The Evolution of the Local and System Therapy of Breast Cancer Stage I: 27-Years’s Data Analysis

The aim of the investigation is to study the dynamics of approaches in surgery, adjuvant radiotherapy and systemic therapy for breast cancer stage I over the past 27 years.

Materials and Methods. In the study included 1341 women (aged 21–88 years) with invasive breast cancer stage I, who had received treatment in N.N. Blokhin Russian Cancer Research Center and Clinic of RMAPE (Moscow) from 1985 to 2012. The first stage of treatment for all the patients included radical surgery (43.5% patients — radical mastectomy; and 56.5% — breast-conserving surgery). More than half of the patients (58.9%) received adjuvant radiotherapy; adjuvant systemic therapy was used in 821 patients (61.0%), endocrine therapy alone — in the third of patients (432 women, 32.1%), chemotherapy alone — in 124 women (9.2%), and 526 patients (19.7%) received a combined systemic therapy (chemotherapy and endocrine therapy). We analyzed the change of approach to the surgical treatment, adjuvant radiotherapy and systemic therapy from 1985 to 2012. A statistical analysis was made by international statistical program SPSS 20.0.

Results. Over the past 27 years local treatment structure of stage I breast cancer has changed: radiotherapy has become an indispensible part of breast conserving therapy, and was added by “boost” (radiotherapy with a dose of 14–16 Gy) on tumor bed by a half of women (50.3%). The part of patients who received radiotherapy after radical mastectomy has decreased (from 14.6 to 4.5%, p < 0.05). Adjuvant systemic therapy has been used by the majority of women (86.7%): a part of patients receiving endocrine therapy has significantly increased (from 20.7 to 44.3%), chemotherapy (from 2.6 to 13.6%), or chemo-hormone therapy (from 8.4 to 28.8%), p < 0.05. Chemotherapy regimens have been changed: non-anthracycline combinations are used instead of anthracycline regimens, and after 2005 — taxanes. HER2-status detection has been used in clinical practice since 2000, and trastuzumab in adjuvant therapy — after 2005; about half of the women with HER2-positive breast cancer stage I (50.8%) have received anti-HER2-therapy by trastuzumab. The proportion of patients receiving endocrine therapy by tamoxifen alone has decreased (from 84.2 to 52.4%, p < 0.05) in favor of other agents (aromatase inhibitors and sequential modes).

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Kolyadina I.V., Poddubnaya I.V., Trofimova О.P., Komov D.V., Karseladze A.I., Ermilova V.D., Vishnevskaya Y.V., Frank G.A., Khaylenko V.А., Banov S.M. The Evolution of the Local and System Therapy of Breast Cancer Stage I: 27-Years’s Data Analysis. Sovremennye tehnologii v medicine 2014; 6(1): 54