Post-mastectomy radiotherapy in pT3N0M0 breast cancer: is it needed?

Prognostic Significance of Local Recurrence in Breast Cancer after Postmastectomy Radiotherapy

“…In these selected patients, we observed a local failure rate of 2.1% despite the fact that patients referred for radiotherapy have probably more often risk factors than patients treated with surgery alone. For patients with locally advanced disease, the local recurrence rate of 6.9% in our series also compares favorably to failure rates of 25% or more that have been reported in these patients with mastectomy alone in a lot of series, although some authors have observed low failure rates comparable to those in our series with additional radiotherapy [2,3,6,7,13,30,31,34,35,38]. In summary, our data are in accordance with radiotherapy results reported in recent studies which showed that radiotherapy prevents seven out of ten local recurrences that would occur without radiation therapy [8,9,24,25,27].…”

Outcomes of Node-Negative Breast Cancer 5 Centimeters and Larger Treated With and Without Postmastectomy Radiotherapy

“…However, these trials included very few cases of pathologic (p)T3N0M0 breast cancer, as defined by the American Joint Committee on Cancer Cancer Staging Manual, 6th edition: Stage IIB breast carcinoma, tumor >5 cm in the greatest dimension without direct extension to the chest wall or skin (Stage T3), no nodal metastasis (N0), and no distant metastasis (M0) (3). The rarity of Stage pT3, >5-cm, N0 breast cancer, representing <1% of new breast cancer cases (4), and the paucity of clinical evidence have contributed to the controversy regarding the optimal treatment of these patients (5,6).…”

Postmastectomy radiation therapy in T3 node-negative breast cancer

“…A small retrospective study by Helinto et al [3] including 38 patients with T3N0M0 breast cancer found a locoregional failure rate of 60% in patients who were not treated with postoperative radiation therapy compared with 9% of patients who were given radiation, concluding that radiation therapy may be beneficial within this population. Because of the small sample size and control group of five patients who did not receive radiation, this study had insufficient power to determine a true effect of radiation.…”

“…Tumor size has also been established as an independent predictor of prognosis and, in the absence of nodal metastases, is arguably one of the most important markers for patient outcomes [2]. Patients with locally advanced breast cancer without nodal metastasis represent a unique subset of patients that comprise approximately 1%e 2% of all breast cancers [3]. This subset is defined by patients with tumors >5 cm in greatest diameter without axillary nodal involvement and is specifically designated by the American Joint Committee on Cancer staging system as T3N0M0 [4].…”

“…Several studies have cited a locoregional recurrence rate of less than 10% in patients without postmastectomy radiation therapy (PMRT), suggesting that tumor biology within this population may be indolent and radiation therapy may not be beneficial [6]. In stark contrast, several other published trials have identified a reduction in locoregional failure with PMRT within this population of breast cancer patients [3]. A survey of North American radiation oncologists revealed that 88% would recommend adjuvant radiation therapy to the T3N0 population [7].…”