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Pattern of care of adjuvant radiotherapy in male breast cancer patients in clinical practice: an observational study

Adjuvante Radiotherapie beim Mammakarzinom des Mannes in der klinischen Praxis: Eine Beobachtungsstudie

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Abstract

Background and purpose

Due to the rarity of male breast cancer (male BC), no consensus has been reached regarding the most appropriate curative treatment strategy. The objective of the present observational study was to identify patient and tumor characteristics and assess the role of radiotherapy (RT) in clinical practice.

Methods

Between 1998 and 2014, data of male BC patients treated at two breast centers were consecutively collected and retrospectively analyzed. Patients were stratified based on the addition of adjuvant RT. Data on overall survival (OS) and local recurrence-free survival (LRFS) were estimated with the Kaplan–Meier method and compared by the log-rank test.

Results

A consecutive cohort of 58 male BC patients was evaluated. Median follow-up was 56 months. Twenty-one patients (36.2%) received adjuvant RT. Overall, patients undergoing postoperative RT were characterized by more high-risk features. Patients receiving postoperative RT had significantly more frequently a high UICC stage (50 vs. 9.7% UICC III, p = 0.018) and positive lymph nodes as compared to patients undergoing surgery alone (65 vs. 34.4% pN+, p = 0.046). Accordingly, there was a higher proportion of patients receiving axillary lymph node dissection in the RT group (71.4 vs. 35.6%). Mastectomy was performed in 31/37 (86.1%) in the surgery group as compared to 14/21 (66.7%) in patients receiving postoperative RT. In addition, RT patients were more likely to receive endocrine therapy (78.9 vs. 39.3%, p = 0.016). Outcome was not significantly different between the groups (5-year LRFS: 89.8 vs. 80.0%, p = 0.471 and 5‑year OS 88.4 vs. 88.9%, p = 0.819).

Conclusion

The present observational study evaluated the pattern of care in male BC patients treated in clinical practice. Due to its rarity, randomized clinical trials are unlikely and male BC remains an entity with a poor evidence base. Nevertheless, RT remains a crucial component of the multidisciplinary treatment strategy in male BC.

Zusammenfassung

Hintergrund und Zielsetzung

Das Mammakarzinom (MC) des Mannes ist eine seltene Erkrankung. Bis heute wurde noch kein Konsens hinsichtlich der optimalen kurativen Behandlungsstrategie erzielt. Das Ziel dieser Beobachtungsstudie ist es, Patienten- und Tumormerkmale zu identifizieren und die Rolle der Radiotherapie (RT) in der klinischen Praxis zu beurteilen.

Methoden

Daten von Männern mit MC wurden analysiert, die zwischen 1998 und 2004 in zwei Brustzentren behandelt wurden. Die eingeschlossenen Patienten waren entweder adjuvant bestrahlt worden oder nicht. Gesamtüberleben (OS) und lokal-rezidivfreies Überleben (LRFS) wurden mit der Kaplan-Meier-Methode bestimmt und mit dem Log-Rank-Test verglichen.

Ergebnisse

Eine Kohorte von 58 männlichen MC-Patienten wurde analysiert. Die mediane Beobachtungszeit betrug 56 Monate. Eine adjuvante RT erhielten 21 Patienten (36,2 %). Insgesamt wiesen Patienten, die postoperativ bestrahlt wurden, mehr Hochrisikofaktoren auf. Sie hatten im Vergleich zu den nur operierten Patienten signifikant häufiger ein höheres UICC-Stadium (UICC III bei 50 vs. 9,7 %; p = 0,018) und befallene Lymphknoten (pN+ in 65 vs. 34,4 %; p = 0,046). Dementsprechend erhielt in der RT-Gruppe ein größerer Anteil der Patienten eine axilläre Lymphknotendissektion (71,4 vs. 35,6 %). Eine Mastektomie wurde bei 31/37 Patienten (86,1 %) in der Gruppe mit alleiniger Operation durchgeführt, verglichen mit 14/21 Patienten (66,7 %), die eine adjuvante RT erhielten. Außerdem wurden Patienten in der RT-Gruppe häufiger mit einer zusätzlichen endokrinen Therapie behandelt (78,9 vs. 39,3 %; p = 0,016). Das Outcome war zwischen den Gruppen nicht signifikant unterschiedlich (LRFS und OS nach 5 Jahren 89,8 vs. 80,0 %; p = 0,471 bzw. 88,4 vs. 88,9 %; p = 0,819).

Schlussfolgerung

Die vorliegende Beobachtungsstudie untersuchte das Behandlungskonzept von männlichen Patienten im klinischen Alltag. Aufgrund der Seltenheit der Erkrankung sind randomisierte klinische Studien unwahrscheinlich und das MC des Mannes bleibt eine Entität mit schlechter Evidenzlage. Die RT bleibt ein wichtiger Bestandteil der multidisziplinären Behandlungsstrategie.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Paul Rogowski, Stephan Schönecker, Montserrat Pazos, Daniel Reitz, Claus Belka & Stefanie Corradini

  2. Red Cross Breast Center, Taxisstr. 3, 80637, Munich, Germany

    Michael Braun, Martin Pölcher & Claus Hanusch

  3. Breast Center at the Department of Obstetrics and Gynecology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Rachel Wuerstlein, Nadia Harbeck & Sven Mahner

  4. Comprehensive Cancer Center (CCC-LMU), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Rachel Wuerstlein, Nadia Harbeck, Sven Mahner & Claus Belka

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  1. Paul Rogowski
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Correspondence to Stefanie Corradini.

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Conflict of interest

P. Rogowski, S. Schönecker, M. Pazos, D. Reitz, M. Braun, M. Pölcher, C. Hanusch, R. Wuerstlein, N. Harbeck, S. Mahner, C. Belka, and S. Corradini declare that they have no competing interests.

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Rogowski, P., Schönecker, S., Pazos, M. et al. Pattern of care of adjuvant radiotherapy in male breast cancer patients in clinical practice: an observational study. Strahlenther Onkol 195, 289–296 (2019). https://doi.org/10.1007/s00066-018-1337-8

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