Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Local and regional recurrence following mastectomy in breast cancer patients with 1-3 positive nodes: implications for postmastectomy radiotherapy volume

  • Park, Shin-Hyung (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Lee, Jeeyeon (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Lee, Jeong Eun (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Kang, Min Kyu (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Kim, Mi Young (Department of Radiation Oncology, Kyungpook National University Chilgok Hospital) ;
  • Park, Ho Yong (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Jung, Jin Hyang (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Chae, Yee Soo (Deaprtment of Hemato-Oncology, School of Medicine, Kyungpook National University) ;
  • Lee, Soo Jung (Deaprtment of Hemato-Oncology, School of Medicine, Kyungpook National University) ;
  • Kim, Jae-Chul (Department of Radiation Oncology, School of Medicine, Kyungpook National University)
  • Received : 2018.10.08
  • Accepted : 2018.11.28
  • Published : 2018.12.31
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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.

Keywords

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