Results in patients with breast cancer treated by radical mastectomy and postoperative irradiation with no adjuvant chemotherapy

Abstract

In 1963 an electron beam became available, making irradiation of the chest wall technically easy. In addition to peripheral lymphatic irradiation in patients with positive axillary nodes and/or the tumor in the inner quadrants or centrally located, patients with tumor larger than 5 cm or with grave signs and/or a significant incidence of positive axillary nodes received chest wall irradiation. None of the patients has received elective chemotherapy. Disease-free survival rates at ten years are 54% for the overall group, 79% for the patients with negative nodes, 44% for patients with positive nodes, 61% for patients with 1-3 positive nodes, and 33% for patients with four or more positive nodes. The incidence of peripheral lymphatic failures is low as well as the incidence of failures on the chest wall in the patients having had chest wall irradiation. With the availability of electron beam and adjustments in doses, complications are nonexistent. The incidence of treatment failures, local-regional, or distant, that have appeared by ten years are compared with the incidence of failures that were experienced by the placebo patients in the clinical trial of the NSABP of thio-TEPA versus placebo. The clearly lesser incidence of treatment failures in the U.T.M.D. Anderson Hospital patients either suggests that postoperative irradiation may have survival benefits or that the data of the NSABP series are not representative of all series.

Should all breast cancer patients with four or more positive lymph nodes who underwent modified radical mastectomy be treated with postoperative radiotherapy? A population-based study

“…In fact, early randomized trials of breast cancer with PMRT did not prove the improvement in overall survival and just demonstrated that the risk of locoregional recurrence was reduced [8–10]. With the popularity of systemic therapy and the development of radiotherapy, several studies have demonstrated that the patients of breast cancer may benefit from the administration of PMRT.…”

Neoadyavant chemotherapy and postoperative irradiation in breast cancer: interrelation and prospects

“…Наиболее ранние данные о роли ЛТ после мастэктомии относятся к исследованиям, в которых больные были про-лечены без системной терапии и с применением старой радиотерапевтической техники [1,2]. Авторы в них проде-монстрировали улучшенные показатели локорегионального контроля, но никаких преимуществ в общей выживаемости.…”

Progress and controversies: Radiation therapy for invasive breast cancer

“…Early randomized trials of postmastectomy radiation generally demonstrated a reduction in the risk of locoregional recurrence of breast cancer without improvement in overall survival, particularly before the advent of effective systemic therapies. [103][104][105][106] As experience with systemic therapy for breast cancer grew, it became increasingly apparent that certain subgroups of patients might harbor a burden of residual locoregional disease that systemic therapies could not eradicate and, thus, might benefit from the administration of postmastectomy radiation therapy. Therefore, several trials were initiated to explore the role of postmastectomy radiation in conjunction with chemotherapy.…”