Breast Cancer-specific Survival Hazard Ratio Research Articles

Associations of a Breast Cancer Polygenic Risk Score With Tumor Characteristics and Survival.

A polygenic risk score (PRS) consisting of 313 common genetic variants (PRS313) is associated with risk of breast cancer and contralateral breast cancer. This study aimed to evaluate the association of the PRS313 with clinicopathologic characteristics of, and survival following, breast cancer. Women with invasive breast cancer were included, 98,397 of European ancestry and 12,920 of Asian ancestry, from the Breast Cancer Association Consortium (BCAC), and 683 women from the European MINDACT trial. Associations between PRS313 and clinicopathologic characteristics, including the 70-gene signature for MINDACT, were evaluated using logistic regression analyses. Associations of PRS313 (continuous, per standard deviation) with overall survival (OS) and breast cancer-specific survival (BCSS) were evaluated with Cox regression, adjusted for clinicopathologic characteristics and treatment. The PRS313 was associated with more favorable tumor characteristics. In BCAC, increasing PRS313 was associated with lower grade, hormone receptor-positive status, and smaller tumor size. In MINDACT, PRS313 was associated with a low risk 70-gene signature. In European women from BCAC, higher PRS313 was associated with better OS and BCSS: hazard ratio (HR) 0.96 (95% CI, 0.94 to 0.97) and 0.96 (95% CI, 0.94 to 0.98), but the association disappeared after adjustment for clinicopathologic characteristics (and treatment): OS HR, 1.01 (95% CI, 0.98 to 1.05) and BCSS HR, 1.02 (95% CI, 0.98 to 1.07). The results in MINDACT and Asian women from BCAC were consistent. An increased PRS313 is associated with favorable tumor characteristics, but is not independently associated with prognosis. Thus, PRS313 has no role in the clinical management of primary breast cancer at the time of diagnosis. Nevertheless, breast cancer mortality rates will be higher for women with higher PRS313 as increasing PRS313 is associated with an increased risk of disease. This information is crucial for modeling effective stratified screening programs.

Effect of postoperative radiotherapy in women with localized pure mucinous breast cancer after lumpectomy: a population-based study

PurposePure mucinous breast cancer is a rare subtype of invasive breast cancer with favorable prognosis, in which the effect of postoperative radiotherapy remains unclear. We aimed to investigate the prognostic value of postoperative radiotherapy in women with localized pure mucinous breast cancer after lumpectomy.MethodsWe conducted a retrospective cohort study to compare the effectiveness of postoperative radiotherapy (RT) and omitting postoperative radiotherapy (non-RT) in patients with first primary T1-2N0M0 (T ≤ 3 cm) pure mucinous breast cancer who underwent lumpectomy between 1998 and 2015 using the Surveillance, Epidemiology, and End Results (SEER) database. Breast cancer-specific survival (BCSS) was compared between RT and non-RT groups using Kaplan–Meier method and Cox proportional hazards regression model. Propensity score matching (PSM) was carried out to balance cohort baselines. In addition, an exploratory analysis was performed to verify the effectiveness of RT in subgroup patients.ResultsOf 7832 eligible patients, 5352 (68.3%) underwent lumpectomy with postoperative RT, 2480 (31.7%) received lumpectomy without postoperative RT. The median follow-up duration was 92 months. The median age was 66 years in the RT group and 76 years in the non-RT group.The 15-year BCSS was 94.39% (95% CI, 93.08% to 95.35%) in the RT group versus 91.45%(95% CI, 88.93% to 93.42%) in the non-RT group (P < 0.001). The adjusted hazard ratio for BCSS was 0.64 (95% CI, 0.49 to 0.83; P = 0.001) for RT group versus non-RT group. After propensity score matching, similar results were yielded. Adjuvant RT reduced the 15-year risk of breast cancer death from 7.92% to 6.15% (P = 0.039). The adjusted hazard ratio for BCSS were 0.66 (95%CI, 0.47 to 0.92; P = 0.014) for RT group versus non-RT group. The benefit of RT was well consistent across subgroup patients.ConclusionAmong women with T1-2N0M0 (tumor size ≤ 3 cm) pure mucinous breast cancer, the addition of RT after lumpectomy was significantly associated with a reduced incidence of breast cancer death compared with non-RT, and the magnitude of benefit may be modest. This suggests that postoperative RT is recommended in the treatment of localized pure mucinous breast cancer.

