Abstract
Abstract Objective: Post-mastectomy radiotherapy (PMRT) is strongly recommended for breast cancer patients with 1 to 3 axillary lymph node metastasis (N1-3) in NCCN guidelines Version 3.2013 (category 1), whereas the indication of that treatment should be considered individually according to the risk of local recurrence (St Gallen Consensus Meeting 2013). In order to support decision making of PMRT, we evaluated the risk factors of local recurrence after mastectomy. Patients and methods: We reviewed retrospectively 2422 cases with Stage I – III primary breast cancer receiving surgery at National Kyushu Cancer Center between 2000 and 2009. Seven hundred seventy six of them underwent mastectomy, and 547 of them received no PMRT. We analyzed the risk of local recurrence in relation to clinicopathologial factors, the status of hormone receptor and HER2, especially in cases with N1-3. Results: Among 547 cases with no PMRT, there were 364 cases with no LN metastasis (N0), 146 N1-3, and 37 N≥4, and 5-year local disease free survival (DFS) rates were 97.0%, 91.2%, and 73.4%, respectively. In N1-3 (146) cases who underwent no post-operative regional radiotherapies, the 5-year DFS in extent of lymph vessel infiltration (ly) were: ly0 was 97.9% (50) and ly1-3 was 87.9% (92) (ly unknown were 4). In the ly0 cases, the 5-year local DFSs were 100% in grade 2 and 85.7% in grade 3; 100% in ER positive and 90.0% in ER negative; 90.9% in HER2 positive and 100% in HER2 negative. Those in the cases of ly1-3 were 94.5% and 73.4%, 88.7% and 76.6%, and 91.0% and 64.3%, respectively. Conclusion: In patients with N1-3 breast cancer, the risk of local recurrence after mastectomy was significantly related to grade, extent of lymph vessel infiltration, ER and HER2. PMRT could be omitted in case with ly0,additionaly with grade 1-2, ER positive and HER2 negative. The remaining cases have the risk of local recurrence over 10%, if they don't receive PMRT, in which the indication of PMRT should be considered. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-18.
Published Version
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