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. 2018 Jul;25(7):1912-1920.
doi: 10.1245/s10434-018-6422-9. Epub 2018 Mar 21.

Most Breast Cancer Patients with T1-2 Tumors and One to Three Positive Lymph Nodes Do Not Need Postmastectomy Radiotherapy

Shirin Muhsen  1 , Tracy-Ann Moo  1 , Sujata Patil  2 , Michelle Stempel  1 , Simon Powell  3 , Monica Morrow  1 , Mahmoud El-Tamer  4
Affiliations

Most Breast Cancer Patients with T1-2 Tumors and One to Three Positive Lymph Nodes Do Not Need Postmastectomy Radiotherapy

Shirin Muhsen et al. Ann Surg Oncol. 2018 Jul.

Abstract

Background/objective: Guidelines concur that postmastectomy radiation therapy (PMRT) in T1-2 tumors with one to three positive (+) lymph nodes (LNs) decreases locoregional recurrence (LRR) but advise limiting PMRT to patients at highest risk to balance against potential harms. In this study, we identify the risks of LRR after mastectomy in patients with T1-2N1 disease, treated with modern chemotherapy, and identify predictors of LRR when omitting PMRT.

Methods: Patients with T1-2N1 breast cancer undergoing mastectomy between 1995 and 2006 were categorized by receipt of PMRT. The Chi square test compared the clinicopathologic features between both groups, and Kaplan-Meier and Cox regression analysis was used to determine the rates of LRR, recurrence-free survival (RFS), and overall survival (OS).

Results: Overall, 1087 patients (924 no PMRT, 163 PMRT) were included in the study, with a median follow-up of 10.8 years (range 0-21). We identified 63 LRRs (56 no PMRT, 7 PMRT), and 10-year rates of LRR with and without PMRT were 4.0% and 7.0%, respectively. Patients receiving PMRT were younger (p = 0.019), had larger tumors (p = 0.0013), higher histologic grade (p = 0.029), more positive LNs (p < 0.0001), lymphovascular invasion (LVI) (p < 0.0001), extracapsular nodal extension (p < 0.0001), and macroscopic LN metastases (p < 0.0001). There was no difference in LRR, RFS, or OS between groups. On multivariate analysis, age < 40 years (p < 0.0001) and LVI (p < 0.0001) were associated with LRR in those not receiving PMRT.

Conclusion: Consistent with the guidelines, 85% of patients with T1-2N1 were spared PMRT at our center, while maintaining low LRR. Age < 40 years and the presence of LVI are significantly associated with LRR in those not receiving PMRT.

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Conflict of interest statement

Conflict of Interest Disclosures: The preparation of this study was supported by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. This study was presented in part of an oral presentation at the Society of Surgical Oncology 2017 Annual Cancer Symposium, March 15–18, 2017, Seattle WA. The authors have no conflict of interest disclosures to report.

Figures

Fig. 1
Fig. 1
Univariate and unadjusted comparison of (A) locoregional recurrence, (B) recurrence-free survival, and (C) overall survival in postmastectomy radiotherapy versus no postmastectomy radiotherapy groups.
Fig. 2
Fig. 2
Comparison of locoregional recurrence rates in the no-PMRT group by age and lymphovascular invasion. PMRT, postmastectomy radiotherapy; LVI, lymphovascular invasion
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References

    1. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35. - PMC - PubMed
    1. Frasier LL, Holden S, Holden T, Schumacher JR, Leverson G, Anderson B, Greenberg CC, et al. Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines. JAMA Oncol. 2016;2(1):95–101. - PMC - PubMed
    1. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, et al. 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(9503):2087–106. - PubMed
    1. The National Institutes of Health Consensus Development Conference: Adjuvant Therapy for Breast Cancer. Bethesda, Maryland, USA. November 1–3, 2000. Proceedings. J Natl Cancer Inst Monogr. 2001;(30):1–152. - PubMed
    1. Killander F, Anderson H, Ryden S, Moller T, Aspegren K, Ceberg J, Danewid C, et al. Radiotherapy and tamoxifen after mastectomy in postmenopausal women -- 20 year follow-up of the South Sweden Breast Cancer Group randomised trial SSBCG II:I. Eur J Cancer. 2007;43(14):2100–8. - PubMed

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