Risk evaluation of early-stage hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer patients: a population-based study from Taiwan

To assess the prognostic value of the Dutch criteria for patients with early-stage hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer from the Taiwan Cancer RegistryDatabase. We included 8295 patients with early-stage node-negative breast cancer who underwent surgery during January 2008-December 2012. Patients were stratified into low- and high-risk groups based on the Dutch criteria. The Kaplan-Meier method and log-rank test were used to estimate the difference in breast cancer-specific survival (BCSS) and overall survival (OS) between groups. Multivariable analysis was used to evaluate the prognostic value of the Dutch criteria. Overall, the low-risk and high-risk groups comprised 5375 and 2920 patients, respectively. In the low- and high-risk groups, the 5-year BCSS rate was 99.6% and 98.2% (P < 0.0001) and the 5-year OS rate was 98.3% and 96.8% (P < 0.0001), respectively. The hazard ratio for BCSS was 4.18 (95% confidence interval [CI] 2.63-6.63, P < 0.0001), and the hazard ratio for OS was 1.94 (95% CI 1.48-2.55); both were significantly poorer in the high-risk group than in the low-risk group. In the low-risk group, the 5-year BCSS and OS of patients who did and did not receive adjuvant chemotherapy were similar (99.5% versus 99.6% [P = 0.927] and 98.8% and 98.1% [P = 0.0683], respectively). The prognosis of low-risk patients as classified using the Dutch criteria is excellent with or without adjuvant chemotherapy. The benefit of multi-gene testing for chemotherapy decision-making might be minimal in these patients.

Prognostic impact of discrepant Ki67 and mitotic index on hormone receptor-positive, HER2-negative breast carcinoma

Background:Inconsistencies between mitotic index (MI) and Ki67 measures have been identified in many breast tumour samples. The aim of this study was to describe the prognosis of hormone receptor-positive (HR+) HER2− tumours having discrepant MI and Ki67.Methods:We included a cohort of breast cancer patients initially treated by surgery between 2001 and 2005 in the Institut Curie. Breast cancer-specific survival (BCSS) and disease-free survival (DFS) were analysed according to three proliferation groups: high MI/high Ki67 (MI=3, Ki67>20%), low MI/low Ki67 (MI<3, Ki67⩽20%) and discrepant (high MI/low Ki67 or low MI/high Ki67).Results:Among the 1430 patients, 19.6% had discrepant Ki67 and MI, 11.6% had high markers and 68.8% had low markers. The 5-year BCSS was 95.8%, 95% CI (0.93–0.98) in the discrepant group, 99.3%, 95% CI (0.993–0.999) in the low-proliferation group and 91.8%, 95% CI (0.88–0.96) in the high-proliferation group. In multivariate analysis, the survival of the discrepant group was lower than that of the low-proliferation group: BCSS hazard ratio (HR)=3.01 (1.32–6.84; P=0.008) and DFS HR=2.07, 95% CI (1.31–3.26; P=0.002). Among grade 2 tumours in multivariate analysis, DFS of the discrepant group was lower than that of the low MI/low Ki67 group: HR=1.98, 95% CI (1.14–3.46), P=0.02. Regarding BCSS, the obtained results were similar.Conclusion:The prognosis of patients with discrepant MI and Ki67 appears intermediate between that of low MI/low Ki67 and high MI/high Ki67 groups. These markers should be jointly analysed to clarify prognosis.

Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort.

