Selecting breast cancer patients with T1-T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy

Truong, Pauline T.; Olivotto, Ivo A.; Kader, Hosam A.; Panades, Miguel; Speers, Caroline; Berthelet, Eric

doi:10.1016/j.ijrobp.2004.08.009

Cited by 164 publications

(106 citation statements)

References 37 publications

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“…16,17 Conversely, in the current study, risk factors like pT2 disease and systemic therapy, which were previously reported as significant predictors for LRR in the modified radical mastectomy setting, 16 revealed no correlation. Our observation of 13 CW relapses among 31 LRR events is concordant with previous reports that the CW is the most common site of postmastectomy LRR.…”

Section: Discussioncontrasting

confidence: 74%

“…It should be highlighted that the patients enrolled on those large trials had heterogeneous molecular subtypes, and no parameters other than tumor classification and lymph node status were analyzed for prognostic value. Although accumulating data have identified additional clinicopathologic factors-young age, high-grade tumors, the presence of LVI, and negative ER status are predictors of higher LRR in early stage breast cancer 16,17 , molecular characteristics still were not considered in those studies. This appears be an oversimplification in the new era, in which individual therapy based on biologic characteristics has been increasingly accepted.…”

Section: Discussionmentioning

confidence: 99%

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Analysis in early stage triple‐negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors

Chen

et al. 2013

Cancer

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BACKGROUND:The objective of this study was to evaluate and identify patterns of failure and prognostic factors for locoregional recurrence (LRR) that could justify postmastectomy radiotherapy after modified radical mastectomy in patients with early stage triplenegative breast cancer. METHODS: Between January 2000 and July 2007, the authors retrospectively analyzed 390 patients who had triple-negative breast cancer with T1/T2 tumors and from zero to 3 positive lymph nodes (pathologic T1-T2N0-N1) who underwent modified radical mastectomy without postmastectomy radiotherapy at the author's institution. The 5-year cumulative incidence for events was calculated using Kaplan-Meier analysis, and subgroups were compared using the log-rank test. Multivariate analysis was performed using a Cox proportional hazards model. RESULTS: Overall, 86.4% of patients received chemotherapy. At a median follow-up of 60.5 months, the 5-year cumulative rates of local recurrence, regional recurrence, LRR, and distant metastasis were 5.4%, 4.7%, 8%, and 13.4%, respectively. On multivariate analysis, age <50 years, the presence of lymphovascular invasion, grade 3 tumor, and 3 involved lymph nodes were associated significantly with an increased risk of LRR. The 5-year LRR rate for patients who had 0 or 1 risk factor, 2 risk factors, and 3 or 4 risk factors was 4.2%, 25.2%, and 81% (P <.0001), respectively. The presence of lymphovascular invasion and having 3 involved lymph nodes were statistically significant predictors of regional recurrence, and the patients who had regional recurrence had a significantly greater risk of distant metastases compared with patients who had local recurrence (59.1% vs 20.9%; P < .0001). CONCLUSIONS: Several risk factors were identified in this study that correlated independently with a greater incidence of LRR in patients who had early stage triple-negative breast cancer. The current results indicated that postmastectomy radiotherapy should be considered for those patients who have 2 or more of these factors. Cancer 2013;119:2366-74.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Analysis in early stage triple‐negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors

Chen

et al. 2013

Cancer

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“…A recent large retrospective study from Canada that analyzed >800 patients with T1-T2 disease and one to three positive lymph nodes treated with mastectomy and chemotherapy found age <45 years to be an independent risk factor for LRR after mastectomy, with a hazard ratio of 2.5 (13). Furthermore, a large meta-analysis of five National Surgical Adjuvant Breast Project trials with >5,700 patients with all disease stages treated with mastectomy and adjuvant chemotherapy found that younger patients had greater rates of LRR with or without distant failure (26.1% among the 20-39-year-old patients) (14).…”

Section: Discussionmentioning

confidence: 99%

Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy

Garg

Oswald

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II-III breast cancer.Patients and Methods-We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA-IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival.Results-Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27).Conclusion-Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in

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“…There is evidence to support third-field radiation even for small tumors in premenopausal women with lymph node involvement. [2][3][4][5][6] Reoperative axillary surgery after a SNB is usually not technically different and is facilitated by dissecting around the planes of previous dissection.…”

Section: To the Editorsmentioning

confidence: 99%

Author Reply: Re: Axillary Staging in the Neoadjuvant Setting

Chung

Giuliano

2011

Ann Surg Oncol

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Selecting breast cancer patients with T1-T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy

Cited by 164 publications

References 37 publications

Analysis in early stage triple‐negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors

Analysis in early stage triple‐negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors

Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy

Author Reply: Re: Axillary Staging in the Neoadjuvant Setting

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