***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of either exemestane or the sequence of tamoxifen followed by exemestane in postmenopausal hormone-sensitive breast cancer . The present analyses explored the association between locoregional therapy and recurrence ( LRR ) in this population . MATERIAL AND METHODS Between 2001 and 2006 , 9779 patients were r and omized . Local treatment was breast conserving surgery plus radiotherapy ( BCS+RT ) , mastectomy without radiotherapy ( MST-only ) , or mastectomy plus radiotherapy ( MST+RT ) .  Patients with unknown data on surgery , radiotherapy , tumor or nodal stage ( n=199 ) , and patients treated by lumpectomy without radiotherapy ( n=349 ) were excluded . RESULTS After a median follow-up of 5.2 years , 270 LRRs occurred ( 2.9 % ) among 9231 patients . The 5-years actuarial incidence of LRR was 4.2 % ( 95 % CI 3.3 - 4.9 % ) for MST-only , 3.4 % ( 95 % CI 2.4 - 4.2 % ) for MST+RT and 1.9 % ( 95 % CI 1.5 - 2.3 % ) for BCS+RT . After adjustment for prognostic factors , the hazard ratio ( HR , reference BCS+RT ) for LRR remained significantly higher for MST-only ( HR 1.53 ; 95 % CI 1.10 - 2.11 ) , not for MST+RT ( HR 0.78 ; 95 % CI 0.50 - 1.22 ) . CONCLUSION This explorative analysis showed a higher LRR risk after MST-only than after BCS+RT , even after adjustment for prognostic factors . As this effect was not seen for MST+RT versus BCS+RT , it might be explained by the beneficial effects of radiation treatment Introduction This study had three aims : to establish the incidence of ipsilateral breast tumour recurrence ( IBTR ) in a community treatment setting , to evaluate known factors – in particular younger age ( < 40 years ) – predictive for local recurrence , and to assess the impact of local recurrence on disease-specific survival ( DSS ) . Methods A consecutive series of 1,540 women with node-negative breast cancer , diagnosed between the ages of 18–75 years , were prospect ively accrued between September 1987 and September 1999 . All had undergone a resection of the primary breast cancer with clear margins , an axillary lymph node dissection with a minimum of four sample d nodes , and breast-conserving surgery ( of any type ) .  Results During the study follow-up period , 98 ( 6.4 % ) IBTRs and 117 ( 7.6 % ) deaths from or with breast cancer were observed . The median time to IBTR was 3.1 years and to death from or with disease was 4.3 years . In the multivariate Cox proportional hazards ( PH ) regression model for IBTR with adjuvant therapy factors , independent risk factors included age < 40 years ( relative risk ( RR ) = 1.89 , 95 % confidence interval ( CI ) of 1.00 – 3.58 ) , presence of intraductal disease ( RR = 1.81 , 95 % CI = 1.15–2.85 ) and histological grade ( ' G2 ' or G3 versus G1 : RR = 1.59 , 95 % CI = 0.87–2.94 ) . In the multivariate Cox PH regression model for DSS with adjuvant therapy factors , independent risk factors included previous IBTR ( RR = 2.58 , 95 % CI = 1.41–4.72 ) , tumor size ( 1–2 cm versus < 1 cm : RR = 1.95 , 95 % CI = 1.05–3.64 , > 2 cm versus < 1 cm : RR = 2.94 , 95 % CI = 1.56–5.56 ) , progesterone receptor status ( negative or equivocal versus positive or unknown : RR = 2.15 , 95 % CI = 1.36–3.39 ) , lymphatic invasion ( RR = 1.78 , 95 % CI = 1.17–2.72 ) , and histological grade ( ' G2 ' or G3 versus G1 : RR = 8.59 , 95 % CI = 2.09–35.36 ) . The effects of competing risks could be ignored . Conclusion The Cox PH analyses confirmed the importance of known risk factors for IBTR and DSS in a community treatment setting . This study also revealed that the early occurrence of an IBTR is associated with a relatively poor five-year survival rate Abstract Objectives Breast-conserving therapy ( BCT ) , including postoperative whole breast irradiation ( WBI ) , is generally accepted as the treatment of choice for most patients with early-stage breast cancer . The question whether WBI is m and atory in all patients remains one of the most controversial issues in BCT . To answer this question , a r and omized , prospect i ve , multicentre study was launched in January 2001 . Primary endpoints of the study were to assess the cumulative incidence of in-breast-recurrences ( IBR ) and overall survival ( OAS ) after conservative surgery ( BCS ) with or without WBI . Methods From January 2001 until December 2005 , 749 patients with unifocal infiltrating breast cancer up to 25 mm , 0–3 positive axillary lymph nodes , no extensive intraductal component or lymphvascular invasion from 11 centres in Italy , were r and omly assigned to BCS+WBI ( arm 1:373 patients ) or BCS alone ( arm 2:376 patients ) . Treatment arms were well balanced in terms of baseline characteristics . Systemic adjuvant therapy was administered according to the institutional policies . Kaplan – Meier method was used for survival analysis and log-rank test to evaluate the difference between the two arms . Results ( Last Analysis 31.12.2012)After median follow-up of 108 months , 12 ( 3.4 % ) IBR were observed in arm 1 and 16 ( 4.4 % ) in arm 2 . OAS was 81.4 % in arm 1 and 83.7 % in arm 2 . There was no statistically significant difference regarding IBR and death in the two treatment groups . Conclusions These data are promising and suggest that WBI after BCS can be omitted in selected patients with early stage breast cancer without exposing them to an increased risk of local recurrence and death . Longer follow-up is needed to further consoli date these results Purpose All Dutch hospitals are obliged to report their 5-year ipsilateral breast tumor