This study compared overall and breast cancer-specific survival using long-term follow-up data among women diagnosed with invasive breast cancer undergoing mastectomy or breast reconstruction. Retrospective study using population-based data from Ontario Cancer Registry (1980 to 1990) including women receiving breast reconstruction within 5 years after mastectomy and controls of age- and cancer histology-matched women with mastectomy alone. We compared overall and breast cancer-specific survival using an extended Cox hazards model. Secondary analysis examined conditional survival across early, intermediate, and late follow-up. Seven hundred fifty-eight matched pairs formed the cohort, with a median follow-up of 23.4 years (interquartile range, 1.1 to 33.0 years). Fewer breast reconstruction patients died overall or from breast cancer compared with controls (overall survival, 44.5 percent versus 56.7 percent, p < 0.0001; breast cancer-specific survival, 31.8 percent versus 42.6 percent, p = 0.0002, respectively). Breast reconstruction was associated with a 17 percent reduced risk of death and a 19 percent reduced risk of breast cancer death, after adjustment (overall survival hazard ratio, 0.83; 95 percent CI, 0.72 to 0.96; breast cancer-specific survival hazard ratio, 0.81; 95 percent CI, 0.68 to 0.99). Among 885 women (58 percent) surviving 20 or more years, there was no difference in risk of death from breast cancer (hazard ratio, 0.59; 95 percent CI, 0.31 to 1.10). In a large cohort with invasive breast cancer followed over 20 years, there is no evidence that breast reconstruction is associated with worse survival outcomes compared with mastectomy alone. Therapeutic, III.

Progesterone receptor expression is an independent prognostic variable in early breast cancer: a population-based study

Background:Progesterone receptor (PR) expression assessment in early invasive breast cancer remains controversial. This study sought to re-evaluate PR expression as a potential therapeutic guide in early breast cancer; particularly in oestrogen receptor (ER)-positive, lymph node (LN)-negative disease.Methods:A population cohort of 1074 patients presenting to a single Cancer Centre over 4 years (2000–2004) underwent surgery for primary invasive breast cancer with curative intent. Prospective data collection included patient demographics, pathology, ER and PR expression, HER2 status, adjuvant chemotherapy and endocrine therapy. Progesterone receptor expression was compared with (all causes) overall survival (OS), breast cancer-specific survival (BCSS) and disease-free survival (DFS).Results:Overall survival was 71.0% and BCSS was 83.0% at median follow-up of 8.34 years. Absent PR expression was significantly associated with poorer prognosis for OS, BCSS and DFS (P<0.0001, log-rank), even within the ER-positive, LN-negative group (hazard ratio for BCSS 3.17, 95% CI 1.43–7.01) and was not influenced by endocrine therapy. Cox's regression analysis demonstrated that PR expression was an independent prognostic variable.Conclusion:Absence of PR expression is a powerful, independent prognostic variable in operable, primary breast cancer even in ER-positive, LN-negative patients receiving endocrine therapy. Absence of PR expression should be re-evaluated as a biomarker for poor prognosis in ER-positive breast cancer and such patients considered for additional systemic therapy.

Abstract P2-10-20: A tumor DNA complexity index is an independent predictor of survival in a dataset of 1950 breast cancers; a METABRIC group study.

Abstract Background: Cancer genomes undergo substantial alterations during carcinogenesis. Patterns of such rearrangements differ with respect to cancer subtypes and may affect crucial parts of the genome. DNA based markers would make clinical implementation more feasible as markers based on RNA expression are challenging due to the intrinsic problem of RNA stability and volatility in expression patterns. Complex genomic rearrangements in breast cancer genomes, quantified by the complex arm-wise aberration index (CAAI), have previously been shown to be of prognostic value. However this finding has not been validated in independent large-scale breast cancer cohorts or compared with other molecular predictors. Methods: A total of 1950 breast carcinomas from the METABRIC cohort with log term follow up were included in this study. Microarray based copy number and expression data from fresh frozen primary tumors were available. Cases were classified as CAAI positive if at least one complex event was present in the tumor genome. The clinical end points were breast cancer specific survival (BCSS) and overall survival (OS). Results: A total of 33 % of breast cancer cases were CAAI positive with a Cox proportional hazard ratio (HR) of 1.78 (95% CI, 1.49–2.12) for BCSS. Using multivariate Cox regression the adjusted HR for BCSS of 1.42 (95% CI, 1.12–1.80) and 1.44 (95% CI, 1.02–2.03) in estrogen receptor positive (ER+) and estrogen receptor negative breast cancers, respectively. Gene expression classifiers based on OncotypeDX and MammaPrint were not independently prognostic in the ER− subset. Significant difference in survival was both seen in patients that received systemic treatment, and in patients that did not. Conclusions: DNA based prognostic profiling is a robust method for both fresh frozen and FFPE tumor material. This study shows that complex genomic alterations of tumor DNA, measured as CAAI, is an independent predictor of survival in breast cancer, in both ER+ and ER− disease in a large scale breast cancer cohort with long term follow up. The effect seems unrelated to systemic endocrine treatment or chemotherapy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-20.

