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  Cancer Not Local After All?

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By: Gunver Sophia Kienle, M.D.
Effect of Surgery and Radiotherapy on Evolution of Early Breast Cancer (Original title: 1st Krebs doch keine Lokalerkrankung? Die Wirkung von Operation und Bestrahlung auf den Krankheitsverlauf von fruehem Brustkrebs. Der Merkurstab 19%; 49:157-8. English by A. R. Meuss, FIL, MTA)

The effect of surgery and radiotherapy on the evolution of early breast cancer was the subject of a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group.(1) The issue under investigation was:

Do the radical nature of the operation and additional local irradiation of early breast cancer influence frequency of recurrences and survival (ten-year survival rate)?

A total of 64 randomized trials was analyzed. 36 of these compared radiotherapy plus surgery with surgery only; 10 compared extensive with limited (retaining the breast) surgical techniques; 18 concerned extensive vs. limited surgery plus radiotherapy. The result was as follows:

Depending on local treatment, frequency of recurrence showed considerable variation, e.g. fewer recurrences after additional radiotherapy. Surprisingly, total 10-year survival was the same for all groups, irrespective of the treatment used.

This means that reduced frequency of breast cancer recurrence is not synonymous with improved survival or, conversely, a greater number of recurrences is not synonymous with reduced life expectancy.

Surely these findings cast a cloud on the image currently presented, which is that cancer is entirely local, with treatment accordingly limited to radical eradication of tumor cells.
We must not be too hasty, however, in drawing our conclusions. Meta-analysis and the interpretation of trial results tend to present far too many problems.

1 Early Breast Cancer Trialists' Collaborative Group. Effects of Radiotherapy and Surgery in Early Breast Cancer - An Overview of the Randomized Trials. N Engi J Med 1995; 333:1444-55.

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