Use of Postmastectomy Radiotherapy and Survival Rates for Breast Cancer Patients with T1–T2 and One to Three Positive Lymph Nodes

Huo, Dezheng; Hou, Ningqi; Jaskowiak, Nora; Winchester, David J.; Winchester, David P.; Yao, Katharine

doi:10.1245/s10434-015-4528-x

Cited by 45 publications

(47 citation statements)

References 35 publications

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“…30 recommendations continue to support the consideration of post-mastectomy radiation for 1-3 lymph node positive patients despite a SEER data study evaluating patients from 1998 to 2008 that found no survival benefit in patients post-mastectomy who received radiation for 1 positive lymph node. [30][31][32][33][34] Since the vast majority of patients for whom IBR is offered are early stage and clinically node negative, those who are found to be pathologically node positive are typically in the 1-3 node positive category, and the benefits of radiation to these patients should outweigh the potential toxicity and the implications for successful reconstruction. 31 Discussions around possible post-mastectomy radiation avoidance in IBR patients fits with an evolving trend to choose wisely with adjuvant treatments such as radiation in patients aged 65 years or older, where radiation (at least in breast conserving surgery for early stage disease) can be safely avoided without adversely impacting overall survival.…”

Section: Discussionmentioning

confidence: 99%

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

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In the last decade, there has been an increase in women undergoing immediate breast reconstruction (IBR) at the time of mastectomy. Recent literature suggests a shift in practice: Surgeons are becoming more comfortable with IBR in the setting of possible postoperative adjuvant radiotherapy, despite the known complications. This study sought to investigate, at a population level, the patient and surgeon characteristics associated with the use of IBR and which of these factors were predictive of adjuvant radiotherapy. This retrospective population‐based cohort study included all adult women who underwent mastectomy in the province of Ontario from 2007 to 2014. The Canadian Institute for Health Information (CIHI) administrative data base was used to generate patient demographic and clinical data. The Ontario Health Insurance Plan (OHIP) data base was used to elicit surgeon characteristics including clinical experience and volume of practice dedicated to breast surgery. Outcome variables included reconstruction concurrent with mastectomy, alloplastic vs autologous reconstruction, and use of radiation. A total of 25 861 patients underwent mastectomy and 2972 had IBR (11.5%). The rate of IBR after mastectomy increased over time from 7.2% in 2007 to 17.2% in 2014 (P < .001). There was also an increase in the proportion of patients with IBR who received radiation over the time period, from 19.4% in 2007 to 28.2% in 2014 (P = .003). In the first regression analysis, IBR was associated with younger patient age, residing in closer proximity to cancer clinics, absence of malignant breast disease (ie, prophylactic mastectomy), having a younger surgeon performing the mastectomy, and receiving care at a teaching hospital. A second analysis showed that patient variables predictive of radiation after IBR were a younger age and a more advanced cancer stage and no variables specific to surgeon or institution were predictive of radiation in patients with IBR. A significant increase in the rate of IBR as well as the use of radiation occurred over the 7‐year study period. Multiple patient and surgeon factors were associated with IBR. Variables associated with radiation in IBR were harder to predict. Given the increase in the use of radiation in IBR, further research is needed to look at long‐term outcomes in these patients at the population level.

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Section: Discussionmentioning

confidence: 99%

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

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“…Our findings corroborate results from a combined analysis of patients who had breast cancer with 1 to 3 positive lymph nodes from the Surveillance, Epidemiology, and End Results program and the NCDB who underwent mastectomy between 1998 and 2008, in which the reported rate of PMRT use was similar (21.5%) to that reported in our current study (22.5%). 12 However, in that analysis, the dose range for PMRT was not specified.…”

Section: Discussionmentioning

confidence: 99%

“…However, a lack of consistency in identifying these subsets in the era of modern surgical and systemic therapies has likely resulted in highly variable treatment patterns across the United States. Reports from national and state cancer registries have demonstrated that PMRT rates vary from 21% to 36% in these patients …”

Section: Introductionmentioning

confidence: 99%

“…Reports from national and state cancer registries have demonstrated that PMRT rates vary from 21% to 36% in these patients. [12][13][14] Recognizing that trends in PMRT use may have fluctuated widely over the past decade, the current study was undertaken to identify patterns and predictors of PMRT use in the United States for patients who have breast cancer with 1 to 3 positive lymph nodes using the National Cancer Data Base (NCDB).…”

Section: Introductionmentioning

confidence: 99%

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Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis

Ohri

Sittig

Tsai

et al. 2017

Cancer

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“…The NCDB is a comprehensive national oncologic database with detailed information available regarding sociodemographic, tumor, and treatment characteristics . Several comparison studies have documented the validity of NCDB‐based analysis . However, the current study has several limitations.…”

Section: Discussionmentioning

confidence: 94%

Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base

Sineshaw

Jemal

Thomas

et al. 2016

Cancer

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BACKGROUND In the United States, neoadjuvant chemoradiotherapy (NACRT) is widely accepted as the standard of care in the treatment of patients with locally advanced rectal cancer. In the current study, the authors attempted to examine patterns of treatment in the United States over the past decade. METHODS Using the National Cancer Data Base, a total of 66,197 patients who were diagnosed with American Joint Committee on Cancer stage II to III rectal adenocarcinoma and treated between 2004 and 2012 were identified. The authors described trends in the receipt of treatment for 3 time periods (2004‐2006, 2007‐2009, and 2010‐2012) and analyzed 5‐year overall survival probabilities for 28,550 patients treated between 2004 and 2007. RESULTS Receipt of NACRT increased significantly from 42.9% between 2004 and 2006 to 50.0% between 2007 and 2009, and to 55.0% between 2010 and 2012 (P < .0001). In contrast, the use of adjuvant chemoradiotherapy (CRT) decreased from 16.7% between 2004 and 2006 to 10.5% between 2007 and 2009, and to 6.7% between 2010 and 2012 (P < .0001). Similarly, the use of surgery alone decreased from 13.1% between 2004 and 2006 to 8.7% between 2010 and 2012 (P < .0001). Older age, the presence of comorbidities, larger primary tumor size, lymph node involvement, not being of non‐Hispanic white race/ethnicity, lack of private insurance, and treatment at a facility that did not have a high case volume were associated with a significantly lower possibility of receiving NACRT. The 5‐year overall survival rates for patients treated with NACRT, surgery and adjuvant CRT, surgery alone, and definitive CRT were 72.4%, 70.9%, 44.9%, and 48.8%, respectively. CONCLUSIONS The use of NACRT before surgery in US patients with rectal cancer has substantially increased over the past decade. However, only approximately one‐half of patients currently receive this standard therapy, which could be explained in part by socioeconomic factors. Trimodality therapy is associated with the best outcomes for these patients. Cancer 2016;122:1996–2003. © 2016 American Cancer Society.

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Use of Postmastectomy Radiotherapy and Survival Rates for Breast Cancer Patients with T1–T2 and One to Three Positive Lymph Nodes

Abstract: The effectiveness of radiotherapy depends on the combination comprising the number of positive lymph nodes and tumor size, which may enable more precise patient selection for PMRT.

Cited by 45 publications

References 35 publications

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis

Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: An analysis from the National Cancer Data Base

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