IIIA Breast Cancer Patients Research Articles

The Correlation of Fibronectin and Vimentin Expression on Anthracycline-Based Neoadjuvant Chemotherapy Response in Stage IIIA and Luminal Subtype IIIB Breast Cancer

ABSTRACT Introduction: Breast cancer has a phenotype of interconnected epithelial cells and then changes to mesenchymal cells through activation of epithelial-to-mesenchymal transition (EMT). Vimentin, as the main component of forming a cell frame, can be used as a marker of the EMT process. Fibronectin is an extracellular glycoprotein that binds to receptor proteins known as EMT markers. This study aims to evaluate the correlation between these proteins on neoadjuvant chemotherapy (NAC) response. Methods: This study was carried out from November 2029 to March 2020 and used the consecutive sampling of Stage IIIA and Luminal Subtype IIIB breast cancer patients after chemotherapy using anthracycline. Subject obtained from outpatient at oncological surgery of Dr. Saiful Anwar Hospital Malang, Indonesia. Fibronectin and vimentin expression was measured from paraffin block by immunohistology staining. Statistical analysis used correlation tests and logistic regression with a significant level of P < 0.05. Results: Mean patient age in this study was 54 ± 4.5 years old, and most of the patients were Stage IIIB patients (98.48%). Most patients have negative vimentin and fibronectin expression. In this study, we found a significant relationship between vimentin expression and NAC response with P = 0.000 and a correlation coefficient was 0.440. Conclusion: There was a significant correlation between vimentin expression and the response of NAC. There is a significant correlation between fibronectin expression and the response of NAC. Fibronectin expression can be used as a predictive factor for nac in stage iiia breast cancer patients.

Đánh giá kết quả hóa trị bổ trợ phác đồ 4AC + 4 T trên bệnh nhân ung thư vú giai đoạn II, IIIA hạch nách dương tính tại Bệnh Viện Đa Khoa Tỉnh Hà Tĩnh

Objectives: (1) Evaluate the efficacy of 4AC+4T regimen as adjuvant chemotherapy for stage II, IIIA breast cancer patients with axillary lymph node positive. (2) Describe toxicity of the regimen. Methods: Retrospective and prospective descriptive longitudinal study, in 39 stage II-III breast cancer patients with lymph node positive underwent modified radical mastectomy and axillary lymph node dissection, treated with 4AC + 4T regimen at Ha Tinh General Hospital from January 2013 to June 2019. Results: Overall survival was 83.6%. Disease-free survial was 75.6%. DFS and OS are inversely proportional to tumor size, the number of metastatic lymph nodes, ER and/PR positive have a better prognosis than ER/PR negative, stage II disease have better prognosis than stage IIIA (p<0.05). Toxicities of AC+4T: Leukopenia in 64.1% of patients, with 10,1% was grade 3, 4. Neutropenia in 61.5% of patients, with 7,6% was grade 3, 4. Hypopigmentation in 51.3% of patients, with 7,6% was grade 3, 4. Thrombocytopenia in 17.9% of patients. Transaminase elevation in 43.6% of patients, no seen grade 3, 4. Increased blood creatinine was only recorded at grade 1 at 5.1%. Vomiting and nausea 87%, stomatitis 30.8%, diarrhea 38.4%, muscle pain 87%, peripheral neuropathy 74.4% peripheral edema 38.5%. Conclusion: The 4AC + 4T regimen shows high efficacy and a acceptable toxicity in the treatment of stage II, IIIA breast cancer with axillary lymph node positive.

Observational Multicenter Study on the Prognostic Relevance of Coagulation Activation in Risk Assessment and Stratification in Locally Advanced Breast Cancer. Outline of the ARIAS Trial

A hypercoagulable state may either underlie or frankly accompany cancer disease at its onset or emerge in course of cancer development. Whichever the case, hypercoagulation may severely limit administration of cancer therapies, impose integrative supporting treatments and finally have an impact on prognosis. Within a flourishing research pipeline, a recent study of stage I-IIA breast cancer patients has allowed the development of a prognostic model including biomarkers of coagulation activation, which efficiently stratified prognosis of patients in the study cohort. We are now validating our risk assessment tool in an independent cohort of 108 patients with locally advanced breast cancer with indication to neo-adjuvant therapy followed by breast surgery. Within this study population, we will use our tool for risk assessment and stratification in reference to 1. pathologic complete response rate at definitive surgery, intended as our primary endpoint, and 2. rate of thromboembolic events, intended as our secondary endpoint. Patients’ screening and enrollment procedures are currently in place. The trial will be shortly enriched by experimental tasks centered on next-generation sequencing techniques for identifying additional molecular targets of treatments which may integrate current standards of therapy in high-risk patients.

