Is There a Role for Postmastectomy Radiation (PMRT) in Patients with T1–2 Tumors and One to Three Positive Lymph Nodes Treated in the Modern Era?

Ohri, Nisha; Haffty, Bruce G.

doi:10.1245/s10434-018-6493-7

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…At the present time, majority of the panel of 2021 SG-BCC agree that commercially available multigene signatures (e.g., MammaPrint and Recurrence Score) should not provide a solid recommendation for deciding RNI (92%) or PMRT (89%) when prospective trials such as TAILOR RT are still ongoing ( 30 ). Most of the ongoing trials integrating genomic profile are focused on ER-positive, HER2-negative tumors with one to three positive axillary nodes ( 31 ). To acknowledge the advantage of molecular and genomic profile in individualizing risk in a defined population, the inconvenience that other molecular subtypes are not covered by most of the trials should also be noticed.…”

Section: Discussionmentioning

confidence: 99%

Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy

Cao

et al. 2022

Front. Oncol.

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PurposeThe effect of adjuvant irradiation after mastectomy in early-stage breast cancer patients remains controversial. The present study aims to explore the clinical benefit obtained from adjuvant radiotherapy among post-mastectomy pT1-2N1 breast cancer patients who received adjuvant modern systemic therapy.MethodsMedical records of consecutive patients with pT1-2N1 breast cancer who received mastectomy in our institution between January 2009 and December 2016 were retrospectively reviewed. High-risk features consist of patient age, number of positive lymph nodes, T stage, and Ki67 index, which were developed previously at our institution using early-stage breast cancer patients after mastectomy without adjuvant radiotherapy. Differences of survival and local recurrence were compared between no-postmastectomy radiotherapy (PMRT) and PMRT group according to number of risk factors. The time-to-event curves were calculated by the Kaplan–Meier methods and compared by the log-rank test. Propensity score matching (PSM) was performed to reduce the imbalances in patient characteristics.ResultsA total of 548 patients were enrolled (no-PMRT: 259 and PMRT: 289). After a median follow-up of 69 months, the 5-year rate of DFS, BCSS, and LRR in the overall cohort was 90.2%, 97.4%, and 3.6%, respectively. PMRT did not significantly improve DFS, BCSS, and LRRFS in the whole cohort. Patients were divided into low-risk (with no or one risk factor) and high-risk (with two or more risk factors) groups. According to the univariable and multivariable analysis, high-risk group (HR = 1.81, 95% CI 1.11–2.98, p = 0.02) was demonstrated as an independent risk factor for DFS. For the high-risk group, PMRT significantly improved DFS from 81.4% to 91.9% and BCSS from 95.5% to 98.6% and decreased the 5-year rate of LRR from 5.6% to 1.4%, respectively (p < 0.01, p = 0.05, and p = 0.06). However, no survival benefit from PMRT was observed in the low-risk group in terms of DFS, BCSS, and LRR (p = 0.45, p = 0.51, and p = 0.99, respectively). In multivariate analysis, PMRT remained an independent prognostic factor for DFS (HR = 0.50, 95% CI 0.24–1.00, p = 0.05) in the high-risk group. After PSM analysis, the survival benefit of PMRT was sustained in high-risk patients.ConclusionPMRT significantly improved DFS in high-risk pT1-2N1 breast cancer patients, but not in low-risk patients. Independent validation of our scoring system is recommended.

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Section: Discussionmentioning

confidence: 99%

Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy

Cao

et al. 2022

Front. Oncol.

