Postmastectomy radiotherapy: questions for the twenty-first century.

Recht, A.; Bartelink, H.; Fourquet, A.; Fowble, Barbara; Haffty, Bruce G.; Harris, J.R.; Kurtz, John M.; McCormick, Beryl; Olivotto, Ivo A.; Rutqvist, Lars‐Erik; Solin, Lawrence J.; Yarnold, J.R.

doi:10.1200/jco.1998.16.8.2886

Cited by 85 publications

(24 citation statements)

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“…Recent results strongly suggest that adjuvant radiotherapy may give a beneficial effect in terms of overall survival (23). This effect could be explained by the prevention of secondary dissemination from residual tumor left in the tumor bed (12,14).…”

Section: Discussion and Perspectivesmentioning

confidence: 99%

“…2. More specifically, the exact role of the IMC irradiation using modern techniques merits further investigation because of its potential toxic effect (23). A French trial, performed in Lyon, including more than 1 000 patients has recently terminated, while a large European Organization for Research and Treatment of Cancer (EORTC) randomized trial has been launched on this subject to include more than 3 000 patients.…”

Section: Discussion and Perspectivesmentioning

confidence: 99%

“…possibility of metastasis generated from locoregional tumor nests, is a matter of controversy (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). However, this hypothesis may be evaluated through the effect of locoregional treatments on distant metastasis rates or on overall survival.…”

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confidence: 99%

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Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Arriagada

Lê

2000

Acta Oncologica

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Section: Discussion and Perspectivesmentioning

confidence: 99%

Section: Discussion and Perspectivesmentioning

confidence: 99%

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Adjuvant Radiotherapy in Breast Cancer: The Treatment of Lymph Node Areas

Arriagada

Lê

2000

Acta Oncologica

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“…[1][2][3] This controversy is related to discrepancies in the reported locoregional recurrence (LRR) risks in the absence of radiotherapy among these patients. In two randomized trials of PMRT that were conducted by the Danish Breast Cancer Cooperative Group, LRR rates in patients with 1-3 positive lymph nodes who received systemic therapy but did not receive radiotherapy were approximately 30% at 10 years.…”

mentioning

confidence: 99%

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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BACKGROUNDAdjuvant therapy for women with T1–T2 breast carcinoma and 1–3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODSThe study cohort was comprised of 542 women with pathologic T1–T2 breast carcinoma who had 1–3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten‐year Kaplan–Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut‐off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTSThe median follow‐up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut‐off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10‐year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONSThe presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1–3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. Cancer 2005. © 2005 American Cancer Society.

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“…Some have felt that the rate of locoregional failure in all 3 trials was substantially higher than that currently observed. 12,[39][40][41] The high risk of local failure has been attributed to the limited axillary dissection performed (median number of axillary nodes removed was 7 in the Danish trials and 11 in the British Columbia trial). As well, in the Danish 82c trial, 1 year of tamoxifen therapy was used, as opposed to the current standard of 5 years of tamoxifen therapy.…”

Section: Evidence For Post-mastectomy Radiotherapymentioning

confidence: 99%