Chest wall recurrence in pT1-2N0-1 breast cancer patients after mastectomy without radiotherapy

Chang, Ji Hyun; Shin, Kyung Hwan; Ahn, Seung Do; Park, Hae Jin; Chie, Eui Kyu; Kim, Jin Ho; Kim, Su Ssan; Kim, Yong Bae; Park, Won; Kim, Yeon Joo; Shin, Hyun Soo; Kim, Jin Hee; Lee, Sun Young; Kim, Kyubo; Park, Kyung Ran; Jeong, Bae Kwon; Kim, Ja Young; Kim, Suzy

doi:10.1007/s10549-018-4707-0

Cited by 15 publications

(14 citation statements)

References 27 publications

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“…Likewise, a Korean multicenter study (KROG 14–18) also reported that the frequency of local recurrence (6/584 patients) had an incidence of approximately 1/4 for regional recurrence (22/584 patients) [20]. Other recently published results from two Korean multicenter studies (KROG 14–22 and KROG 14–23) showed very low chest wall recurrence rate in patients with <5 cm tumor and 1–3 positive lymph nodes [25]. Based on these results, the authors questioned the necessity of chest wall radiotherapy in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

et al. 2018

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PurposeTo determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1–3 positive nodes and a tumor size of <5 cm.Materials and MethodsWe retrospectively analyzed data of 133 female breast cancer patients with 1–3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%).ResultsThree patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. ConclusionOur study showed a very low local recurrence in patients with 1–3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient’s given risk for local and regional recurrence, and possible radiation-related toxicities.

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Section: Discussionmentioning

confidence: 99%

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

et al. 2018

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“…Moreover, the risk of loco‐regional failure is likely to reduce with improvement of adjuvant systemic therapies, consequently leading to reduction of PMRT in both relative and absolute benefits 19 . There are studies showing that the risk of 5‐year LRR in patients not receiving PMRT ranged from 3.2% to 6.1% and was still less than 10% even after 10 years of follow‐up 23‐26 . It can be seen that PMRT may be actually of little absolute benefit to pT1‐2N1M0 breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…19 There are studies showing that the risk of 5-year LRR in patients not receiving PMRT ranged from 3.2% to 6.1% and was still less than 10% even after 10 years of follow-up. [23][24][25][26] It can be seen that PMRT may be actually of little absolute benefit to pT1-2N1M0 breast cancer. Recently updated guidelines propose that for pT1-2N1M0 breast cancer patients at low risk of LRR, PMRT may be omitted potentially.…”

Section: Discussionmentioning

confidence: 99%

Is it beneficial for patients with pT1‐2N1M0 breast cancer to receive postmastectomy radiotherapy? An analysis based on RecurIndex assay

Zhang

Zhou

Liu

et al. 2021

Intl Journal of Cancer

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The benefit of postmastectomy radiotherapy (PMRT) for pT1-2N1M0 breast cancer patients currently remains controversial. This study was conducted to investigate whether pT1-2N1M0 breast cancer patients could benefit from PMRT based on RecurIndex assay. The clinical data of 213 pT1-2N1M0 breast cancer patients were retrospectively analyzed. Through RecurIndex assay, 81 cases were assessed as the low risk, and 132 as the high risk. Compared to low-risk patients, high-risk patients especially those not receiving PMRT had a significantly increased risk of recurrence and metastasis, and worse 7-year local-regional recurrence-free interval (LRFI), distance recurrence-free interval (DRFI) and recurrence-free survival (RFS) rates. PMRTbased subgroup analysis indicated no significant differences between the low-risk patients with and without PMRT in 7-year LRFI, DRFI, RFS and overall survival (OS) rates, but apparent differences were all shown between the high-risk patients with and without PMRT in 7-year LRFI, DRFI, RFS and OS rates. Overall, for pT1-2N1M0 breast cancer patients at low risk of recurrence and metastasis stratified by RecurIndex assay, there may be a phenomenon of no PMRT benefits, while for those at high risk, use of PMRT may produce survival benefits.

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“…In another study in patients at pathological stage T1‐2 without axillary lymph node metastasis and who did not undergo PMRT, the local recurrence rate was extremely low (1.68%). The study protocol, however, excluded patients with positive margins from the analysis . In a study involving patients at pathological stage T3 without axillary lymph node metastasis who did not undergo PMRT, the locoregional recurrence rate was 7.1%.…”

Section: Discussionmentioning

confidence: 99%

Partial chest wall radiation therapy for positive or close surgical margins after modified radical mastectomy for breast cancer without lymph node metastasis

Ishibashi

Nishimaki

Maebayashi

et al. 2019

Asia-Pac J Clncl Oncology

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Aim: Whole-breast radiation therapy after breast-conserving surgery can control local recurrence with a long-term survival rate equivalent to that of radical mastectomy for patients with early breast cancer. However, the significance of radiation therapy for patients with positive/close margins after mastectomy remains controversial. Following radical mastectomy, no residual breast parenchyma remains, and thus radiation therapy of the entire chest wall may represent overtreatment in the patients, especially those without lymph node metastasis (N0). We therefore implemented partial chest wall radiation therapy for patients with N0 breast cancer and positive and/or close margins after mastectomy.Methods: A total of 22 patients with N0 status but positive/close margins underwent partial chest wall radiation therapy to irradiate the predetermined clinical target volume, which had margins of at least 2 cm medial, lateral, superior, and inferior to the primary tumor bed. With reference to chest wall thickness, 4-10-MV photons or 5-8-MeV electrons with/without a bolus were delivered.The total dose was 50-66 Gy. We compared the results with those from 18 nonradiation therapy patients using Pearson's 2 test.Results: All patients in the partial chest wall radiation therapy group achieved good local control despite having a significantly higher proportion of positive margins (77.3%) compared with the nonradiation therapy group (27.8%) (P = 0.002). Both groups showed 100% recurrence-and disease-free survival. Conclusion:Partial chest wall radiation therapy may offer recurrence-and disease-free survival without local recurrence in N0 mastectomy patients with positive/close surgical margins. K E Y W O R D Spartial chest wall radiation therapy, positive surgical margin, radical mastectomy

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Chest wall recurrence in pT1-2N0-1 breast cancer patients after mastectomy without radiotherapy

Abstract: The incidence of CWR in pT1-2N0-1 breast cancer patients is very low, especially with isolated recurrence. Also, the obtained data showed that the nodal status had no impact on CWRFS.

Cited by 15 publications

References 27 publications

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

Is it beneficial for patients with pT1‐2N1M0 breast cancer to receive postmastectomy radiotherapy? An analysis based on RecurIndex assay

Partial chest wall radiation therapy for positive or close surgical margins after modified radical mastectomy for breast cancer without lymph node metastasis

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