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. 2016 Oct;5(4):429-436.
doi: 10.3892/mco.2016.971. Epub 2016 Aug 1.

Improvement of survival with postmastectomy radiotherapy in patients with 1-3 positive axillary lymph nodes: A systematic review and meta-analysis of the current literature

Hannah Headon  1 , Abdul Kasem  1 , Reham Almukbel  1 , Kefah Mokbel  1
Affiliations

Improvement of survival with postmastectomy radiotherapy in patients with 1-3 positive axillary lymph nodes: A systematic review and meta-analysis of the current literature

Hannah Headon et al. Mol Clin Oncol. 2016 Oct.

Abstract

In breast cancer with >4 positive axillary lymph nodes, it is common practice to deliver radiotherapy to the affected site following mastectomy. However, less is known regarding the benefits this may confer on women with 1-3 positive lymph nodes. In this meta-analysis, we aimed to assess whether post-mastectomy radiotherapy (PMRT) was beneficial for such patients. A literature review was conducted using the PubMed and Ovid databases. Selected studies were analysed and data regarding overall survival (OS) and locoregional recurrence (LRR) rates were extracted. Statistical analysis was then conducted in order to develop a combined risk ratio (RR) for both OS and LRR in the setting of PMRT in women with breast cancer with 1-3 positive lymph nodes. PMRT in women with 1-3 positive lymph nodes significantly reduced the risk of LRR, with a RR of 0.3 [95% confidence interval (CI): 0.23-0.38] and also showed a minor benefit in terms of OS (RR=1.03, 95% CI: 1.00-1.07). Therefore, in breast cancer patients with 1-3 positive lymph nodes, PMRT significantly reduced the risk of LRR and was associated with a minor OS benefit. Until the results of ongoing randomised controlled trials are published, PMRT should be recommended in this group of patients following a careful multidisciplinary discussion.

Keywords: axillary lymph nodes; breast cancer; postmastectomy radiotherapy.

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Figures

Figure 1.
Figure 1.
Flow chart outlining the methodology followed through the process of the literature review.
Figure 2.
Figure 2.
Forest plot showing the summary relative risk ratio of overall survival in breast cancer patients with 1–3 positive axillary lymph nodes undergoing post-mastectomy radiotherapy. This forest plot outlines the studies included in the overall survival analysis and demonstrates the summary relative risk ratio, which was calculated at 1.03, therefore favouring the intervention. CI, confidence interval.
Figure 3.
Figure 3.
Forest plot showing the summary relative risk ratio of locoregional recurrence in breast cancer patients with 1–3 positive axillary lymph nodes undergoing post-mastectomy radiotherapy. This forest plot outlines the studies included in the locoregional recurrence analysis and demonstrates a summary relative risk ratio of 0.30, therefore favouring the intervention by indicating that post-mastectomy radiotherapy reduces the risk of locoregional recurrence in these patients. CI, confidence interval.
See this image and copyright information in PMC

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