Second Place Tie Residents' Competition: irradiation effect after mastectomy on breast cancer recurrence in patients presenting with locally advanced disease

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• 作者：Angie R. Taras M.D.^a ; Jason D. Thorpe M.S.^b ; Astrid D. Morris M.D.^c ; Mary Atwood C.T.R.^d ; Kimberly A. Lowe Ph.D.^e ; J. David Beatty M.D.^a ; ^{David.Beatty@swedish.org"" rel=""nofollow}
• 关键词：Breast cancer ; Irradiation ; Mastectomy ; Recurrence ; Disease-free survival
• 刊名：The American Journal of Surgery
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：201
• 期：5
• 页码：603-607
• 全文大小：339 K

文摘

Background

Current guidelines recommend postmastectomy irradiation (PMI) for patients with tumors >5 cm and/or ≥4 positive lymph nodes. This study evaluates the effect of PMI on recurrence and survival within tumor size and node status groups.

Methods

Locoregional and distant recurrences and survival for different tumor and treatment characteristics were analyzed in 2,797 patients with invasive breast cancer treated with mastectomy.

Results

Tumor size, positive nodes, extranodal extension, lymphatic/vascular invasion, estrogen receptor/progesterone negative, HER-2 positive, and high grade were associated with significantly increased recurrence. In patients with ≥4 positive nodes and patients with tumors >5 cm and positive nodes, PMI decreased local and distant recurrence (overall 53 % vs 24 % , P < .001) and increased disease-free survival (P < .001) but not overall survival. In patients with less disease, a benefit from PMI irradiation could not be identified.

Conclusions

PMI is indicated for patients with ≥4 positive nodes or patients with tumors >5 cm and positive nodes.