Journal of Clinical Oncology, Vol 15, 963-968, Copyright © 1997 by American Society of Clinical Oncology
Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France
P Romestaing, Y Lehingue, C Carrie, R Coquard, X Montbarbon, JM Ardiet, N Mamelle and JP Gerard
Service de Radiotherapie-Oncologie des Hospices Civils de Lyon, CentreHospitalier Lyon Sud, Pierre Benite, France.
PURPOSE: To define the role of a 10-Gy boost to the primary tumor in the
conservative treatment of early infiltrating breast carcinoma treated by
limited surgery and radiotherapy. PATIENTS AND METHODS: Between 1986 and
1992, 1,024 women with early breast carcinoma (< or = 3 cm in diameter)
were treated by local excision, axillary dissection, and conventional 50-Gy
irradiation given in 20 fractions over 5 weeks and then randomly assigned
to receive either no further treatment or a boost of 10 Gy by electrons to
the tumor bed. The median follow-up time was 3.3 years as of September
1994. The occurrence of telangiectasia was reported, and the patients were
asked to evaluate the cosmetic result. RESULTS: At 5 years, 10 patients of
521 who had received the boost (Kaplan-Meier estimate of local relapse
rate, 3.6%) and 20 of 503 who had received no further treatment
(Kaplan-Meier estimate of local relapse rate, 4.5%) had developed a local
recurrence (P = .044). After adjustment for the main prognostic variables,
the relative risk was still significantly lower for the boost group (0.3;
range, 0.12 to 0.95). The boost group had a higher rate of grade 1 and 2
telangiectasia (12.4% v 5.9%), but no difference was seen between the two
treatment arms in the self-assessment score for the cosmetic result.
CONCLUSION: Delivery of a boost of 10 Gy to the tumor bed after 50 Gy to
the whole breast following limited surgery significantly reduces the risk
of early local recurrence, with no serious deterioration in the cosmetic
result. Additional follow-up evaluation will be required to assess the
long-term results.
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