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Impact of radiotherapy on survival of locoregional breast cancer and lymph node ratio revisited as a prognostic factor

Thursday, 9 February, 2006 - 17:00
Campus: Brussels Health Campus
Faculty: Medicine and Pharmacy
auditorium R. Vanden Driessche
Vincent Vinh-Hung
phd defence

The dissertation makes a synthesis of our series of
studies starting from population data and
investigating two local-regional procedures applied
in early breast cancer: axillary lymph node
dissection and adjuvant (post-operative)
radiotherapy. 1) Though the extent of axillary lymph
node dissection as measured by the number of
lymph nodes removed appeared to be an
important prognostic factor, the other factor
coming to the fore as being even more important
was in fact the lymph node ratio (number of
involved lymph nodes divided by the total number
of lymph nodes removed). Since then, research on
the lymph node ratio – not only in breast cancer
but also in other tumours – has been a rapidly
expanding domain taken over by other
investigators. 2) Our studies on adjuvant
radiotherapy established that both population data
and randomized clinical trials indicated a
significantly improved overall survival in patients
receiving radiotherapy as compared with those
who did not receive radiotherapy. The improved
survival was observed regardless of the extent of
surgery, and regardless of the extent of nodal
involvement in node-positive patients. This result
was in contradiction with a systemic concept of
breast cancer. 3) In a further study that investigated
how tumour size and nodal involvement related
with survival, it was established that the effect of
tumour size on survival was functionally and
quantitatively independent of the extent of nodal
involvement. In other words, this latter result argued
that tumour growth and metastasis independently
contributed each to the risk of death.

The dissertation concludes that exclusive
consideration of breast cancer as a systemic
disease is an over-simplification that masks the
complexity of the disease. Optimal treatment of
breast cancer requires careful consideration of its
local-regional management.