Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation - PubMed (original) (raw)
Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation
A Katz et al. J Clin Oncol. 2000 Aug.
Abstract
Purpose: The objective of this study was to determine locoregional recurrence (LRR) patterns after mastectomy and doxorubicin-based chemotherapy to define subgroups of patients who might benefit from adjuvant irradiation.
Patients and methods: A total of 1,031 patients were treated with mastectomy and doxorubicin-based chemotherapy without irradiation on five prospective trials. Median follow-up time was 116 months. Rates of isolated and total LRR (+/- distant metastasis) were calculated by Kaplan-Meier analysis.
Results: The 10-year actuarial rates of isolated LRR were 4%, 10%, 21%, and 22% for patients with zero, one to three, four to nine, or >/= 10 involved nodes, respectively (P <.0001). Chest wall (68%) and supraclavicular nodes (41%) were the most common sites of LRR. T stage (P <.001), tumor size (P <.001), and >/= 2-mm extranodal extension (P <.001) were also predictive of LRR. Separate analysis was performed for patients with T1 or T2 primary disease and one to three involved nodes (n = 404). Those with fewer than 10 nodes examined were at increased risk of LRR compared with those with >/= 10 nodes examined (24% v 11%; P =.02). Patients with tumor size greater than 4.0 cm or extranodal extension >/= 2 mm experienced rates of isolated LRR in excess of 20%. Each of these factors continued to significantly predict for LRR in multivariate analysis by Cox logistic regression.
Conclusion: Patients with tumors >/= 4 cm or at least four involved nodes experience LRR rates in excess of 20% and should be offered adjuvant irradiation. Additionally, patients with one to three involved nodes and large tumors, extranodal extension >/= 2 mm, or inadequate axillary dissections experience high rates of LRR and may benefit from postmastectomy irradiation.
Similar articles
- T3 disease at presentation or pathologic involvement of four or more lymph nodes predict for locoregional recurrence in stage II breast cancer treated with neoadjuvant chemotherapy and mastectomy without radiotherapy.
Garg AK, Strom EA, McNeese MD, Buzdar AU, Hortobagyi GN, Kuerer HM, Perkins GH, Singletary SE, Hunt KK, Sahin A, Schechter N, Valero V, Tucker SL, Buchholz TA. Garg AK, et al. Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):138-45. doi: 10.1016/j.ijrobp.2003.10.037. Int J Radiat Oncol Biol Phys. 2004. PMID: 15093909 - Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size.
Fodor J, Polgár C, Major T, Németh G. Fodor J, et al. Strahlenther Onkol. 2003 Mar;179(3):197-202. doi: 10.1007/s00066-003-1010-7. Strahlenther Onkol. 2003. PMID: 12627264 - Locoregional recurrence after doxorubicin-based chemotherapy and postmastectomy: Implications for breast cancer patients with early-stage disease and predictors for recurrence after postmastectomy radiation.
Woodward WA, Strom EA, Tucker SL, Katz A, McNeese MD, Perkins GH, Buzdar AU, Hortobagyi GN, Hunt KK, Sahin A, Meric F, Sneige N, Buchholz TA. Woodward WA, et al. Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):336-44. doi: 10.1016/s0360-3016(03)00593-5. Int J Radiat Oncol Biol Phys. 2003. PMID: 12957243 - Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy.
Bijker N, Rutgers EJ, Peterse JL, van Dongen JA, Hart AA, Borger JH, Kroon BB. Bijker N, et al. Cancer. 1999 Apr 15;85(8):1773-81. Cancer. 1999. PMID: 10223572 Review. - Postmastectomy radiation in patients with one to three positive axillary nodes receiving adjuvant chemotherapy: An unresolved issue.
Fowble B. Fowble B. Semin Radiat Oncol. 1999 Jul;9(3):230-40. doi: 10.1016/s1053-4296(99)80014-9. Semin Radiat Oncol. 1999. PMID: 10378961 Review.
Cited by
- Post-Operative Radiation in Early Breast Cancer with N1 Disease: 10-Year Follow-Up.
Tang ELS, Sim EJ, Ang WW, Su J, Chen JJC, Chan MYP, Choo BA, Tan EY. Tang ELS, et al. Diseases. 2024 Jul 5;12(7):145. doi: 10.3390/diseases12070145. Diseases. 2024. PMID: 39057116 Free PMC article. - Prognosis of isolated locoregional recurrence after early breast cancer with immediate breast reconstruction surgery: a retrospective multi‑institutional study.
Seki H, Ogiya A, Nagura N, Shimo A, Narui K, Sasada S, Ishitobi M, Nogi H, Kondo N, Sakurai T, Yamauchi C, Mori H, Saiga M, Niikura N, Shien T; Collaborative Study Group of Scientific Research of the Japanese Breast Cancer Society. Seki H, et al. Breast Cancer. 2024 Sep;31(5):935-944. doi: 10.1007/s12282-024-01607-0. Epub 2024 Jun 19. Breast Cancer. 2024. PMID: 38890202 - The impact of bolus on clinical outcomes for post-mastectomy breast cancer patients treated with IMRT: data from China.
Jiang T, Tian J, Lei P, Meng C, Fu J, Cao L, Cheng J, Zhou F, Zhang H, Song H, Lu H, Wei X. Jiang T, et al. Radiat Oncol. 2024 May 28;19(1):64. doi: 10.1186/s13014-024-02456-z. Radiat Oncol. 2024. PMID: 38807176 Free PMC article. - Internal mammary node abnormality in imaging studies and treatment outcomes in patients with breast cancer.
Makita K, Hamamoto Y, Kanzaki H, Nagasaki K, Aogi K. Makita K, et al. Oncol Lett. 2024 Mar 21;27(5):218. doi: 10.3892/ol.2024.14352. eCollection 2024 May. Oncol Lett. 2024. PMID: 38586202 Free PMC article. - Impact of radiation on immediate breast reconstruction: a retrospective single institution cohort study.
Saksornchai K, Ganoksil P, Rongkavilit S, Suwajo P. Saksornchai K, et al. Gland Surg. 2023 Aug 30;12(8):1050-1059. doi: 10.21037/gs-23-61. Epub 2023 Aug 23. Gland Surg. 2023. PMID: 37701294 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical