Results of Postoperative Radiation Therapy in 77 Patients of Breast Cancer

Kim, Yeon Shil; Jang, Hong Seok; Ryu, Mi Ryeong; Kim, Sung Hwan; Chung, Sang Sul; Yoon, Sei Chul; Kim, In Chul; Shinn, Kyung Sub

Abstract

PURPOSE: This retrospective study was performed to evaluate the effect of postoperative adjuvant radiation therapy of breast cancer on survival, failure patterns and to identify unfavorable prognostic factors.
MATERIALS AND METHODS
Seventy-seven patients were analysed retrospectively. Median follow up period was 72 months. According to AJCC system, fifty-eight patients (75%) were advanced than Stage IIb. Among 77 patients, 66 patients (86%) received mastectomy and axillary LN dissection and the other 11 patients (14%) received partial mastectomy and axillary LN dissection. Postoperative radiation therapy with 6 MV X-ray was given to the chest wall and regional lymphatics with total dose of 50 to 55 Gy. Fifty-five patients (71%) received CMF or CAF chemotherapy prior to or after radiation therapy.
RESULTS
The 5 year and 10 year survival rate were 64.4% and 51.3%, respectively and 5 year and 10 year disease free survival rate were 57.6% and 47.5%, respectively. Median survival duration was 91 months. Of the 77 patients, 59 patients were evaluable for pattern of failure. Of these, eighteen patients (31%) failed. Initial failure pattern was as follow: 7 (12%) at locoregional, 3 (5%) in distant metastasis, 8 (14%) with locoregional and distant metastasis. But the pattern of final failure at the time of last follow up was contrasted. Distanf failure was the predominant pattern of failure with 29% of patients. Overall survival and disease free survival was significantly influenced by 6 factors with univariated analysis (p<0.05): AJC Stage, T stage, N Stage, number of involved axilliary LN, SCL LN mets, failure pattern. By multivariate analysis the survival difference continued to be significant in 3 factors : T stage, number of involved axillary LN, failure pattern.
CONCLUSION
These data demonstrate high locoregional control and survival rate using the combination of surgery and radiotherapy for the patients with locally advanced breast cancer. But predominant failure pattern was distant dissemination. Therefore more effective systemic therapy is needed to improve overall survival.