CD16+NKG2Ahigh Natural Killer Cells Infiltrate Breast Cancer-Draining Lymph Nodes.

Tumor-draining lymph nodes (TD-LNs) are the first site of metastasis of breast cancer. Natural killer (NK) cells that infiltrate TD-LNs [including noninvaded (NI) or metastatic (M)-LNs from breast cancer patients] and NK cells from healthy donor (HD)-LNs were characterized, and their phenotype analyzed by flow cytometry. Low percentages of tumor cells invaded M-LNs, and these cells expressed ULBP2 and HLA class I molecules. Although NK cells from paired NI and M-LNs were similar, they expressed different markers compared with HD-LN NK cells. Compared with HD-LNs, TD-LN NK cells expressed activating DNAM-1, NKG2C and inhibitory NKG2A receptors, and exhibited elevated CXCR3 expression. CD16, NKG2A, and NKp46 expression were shown to be increased in stage IIIA breast cancer patients. TD-LNs contained a large proportion of activated CD56brightCD16+ NK cells with high expression of NKG2A. We also showed that a subset of LN NK cells expressed PD-1, expression of which was correlated with NKp30 and NKG2C expression. LN NK cell activation status was evaluated by degranulation potential and lytic capacity toward breast cancer cells. NK cells from TD-LNs degranulated after coculture with breast cancer cell lines. Cytokine-activated TD-LN NK cells exerted greater lysis of breast cancer cell lines than HD-LN NK cells and preferentially lysed the HLA class Ilow MCF-7 breast cancer cell line. TD-LNs from breast cancer patients, thus, contained activated lytic NK cells. The expression of inhibitory receptor NKG2A and checkpoint PD-1 by NK cells infiltrating breast cancer-draining LNs supports their potential as targets for immunotherapies using anti-NKG2A and/or anti-PD-1.

1592P - No effect of length time bias on the genomic risk in ER+ HER2-stage I-IIA breast cancer (BC) patients according to diagnosis in a screening programme: An exploratory analysis

1592P - No effect of length time bias on the genomic risk in ER+ HER2-stage I-IIA breast cancer (BC) patients according to diagnosis in a screening programme: An exploratory analysis

Practice Patterns and Outcomes for Postmastectomy Radiation After Complete Pathological Response in Stage II and IIIA Breast Cancer Patients: Analysis of the National Cancer Data Base

Practice Patterns and Outcomes for Postmastectomy Radiation After Complete Pathological Response in Stage II and IIIA Breast Cancer Patients: Analysis of the National Cancer Data Base

Randomized phase 2 trial of a coordinated breast cancer follow-up care program.

Previous research has demonstrated that cancer survivors often fail to receive recommended care and also undergo unnecessary care; this reduces care quality and increases costs. This phase 2 trial randomized 100 stage 0 to IIIa breast cancer patients who had primary care providers within a large Massachusetts-based hospital network (with accessible online records) to either coordinated follow-up care (CC), which entailed a tailored survivorship care plan (SCP) and patient navigator calls every 3 months, or standard care (SC), which did not include an SCP or patient navigation, for 1 year after the completion of their last chemotherapy, surgery, or radiation treatment. The primary endpoint was the frequency of redundant examinations (>1 breast/chest wall examination per patient within any 30-day period in the absence of a new breast or chest wall complaint) over the year of follow-up. The total number of non-plastic surgery visits in the year of follow-up was a secondary endpoint. Two patients (both on CC) were ineligible, and 2 patients (1 per arm) had a recurrence or died during follow-up; this left 96 for analysis (47 in the CC arm and 49 in the SC arm). Twenty-two of the 47 CC patients (47%; 95% confidence interval, 32%-62%) and 19 of the 49 SC patients (39%; 95% confidence interval, 25%-54%) had 1 or more redundant breast/chest wall examinations during the year. The median number of non-plastic surgery visits was 12 for CC patients and 8 for SC patients. Early-stage breast cancer patients visit health care providers very frequently during their first year of follow-up and often receive unnecessary breast/chest wall examinations. An SCP and patient navigator calls did not reduce this surrogate for redundant care. Cancer 2016;122:3546-3554. © 2016 American Cancer Society.

