Survival Benefit of Post-mastectomy Radiotherapy in Breast Carcinoma Patients with T1-2 Tumor and 1-3 Axillary Lymph Node(s) Metastasis

Abstract

Objective: To investigate the role of post-mastectomy radiotherapy in breast carcinoma patients with a tumor size of 5 cm or smaller (T1-2) and 1 -3 axillary lymph node(s) metastasis (N1). Methods: We retrospectively reviewed the file records of 575 patients receiving radiotherapy (452 patients) and not receiving radiotherapy (123 patients). Results: In the whole series, locoregional recurrence-free survival was significantly better in patients receiving radiotherapy compared with patients not receiving radiotherapy (P , 0.001); in the multivariate Cox analysis, radiotherapy had an independent prognostic value (P , 0.001). In patients with a tumor size of 2 cm or less (T1), locoregional recurrence-free survival was significantly better in patients receiving radiotherapy compared with those not receiving radiotherapy (P ¼ 0.016). In the patient subgroup with a T1 tumor and a lymph node ratio (the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) of 0.25 or less, there was no significant difference between the patients receiving and not receiving radiotherapy in terms of locoregional recurrence-free survival (P ¼ 0.071). In patients with a tumor size of 2.1 -5 cm (T2), locoregional recurrence-free survival was significantly better for patients who received radiotherapy compared with those who did not (P ¼ 0.001). In patients with a T2 tumor and a lymph node ratio of 0.08, there was no significant difference in locoregional recurrence-free survival between the patients receiving and not receiving radiotherapy (P ¼ 0.645). Conclusions: Post-mastectomy radiotherapy is beneficial in reducing the locoregional recurrence risk in T1N1 breast carcinoma patients with a lymph node ratio of .0.25 and in T2N1 breast carcinoma patients with a lymph node ratio of .0.08. In patients with a lymph node ratio equal to or less than these ratios, post-mastectomy radiotherapy could be omitted to avoid radiotherapy-related risks.

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

“…Similar result was reported by Duraker et al , who reported fewer removed LN was associated with worse survival 30. An indirect method to evaluate the adequacy of removed LN is the ratio of positive LN of all removed LN 30–33. In our analysis, we also found that PMRT can significantly reduce LR in T1–2, N1 breast cancers with ratio > 0.25 of positive LN.…”

“…Fewer uninvolved LN might be associated with inadequate surgical sampling or pathological examination. Similar result was reported by Duraker et al , who reported fewer removed LN was associated with worse survival 30. An indirect method to evaluate the adequacy of removed LN is the ratio of positive LN of all removed LN 30–33.…”

Benefit of Post-mastectomy Radiotherapy of the Supra-/infraclavicular Lymphatic Drainage Area in Breast Cancer Patients

“…Kong et al (2013) reported that histologic grade 3 and extracapsular extension were significant predictive factors for SCFR. Duraker et al (2012) reported lymph node ratios > 0. 25 in patients with T1N1 breast cancer and >0.…”

“…2% in patients with 1-3 positive ALN without RT (Strom et al, 2005;Macdonald et al, 2009;Yu et al, 2010;Yates et al, 2012;Grotenhuis et al, 2013;Yu et al, 2013). In addition, SCFR may increase the incidence of distant metastasis (Fan et al, 2010;Reddy et al, 2011;Duraker et al, 2012), which impacts the quality of life and OS. Currently, the guidelines of NCCN (2011) and DEGRO (SautterBihl et al, 2008) recommend supraclavicular radiation therapy (SCRT), but the NZGG recommends SCRT only in patients with ≥4 positive ALN.…”

Postmastectomy radiotherapy: Indications and implications

“…Truong et al 15 suggest that the percentage of positive lymph nodes rather than the number should be used to guide decision making with regards to post-mastectomy radiotherapy. Duraker et al 16 made a similar recommendation, based on their study of 575 women with T1-2 tumours and 1e3 positive lymphnodes. In this study, lymphnode ratio was defined as the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes.…”