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Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):392-8. doi: 10.1016/j.ijrobp.2014.02.013. Epub 2014 Apr 7.

Locoregional recurrence risk for patients with T1,2 breast cancer with 1-3 positive lymph nodes treated with mastectomy and systemic treatment.

Author information

1
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; University of Arizona School of Medicine, Phoenix, Arizona.
2
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: tbuchhol@mdanderson.org.

Abstract

PURPOSE:

Postmastectomy radiation therapy (PMRT) has been shown to benefit breast cancer patients with 1 to 3 positive lymph nodes, but it is unclear how modern changes in management have affected the benefits of PMRT.

METHODS AND MATERIALS:

We retrospectively analyzed the locoregional recurrence (LRR) rates in 1027 patients with T1,2 breast cancer with 1 to 3 positive lymph nodes treated with mastectomy and adjuvant chemotherapy with or without PMRT during an early era (1978-1997) and a later era (2000-2007). These eras were selected because they represented periods before and after the routine use of sentinel lymph node surgery, taxane chemotherapy, and aromatase inhibitors.

RESULTS:

19% of 505 patients treated in the early era and 25% of the 522 patients in the later era received PMRT. Patients who received PMRT had significantly higher-risk disease features. PMRT reduced the rate of LRR in the early era cohort, with 5-year rates of 9.5% without PMRT and 3.4% with PMRT (log-rank P=.028) and 15-year rates 14.5% versus 6.1%, respectively; (Cox regression analysis: adjusted hazard ratio [AHR] 0.37, P=.035). However, PMRT did not appear to benefit patients treated in the later cohort, with 5-year LRR rates of 2.8% without PMRT and 4.2% with PMRT (P=.48; Cox analysis: AHR 1.41, P=.48). The most significant factor predictive of LRR for the patients who did not receive PMRT was the era in which the patient was treated (AHR 0.35 for later era, P<.001).

CONCLUSION:

The risk of LRR for patients with T1,2 breast cancer with 1 to 3 positive lymph nodes treated with mastectomy and systemic treatment is highly dependent on the era of treatment. Modern treatment advances and the selected use of PMRT for those with high-risk features have allowed for identification of a cohort at very low risk for LRR without PMRT.

PMID:
24721590
DOI:
10.1016/j.ijrobp.2014.02.013
[Indexed for MEDLINE]

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