Effect of intercostobrachial nerve preserving in axillary lymph node dissection on sensory disturbance for breast cancer

Objective To explore the effect of preserving intercostobrachial nerve (ICBN) in axillary lymph node dissection on sensory disturbance for breast cancer. Methods Clinical data of 146 cases of stageⅠ, Ⅱ and Ⅲa breast cancer patients treated by modified radical mastectomy was analyzed. The patients were randomly divided into two groups. Retention group included 67 patients who were performed axillary lymph node dissection preserving ICBN, and 79 cases undergoing axillary lymph node dissection were taken as control group. Data of the two groups were assessed to compare the operation time, number of lymph nodes dissection and sensory abnormalities of upper arms. Results In the follow-up of 1, 3 and 6 months, the incidence rate of the lateral upper arm sensory disturbance were 17.9% and 74.9%, 11.9% and 60.7%, 7.4% and 59.5% respectively in the retention and control group, and the difference was statistically significant (χ2=46.78, P 0.05). No local recurrence after operation occurred in the follow-up of 8 months to 5 years. Conclusions For stage Ⅰ, Ⅱ and Ⅲa breast cancer patients undergoing axillary lymph node dissection, retaining ICBN can significantly reduce the chance of the postoperative medial upper arm sensory disturbance, improve the quality of life with no increase of local recurrence rate. Key words: Modified radical mastectomy of breast cancer; Axillary lymph node excision; Intercosto-brachial nerve

Use of imaging studies for early-stage breast cancer at Cleveland Clinic.

e18217Background: Use of staging imaging (SI), including CT, PET and bone scans, is not routinely recommended in stage I-IIA breast cancer patients (ESBCP) in the absence of signs or symptoms of me...

Abstract 4364: S1P generated by SphK1 is important not only for primary tumor growth but also for tumor-induced hemangiogenesis and lymphangiogenesis

Abstract INTRODUCTION: Sphingosine-1-phosphate (S1P), a pleiotropic bioactive lipid mediator, regulates many cellular processes important for breast cancer progression. The aim of this study is to investigate a role for S1P produced by sphingosine kinase 1 (SphK1) in breast cancer progression and tumor-induced hemangiogenesis and lymphangiogenesis. METHODS: An isozyme-specific inhibitor of SphK1 (SK1-I) was used. Tumor burden were quantified using an in vivo imaging system (IVIS 2000). S1P and SK1-I levels were measured by LC-ESI-MS/MS. Hemangiogenesis and lymphangiogenesis are determined by morphological analysis of microvessel density as well as by flow cytometric analysis of endothelial cells. RESULTS: A significant dose dependent effect of SK1-I on inhibition of 4T1-luc2 murine breast cancer cell growth was observed. We confirmed that SK1-I decreased the enzymatic activity of SphK1 and that downregulation of SphK1 with specific siRNA also suppressed growth of these cells. We found that S1P levels increased in the tumor and in the circulation after orthotopic implantation of 4T1-luc2 cells. Similarly, serum S1P levels were significantly elevated in stage IIIA breast cancer patients who have lymph node metastases, compared to age/ethnicity-matched healthy volunteers. SK1-I blocked serum S1P increases in in vivo model and reduced lymph node and lung metastases and overall tumor burden in vivo as well. Importantly, SK1-I also decreased hem- and lymphangiogenesis not only in the primary tumor, but also in lymph nodes, the host tumor microenvironment. Whereas supernatants from 4T1-luc2 cells significantly stimulated tube formation of HUVECs and HLECs, shRNA knockdown of SphK1 markedly reduced them, indicating that S1P produced by SphK1 in 4T1-luc2 breast cancer cells is an important contributor to hem- and lymphangiogenesis. CONCLUSIONS: S1P generated by SphK1 is important for tumor progression, tumor-induced hemangiogenesis and lymphangiogenesis, and lymph node metastais. Therefore targeting SphK1 and its product S1P would be a multi-pronged attack against breast cancer. This work was supported by Sumitomo Life Social Welfare Services Foundation grant to MN, NIH (K12HD055881) and Susan G. Komen for the Cure (KG090510) to KT, and NCI (R01CA61774) to SS. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4364. doi:1538-7445.AM2012-4364

Preoperative Chemotherapy for Operable Breast Cancer Is Associated with Better Compliance with Adjuvant Therapy in Matched Stage II and IIIA Patients