recurrence ( IBTR ) rate after breast cancer surgery . Experts decided that these rates should not exceed 5 % . This study determined the value of IBTR as an indicator to compare quality of care between hospitals . Methods All patients with breast cancer ( pT1–3 , any N , M0 ) who underwent surgery in 1 of 92 Dutch hospitals from 2003 to 2006 were identified in the Netherl and s Cancer Registry . Data of recurrence was retrieved from hospital records . Five-year IBTR rates for breast-conserving surgery ( BCS ) and mastectomy were calculated by using the Kaplan – Meier method . Hospital variation was presented in funnel plots . Multivariate analysis was used to assess hospital characteristics associated with IBTR rates . Results A total of 40,892 breast cancer patients were included . The overall 5-year IBTR rate was 2.85 % ( 95 % confidence interval 2.68–3.03 ) and was significantly lower for BCS than for mastectomy ( 2.38 vs. 3.45 % , p < 0.001 ) . IBTR rates decreased over time in both groups . Rates varied between 0.77 and 5.70 % between hospitals . When r and om variation is taken into account , only extremely high IBTR rates can be detected as deviant from the target value of 5 % . Adjusting for tumor and patient characteristics , analyses showed that a higher volume of mastectomies is associated with lower IBTR rates . Conclusions Our population -based findings show that IBTR rates in the Netherl and s are low and have improved over time . The 5-year IBTR rate as an indicator for quality of care of individual hospitals is of limited value PURPOSE Postmastectomy radiotherapy ( RT ) in high-risk breast cancer patients can reduce locoregional recurrences ( LRRs ) and improve disease-free and overall survival . The aim of this analysis was to examine the overall disease recurrence pattern among patients r and omly assigned to receive treatment with or without RT . PATIENTS AND METHODS A long-term follow-up was performed among the 3,083 patients from the Danish Breast Cancer Cooperative Group 82 b and c trials , except in those already recorded with distant metastases ( DM ) or contralateral breast cancer ( CBC ) . The end points were LRR , DM , and CBC , and the follow-up continued until DM , CBC , emigration , or death . Information was selected from medical records , general practitioners , and the National Causes of Death Registry . The median potential follow-up time was 18 years . RESULTS The 18-year probability of any first breast cancer event was 73 % and 59 % ( P < .001 ) after no RT and RT , respectively ( relative risk [ RR ] , 0.68 ; 95 % CI , 0.63 to 0.75 ) . The 18-year probability of LRR ( with or without DM ) was 49 % and 14 % ( P < .001 ) after no RT and RT , respectively ( RR , 0.23 ; 95 % CI , 0.19 to 0.27 ) . The 18-year probability of DM subsequent to LRR was 35 % and 6 % ( P < .001 ) after no RT and RT , respectively ( RR , 0.15 ; 95 % CI , 0.11 to 0.20 ) , whereas the probability of any DM was 64 % and 53 % ( P < .001 ) after no RT versus RT , respectively ( RR , 0.78 ; 95 % CI , 0.71 to 0.86 ) . CONCLUSION Postmastectomy RT changes the disease recurrence pattern in high-risk breast cancer patients ; fewer patients have LRR as first site of recurrence , and overall fewer patients have DM BACKGROUND The EORTC 10801 trial compared breast-conserving therapy ( BCT ) with modified radical mastectomy ( MRM ) in patients with tumours 5 cm or smaller and axillary node negative or positive disease . Compared with BCT , MRM result ed in better local control , but did not affect overall survival or time to distant metastases . We report 20-year follow-up results . METHODS The EORTC 10801 trial was open for accrual between 1980 and 1986 in eight centres in the UK , the Netherl and s , Belgium , and South Africa . 448 patients were r and omised to BCT and 420 to MRM .  R and omisation was done central ly , stratifying patients by institute , carcinoma stage ( I or II ) , and menopausal status . BCT comprised of lumpectomy and complete axillary clearance , followed by breast radiotherapy and a tumour-bed boost . The primary endpoint was time to distant metastasis . This analysis was done on all eligible patients , as they were r and omised . FINDINGS After a median follow-up of 22·1 years ( IQR 18·5 - 23·8 ) , 175 patients ( 42 % ) had distant metastases in the MRM group versus 207 ( 46 % ) in the BCT group . Furthermore , 506 patients ( 58 % ) died ( 232 [ 55 % ] in the MRM group and 274 [ 61 % ] in the BCT group ) . No significant difference was observed between BCT and MRM for time to distant metastases ( hazard ratio 1·13 , 95 % CI 0·92 - 1·38 ; p=0·23 ) or for time to death ( 1·11 , 0·94 - 1·33 ; 0·23 ) . Cumulative incidence of distant metastases at 20 years was 42·6 % ( 95 % CI 37·8 - 47·5 ) in the MRM group and 46·9 % ( 42·2 - 51·6 ) in the BCT group . 20-year overall survival was estimated to be 44·5 % ( 95 % CI 39·3 - 49·5 ) in the MRM group and 39·1 % ( 34·4 - 43·9 ) in the BCT group . There was no difference between the groups in time to distant metastases or overall survival by age ( time to distant metastases : < 50 years 1·09 [ 95 % CI 0·79 - 1·51 ] vs ≥50 years 1·16 [ 0·90 - 1·50 ] ; overall survival < 50 years 1·17 [ 0·86 - 1·59 ] vs ≥50 years 1·10 [ 0·89 - 1·37 ] ) . INTERPRETATION BCT , including radiotherapy , offered as st and ard care to patients with early breast cancer seems 
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The presented rates are therefore the best available estimates of isolated IBTR and CBC annual incidence rates based on the current literature .