The prognostic significance of tumour cell detection in the peripheral blood versus the bone marrow in 733 early-stage breast cancer patients

IntroductionThe detection of circulating tumour cells (CTCs) in the peripheral blood and disseminated tumour cells (DTCs) in the bone marrow are promising prognostic tools for risk stratification in early breast cancer. There is, however, a need for further validation of these techniques in larger patient cohorts with adequate follow-up periods.MethodsWe assayed CTCs and DTCs at primary surgery in 733 stage I or II breast cancer patients with a median follow-up time of 7.6 years. CTCs were detected in samples of peripheral blood mononuclear cells previously stored in liquid-nitrogen using a previously-developed multi-marker quantitative PCR (QPCR)-based assay. DTCs were detected in bone marrow samples by immunocytochemical analysis using anti-cytokeratin antibodies.ResultsCTCs were detected in 7.9% of patients, while DTCs were found in 11.7%. Both CTC and DTC positivity predicted poor metastasis-free survival (MFS) and breast cancer-specific survival (BCSS); MFS hazard ratio (HR) = 2.4 (P < 0.001)/1.9 (P = 0.006), and BCSS HR = 2.5 (P < 0.001)/2.3 (P = 0.01), for CTC/DTC status, respectively). Multivariate analyses demonstrated that CTC status was an independent prognostic variable for both MFS and BCSS. CTC status also identified a subset of patients with significantly poorer outcome among low-risk node negative patients that did not receive adjuvant systemic therapy (MFS HR 2.3 (P = 0.039), BCSS HR 2.9 (P = 0.017)). Using both tests provided increased prognostic information and indicated different relevance within biologically dissimilar breast cancer subtypes.ConclusionsThese results support the use of CTC analysis in early breast cancer to generate clinically useful prognostic information.

Steroid Receptor RNA Activator Protein (SRAP): A Potential New Prognostic Marker for Estrogen Receptor-Positive/Node-Negative/Younger Breast Cancer Patients.

Abstract Purpose: The steroid receptor RNA activator (SRA) is a functional RNA suspected to participate in the mechanisms underlying breast tumor progression. This RNA is also able to encode for a protein, SRAP, whose exact function remains to be determined. Our aim was to assess, in a large breast cancer cohort, whether levels of this protein could be associated with outcome or established clinical parameters.Experimental Design: Following antibody validation, we have assessed SRAP expression by tissue-microarray (TMA) analysis of 372 tumors with known steroid receptor and node status. Clinical follow-up was available for all the corresponding patients. Immunohistochemical scores were independently determined by two investigators and averaged. Statistical analyses were performed using standard univariate and multivariate tests.Results: SRAP levels were significantly (Mann-Whitney rank sum test, P&amp;lt;0.05) higher in estrogen receptor-alpha positive (ER+, n = 273), in progesterone receptor positive (PR+, n= 256) and in older patients (age ≥ 65 years, n = 183). When considering ER+ tumors, PR+ tumors, or young patients (&amp;lt; 65 years), patients with high SRAP expression had a significantly (Mantel-Cox test, P &amp;lt; 0.05) worse breast cancer specific survival (BCSS) than patients with low SRAP levels. SRAP also appeared as a very powerful indicator of poor prognostic for BCSS in the subset of ER+, node negative and young breast cancer patients (Cox regression analysis, n = 60, BCSS Hazard Ratio=13.937, P&amp;lt;0.0001).Conclusion: Our data suggest that SRAP might be a new predictor of breast cancer specific survival in younger breast cancer patients with ER+/node negative tumors. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2017.