Preoperative chemotherapy (PC) for operable breast cancer has shown significant benefits in prospective trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting. Retrospective review was performed of stage II and IIIA breast cancer patients treated from January 2002 to July 2009. Fifty-three of 57 patients who underwent PC were matched based on age, tumor size, and hormone receptor status with 53 patients who did not undergo PC. Differences in patient compliance with physician recommendations for all types of adjuvant therapy were evaluated. Crude odds ratios and adjusted odds ratios derived from conditional logistic regression models were calculated. There were 106 patients included. Patient compliance with chemotherapy was better in the PC group than in the adjuvant chemotherapy (AC) group (100% versus 70%; p = .0001). Similarly, more patients in the PC group completed radiation therapy (96% versus 65%; p = .0003) and initiated hormonal therapy (100% versus 62%; p = .0001). Conditional logistic regression revealed that higher pathologic stage and current cigarette smoking were associated with poorer compliance with chemotherapy. For radiation therapy, the univariate model revealed that compliance with chemotherapy and being employed were associated with completion of radiation, whereas current cigarette smoking and larger pathologic size were associated with poorer compliance with radiation. For hormonal therapy, current cigarette smokers were more likely to be noncompliant with initiation of hormonal therapy. PC for operable breast cancer can improve patient compliance with chemotherapy. Current cigarette smokers were more likely to be noncompliant with all types of adjuvant therapy.

Preoperative Chemotherapy for Operable Breast Cancer Improves Surgical Outcomes in the Community Hospital Setting

Preoperative chemotherapy (PC) for operable breast cancer has demonstrated significant benefits in clinical trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting. The potential benefits of PC in terms of surgical outcomes in a community practice were examined. A retrospective review was performed of stage II and stage IIIA breast cancer patients from January 1, 2002 to July 31, 2009. Surgical outcomes of margin status, volume of lumpectomy, rate of lumpectomy, and re-excision lumpectomy were evaluated. There were 212 patients included. Seventy-nine percent of patients who underwent PC had a clinical response and 25% had a pathologic complete response. For clinical stage T2 and stage T3 tumors, the PC group underwent lumpectomy more often than patients in the adjuvant chemotherapy (AC) group (78% versus 50%; p = .016 and 60% versus 29%; p = .015, respectively). The rate of close or positive margins in the PC group was half the rate in the AC group (23% versus 46%; p = .04) and this resulted in fewer re-excisions (p = .01). The volume of tissue removed was also smaller in the PC group (143.6 cm³ versus 273.9 cm³; p = .003). Conclusions. PC for operable breast cancer can significantly improve surgical outcomes in community-based practice.

Thermal boost combined with interstitial brachytherapy in breast conserving therapy – Assessment of early toxicity

Background Hyperthermia (HT) causes a direct damage to cancerous cells and/or sensitize them to radiotherapy with usually minimal injury to normal tissues. Adjuvant HT is probably one of the most effective radiation sensitizers known and works best when delivered simultaneously with radiation. In breast conserving therapy, irradiation has to minimize the risk of local relapse within the treated breast, especially in an area of a tumor bed. Brachytherapy boost reduces 5-year local recurrence rate to mean 5,5%, so there still some place for further improvement. The investigated therapeutic option is an adjuvant single session of local HT (thermal boost) preceding standard CT-based multicatheter interstitial HDR brachytherapy boost in order to increase the probability of local cure. Aim To report the short-term results in regard to early toxicity of high-dose-rate (HDR) brachytherapy (BT) boost with or without interstitial microwave hyperthermia (MV HT) for early breast cancer patients treated with breast conserving therapy (BCT). Materials and methods Between February 2006 and December 2007, 57 stage IA–IIIA breast cancer patients received a 10 Gy HDR BT boost after conservative surgery and 42.5–50 Gy whole breast irradiation (WBI) ± adjuvant chemotherapy. 32 patients (56.1%) were treated with additional pre-BT single session of interstitial MW HT to a tumor bed (multi-catheter technique). Reference temperature was 43 °C and therapeutic time (TT) was 1 h. Incidence, severity and duration of radiodermatitis, skin oedema and skin erythema in groups with (I) or without HT (II) were assessed, significant p-value ≤ 0.05. Results Median follow-up was 40 months. Local control was 100% and distant metastasis free survival was 91.1%. HT sessions (median): reference temperature 42.2 °C, therapeutic time (TT) 61.4 min, total thermal dose 42 min and a gap between HT and BT 30 min. Radiodermatitis grades I and II occurred in 24 and 6 patients, respectively, differences between groups I and II were not significant. Skin oedema and erythema occurred in 48 (85.7%) and 36 (64.3%) cases, respectively, and were equally distributed between the groups. The incidence and duration of skin oedema differed between the subgroups treated with different fractionation protocols of WBI, p = 0.006. Skin oedema was present up to 12 months. No difference in pattern of oedema regression between groups I and II was observed, p = 0.933. Conclusion Additional thermal boost preceding standard HDR BT boost has a potential of further improvement in breast cancer local control in BCT. Pre-BT hyperthermia did not increase early toxicity in patients treated with BCT and was well tolerated. All side effects of combined treatment were transient and were present for up to 12 months. The increase in incidence of skin oedema was related to hypofractionated protocols of WBI. The study has to be randomized and continued on a larger group of breast cancer patients to verify the potential of local control improvement and to assess the profile of late toxicity.