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“…16 However, there are many controversial issues to identify, such as ages, T stage, treatment modality, and molecular subtypes. [17][18][19] In this study, we identi ed patients from 2001-2011 because the outcomes of treatment were different before and after 2000 6 , with su cient time for follow-ups. In the dataset before matching, we found that majority of the patients (73.5%) did not undergo PMRT, and the data was also unbalanced between the PMRT and No-PMRT groups, so we used propensity scores for balancing the characteristic factors between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Postmastectomy Radiotherapy in T1–2 Female Breast Cancer Patients with 1–3 Positive Axillary Lymph Nodes: A Propensity Score Matched SEER Analysis

Wang

et al. 2021

Preprint

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Purpose The application of postmastectomy radiotherapy (PMRT) in T1–2 female breast cancer patients with 1–3 positive lymph nodes has been controversial. We sought to determine the survival benefits of PMRT in the patients with T1–2 and 1–3 positive nodes. Methods A retrospective study using the Surveillance, Epidemiology, and End Results (SEER) Regs Custom Data (with additional treatment fields) from 2001 to 2011 was performed. Patients who received PMRT were matched by the propensity score with patients who did not receive PMRT. The Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed. Results We identified 56,725 female breast cancer patients with T1–2 and 1–3 positive nodes, and 18,646 patients were included in the analysis. After propensity score matching (1:1), with a median follow-up of 116 months, PMRT showed an increase in the OS (P = 0.018) but had no effect on the BCSS. The 10-year OS rates were 76.8% and 74.4%, and the 10-year BCSS rates were 82.8% and 82.2% for the patients who received and who did not receive PMRT, respectively. Only patients with 3 positive nodes could gain the benefit of PMRT for BCSS. Conclusion PMRT for patients with T1–2 and 1–3 positive lymph nodes could increase the 10-year OS, and had no effect on the 10-year BCSS. Subgroup analysis indicated that only patients with 3 positive lymph nodes could benefit from PMRT for both the OS and BCSS.

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“…Although the EBCTCG meta-analysis showed that PMRT reduced locoregional recurrence and mortality in women with 1-3 positive lymph nodes, and increased patients' radiotherapy session in recent years 15 . However, there are many controversial issues to identify, such as ages, T stage, treatment modality, and molecular subtypes [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Postmastectomy Radiotherapy in T1–2 Women Breast Cancer Patients with 1–3 Positive Axillary Lymph Nodes: A Propensity Score Matched SEER Analysis

Xu¹,

Bu²,

Wang³

et al. 2020

Preprint

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Purpose: The application of postmastectomy radiotherapy (PMRT) in T1–2 women breast cancer patients with 1–3 positive lymph nodes has been controversial. We sought to determine the survival benefits of PMRT in the patients with T1–2 and 1–3 positive nodes.Methods: A retrospective study using the Surveillance, Epidemiology, and End Results (SEER) Regs Custom Data (with additional treatment fields) from 2001 to 2011 was performed. Patients who received PMRT were matched by the propensity score with patients who did not receive PMRT. The Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed. Results: We identified 56,725 women breast cancer patients with T1–2 and 1–3 positive nodes, and 18,646 patients were included in the analysis. After propensity score matching (1:1), with a median follow-up of 116 months, PMRT showed an increase in the OS (P = 0.018) but had no effect on the BCSS. The 10-year OS rates were 76.8% and 74.4%, and the 10-year BCSS rates were 82.8% and 82.2% for the patients who received and who did not receive PMRT, respectively. Only patients with 3 positive nodes could gain the benefit of PMRT for BCSS.Conclusion: PMRT for patients with T1–2 and 1–3 positive lymph nodes could increase the 10-year OS, and had no effect on the 10-year BCSS. Subgroup analysis indicated that only patients with 3 positive lymph nodes could benefit from PMRT for both the OS and BCSS.

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Is There a Role for Postmastectomy Radiation (PMRT) in Patients with T1–2 Tumors and One to Three Positive Lymph Nodes Treated in the Modern Era?

Cited by 7 publications

References 14 publications

Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy

Practical Model to Optimize the Strategy of Adjuvant Postmastectomy Radiotherapy in T1-2N1 Breast Cancer With Modern Systemic Therapy

Postmastectomy Radiotherapy in T1–2 Female Breast Cancer Patients with 1–3 Positive Axillary Lymph Nodes: A Propensity Score Matched SEER Analysis

Postmastectomy Radiotherapy in T1–2 Women Breast Cancer Patients with 1–3 Positive Axillary Lymph Nodes: A Propensity Score Matched SEER Analysis

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