Effects
of local therapy on breast cancer mortality
Interview
with Neil Love, MD Breast Cancer Update for Medical Oncologists,
Program 6 2000
Play
Audio Below:
When
you get better local control with radiotherapy or with any types
of surgery that really do reduce the risk of local recurrence, then
you do get some decrease in the long-term mortality from breast
cancer. I would say an absolute reduction of about 20 percent in
local recurrence seems to go with an absolute reduction of around
about five percent in long-term mortality from breast cancer 10
or 15 years later. You don’t see much in the first few years,
but then it comes in 10-15 years later.
The
trouble is, with radiotherapy, a lot of the older forms of radiotherapy
produced such toxicity in terms of scatter into the chest and vascular
hazards — not just the heart but also other arteries, as well,
you know, increase in vascular disease in general, increase in lung
cancer, increase in pneumonia — that it really was sort of
roughly equal and opposite to the benefits. But, if the radiotherapists
can be a lot more selective and, you know, really avoid scatter
into the thoracic cavity, they ought to be able to get most of the
benefits while avoiding most of the hazard, I hope. That, I think,
is the conclusion from the meta-analysis of the radiotherapy trials.
So, although the meta-analysis, the old trial, suggested no net
benefit, when you look separately, the breast deaths and the non-breast
deaths, I think that they actually show that better local control
does matter in terms of long-term survival. But, that you’ve
got to be very much more careful than people had been in terms of
avoiding the side effects of radiotherapy, which don’t turn
up until more than 10 years after treatment.
Relevant
Articles:
8.Radiation
therapy for primary and metastatic breast cancer
UK
and USA breast cancer deaths down 25% in year 2000 at ages 20-69
years R.; Boreham, J.; Clarke, M.; Davies, C., and Beral, V..
Lancet. 355(9217):1822, 2000 May 20. No abstract