Benefits of preoperative chemotherapy for operable breast cancer in the community hospital setting

e11594 Background: The benefits of preoperative chemotherapy (PC) for operable breast cancer have been demonstrated in prospective clinical trials. For palpable breast cancers, however, operative intervention remains the most common initial treatment. The benefits of PC for operable breast cancer were examined in a community hospital. Methods: Maricopa Medical Center is the safety net hospital in Arizona. A retrospective review was performed of all breast cancer patients from 2004 to 2008. All patients who were stage IIA - IIIA breast cancer patients were included. Outcomes of breast cancer were evaluated based on whether the patient underwent PC or adjuvant chemotherapy (AC). All patients in the PC group received anthracyclines and a taxane in their treatment. The Fisher's exact test and the Chi-square test were used to determine differences between the two populations. Unpaired t-test was used to compare means of the two populations. Results: During this period, 145 patients were treated. In the PC group, the clinical response rate was 81% and the pathologic complete response rate was 26%. Patients in the PC group underwent lumpectomy more often for T2 (73% vs. 40%, P = 0.01) and for T3 tumors (73% vs. 37%, P = 0.06). The positive margin rate was lower (14% vs.37%, P = 0.02) and the lumpectomy volume was smaller in the PC group compared to the AC group (132 cm3 vs. 245 cm3, P < 0.01). Despite similar demographics, compliance with chemotherapy was improved in the PC group (100% vs. 71%, P < 0.01). In addition, compliance was also improved for adjuvant radiation (97% vs. 70%, P < 0.01) and hormone therapy (100% vs. 76%, P = 0.01) in the PC group. Conclusions: Preoperative chemotherapy improved compliance with chemotherapy. This could represent a significant benefit over AC in populations where compliance with chemotherapy recommendations is not ideal. Improvements in surgical outcomes were also seen in patients who received preoperative chemotherapy in the community hospital setting. No significant financial relationships to disclose.

Physicians' Assessments of Adjuvant Tamoxifen's Effectiveness in Older Patients with Primary Breast Cancer

To examine physicians' assessments of tamoxifen effectiveness in breast cancer patients, identify predictors of these assessments, and estimate the relationship between these assessments and receipt of tamoxifen prescription. A cohort of breast cancer patients aged 65 and older at diagnosis and their physicians were surveyed using mailed questionnaires and telephone interviews. Community and academic hospitals in Rhode Island; North Carolina; Minnesota; and Los Angeles, California between 1996 and 1998. Physicians completed treatment recommendation forms for 496 of 865 Stage Ic to IIIa breast cancer patients. Visual scales measured physicians' assessments of the risk that individual patients would have a breast cancer recurrence or die of breast cancer with, and without, tamoxifen therapy. The mean risk ratio+/-standard deviation comparing risk of recurrence without tamoxifen with the risk with tamoxifen was 1.8+/-1.0 and for breast cancer mortality was 1.8+/-1.2. Only estrogen-receptor status and enrollment site emerged as significant predictors of recurrence and mortality risk ratios in regression models. Patients for whom the physician estimated that the recurrence or mortality risk doubled without tamoxifen were more likely to receive a tamoxifen prescription than patients for whom the physician estimated that tamoxifen would have no effect (odds ratio (OR)=1.4, 95% confidence interval (CI)=0.98-2.1 for recurrence risk, OR=1.8; 95% CI=1.2-2.6 for mortality risk). Estrogen receptor status most strongly influenced physicians' assessments of tamoxifen's effectiveness in individual patients; this effectiveness was not found to be associated with advancing patient age. Estrogen receptor status and enrollment site were related to receipt of tamoxifen prescription, but advancing age was not after accounting for physician's individualized assessment of tamoxifen's effectiveness. These findings suggest that an evidence-based approach for hormonal therapy has been widely adopted for care of older patients with breast cancer.

