Which Patients Might Benefit from Postmastectomy Radiotherapy in Breast Cancer Patients with T1-2 Tumor and 1-3 Axillary Lymph Nodes Metastasis?

Abstract

PurposeThis study compared the clinical outcomes of T1-2N1 breast cancer patients with and without postmastectomy radiotherapy (PMRT). Risk factors for loco-regional recurrence (LRR) were identified in order to define a subgroup of patients who might benefit from PMRT.Materials and MethodsOf 110 T1-2N1 breast cancer patients who underwent mastectomy from January 1994 through December 2009, 32 patients underwent PMRT and 78 patients did not. Treatment outcomes and risk factors for LRR were analyzed.ResultsThe 5- and 10-year LRR rates were both 6.2% in the PMRT group, and 10.4% and 14.6% in the no-PMRT group (p=0.336). In addition, no significant differences in distant metastasis-free survival (DMFS) or overall survival (OS) were observed between patients receiving and not receiving PMRT. In multivariate analysis, factors associated with higher LRR rates included grade 3 disease, extracapsular extension (ECE), and triple negative subtype. Patients who had one or more risk factors for LRR were defined as a high-risk patient group. In the high-risk group, both 5- and 10-year LRR rates for patients who underwent PMRT was 18.2%, and LRR rates of 21.4% at five years and 36.6% at 10 years were observed for patients who did not undergo PMRT (p=0.069).ConclusionPMRT in T1-2N1 breast cancer patients should be considered according to several prognostic factors in addition to T and N stage. Findings of our study indicated that PMRT did not improve LRR, DMFS, or OS in T1-2N1 breast cancer patients. However, in a subgroup of patients with grade 3 disease, ECE, or triple negative subtype, PMRT might be beneficial.

Improvement of survival with postmastectomy radiotherapy in patients with 1-3 positive axillary lymph nodes: A systematic review and meta-analysis of the current literature

“…location, HER2̸neu overexpression and negative oestrogen receptor status were associated with poorer outcomes and a reduction in OS (4)(5)(6)10,12). Higher-grade disease, a triple-negative subtype, age <40 years, HER2̸neu overexpression and negative oestrogen receptor status were all identified as independent poor prognostic factors for LRR (5,6,10,12,13). In order to fully elucidate the effect of these factors, and other factors, such as the use of systemic therapy, on the suggested LRR rates and OS when PMRT is used, future prospective randomised trials are warranted.…”

ABCB1 polymorphism as prognostic factor in breast cancer patients treated with docetaxel and doxorubicin neoadjuvant chemotherapy

“… 21 , 22 Adequate radiation or hormonal therapy was performed as indicated. 23 , 24 The radiological response was evaluated using breast MRI for the primary breast lesion and chest CT for the lymph node lesions with RECIST criteria 1.0. 25 Pathologic complete response (pCR) was defined as complete disappearance of invasive carcinoma in both breast and axillary lymph nodes after three cycles of chemotherapy.…”

Comparison of Treatment Outcomes between Breast Conserving Surgery Followed by Radiotherapy and Mastectomy Alone in Patients with T1-2 Stage and 1-3 Axillary Lymph Nodes in the Era of Modern Adjuvant Systemic Treatments

“…For example, although young age was a common risk factor, the cutoff for young age varied among the studies [ 7 – 9 , 13 ]. Moreover, in several studies including ours, age was not associated with an increased risk of LRR after mastectomy [ 11 , 12 , 14 , 26 ]. In our study, HER2 overexpression was identified as an independent risk factor for LRR.…”