even sometimes my hands. I'm beginning to wonder if it's arthritis or just Carpal tunnel. Of course now my right hip is acting up lately as I lay down to sleep. Last night I had to sleep on my back because of my bursitis in now both hips. I guess I should of let my PCP give me a cortisone shot in that hip last month when I saw him so at least I could sleep on one side. Maybe my Tamoxifen is also part of the stiffness
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Could be the Tamoxifen Josie. At least it was for me. I had to sleep on my back too. It was really hard to do since I slept on my side as well.Also, I had consistent joint pain with Tamoxifen. It is supposed to make your bones stronger. My MO switched me from Arimidex after the first year because I got a borderline osteoporosis DX and Arimidex attacks the bones.
Tamoxifen was no walk in the park for me but the side effects were at least tolerable. I do know of several women who suffered with debilitating side effects from the drug.
Maybe get the cortisone shot next time for some relief. I have found picking up those twins and constantly picking up after them forced me to use muscles I hadn't used in a while. They are worth it of course!
6 years out this month! So blessed.
Diane
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congrats Diane.
I'll be 5 years out in January. But didn't start Tamoxifen till July of 2013 so I still have till July 2018 when Im finally done with Tamoxifen.
My doctor also gave me certain exercises to help my bursitis but I never have tried them
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congrats Diane.
I'll be 5 years out in January. But didn't start Tamoxifen till July of 2013 so I still have till July 2018 when Im finally done with Tamoxifen.
My doctor also gave me certain exercises to help my bursitis but I never have tried them
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Thanks Josie. It's hard to believe it's been that long. My ONC weaned me off Tamoxifen for a month rather than quitting cold turkey.
My sister who also has BC takes a shot every month. She was taking Arimidex but couldn't tolerate the side effects. Idk what the shot is. She is 5 years out this October but haven't heard whether her ONC will have her continue on after that or not. She has IBC and mine is IDC. She and I both had the Oncotype test done. Her score was intermediate; mine was low.
So how is your daughter's pregnancy going? She's going to have her hands full with 2 little ones. Thank goodness you are there to help.
Diane
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Diane, she's good but I worry. She spent 6 hours at the zoo last Sunday and complained of a headache, Braxton hicks contractions and a back ache all day last Monday. Well yesterday she decided to go to a craft fair yesterday in the heat and although she had her boyfriend with her and she says she only stayed like 20 min she felt pretty rotten today. I took her BP and it was good and of course encouraged her to drink some Gatorade. She claims she's drinking enough but sometimes I wonder. Her and Maisie had a 2 hour nap this afternoon.0 -
She so needs to take it easy Josie. Hope she will. This sweltering heat doesn't help. I had my kids in August and September. Plus your daughter has a little one already to wear her out! Good thing she has you!
Such a precious baby!
Diane
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Yes she does when she can. Too bad she accidentally brought a wet blanket home after doing her laundry at my house and he screamed at her and threatened to wake up the baby if she didn't come over at 1am and get a dry blanket. I've so had it with him...grrrr. She is going to Dr tommorow because her headache won't stop and she's seeing spots
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Good grief he is a piece of work. That is just outrageous. Neither wonder she is having headaches. He's the headache.
I can relate to issues with the boyfriend. My son's X GFF was constantly criticizing him, never appreciative of what he did or us either and used to make him wait forever when it was time to go somewhere. That's control. Plus she had 2 other children. Recipe for failure. He was exhausted from working and stress that comes with 4 kids. He is 28 years old. Way too much to take on at that age. His boys are his responsibility too and while he cares about her girls he didn't want to take on such a ready made family.
He is much happier and currently has a new GFF. She is a few years older but very nice and a pretty girl and cares about him. So for now he isn't as uptight.
I wish your DD had a different BFF. Sounds like he has anger issues not to mention he's too controlling. She deserves better. I'm sure it's hard on you and your DH too. We want the best for our kids. I know it was tough for us. We were civil to her but knew she was not a good match for him for multiple reasons. I do hope she finds someone some day. She is a good mother.
Do you guys ever call him out? We did with son's X but chose our battles because he's not a child and we didn't want to make matters worse.
Hope she gets good report from the doctor.
