Influence of Lymphatic Invasion on Locoregional Recurrence Following Mastectomy: Indication for Postmastectomy Radiotherapy for Breast Cancer Patients With One to Three Positive Nodes

Matsunuma, Ryoichi; Oguchi, Masahiko; Fujikane, Tomoko; Matsuura, M.; Sakai, Takehiko; Kimura, Kiyomi; Morizono, Hidetomo; Iijima, Kotaro; Izumori, Ayumi; Miyagi, Yohei; Nishimura, Seiichiro; Makita, Masujiro; Gomi, Naoya; Horii, Rie; Akiyama, Futoshi; Iwase, Takuji

doi:10.1016/j.ijrobp.2011.08.029

Cited by 30 publications

(14 citation statements)

References 19 publications

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“…However, we examined the impact of LVI in the hormone receptor-positive subgroup of the present cohort, and found that LVI was not abrogated by endocrine therapy and remained the significant adverse factor in RFS (5-year RFS: LVI vs. non-LVI, 69.2% vs. 95.2%, P < 0.001). In breast cancer with 1-3 positivenodes, prior studies revealed that LVI was also an adverse factor for tumor recurrence, and adjuvant radiotherapy was documented to reduce this poor risk [13,19]. This was similar to our result, and revealed that radiotherapy was confirmed to overcome the poor risk of LVI in both node-positive and node-negative disease.…”

Section: Journal Of Surgical Oncologysupporting

confidence: 91%

“…LVI is considered to be occluded tumor metastasis, associated with positive sentinel nodes and distal tumor spread . In previous reports and in our study, LVI was an independent prognostic factor in NNBC, and also influenced the survival of patients with 1–3 maxillary lymph nodes metastases . Another pathologic factor, Nottingham grade 3, was also identified as a risk factor predicting tumor recurrence in the present study.…”

Section: Discussionsupporting

confidence: 78%

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Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

et al. 2013

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Section: Journal Of Surgical Oncologysupporting

confidence: 91%

Section: Discussionsupporting

confidence: 78%

Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

et al. 2013

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“…The effect of these factors in different studies often varies substantially. Until more definitive evidence is available, using its best clinical opinion, the panel recommends that such a strategy or risk estimation include assessment of patient age as it affects the risk of LRF,7,10,21,22,38,39 estimated life expectancy in relation to age and comorbid conditions that might reduce life expectancy40–44 or increase the risk of complications,45–49 tumor size,6,7 axillary lymph node burden (number of positive nodes,9,16,19,22 nodal ratio,10,20,22,38 and size of nodal tumor deposits16,17,19), tumor grade,11,16,20,22,38,50 lymphovascular invasion,10,16,21,22,38,51 biomarker or receptor status,7,8,16,22,38,52–56 and planned systemic therapy (Data Supplement provides discussions of these and additional factors, such as margin status57,58 and extranodal extension16,19,20). Several groups have proposed prognostic models to estimate the risk of LRF after mastectomy by combining several of these factors 10,16,20,22,38.…”

Section: Recommendationsmentioning

confidence: 99%

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

Recht

Comen

Fine³

et al. 2016

Ann Surg Oncol

126

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PurposeA joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT).MethodsA recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data.RecommendationsThe panel unanimously agreed that available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment. The panel agreed clinicians making such recommendations for individual patients should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer-specific mortality, and/or increase risk of complications resulting from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the panel recommends that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know additional axillary nodes are involved. Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT. The panel recommends treatment generally be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5558-8) contains supplementary material, which is available to authorized users.

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“…An age of ,50 years, Grade III histology and LVI were the other adverse predictors for higher LRR as revealed by the multivariate analysis in other studies (1,7,27). In one recent Canadian study, Truong et al (18) also reported that patients with one to three positive nodes and young age, Grade III histology or ER-negative disease have a high LRR risk of 15-20%.…”

mentioning

confidence: 67%

“…LVI might be strongly related to the presence of lymph node metastases and predict poor prognosis (7,27,33). Through a multivariate analysis, Cosar et al (16) reported LVI, a positive nodal ratio of 25% and PMRT being independent significant factors for improving OS.…”

mentioning

confidence: 99%

Comparison of Clinical Outcome of Breast Cancer Patients with T1-2 Tumor and One to Three Positive Nodes with or without Postmastectomy Radiation Therapy

Huang

Hou

Chuang

et al. 2012

Japanese Journal of Clinical Oncology

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Objective: The value of postmastectomy radiation therapy for breast cancer patients with T1-2 tumor and one to three positive nodes remains controversial. The purpose of this retrospective study was to compare the clinical outcomes of breast cancer patients with T1-2 and one to three positive nodes with and without postmastectomy radiation therapy. Methods: Between May 1990 and June 2008, of 318 breast cancer patients with T1-2 and one to three positive nodes who had undergone modified radical mastectomy, 163 received postmastectomy radiation therapy and 155 did not. The clinico-pathologic characteristics were analyzed for clinical outcomes including loco-regional recurrence, distant metastasis, disease-free survival and overall survival. Results: During the median follow-up period of 102 months, the clinical outcomes in postmastectomy radiation therapy versus no-postmastectomy radiation therapy groups were as follows: loco-regional recurrence rate (3.1 versus 11.0%, P ¼ 0.006); distant metastasis rate (20.9 versus 27.7%, P ¼ 0.152); 10-year disease-free survival rate (73.8 versus 61.3%, P ¼ 0.001); and 10-year overall survival rate (82.1 versus 76.1%, P ¼ 0.239). Through a multivariate analysis, a positive nodal ratio of 25% (hazard ratio ¼ 4.571, P ¼ 0.003) and positive lymphovascular invasion (hazard ratio ¼ 2.738, P ¼ 0.028) were found to be independent poor prognostic predictors of loco-regional recurrence. The reduction in loco-regional recurrence (hazard ratio ¼ 0.208, P ¼ 0.004) by postmastectomy radiation therapy was found to be significant. Conclusions: On the basis of our results, postmastectomy radiation therapy is highly recommended for breast cancer patients with T1-2 and one to three positive nodes, especially for high-risk subgroups with a positive nodal ratio of 25% and positive lymphovascular invasion, not only for reducing loco-regional recurrence but also for improving disease-free survival.

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Influence of Lymphatic Invasion on Locoregional Recurrence Following Mastectomy: Indication for Postmastectomy Radiotherapy for Breast Cancer Patients With One to Three Positive Nodes

Cited by 30 publications

References 19 publications

Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

Comparison of Clinical Outcome of Breast Cancer Patients with T1-2 Tumor and One to Three Positive Nodes with or without Postmastectomy Radiation Therapy

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