Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy

Truong, Pauline T.; Olivotto, Ivo A.; Whelan, Timothy J.; Levine, Mark

doi:10.1503/cmaj.1031000

Cited by 162 publications

(91 citation statements)

References 94 publications

(182 reference statements)

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“…In particular, the extent of axillary dissection has been implicated as a contributing factor for the disparities in LRR rates reported in the literature among patients with one to three positive lymph nodes. 2,3 There is general agreement that the Level I and II lymph nodes located lateral to and deep to the pectoralis minor muscle should be removed for accurate staging and to reduce axillary recurrence. [15][16][17][18][19][20][21] A study of 13,851 patients registered by the Danish Breast Cancer Cooperative Group suggests that the number of lymph nodes removed with Level I and II dissection should be at least 10 to exclude misclassification of patients with positive lymph nodes as lymph node-negative.…”

Section: Lrrmentioning

confidence: 99%

“…[1][2][3] This controversy is related to discrepancies in the reported locoregional recurrence (LRR) risks in the absence of radiotherapy among these patients. In two randomized trials of PMRT that were conducted by the Danish Breast Cancer Cooperative Group, LRR rates in patients with 1-3 positive lymph nodes who received systemic therapy but did not receive radiotherapy were approximately 30% at 10 years.…”

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confidence: 99%

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The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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BACKGROUNDAdjuvant therapy for women with T1–T2 breast carcinoma and 1–3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODSThe study cohort was comprised of 542 women with pathologic T1–T2 breast carcinoma who had 1–3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten‐year Kaplan–Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut‐off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTSThe median follow‐up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut‐off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10‐year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONSThe presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1–3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. Cancer 2005. © 2005 American Cancer Society.

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Section: Lrrmentioning

confidence: 99%

mentioning

confidence: 99%

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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“…The selection and sequencing of the different treatment are based on patient and tumor variables, including prognostic scores and axillary lymph nodes or distant metastases. The current standard treatment approach is surgery, if technically feasible, followed by adjuvant radiotherapy (RT) in all patients undergoing breast conservation, and postmastectomy in patients with T3 or T4 tumors, or with four or more positive axillary nodes [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Radiotherapy of Early-Stage and Locally Advanced Breast Cancer: Review of the Literature

Maghous¹,

Marnouche²,

Zaghba³

et al. 2018

J Nucl Med Radiat Ther

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“…Risk factors for locoregional recurrence include a large tumour size, a positive deep margin, lymph node involvement, grade 3 tumour and the presence of lymphovascular invasion. 6,7 The use of chest wall radiotherapy has been shown to reduce the risk of local recurrence in the chest wall to 5-10% at 10 years in various studies. 6,7 A meta-analysis of several randomized controlled trials shows that approximately 75% of locoregional recurrences occur within 5 years of initial treatment.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 The use of chest wall radiotherapy has been shown to reduce the risk of local recurrence in the chest wall to 5-10% at 10 years in various studies. 6,7 A meta-analysis of several randomized controlled trials shows that approximately 75% of locoregional recurrences occur within 5 years of initial treatment. 8 Chest wall radiotherapy can be delivered with the use of a "bolus", a tissue-equivalent material on the skin surface.…”

Section: Introductionmentioning

confidence: 99%

Technique and outcome of post-mastectomy adjuvant chest wall radiotherapy—the role of tissue-equivalent bolus in reducing risk of local recurrence

Turner¹,

Zeniou²,

Williams³

et al. 2016

The British Journal of Radiology

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Objective: Adjuvant chest wall radiotherapy is used in patients with high-risk histological features post-mastectomy to reduce the risk of locoregional recurrence. Treatment can be given with or without a tissue-equivalent bolus to increase skin surface dose. The additional benefit of using a bolus remains unclear; however, it is known to be associated with a higher incidence of skin toxicity. This study compared chest wall recurrence and skin toxicity in patients treated with and without a bolus. Methods: This retrospective cohort study reviewed 314 consecutive patients who received chest wall radiotherapy between 2005 and 2010. Data were collected on histological, demographic and treatment parameters and on the incidence and grade of acute skin reactions. Treatment outcomes analyzed included chest wall recurrence, disease-free survival and overall survival (OS). Results: 101 patients received treatment with a bolus; 213 patients received treatment without a bolus. A significantly higher incidence of acute skin toxicity was seen in the bolus treatment group (p = 0.002). One patient treated with a bolus developed chest wall recurrence compared with four patients treated without a bolus. No statistically significant difference could be shown between the two groups. 66 (21%) patients had metastatic relapse. Median time to relapse was 29.5 months and OS was 76% in both treatment groups. Conclusion: No statistically significant difference in chest wall recurrence can be demonstrated between patients treated with and without a bolus. Advances in knowledge: This study is consistent with limited previous literature and invites further evaluation of the role of a bolus in post-mastectomy chest wall radiotherapy, especially considering the increased toxicity that the use of a bolus generates.

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Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy

Cited by 162 publications

References 94 publications

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Neoadjuvant Radiotherapy of Early-Stage and Locally Advanced Breast Cancer: Review of the Literature

Technique and outcome of post-mastectomy adjuvant chest wall radiotherapy—the role of tissue-equivalent bolus in reducing risk of local recurrence

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