Diane
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thanks Diane she's waiting on blood test now but mainly still dealing with the headache. We don't say much to him because he isn't too approachable. The only time I kind of lost it with him was when I was over at her house watching the baby when she was younger and he came home to find his wallet and contents in pieces. I stopped him from beating that dog although he got a kick in before I could run after him yelling trying to stop him
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Hi, I cannot believe it's been over 3 weeks since I last was here. I got back from Montana, and my family arrived 2 days later. I had guests the entire month through August 14th. Then on Aug. 17th, I had major oral surgery including extractions, implants, and temporary placements. I was at the dentist for 10 hours. I was sedated and have no memory until about 5:45 pm when the sedation was removed. No pain, but lots of drugs and discomfort. I am 6 days out and have been through the worst of it. I have follow up on Friday and I have a ton of quesitons. One of my implants failed and therefore cannot support the temporary teeth. I do not know what is next. This is very costly and my expectations were for much more seamless results. I have not left the house until today ... I was going crazy and just went on a shopping trip to pick up odd things. I enjoyed being out. I have to eat liquid and soft diet. I have plenty of good choices but there is so much still happening in my mouth that I don't love eating. While out, I bought two giant smoothies - avocado with spinach, kale, pineapple and coconut; and triple berry with oatmeal and nutrients. I split them into 6 servings and will enjoy them for a few days.
My main challenge is that I have to go back to work. My speech is affected, and there is a lot of care involved. I need more time off...will see what I can do. My classes start 2 weeks from today and I do not know how I will recover by then. I am looking for subs.
Fran, I was so surprised to hear about all that wind damage. My gosh! When I was in northern Montana, there were a lot of wildfires. Are you having any fires this summer? I hope not....My friend in MT has been picking cherries at her friend's orchard. She picked 35 pounds one week. I think she baked and froze for days. You are a hard worker, Fran. Sorry you have such pain to deal with. It is better to be active through join pain, I think. Have you tried PT or cortisone? It worked for me. I was sorry to hear about your friend's dog...how sad for the family and especially the children. That memory will never go away...
Josie, so good to see you. Maisie is so beautiful, and I see the family resemblance. It sounds like your daughter is having dehydration problems coupled with stress. If her boyfriend continues to be controlling and angry, your daughter may need your family's support to deal with him. I know it's tough but your health and your daughter's health is too important. This new baby will be loved and as far as I'm concerned, love is what is needed. I know your daughter leans on you for help, but don't forget you need to work and find a job and that comes first right now You can best help her by being in a good place yourself. Wishing you a wonderful birthday tomorrow! I am glad you and your husband got out for the night. Sending hugs and prayers for you and your daughter and for the new baby.Diane, those twins are precious and yes, they do spell mischief! That's their job....yours is to see they don't get hurt while exploring, and to protect your stuff! I think your planned changes will help.
You reminded me that I am 6 years out...my surgery was Aug. 29th 2011. I consider that my cancer-free day. I was on a thread here for August 2011 surgeries. We had a list of each lady and her surgery date. It is still there...the founder of the thread did not survive, and over the years, several others have become angels. I revisit there each year and hope the ladies will check in but few do. There are happy stories and sad...that is the nature of BC. So let's celebrate each year and make the best of it, and let's always stay close to one another to help and support through all of life's joys and challenges.To the ladies who are recovering from radiation, I admire your courage and persistence. It was easy for me, no LE and skin healed in a few weeks. I remember the swelling coming down slowly. I had a lumpectomy and it is hardly noticeable. I do wish you a full recovery from surgery and radiation. There is life after BC and sometimes it takes awhile.
Sorry to hear about Bunkie...hope she checks in some day. And Janis and Gigil and April and Cindy....and so many more who are still part of our group.
Hugs all around!Joan
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Joan, sounds like you had a rough time. I remember having several teeth pulled and how painful that was and I was awake through it all. I couldn't afford implants so dentures were my savior. I am glad to not have that terrible gum disease though. I also knew with my sever bone loss in my jaws that implants were not the option. Take care of yourself.
I must of missed the news about Bunkie what happened
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got to spend some time with one of our twins!
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Joan - glad you dropped by. Sorry for your dental pain. I don't have implants but I've had all the rest except braces. Hope you feel better.
The twins are a handful! I'm babysitting tomorrow so DS can go to rugby practice. He is picking up their toddler beds and giving us the pack n plays. We have purchased 2 sets of beds and several high chairs and we don't have either at our house. We will be taking care of them for a few days next weekend too. DS will b in Washington DC with his GFF.
Hope you can find some subs. You so need recovery time. My SIL and neighbor both had implants. I know insurance doesn't cover them so I'll opt for new partials.
OMG kicked the dog? Josie that guy is a POS. Your daughter deserves better. I agree with Joan you have your own worries and they have to come first but I also know you are worried about her and the babies and the dog. I can't stand him and I dint even know him. Wish your daughter could make it w/o him. She does deserve better.
I dont know about Bunkie either? Did I miss something too?
