Radiat Oncol J.  2018 Dec;36(4):285-294. 10.3857/roj.2018.00458.

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

• Park SH
• Lee J
• Lee JE
• Kang MK
• Kim MY
• Park HY
• Jung JH
• Chae YS
• Lee SJ
• Kim JC

• KMID: 2434317
• DOI: http://doi.org/10.3857/roj.2018.00458

Abstract

PURPOSE
To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1-3 positive nodes and a tumor size of <5 cm.
MATERIALS AND METHODS
We retrospectively analyzed data of 133 female breast cancer patients with 1-3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%).
RESULTS
Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence.
CONCLUSION
Our study showed a very low local recurrence in patients with 1-3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient's given risk for local and regional recurrence, and possible radiation-related toxicities.

Keyword

Breast neoplasms; Recurrence; Mastectomy; Radiotherapy

MeSH Terms

Breast Neoplasms*
Breast*
Chemotherapy, Adjuvant
Cyclophosphamide
Disease-Free Survival
Drug Therapy
Female
Follow-Up Studies
Humans
Lymph Node Excision
Mastectomy*
Neoplasm Metastasis
Radiotherapy*
Recurrence*
Retrospective Studies
Trastuzumab
Cyclophosphamide
Trastuzumab