Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Sep;123(2):597-605.
doi: 10.1007/s10549-010-0829-8. Epub 2010 Mar 20.

Among women who experience a recurrence after postmastectomy radiation therapy irradiation is not associated with more aggressive local recurrence or reduced survival

Wendy A Woodward #  1 , Pauline T Truong #  2 , Tse-Kuan Yu  1 , Welela Tereffe  1 , Julia Oh  1 , George Perkins  1 , Eric Strom  1 , Funda Meric-Bernstam  1 , Ana-Maria Gonzalez-Angulo  1 , Caroline Speers  3 , Joseph Ragaz  4 , Thomas A Buchholz  1
Affiliations
Comparative Study

Among women who experience a recurrence after postmastectomy radiation therapy irradiation is not associated with more aggressive local recurrence or reduced survival

Wendy A Woodward et al. Breast Cancer Res Treat. 2010 Sep.

Abstract

Recent pre-clinical models suggest that radiation can promote tumor aggressiveness. We hypothesized that if this were occurring clinically, locoregional recurrences (LRRs) after postmastectomy radiation therapy (PMRT) would lead to lower survival than LRR after mastectomy alone. This study used two independent datasets to compare survival after LRR in women treated with versus without PMRT. Data from 229 LRR cases among 1,500 patients enrolled on prospective trials at the MD Anderson Cancer Center (MDA), and 66 LRR cases among 318 patients enrolled in the British Columbia Cancer Agency (BCCA) PMRT randomized trial were analyzed. In the MDA non-randomized dataset, 189/1031 had LRR after mastectomy alone and 40/469 had LRR after PMRT. In the randomized BC trial dataset, 52/158 had LRR after mastectomy alone and 14/160 had LRR after PMRT. In both datasets, survival was calculated from the time of LRR to death. Analysis of MDA data shows that in all LRR cases regardless of distant metastasis (DM), 5/10-year OS were 50/34% without PMRT and 27/19% after PMRT (P = 0.006). However, PMRT-treated patients had increased risk factors for DM (advanced T and N stages) and more PMRT-treated patients developed DM prior to LRR (63 vs. 34%, P = 0.005). Analyzing only patients will an isolated LRR (without previous or simultaneous, DMV), there was no OS difference between groups (P = 0.33). Analysis of BCCA data shows that distributions of T and N stages were similar in patients with LRR after mastectomy alone versus after PMRT. DM free survival after any LRR and after isolated LRR were similar in mastectomy alone versus PMRT-treated patients (P = 0.75, P = 0.26, respectively). Overall survival after any LRR and after isolated LRR were also similar in the two groups (P = 0.93, P = 0.28, respectively). Patients who develop LRR after mastectomy alone have high rates of DM and poor OS but these rates are not affected by the use of PMRT at the time of primary treatment. These data do not support the hypothesis that irradiation promotes biologically aggressive local recurrences.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
MDA non-randomized trial dataset: a Kaplan-Meier DM free survival and b overall survival in patients with any LRR, after mastectomy with versus without PMRT
Fig. 2
Fig. 2
MDA non-randomized trial dataset: a Kaplan-Meier DM free survival and b overall survival in patients with isolated LRR, after mastectomy with versus without PMRT
Fig. 3
Fig. 3
BCCA randomized trial dataset: Kaplan–Meier DM free survival in patients with a any LRR and b isolated LRR, after mastectomy with versus without PMRT
Fig. 4
Fig. 4
BCCA randomized trial dataset: Kaplan–Meier overall survival in patients with a any LRR and b isolated LRR, after mastectomy with versus without PMRT
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Early Breast Cancer Trialists’ Collaborative Group Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–2106. - PubMed
    1. Whelan TJ, Julian J, Wright J, et al. Does locoregional radiotherapy improve survival in breast cancer? A meta-analysis. J Clin Oncol. 2000;18:1220–1229. - PubMed
    1. Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–962. - PubMed
    1. Ragaz J, Olivotto IA, Spinelli JJ, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97:116–126. - PubMed
    1. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337:949–955. - PubMed

Publication types

MeSH terms