For our friends who live in Texas - stay safe. Monster hurricane with lots of rain and damage.
Love that car charger
Diane
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About Bunkie, Fran (Charger) posted this on July 30th: Bunkie is in & out of hospital with her vertigo. They still have not found anything that works for her.
Fran, love your photo!!!
Josie, I also worry about bone loss affecting implants in the short and long term. I hope it does not happen in my case. I will know in about 2 months.
I started this post and fell asleep in the midst...am feeling tired. I am back to work and am already missing summer and the beach...classes start next week.
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Hi ladies, Well, here I go again. I found a small lump on my cancer breast and, of course, tried my LE massage first before seeing my cancer survivor Dr. Needless to say, the massage did nothing to convince this thing to go away and now it's been about 6 weeks. It's about pea size and sits right on top of the breast. I really don't think it's anything, and after my exam today she really doesn't either, but she also found another area on my axilla scar that has thickened up too. So now I go in Friday for a diagnostic mammo, which apparently means they will give me the results immediately as opposed to a routine mammo where they send you the results. They will also do an ultra sound of both areas. I'm sure it's fine, but find it interesting that my breast has started changing just 6 months after I stopped the arimidex. I forgot to ask her about that. Has anyone else had tissue changes 6 months after quitting their AI
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Good luck Sew! HUGGERS((())). I'm sure it is nothing just like your Dr said. Sending good vibes & mojo your way, hang in there. I'm still on AI's so can't help with your question, sorry.
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Bummer Sew. Keep us posted. At least you find out before you leave their office. I always have a diagnostic mammo. I don't wait well. Plus your Dr doesn't think it's anything.
I am almost a year off of Tamoxifen and feel better except the joint pain is back. Go figure. In fact the pain is in the mid range of my back. I thought it was because I've been picking up the twins - at the same time. No more of that but after the Dr ruled out a few other probable causes she did a chest X-ray and it showed multiple lung modules. She thinks it's scar tissue from an infection but of course I'm convinced my BC is back and it's gone to my lungs. Going back to see my Oncologist next week. God this is depressing. She did give me anti-inflammatory meds. We'll see if they work.
Not exhibiting any symptoms that would suggest the beast is back but the fear factor is alive and well.
Hope your results are good.
For all our sisters in Florida be safe. Praying for you guys and our friends in Texas and Louisiana.
Diane0 -
Sew & Edwards- I am thinking of you both and am staying positive for both of you to be nothing to do with this beast.
I am in Florida and thank you for your prayers! We are preparing and praying.
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Sew and Diane prayers. I'm hoping nothing serious.
Diane, picking both twins up at the same time??? Wow no wonder your back hurts.
Meanwhile I'm needing to get my Diagnostic mamma done ASAP since I'm like one month overdue.
Hope everyone in Florida that can't evacuate will be safe
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Charger, Diane, amistyeyes and Josie, greet news for me. This is all just thickening from radiation damage. It's possible that my 9 months on high does prednisone brought this on...or it's just delayed or whatever. I gather this could continue growing and changing forever. But as long as it's nothing to worry about I'm good with that.
Diane, I'm hoping your lung nodules are scaring. I've got several of those too, and they are from prior illnesses so I'm hoping yours are toon.
Misty...good luck to you, I hope you've gotten to a safe place and don't end up with any damage. My thoughts go out to all the people in the paths of Harvey, Irma and Jose.
Thanks for your thoughts everyone..
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Happy Dance for SEW!!
Diane your next in line
Good luck Misty
Almost done my veggies, 111 bags of 3 cups ea. Still have a few more carrots to dig out.
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So its official... I have lymphedema of my breast. I have to do self-massage of my breast, twice daily... then if there is no change in two months, I'll have to see a physical therapist... Fun!
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6cats.... I 'm sorry you're going to have to go thru all this, but it really will help,. I had truncal LE, breast and underarms were the worst. It's amazing how much the LE massage helps. Relieves all the swelling and pain. I did end up having PT and needing to wear a compression bra for almost a year, and a sleeve off and on for about 2 months, but for the last 3 years I've been just fine and don't even do any massage unless it acts up which is rarely and then it only takes a few sessions of the massage to get back to normal. Good Luck.....and a hint: if you end up in PT make certain sure the therapist is trained in this type of massage. Lots out there say they can do it, but have only had a few hours of training. There is an actual school and 30 plus hours of training for it, as I recall.
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6cats, don't get discouraged if the self massage doesn't work, a therapist can do it better. Use the two months to research a great one in your area. Exercise with 3lb weights and a sleeve help too (even though it's in your breast), and keep it cool, it swells in heat.
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