Abstract
The use of postmastectomy radiation therapy (PMRT) has been recommended for patients with 4 or more positive lymph nodes, however, its role in patients with 1-3 positive lymph nodes remains unclear. The purpose of this study is to evaluate oncological outcomes for breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes after undergoing PMRT. We performed a single-institution retrospective investigation that evaluated the association between PMRT and outcomes in breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes, who underwent mastectomy from 2004 to 2015. Multivariable Cox proportional hazards regression was used to evaluate the association of PMRT with disease-free survival and overall survival. A total of 379 patients met inclusion criteria, of which 204 (54%) received PMRT while 175 (46%) did not receive PMRT following mastectomy and were followed over a median of 5.2 years (25th–75th percentile: 2.8–8.4 years). Recurrence was similar in patients receiving PMRT compared to those that did not: locoregional (0 vs 3, P = 0.061), distant (9 vs 3, P = 0.135) and any recurrence (11 vs 7, P = 0.525). After adjustment for potential confounding variables, PMRT was not associated with a statistically significant difference in disease-free survival (HR: 0.93; 95% CI: 0.48, 1.79) or overall survival (HR: 0.91; 95% CI: 0.45, 1.85). PMRT was not associated with improved oncological outcomes in patients with T1-2 breast cancer and 1-3 positive lymph nodes at our institution.
Highlights
Consensus guidelines recommend the use of postmastectomy radiation therapy (PMRT) for patients with T3 and above tumors or T1-2 tumors with 4 or more positive lymph nodes and have advised against its use in patients with lymph node-negative disease[1,2]
We performed a retrospective investigation evaluating the association of receipt of PMRT with oncological outcomes in patients diagnosed with breast cancer with T1-2 tumors and [1,2,3] positive lymph nodes, who underwent mastectomy from 2004 to 2015
Outcomes in patients were similar by PMRT status; while a greater number of locoregional recurrence (LRR) were observed in women who did not receive PMRT (3 vs 0, P = 0.061); fewer distant recurrences (3 vs. 9, P = 0.135) and fewer overall recurrences (7 vs 11, P = 0.525) were observed in women not receiving PMRT compared to those who did
Summary
Consensus guidelines recommend the use of postmastectomy radiation therapy (PMRT) for patients with T3 and above tumors or T1-2 tumors with 4 or more positive lymph nodes and have advised against its use in patients with lymph node-negative disease[1,2]. A major contribution to this topic arose in 2014 when the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) published a meta-analysis on the effects of PMRT in this patient cohort[3]. This trial included 3786 women who underwent mastectomy and axillary nodal dissection, and had zero, one to three, or four or more positive lymph nodes identified. This study has been criticized for its high baseline rate of recurrence and its outcomes have been challenged in the current era of improved locoregional control and systemic therapy. Given the potential toxicity and costs associated with PMRT, there is the potential for a paradigm shift in care which could benefit patients by decreasing health-care costs and eliminating inessential therapies
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