Cancer Res Treat.  2013 Jun;45(2):103-111.

Which Patients Might Benefit from Postmastectomy Radiotherapy in Breast Cancer Patients with T1-2 Tumor and 1-3 Axillary Lymph Nodes Metastasis?

• Kong M
• Hong SE

Abstract

PURPOSE
This study compared the clinical outcomes of T1-2N1 breast cancer patients with and without postmastectomy radiotherapy (PMRT). Risk factors for loco-regional recurrence (LRR) were identified in order to define a subgroup of patients who might benefit from PMRT.
MATERIALS AND METHODS
Of 110 T1-2N1 breast cancer patients who underwent mastectomy from January 1994 through December 2009, 32 patients underwent PMRT and 78 patients did not. Treatment outcomes and risk factors for LRR were analyzed.
RESULTS
The 5- and 10-year LRR rates were both 6.2% in the PMRT group, and 10.4% and 14.6% in the no-PMRT group (p=0.336). In addition, no significant differences in distant metastasis-free survival (DMFS) or overall survival (OS) were observed between patients receiving and not receiving PMRT. In multivariate analysis, factors associated with higher LRR rates included grade 3 disease, extracapsular extension (ECE), and triple negative subtype. Patients who had one or more risk factors for LRR were defined as a high-risk patient group. In the high-risk group, both 5- and 10-year LRR rates for patients who underwent PMRT was 18.2%, and LRR rates of 21.4% at five years and 36.6% at 10 years were observed for patients who did not undergo PMRT (p=0.069).
CONCLUSION
PMRT in T1-2N1 breast cancer patients should be considered according to several prognostic factors in addition to T and N stage. Findings of our study indicated that PMRT did not improve LRR, DMFS, or OS in T1-2N1 breast cancer patients. However, in a subgroup of patients with grade 3 disease, ECE, or triple negative subtype, PMRT might be beneficial.

Keyword

Breast neoplasms; Radiotherapy; Mastectomy; Risk factor

MeSH Terms

Breast
Breast Neoplasms
Humans
Lymph Nodes
Mastectomy
Multivariate Analysis
Recurrence
Risk Factors

Figure

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  Fig. 1 Loco-regional recurrence for patients who received or did not receive postmastectomy radiotherapy (p=0.336). Differences between the two patient groups were not significant. PMRT, postmastectomy radiotherapy.

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  Fig. 2 Distant metastasis-free survival for patients who received or did not receive postmastectomy radiotherapy (p=0.681). Differences between the two patient groups were not significant. PMRT, postmastectomy radiotherapy.

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  Fig. 3 Overall survival for patients who received or did not receive postmastectomy radiotherapy (p=0.824). Differences between the two patient groups were not significant. PMRT, postmastectomy radiotherapy.

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  Fig. 4 Loco-regional recurrence according to molecular subtypes. The 5- and 10-year actuarial loco-regional recurrence rates were 8.2% and 10.5% in the luminal subtype, 10% and 10% in the HER2-positive subtype, and 14.3% and 28.6% in the triple negative subtype. In multivariate analysis, patients who had the triple negative subtype showed a significantly higher loco-regional recurrence rate (hazard ratio, 4.365; 95% confidence interval, 8.365 to 14.760; p=0.030). HER2, human epidermal growth factor receptor-2.

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  Fig. 5 Loco-regional recurrence for patients who received and did not receive postmastectomy radiotherapy in the high-risk patient group. Patients who received postmastectomy radiotherapy showed lower loco-regional recurrence rates, compared with patients who did not receive postmastectomy radiotherapy (p=0.069). However, differences between the two patient groups were not significant. PMRT, postmastectomy radiotherapy.

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