Post-mastectomy radiotherapy benefits subgroups of breast cancer patients with T1-2 tumor and 1–3 axillary lymph node(s) metastasis

Abstract

BackgroundTo determine the role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1–2 and N1 disease.Patients and methods.A total of 207 postmastectomy women were enrolled. The 5-year Kaplan-Meier estimates of locoregional recurrence rate (LRR), distant recurrence rate (DRR) and overall survival (OS) were analyzed by different tumor characteristics. Multivariate analyses were performed using Cox proportional hazards modeling.ResultsWith median follow-up 59.5 months, the 5-year LRR, DRR and OS were 9.1%, 20.3% and 84.4%, respectively. On univariate analysis, age < 40 years old (p = 0.003) and Her-2/neu over-expression (p = 0.016) were associated with higher LRR, whereas presence of LVI significantly predicted higher DRR (p = 0.026). Negative estrogen status (p = 0.033), Her-2/neu overexpression (p = 0.001) and LVI (p = 0.01) were significantly correlated with worse OS. PMRT didn’t prove to reduce 5-year LRR (p = 0.107), as well as 5-year OS (p = 0.918). In subgroup analysis, PMRT showed significant benefits of improvement LRR and OS in patients with positive LVI.ConclusionsFor patients with T1–2 and N1 stage breast cancer, PMRT can decrease locoregional recurrence and increase overall survival only in patients with lymphovascular invasion.

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.…”

Do Recent Advances in Diagnostic and Therapeutic Procedures Negate the Benefit of Postmastectomy Radiotherapy in N1 Patients With a Low Risk of Locoregional Recurrence?

“…The current international consensus does not recommend routine use of PMRT unless there are additional adverse features. 8 However, the indication and frequency of PMRT use varies significantly between institutions, and many investigators have identified various risk factors of LRR including young age (eg, ≤45 years), 20 , 21 large tumor size (eg, T2 or >3 cm), 11 , 21 LN ratio (eg, >15%–25%), 20 , 22 – 24 ER-status, 20 , 25 lymphovascular invasion, 25 , 26 extranodal extension, a medially located tumor, 20 inadequate axillary surgery, 11 and an earlier treatment era (eg, before 1997). 11 However, our results suggest that a risk-adaptive approach should be considered based on overall recurrence risk rather than LRR risk.…”

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast

“…Preoperative diagnosis of axillary metastasis provides important prognostic information and influences decisions on neoadjuvant chemotherapy and the need for more extensive staging 4 . The presence of a metastatic axillary lymph node is also an important factor in the planning of postmastectomy radiotherapy, and consequently may affect reconstructive options 5 . In addition, this approach has been shown to be a cost-effective measure 6,7 .…”