Steroid Receptor RNA Activator Protein (SRAP): a potential new prognostic marker for estrogen receptor-positive/node-negative/younger breast cancer patients

IntroductionThe steroid receptor RNA activator is a functional RNA suspected to participate in the mechanisms underlying breast tumor progression. This RNA is also able to encode for a protein, Steroid Receptor RNA Activator Protein (SRAP), whose exact function remains to be determined. Our aim was to assess, in a large breast cancer cohort, whether levels of this protein could be associated with outcome or established clinical parameters.MethodsFollowing antibody validation, SRAP expression was assessed by tissue-microarray (TMA) analysis of 372 breast tumors. Clinical follow-up and parameters such as steroid receptor and node status were available for all the corresponding cases. Immunohistochemical scores were independently determined by three investigators and averaged. Statistical analyses were performed using standard univariate and multivariate tests.ResultsSRAP levels were significantly (Mann-Whitney rank sum test, P < 0.05) higher in estrogen receptor-alpha positive (ER+, n = 271), in progesterone receptor positive (PR+, n = 257) and in older patients (age > 64 years, n = 182). When considering ER+ tumors, PR+ tumors, or younger patients (≤ 64 years), cases with high SRAP expression had a significantly (Mantel-Cox test, P < 0.05) worse breast cancer specific survival (BCSS) than those with low SRAP levels. SRAP also appeared as a very powerful indicator of poor prognostic for BCSS in the subset of ER+, node negative and young breast cancer patients (Cox regression analysis, n = 60, BCSS Hazard Ratio = 8.61, P < 0.006).ConclusionsOur data suggest that SRAP levels might provide additional information on potential risk of recurrence and negative outcome in a specific set of patients with otherwise good prognosis when considering only estrogen receptor and nodal status.

Combination of low plasma stromal cell-derived factor-1 and phosphorylated-CXCR4: independent prognostic marker for breast cancer.

Abstract Abstract #1069 Background: Stromal cell-derived factor (SDF)-1, a chemoattractant cytokine, has been shown to be overexpressed in those organs to which breast cancer metastasizes, and serves to home in cancer cells which express its receptor, CXCR4. We have previously reported the role of low plasma SDF-1 levels as a host-derived marker predictive of distant metastasis. Low plasma SDF-1 levels are predictive of the formation of distant metastases independently of tumor production of SDF-1. In order to further characterize this cohort of patients with an innate susceptibility for poorer prognosis, we combined low plasma SDF-1 levels with tumor-derived markers. CXCR4 has been shown to be an independent prognostic marker, however it is plausible that activated CXCR4, or phosphorylated (p)-CXCR4 may be able to better discriminate metastatic risk. We hypothesized that the prognostic value of low plasma SDF-1 would be particularly informative in patients with tumors having high CXCR4 or p-CXCR4 expression.&amp;#x2028; Materials and Methods: Using the same cohort of patients in whom we previously measured plasma SDF-1 levels, we built a tissue microarray containing paraffin-embedded tissue blocks of the primary tumor for 237 patients. There were 212 patients for whom plasma and tissue blocks were both available. Plasma SDF-1 levels were previously measured using an ELISA, and tumor protein expression was detected using immunohistochemistry. Survival analysis was calculated using cox regression analysis.&amp;#x2028; Results: We found that tumor p-CXCR4 was a stronger prognostic marker than CXCR4. Patients with high expression of p-CXCR4 demonstrated a 4-fold higher rate of mortality (hazard ratio (HR) 3.95, 95% confidence interval (CI), 1.55-10.03; P=0.004) in comparison to patients who highly expressed CXCR4 (HR, 3.20; 95% CI, 1.09-9.37; P=0.03) in univariate analysis. In the subset of patients for whom plasma and tissue were both available, we confirmed the poor prognostic value of low plasma SDF-1 (HR for breast cancer-specific survival, 3.59; 95% CI, 1.33-9.74; P=0.01), and high p-CXCR4 (HR, 3.98; 95% CI, 1.57-10.13; P=0.004). There appeared to be an enhancing effect of the combination of low plasma SDF-1 and high p-CXCR4 upon prognostic significance (HR, 5.96; 95% CI, (2.57-13.81); P&amp;lt;0.001). This remained significant with multivariate analysis (HR, 3.78; 95% CI, (1.31-10.94); P=0.01).&amp;#x2028; Discussion: We report here for the first time the prognostic value of phosphorylated-CXCR4 in breast cancer, and its superiority over CXCR4 expression. Furthermore, the combination of p-CXCR4 and low-plasma SDF-1 levels was determined to be an independent prognostic marker, stronger than either factor alone, suggesting that low plasma SDF-1 may especially favor the metastatic process in patients with tumors containing its activated CXCR4 receptor. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1069.

