Is There a Cause-specific Survival Benefit of Postmastectomy Radiation Therapy in Women Younger Than Age 50 With T3N0 Invasive Breast Cancer? A SEER Database Analysis

Abstract

This SEER database analysis of patients younger than age 50 and with pT3N0 breast cancer showed that PMRT did not significantly affect CSS at 5 years; however, it implied a trend of benefit for patients younger than 40. The findings that patients with African heritage and negative ER/PR status showing decreased CSS warrant further investigation to determine the role of personalized PMRT in these high-risk cohorts.

The role of postmastectomy radiotherapy in women with pathologic T3N0M0 breast cancer

“…5,6,10,14,26 One of the most referenced studies advocating no PMRT is a pooled analysis of 313 patients with tumors measuring 5 cm who were enrolled on prospective National Surgical Adjuvant Breast and Bowel Project trials. 5,6,10,14,26 One of the most referenced studies advocating no PMRT is a pooled analysis of 313 patients with tumors measuring 5 cm who were enrolled on prospective National Surgical Adjuvant Breast and Bowel Project trials.…”

“…All patients were treated with mastectomy without PMRT. 5,6,10,14,26 When PMRT is administered in patients with pT3N0 breast cancer, there is continued debate regarding the appropriate fields and targets. 5 Moreover, among patients who received any form of systemic therapy, chemotherapy, and/or hormone therapy, the locoregional failure rate was <6%.…”

“…1 Although the overall incidence of breast cancer is high, the number of large primary breast malignancies without lymph node involvement is small because the risk of lymph node disease generally increases with tumor size. [5][6][7][8][9][10][11] Therefore, very few patients with T3N0 disease have received treatment as part of a randomized trial examining postmastectomy radiotherapy (PMRT). [5][6][7][8][9][10][11] Therefore, very few patients with T3N0 disease have received treatment as part of a randomized trial examining postmastectomy radiotherapy (PMRT).…”

“…[2][3][4] In fact, the majority of series published to date have estimated that only 1% to 4% of all breast cancers are >5 cm and lymph node negative (pT3N0). [5][6][7]9,10,[12][13][14] Current National Comprehensive Cancer Network guidelines state that RT to the chest wall, with or without regional lymph node irradiation (RNI), should be considered for patients with pT3N0 breast cancer. Thus, the question of whether PMRT is warranted in this subgroup of patients remains controversial because previous retrospective studies have found differing results, and randomized trials demonstrating the overall survival (OS) benefit of PMRT included only a small number of patients with pT3N0 breast cancer.…”

Assessing the Impact of Socio-economic Variables on Breast Cancer Treatment Outcome Disparity

“…The newest SEER data Nov 2011 have incorporated 2010 US census. However, the newly available socio-economic data have not been used in recent studies (Agarwal et al, 2012;Jagsi et al, 2012;Martinez et al, 2012;Sail et al, 2012;Yan et al, 2012). AJCC staging was found to be the best biological model to predict breast cancer specific survival.…”