Breast carcinoma: value of adjuvant therapy after mastectomy? Overview of personal results over > or = 20 years

Abstract

Analysis of 626 consecutive locoregional postoperative irradiated patients after mastectomy. 49.5% (310/626) were without further therapies, 32.8% (205/626) received TAM and 17.7% (111/626) an adjuvant chemotherapy +/- TAM. All tumours were classified on the basis of the pathologic-anatomical spreading. Median age 59 (25-91) years, follow-up 180 (60-265) months. Local relapses 7.1%, distant metastases 40.4%, death as consequence of breast cancer 35.6%, in 20.3% death of other causes. Cause specific survival (CSS) by negative axilla in 76%, by 1 to 3 LN+ metastases in 55% and by > or = LN+ in 30%. On the basis of the final results, lymphnode status, vascular invasion and initial tumor size have been the most important risk factors of prognostic relevance. Their rate of local relapses have been twice to six times as high, the distant metastasis 1.5 to 2 times more frequent. Immense differences too in comparing the CSS after 20 years: high risk collective 26 to 47%, low risk 65 to 72%. No statistical difference has shown in the low risk collective between the therapy groups. As referred back to the initial axillary status, 39.6% (248/626) have been without positive LN at the time of mastectomy. 76.2% (189/248) have remaind without distant metastases (DM), in 78.4% (149/190) without adjuvant therapy after locoregional irradiation. In 60.4% (378/626) the axilla was attacked. 48.7% (184/378) remained without distant metastases. 19.6% (36/184) with chemotherapy, 49.4% (91/184) with TAM and 31% (57/184) without supplemented systemic therapies. With 1 to 3 LN+ 58.4% (108/185) neither clinical nor radiological dissemination proven. It may be due to the efficiency of chemotherapy and TAM that only in 38.2% (13/34) respectively in 34.3% (23/67) distant metastases have been proven. In contrary after > or = 4 LN+ the chemotherapy-group has had 76.2% (48/63) and by combination with vascular invasion 85.2% (23/27) distant metastases. An opposite effect cannot be excluded. A positive axilla may but doesn't have to be a harbinger of tumor generalisation, since on third has remained without distant metastases despite of the lack of adjuvant therapies after locoregional irradiation. Is it possible a consequence of the irradiation too? No side effects of importance: Absence of plexopathies, no cardiotoxicity, 0.8% rib-necrosis after high dose irradiation as a consequence of R1-resections. There are no reasons for a renunciation of postmastectomy irradiation because of its secondary effects.