Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial

Zeidan, Youssef H.; Habib, Joyce G.; Ameye, Lieveke; Paesmans, Marianne; Azambuja, Evandro de; Gelber, Richard D.; Campbell, Ian; Nordenskjöld, Bo; Gutiérez, Jorge; Anderson, Michael K.; Lluch, Ana; Gnant, Michael; Goldhirsch, Aron; Leo, Angelo Di; Joseph, David; Crown, John; Piccart‐Gebhart, Martine; Francis, Prudence A.

doi:10.1016/j.ijrobp.2018.01.105

Cited by 53 publications

(36 citation statements)

References 32 publications

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“…Patients aged 70 or above may have higher local recurrence rate, metastisis rate and mortality rate than other patients. This is consistent with the results of relevant study [25]. During our analysis, it was found that large applicator diameter was significantly associated with the increase of wound complications.…”

Section: Discussionsupporting

confidence: 93%

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

et al. 2020

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Background To analyze the clinical efficacy of intraoperative radiotherapy (IORT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC), and to investigate the relationship between its influencing factors and clinical efficacy and prognosis. Methods A total of 73 patients with early-stage BC who underwent IORT after BCS in our hospital were selected in this research. Results Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of disease-free survival (DFS) and overall survival (OS). It was found that only age (χ2 = 14.035, P = 0.003) was statistically positively correlated with the patient’s DFS, and local recurrence and metastasis rate and mortality were higher in patients over 70 years old. Log rank test was used to analyze multiple factors. Only the diameter of the applicator (χ2 = 70.378, P < 0.05) was statistically significant with wound complications, and the larger the diameter, the higher incidence of wound complications. The remaining risk factors did not increase the incidence of wound complications. COX multivariate analysis showed that age was an independent risk factor for DFS rate and the risk factor had no significant effect on the OS rate of patients undergoing IORT after BCS. Conclusions IORT may be a safe form of treatment for the selected patients with early-stage BC, and can achieve satisfactory esthetic effect. Larger applicator diameters may increase the incidence of wound complications. Age is an independent risk factor for DFS in early-stage BC patients undergoing IORT after BCS.

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Section: Discussionsupporting

confidence: 93%

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

et al. 2020

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“…The secondary analyses of two prospective studies have indicated the administration of PMRT was related to better locoregional control (10-years LRR 2–2.5% vs. 6.5–9.0%). However, there were comparable survival outcomes between the treatment arms [ 23 , 24 ]. Therefore, in the modern era of individualized treatment, most stage T1-2N1 patients may not need additional PMRT [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…This new pathological substaging seems promising, but very few studies have validated these new substages of stage T1-2N1 disease [ 19 ]. There is also some controversy about the effect of chemotherapy and postmastectomy radiotherapy (PMRT) in patients with stage T1-2N1 disease [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. To the best of our knowledge, no studies so far have tried to determine the effect of locoregional and systemic treatment in this patient subset.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the 8th edition of the American joint committee on cancer’s pathological staging system in prognosis assessment and treatment decision making for stage T1-2N1 breast cancer after mastectomy

Wu¹,

Wang²,

Lian³

et al. 2020

The Breast

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Purpose The 8th edition of the American Joint Committee on Cancer (AJCC) pathological staging system for breast cancer considers biologic factors in addition to the anatomical features included in the previous systems. The purpose of this study was to determine the validity of the 8th AJCC staging system for T1-2N1 breast cancer and to assess the effect of additional chemotherapy and radiotherapy according to the new pathologic stages. Methods The cohort included patients from the Surveillance, Epidemiology, and End Results program (2010–2012) who had stage T1-2N1 invasive breast carcinoma and underwent mastectomy. All patients were restaged using the 8th AJCC staging system. The Kaplan–Meier method, Cox proportional hazards regression, and competing risks models were used for data analysis. Results We identified 9908 patients including 3022 (30.5%), 3131 (31.6%), 1940 (19.6%), 1194 (12.1%), and 621 (6.3%) were classified with stage IA, IB, IIA, IIB, and IIIA disease, respectively. The 5-year breast cancer-specific survival (BCSS) was 97.3%, 94.3%, 88.3%, 84.0%, and 71.1% for stage IA, IB, IIA, IIB, and IIIA disease, respectively. Higher pathological stage was associated with a significantly higher risk of breast cancer-related death. Chemotherapy was associated with better BCSS regardless of the pathological stage, but radiotherapy was only associated with better BCSS in stage IIIA disease. Conclusions The 8th AJCC pathological staging system provides more refined stratification for T1-2N1 breast cancer patients after mastectomy and may meet the needs of the current trend of individualized decision making for chemotherapy and radiotherapy in this patient subset.

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“…A research published by Zeidan et al. [ 27 ] in 2018 analyzed patients with T1-2N1 disease enrolled on the Breast International Group (BIG) 02–98 trial. 684 patients who received adjuvant anthracycline with or without taxane chemotherapy were included in this study, of whom 337 (49%) had additional PMRT.…”

Section: Discussionmentioning

confidence: 99%

The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype

2020

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Objective To evaluate the significance of postmastectomy radiotherapy (PMRT) in female breast cancer patients with T1-2N1M0 disease according to molecular subtypes and other risk factors. Method We conducted a retrospective cohort-based study utilizing the Surveillance, Epidemiology, and End Results database. Patients who were diagnosed with T1-2N1M0 invasive breast cancer and received mastectomy between 2010 and 2014 were enrolled in our study. Overall survival (OS) was calculated with Kaplan-Meier method, and multivariant Cox hazard model was conducted to identify the impact of PMRT according to molecular subtypes and other risk factors. Propensity score matching (PSM) was applied to balance measurable confounders. Results Of all the 16,521 enrolled patients, 5775 (35.0%) cases received PMRT. The distribution of molecular subtype is 71.4% for Luminal A, 13.2% for Luminal B, 5.1% for HER2 enriched, and 10.3% for TNBC. The OS was significantly better for patients in PMRT group than the Non-PMRT group ( P < 0.0001). Stratified by molecular subtype, PMRT significantly prolonged survival in Luminal A patients (HR: 0.759, 95% CI: 0.651–0.884, P < 0.001), Yet it brought no significant survival advantage in Luminal B, TNBC or HER2 enriched subtype ( P = 0.914, P = 0.124, P = 0.103, respectively). Also, PMRT bore prognostic significance among those patients who were older than 56 years old, single, white, exempt from reconstruction and chemotherapy, and were with ductal, GradeⅡtumor (all P < 0.05). After PSM, the survival benefit of PRMT sustained in Luminal A patients with T1 tumor concomitant with one positive lymph node. Conclusion Our study demonstrates a beneficial impact for PMRT on overall survival among Luminal A subtype breast cancer patients with T1-2N1 disease. The selection of PMRT should be stratified by molecular subtype and other risk factors.

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Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial

Cited by 53 publications

References 32 publications

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

Evaluation of the 8th edition of the American joint committee on cancer’s pathological staging system in prognosis assessment and treatment decision making for stage T1-2N1 breast cancer after mastectomy

The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype

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