Polymorphisms inXRCC1,XRCC3, andCCND1and Survival After Treatment for Metastatic Breast Cancer

Single nucleotide polymorphisms (SNPs) in DNA repair and cell cycle control genes may alter protein function and therefore the efficacy of DNA damaging chemotherapy. We retrospectively evaluated the association of SNPs in DNA repair genes, XRCC1-01 (Arg399Gln) and XRCC3-01 (Thr241Met), and a cell cycle control gene, CCND1-02 (A870G), with progression-free survival (PFS) and breast cancer specific survival (BCSS) in patients with metastatic breast cancer (MBC). SNPs in 95 patients with MBC enrolled onto one of five prospective clinical trials of high-dose chemotherapy and autologous stem-cell transplantation were evaluated using genotyping assays. For XRCC1-01, the hazard ratio (HR) for BCSS was 2.8 (95% CI, 1.60 to 5.00) and the HR for PFS was 2.0 (95%CI, 1.12 to 3.43). For XRCC3-01, the HR for BCSS was 2.0 (95%CI, 1.12 to 3.70) and the HR for PFS was 2.0 (95%CI, 1.09 to 3.59). For CCND1-02, the HR for BCSS was 1.8 (95%CI, 1.12 to 2.78) and the HR for PFS was 1.8 (95%CI, 1.15 to 2.85). Patients carrying one variant genotype (HR, 1.7; 95%CI, 1.07 to 2.82) or combinations of any two variant genotypes (HR, 4.7; 95% CI, 2.41 to 8.94) had significantly poorer BCSS compared with patients carrying zero variants. In multivariable analysis, XRCC1-01, presence of liver metastases, and bone metastases independently predicted BCSS. Combinations of any two variant genotypes were stronger independent predictors of BCSS and PFS than the presence of liver or bone metastases. XRCC1-01, XRCC3-01, and CCND1-01 may be predictive of survival outcome in patients with MBC treated with DNA damaging chemotherapy.

Internal Mammary Nodes in Invasive Breast Carcinoma

According to recent data medial location of early breast cancer was associated with a higher risk of systemic relapse and breast cancer death compared with lateral location. This paper will focus on literature data and will also present own data on the prognostic impact of radiation therapy (RT) to internal mammary nodes (IMNs) in early breast cancer patients with medial hemisphere tumor location. Four large recent series of the literature reporting on > 50,000 patients with special focus on the impact of tumor location were evaluated. No systematic RT to IMNs was applied. At the Department of Radiation Oncology, University of Erlangen, Germany, a total of 822 patients (492 with lateral and 330 with medial lesions) with early breast cancer were treated by surgery and postoperative RT with or without chemotherapy (1985–1996). All patients with medial lesions received RT to IMNs by a mixed-beam approach (50% photons, 50% electrons) with a total dose of 50 Gy. In patients with lateral lesions RT was directed to the breast alone (50.4 Gy total dose, boost 12–16 Gy). The magnitude of the negative impact of medial tumor location was relatively similar in all four studies available. According to Zucali et al., the hazard ratio (HR) for distant metastases was 1.29. The HR for breast cancer-specific survival (BCSS) varied between 1.46 (Lohrisch et al.) and 1.31 (Gaffney et al.). 5-year systemic disease-free survival (SDFS) rates were 66.3% and 74.2% for high-risk medial and lateral lesions, respectively (p < 0.005). Corresponding BCSS were 75.7% and 80.8%, respectively (p < 0.03, Lohrisch et al.). For all 822 patients following treatment on IMNs, 5-year overall survival (OS) for lateral lesions and medial lesions was 76.2% and 79.1% (n.s.), and SDFS for lateral and medial tumors 72.6% and 72.9% (n.s.), respectively. No subgroup could be identified in which prognosis of patients with medial tumors was inferior to survival data for patients with lateral lesions. In postmenopausal women, OS was significantly better for patients with medial versus lateral tumors (77.6% vs. 72.7%; p = 0.05); in patients receiving adjuvant chemotherapy SDFS (5 years) was better for those with medial versus lateral tumors (80.5% vs. 67.6%; p = 0.02). Consistent literature data exist indicating a diminished survival in patients with inner versus outer quadrant breast cancer. According to our data, RT with a total dose of 50 Gy to IMNs in breast cancer patients with medial lesions was associated with OS and SDFS rates comparable to patients with lateral tumors.