Abstract
BackgroundThe role of post-mastectomy radiotherapy (PMRT) in patients with T1-2 and 1-3 positive lymph nodes remains controversial. The aim of this study is to investigate the possible benefits of PMRT for this subgroup.MethodsThree electronic databases were systematically quarried (Cochrane Library, MEDLINE, and EMBASE) for published studies evaluating the effects of PMRT on breast cancer patients with T1-T2 tumors with 1-3 positive lymph nodes. Of the 334 studies identified, information was available for 3432 patients from 10 clinical studies. Pooled relative risk estimates (RR) and overall survival (OS) were calculated using the inverse variance weighted approach, publication bias and chi-square test were also calculated. ResultsFrom the 10 studies, the pooled RR (RRs) for locoregional recurrence (LRR) with PMRT was 0.348 (95% CI = 0.254 to 0.477), suggesting a significant benefit for PMRT to decrease the risk of LRR in patients with T1-T2 tumors and 1-3 positive nodes (p<0.05). Reporting bias ( Begg’s p = 0.152; Egger’s p = 0.107) or significant heterogeneity (Cochran’s p = 0.380; I2 = 6.7%) were not detected. For further subset analysis, the RR for T1, N1-3+ tumors was 0.330 (95% CI = 0.171 to 0.639); for T2, N1-3+ tumors the RR was 0.226 (95% CI = 0.121 to 0.424). The pooled RR for overall survival (OS) was not significantly different between PMRT and no-PMRT group (1.051, 95% CI =1.001 to 1.104).ConclusionsOur pooled analysis revealed that PMRT significantly reduces the risk of LRR in patients with TI-T2 tumors with 1-3 positive nodes, and the magnitude of the LRR risk reduction is slightly greater for larger tumors. Our results suggest that PMRT should be considered for patients with T1/T2 tumors with 1-3 positive nodes to decrease the relatively high risk of LRR.
Highlights
Post-mastectomy radiotherapy (PMRT) can reduce the risk for local-regional recurrence(LRR) and improve survival in breast cancer patients with positive nodes [1,2]
Overgaard et al conducted a randomized trial of radiotherapy after mastectomy in 1708 high-risk premenopausal women, which shows the probability of disease-free survival at 10 years was 48% among the women assigned to radiotherapy plus CMF and 34% among those treated only with CMF (P
For the T1/N1-3+ cohort, the pooled relative risk estimates (RR) for locoregional recurrence (LRR) in patients with PMRT was 0.330, suggesting a similar magnitude of benefit with the addition of radiation as was demonstrated from the larger cohort which included T1 and T2 patients from all 10 studies (Figure 3).significant heterogeneity (Cochran’s p = 0.539; I2 = 0.00%) was not detected between the 5 studies included in this portion of the meta-analysis
Summary
Post-mastectomy radiotherapy (PMRT) can reduce the risk for local-regional recurrence(LRR) and improve survival in breast cancer patients with positive nodes [1,2]. Randomized data from the DBCG 82 b & c trials have demonstrated that the addition of PMRT for node positive patients improves the 15year overall survival by approximately 10% (p=0.015). In these trials, PMRT reduced the 15-year LRR rate from 27% to 4% (p
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