269 786

Cited 16 times in

Do Recent Advances in Diagnostic and Therapeutic Procedures Negate the Benefit of Postmastectomy Radiotherapy in N1 Patients With a Low Risk of Locoregional Recurrence?

Authors
 Jee Suk Chang  ;  Jeongshim Lee  ;  Kyung Hwan Kim  ;  Joo Hyuk Sohn  ;  Seung Il Kim  ;  Byeong-Woo Park  ;  Hyun Cheol Chung  ;  Ki Chang Keum  ;  Chang-Ok Suh  ;  Yong Bae Kim 
Citation
 MEDICINE, Vol.94(33) : 1259, 2015 
Journal Title
MEDICINE
ISSN
 0025-7974 
Issue Date
2015
MeSH
Antineoplastic Agents/therapeutic use* ; Breast Neoplasms*/epidemiology ; Breast Neoplasms*/pathology ; Breast Neoplasms*/therapy ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Radical*/methods ; Mastectomy, Radical*/statistics & numerical data ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Outcome Assessment (Health Care) ; Radiotherapy, Adjuvant*/methods ; Radiotherapy, Adjuvant*/statistics & numerical data ; Republic of Korea/epidemiology ; Risk Assessment ; Tumor Burden
Abstract
Recent advances in breast cancer management might make the use of postmastectomy radiotherapy (PMRT) redundant in the treatment of pT1/T2N1 patients. We investigated the impact of PMRT on disease-free survival (DFS) in these patients who have a low risk of locoregional recurrence (LRR) after contemporary multidisciplinary management.Between 1998 and 2011, 1123 patients underwent upfront surgery for pathologically diagnosed pT1/T2N1 breast cancer, at a single institution. A retrospective review was performed on 692 patients who had a mastectomy with axillary lymph node (LN) clearance. Most patients received adjuvant systemic chemotherapy and/or endocrine therapy. PMRT was administered to 17.8% of the patients. The median follow-up time was 98 months.The entire cohort was divided into 2 groups, the early-era (1998-2003) and late-era (2004-2011) cohorts. Grouping was based on the use of modern therapies since 2004 including sentinel LN (SLN) biopsy, anthracycline/taxane-based chemotherapy, and aromatase inhibitors. Late-era patients had a significantly lower 5-year LRR compared with early-era patients (3.2% vs 10.3%, respectively; P < 0.001). In late-era patients, although PMRT did not significantly reduce the 5-year LRR rate (1% vs 3.8%, respectively), it did improve the 5-year DFS rate (96.1% vs 87.5%, respectively). After controlling for all clinicopathological variables, PMRT was independently associated with improved DFS. In subgroup analysis, depending on the presence of micro- or macrometastasis in the axillary nodes, the benefit of PMRT was most apparent in patients with macrometastasis (hazard ratio, 0.19). In the late-era cohort with no PMRT, the 3-year distant metastasis risk increased according to LN tumor burden (0%, 5.2%, and 9.8% in micrometastasis, SLN macrometastasis, and non-SLN macrometastasis, respectively).Advanced surgical and systemic therapies might not negate the benefit of PMRT in recently diagnosed pN1 patients who have a very low risk for LRR. Our data indicate that the overall recurrence risk combined with the LRR should be considered for an indication of PMRT, and raises the question of whether the receipt of PMRT would improve outcome in patients with micrometastasis.
Files in This Item:
T201503083.pdf Download
DOI
10.1097/MD.0000000000001259
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Seung Il(김승일)
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Suh, Chang Ok(서창옥)
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Lee, Jeong Shim(이정심)
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Chung, Hyun Cheol(정현철) ORCID logo https://orcid.org/0000-0002-0920-9471
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140942
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links