Prognostic significance of clinical nodal involvement in patients treated by radical radiotherapy for a locally advanced breast cancer.

Abstract

A group of 230 female patients, treated between 1960-1976 with radical megavoltage radiotherapy for locally advanced breast cancer (T3 greater than 7 cm-T4 Stage), was analyzed retrospectively. Those with inflammatory cancer or evidence of disseminated metastatic disease were excluded. Clinical axillary nodal involvement appears to be a very important prognostic feature. Actuarial disease-free survival at 5 years for the 109 patients with clinically negative nodes (N0N1a) is 52%; whereas it is 28% (p less than 0.001) for the 121 patients with clinically involved nodes (N1b, N2-N3). The 5-year survival following salvage surgery, which was performed on 92/230 patients (40%), correlated with the initial nodal status. It is 62% for the N0 group, but only 27% for those with clinically involved nodes. The survival of the 138 (60%) patients who were treated by radiotherapy only is similar to that obtained in patients who had secondary salvage surgery. This study reinforces the need to stratify patients with locally advanced breast cancer according to the initial clinical status of the axilla when either therapeutic trials are contemplated or the results of treatment are reported. Adjuvant systemic treatment should be strongly considered in patients with clinically involved nodes, since the survival obtained by local treatment alone is poor.