Patterns and Risk Factors of Locoregional Recurrence in T1-T2 Node Negative Breast Cancer Patients Treated With Mastectomy: Implications for Postmastectomy Radiotherapy
| Autor: | Barbara L. Smith, Rimoun Boutrus, Alphonse G. Taghian, Rita F. Abi-Raad, Rui Wang, Shannon M. MacDonald, Andrzej Niemierko |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Oncology Cancer Research medicine.medical_specialty Multivariate analysis Lymphovascular invasion medicine.medical_treatment Breast Neoplasms Article Breast cancer Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Cumulative incidence Mastectomy Aged Neoplasm Staging Aged 80 and over Radiation business.industry Proportional hazards model Incidence (epidemiology) Middle Aged medicine.disease Tumor Burden Surgery Axilla medicine.anatomical_structure Lymphatic Metastasis Lymph Node Excision Female Neoplasm Recurrence Local Epidemiologic Methods business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 81:e151-e157 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2011.01.015 |
| Popis: | Purpose Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN-) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN- who might benefit from PMRT. Methods and Materials We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors. Results Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9–6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5–5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2–28.6%). Conclusion It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size ≥2 cm, close or positive margin, age ≤50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT. |
| Databáze: | OpenAIRE |
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