Methods of preserving intercostobrachial nerve during breast cancer operation and its clinical value

To study the methods and the clinical value of preserving intercostobrachial nerve during the axillary lymph nodes excision in breast cancer operations. One hundred and sixty-two cases of stages I, II, IIIa breast cancer patients were divided into experimental group and control group respectively. The intercostobrachial nerves were preserved in experimental group and not in control group. Both groups were treated following the practice guideline of breast cancer, and found no recurrence during 4 to 36 months following up. The postoperative arm sensory disturbance was 22.2% in the experimental group, which was significantly different from that of the control group 73.3% (chi(2) = 41.80, P < 0.01), the incidence of pain is 12.5% in experimental group, which was also significantly different from that of control group 31.1% (chi(2) = 7.86, P < 0.01). Preserving intercostobrachial nerves may significantly decrease the postoperative morbidity of arm sensory disturbance and pain during axillary excision of stage I, II, IIIa breast cancer patients.

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The detection of occult metastatic breast cancer cells by RT-PCR is limited by the poor specificity of most tumour mRNA markers. MAGE-A3 is a highly specific tumour mRNA marker that is not expressed in non-cancer cells. This study assesses MAGE-A3 mRNA as a molecular marker for the detection of tumour cells in the sentinel lymph nodes (SLN) of breast cancer patients. Serial frozen sections of SLN (n= 121) were obtained from 77 AJCC (American Joint Committee on Cancer) Stage I–IIIA breast cancer patients. MAGE-A3 mRNA analysis of SLN was performed by RT-PCR and Southern blot analysis. Tumour cells were detected in 48 of 121 (40%) SLN from 77 patients by H&E or IHC staining, and 35 of 77 (45%) patients, overall, had histopathologically (H&E and/or IHC) positive SLN. Among histopathologically negative SLN, 28 of 73 (38%) SLN were MAGE-A3 mRNA positive by RT-PCR. Overall, 41 of 77 (53%) patients and 50 of 121 (41%) SLN were positive for MAGE-A3. MAGE-A3 mRNA expression in the SLN occurred more frequently with infiltrating lobular carcinoma (P< 0.001) than with infiltrating ductal carcinoma, adding further evidence of possible phenotypic differences between these 2 subtypes of breast cancer. Due to its high specificity, MAGE-A3 mRNA is a potentially useful marker for detecting breast cancer cells in the SLN. One half of breast tumours expressed MAGE-A3 mRNA, which has important potential implications for antigen-specific targeted immunotherapy. © 2001 Cancer Research Campaign http://www.bjcancer.com

Do surgical oncologists achieve lower rates of local-regional recurrence in node positive breast cancer treated with mastectomy alone?

Adjuvant radiotherapy for node positive breast cancer postmastectomy has been recommended by two previously published randomized controlled trials (RCT). The local-regional recurrence rates in the control arms, however, were considered by some critics to be excessive (> 25% at 10 years). Inadequate surgery, as evidenced by the low number of axillary nodes reported, may have resulted in the high local-regional recurrence rates, allowing for the benefits seen with radiotherapy. Fellowship trained surgical oncologists might provide "better quality" surgery, resulting in lower recurrence rates and thus making adjuvant radiotherapy unnecessary. Our objective was to establish the local-regional control rate postmastectomy in node positive breast cancer patients operated on by surgical oncologists, and to determine if treatment recommendations from previous RCTs are generalizable. Node positive stage IIb and IIIa breast cancer patients treated with mastectomy at the Medical College of Virginia Hospitals by surgical oncologists, without adjuvant radiotherapy, and entered into adjuvant chemotherapy trials between 1978 and 1993 were identified retrospectively. Pathology and follow-up records were reviewed. One hundred and thirty-seven patients were identified. A median of 18 axillary nodes was reported with a median of 4 positive nodes. The locoregional recurrence at 10-years was 27% (95% confidence interval, 19-35%). Despite some evidence of "better quality" surgery, there was no clinically significant difference in the local-regional recurrence rate in this case series compared to controls in two previous RCTs. Recommendations for postmastectomy radiotherapy should be considered for node positive breast cancers, even if operated upon by surgical oncologists.