Prognostication and treatment decision-making in early breast cancer

Fiets, Willem Edward (2006)

Doctoral Thesis

Prognostic factors are used for making treatment decisions regarding adjuvant systemic therapy. The major prognostic variables that are used in clinical practice are the number of positive axillary lymph nodes and tumour size. A number of other variables are associated with disease recurrence and survival as well. In particular UPA and PAI-1 appear to be strong prognostic variables. No differences in prognostic value of oestrogen receptor and progesterone receptor detected by immunocytochemical assay or enzyme immuno assay were found. In the study presented no significant association between mitotic counts and disease recurrence or survival was found, which was explained by the favourable tumour characteristics of the group of patients and the associated low number of events. Several tools have been developed to make individualised estimates of baseline prognosis and absolute survival benefit of adjuvant systemic therapy. Two of these tools, Adjuvant! and Numeracy, were compared. Adjuvant! was the preferred prognostic model. The administration of adjuvant chemotherapy concurrently with radiotherapy appeared too toxic. As anthracyclin-containing regimens have become standard for adjuvant chemotherapy in early breast cancer which are considered more toxic than the regimens studied the concurrent administration of adjuvant chemotherapy and radiotherapy is dissuaded.

• Breast cancer
• Prognosis
• Adjuvant
• Chemotherapy
• Radiotherapy

• All authors: Fiets, Willem Edward
• Supervisor: Nortier, J.W.R.; Struikmans, H.; Blankenstein, M.A.
• Qualification: Doctor (dr.)
• Awarding Institution: Department of Clinical Oncology, Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2006-01-12