Skip to main content

Advertisement

SpringerLink
Log in

Locoregional recurrence risk factors and the impact of postmastectomy radiotherapy on patients with tumors 5 cm or larger

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

Locoregional recurrence (LRR) after mastectomy reduces the patient’s quality of life and survival. There is a consensus that postmastectomy radiotherapy (PMRT) helps achieve locoregional control and reduces LRR. However, in patients with large tumors, the question of which variables affect the likelihood of LRR and the role of PMRT have been subjects of substantial controversy. This study investigated what the risk factors are for LRR and the efficacy of PMRT in this patient population.

Methods

This retrospective study examined 589 cases of invasive breast carcinoma with tumors 5 cm or larger from 1998 to 2008. We divided the study population into 3 groups: patients with negative nodes, 1–3 positive nodes, and ≥4 positive nodes. The relationship between various clinicopathological variables and LRR was examined, and the relationship between LRR and PMRT was estimated.

Results

During the median follow-up of 44.2 months, 38 (6.5 %) patients experienced LRR. In the multivariate analysis, independent risk factors for LRR included pectoral invasion in patients with 1–3 positive nodes, severity of lymphatic invasion, estrogen receptor-negative status, and a nodal ratio of positive/excised nodes >0.50 in patients with ≥4 positive nodes. In patients without positive nodes, none of the examined variables were significantly associated with LRR. Although patients treated with PMRT had good outcomes, there was no significant difference.

Conclusions

With systemic therapy and adequate lymph node dissection, PMRT by itself was of limited value in establishing locoregional control. Due to the very low incidence of LRR observed, PMRT was not necessary for patients with large tumors without lymph node metastasis. Further examination and consensus about the indications for PMRT in patients with 1–3 metastatic nodes are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Overgaad M, Hansen PS, Overgaard J, Rose C, Anderson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337:949–55.

    Article  Google Scholar 

  2. Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–62.

    Article  CAS  PubMed  Google Scholar 

  3. Olson JE, Neuberg D, Pandya KJ, Richter MP, Solin LJ, Gilchrist KW, et al. The role of radiotherapy in the management of operative locally advanced breast cancer: results of a randomized trial by the Eastern Cooperative Oncology Group. Cancer. 1997;79:1138–49.

    Article  CAS  PubMed  Google Scholar 

  4. Pierce LJ. The use of radiotherapy after mastectomy: a review of the literature. J Clin Oncol. 2006;23:1706–17.

    Article  Google Scholar 

  5. Taghian AG, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Low locoregional recurrence rate among node-negative breast cancer patients with tumor 5 cm or larger treated by mastectomy, with or without adjuvant systemic therapy and without radiotherapy: results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol. 2006;24:3927–32.

    Article  PubMed  Google Scholar 

  6. Jagsi R, Raad RA, Goldberg S, Sullivan T, Michaelson J, Powell SN, et al. Locoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy: implications for postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2005;62:1035–9.

    Article  PubMed  Google Scholar 

  7. Floyd SR, Buchholz TA, Haffty BG, Goldberg S, Niemierko A, Raad RA, et al. Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger. Int J Radiat Oncol Biol Phys. 2006;66:258–64.

    Article  Google Scholar 

  8. Floyd SR, Taghian AG. Post-mastectomy radiation in large node-negative breast tumors: does size really matter? Radiother Oncol. 2009;91:33–7.

    Article  PubMed  Google Scholar 

  9. Truong PT, Olivotto IA, Whelan TJ, Levine M. Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ. 2004;170:1263–73.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Goldhirsch A, Glick JH, Gelber RD, Senn HJ. Meeting highlights: international consensus panel on the treatment of primary breast cancer. J Natl Cancer Inst. 1998;90:1601–8.

    Article  CAS  PubMed  Google Scholar 

  11. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ. Meeting highlights: international consensus panel on the treatment of primary breast cancer. J Clin Oncol. 2001;19:3817–27.

    CAS  PubMed  Google Scholar 

  12. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thürlimann B, Senn HJ. Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol. 2003;21:3357–65.

    Article  PubMed  Google Scholar 

  13. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thürlimann B, Panel Members. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol. 2005;16:1569–83.

    Article  CAS  PubMed  Google Scholar 

  14. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thürlimann B, 10th St. Gallen Conference. Progress and promise: highlights of international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol. 2007;18:1133–44.

    Article  CAS  PubMed  Google Scholar 

  15. The World Health Organization. The World Health Organization histological typing of breast tumors second edition. Am J Clin Pathol. 1983;78:806–16.

    Google Scholar 

  16. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histopathological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991;19:403–10.

    Article  CAS  PubMed  Google Scholar 

  17. The Japanese Breast Cancer Society. General rules for clinical and pathological recording of breast cancer. 16th ed. (in Japanese). Tokyo: Kanehara; 2008. p. 61–3.

  18. Tsuda H, Akiyama F, Kurosumi M, Sakamoto G, Watanabe T. Establishment of histological criteria for high-risk node-negative breast carcinoma for a multi-institutional randomized clinical trial of adjuvant therapy. Jpn J Clin Oncol. 1998;28:486–91.

    Article  CAS  PubMed  Google Scholar 

  19. Taghian A, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operative breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol. 2004;22:4247–54.

    Article  PubMed  Google Scholar 

  20. Wallgren A, Bonetti M, Gelber RD, Goldhirsch A, Castiglione-Gertsh M, Holmberg SB, et al. Risk factors for locoregional recurrence among breast cancer patients: results from international breast cancer study group trials I through VII. J Clin Oncol. 2003;21:1205–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Breast Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Tomoya Nagao, Takayuki Kinoshita, Nobuko Tamura & Takashi Hojo

  2. Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Madoka Morota & Yoshikazu Kagami

Authors
  1. Tomoya Nagao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nobuko Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Hojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Madoka Morota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshikazu Kagami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Kinoshita.

About this article

Cite this article

Nagao, T., Kinoshita, T., Tamura, N. et al. Locoregional recurrence risk factors and the impact of postmastectomy radiotherapy on patients with tumors 5 cm or larger. Breast Cancer 21, 292–301 (2014). https://doi.org/10.1007/s12282-012-0391-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-012-0391-9

Keywords

Search

Navigation