To retrospectively evaluate the long-term results of postoperative nodal irradiation. Patients: A total of 271 patients with breast cancer treated between 1976 and 1993 were analyzed retrospectively. All patients underwent modified radical mastectomy and exhibited extensive axillary lymph node involvement.
Of 271 patients, 116 were non-randomly selected for postoperative irradiation (RT) of the internal mammary and supraclavicular nodes. Intensive chemotherapy (CT) such as cyclophosphamide, methotrexate, and 5-FU (CMF) was not used for adjuvant systemic therapy. Eight clinical and laboratory parameters were evaluated for their significance with regard to survival and local control at the irradiated area. Each factor was tested for significance with uni- and multivariate analysis.
The minimum and median follow-up periods for survivors were 37 and 104 months, respectively. Ten-year cause-specific overall survival (OS), disease free survival (DFS), and local control within the irradiated field (LC) for the whole cohort were 51.9%, 33.0% and 78.8%, respectively. Multivariate analysis showed that the estrogen receptor status and the number of involved nodes were the most significant prognostic factors for both OS and DFS in this group of patients. Adding RT did not improve either OS or DFS. For local control, radiation therapy as well as estrogen receptor status were significant prognostic factors.
Although postoperative nodal irradiation clearly reduced the incidence of local recurrence, it did not improve the survival of high risk patients. A clinical trial which combines an intensive CT and postoperative radiotherapy should be undertaken.
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Lythgoe JP, Palmer MK: Manchester regional breast study; 5 and 10 year results.Br J Surg 69:693–696, 1982.
Host H, Brennhovd IO, Loeb M: Postoperative radio-therapy in breast cancer; Long-term results from the Oslo study.Int J Radiat Oncol Biol Phys 12:727–732, 1986.
Rutqvist LE, Pettersson D, Johansson H: Adjuvant radiation therapy versus surgery alone in operable breast cancer; Long-term follow-up of a randomized clinical trial.Radiother Oncol 26:104–110, 1993.
Haybittle J, Brinkley D, Houghton J,et al: Post-operative radiotherapy and late mortality; Evidence from the Cancer Research Campaign trial for early breast cancer.BMJ 298:1611–1614, 1989.
Stewart H, Jack W, Forrest A: South-east Scottish trial of local therapy in node negative breast cancer.Breast 3:31, 1994.
Fisher B, Redmond C, Fisher ER,et al: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.N Engl J Med 312:674–681, 1985.
Early Breast Cancer Trialists’ Collaborative Group: Effects of radiotherapy and surgery in early breast cancer; An overview of the randomized trials.N Engl J Med 333:1444–1455, 1995.
Cuzick J, Stewart H, Rutqvist L,et al: Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy.J Clin Oncol 12:447–453, 1994.
Rutqvist LE, Lax I, Fornander T,et al: Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer.Int J Radiat Oncol Biol Phys 22:887–896, 1992.
Fowble B, Gray R, Gilchrist K,et al: Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy.J Clin Oncol 6:1107–1117, 1988.
Diab SG, Hilsenbeck SG, de Moor C,et al: Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy.J Clin Oncol 16:1655–1660, 1998.
Ragaz J, Jackson SM, Le N,et al: Adjuvant radio-therapy and chemotherapy in node-positive premenopausal women with breast cancer.N Engl J Med 337:956–962, 1997.
Overgaard M, Hansen PS, Overgaard J,et al: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy; Danish Breast Cancer Cooperative Group 82b Trial.N Engl J Med 337:949–955, 1997.
Berg JW, Robbins GF: Factors influencing short and long term survival of breast cancer patients.Surg Gynecol Obstet 122:1311–1316, 1966.
Saez RA, McGuire WL, Clark GM: Prognostic factors in breast cancer.Semin Surg Oncol 5:102–110, 1989.
Fisher B, Bauer M, Wickerham DL,et al: Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer; An NSABP update.Cancer 52:1551–1557, 1983.
Early Breast Cancer Trialists’ Collaborative Group: Polychemotherapy for early breast cancer; An over- view of the randomised trials.Lancet 352:930–942, 1998.
Gatch WD, Culbertson CG: Theories on the treatment of breast cancer and observations on its natural course.Ann Surg 135:775–781, 1952.
Ito H, Kubo A, Shigematsu N,et al: Skin metastases within the previous radiation field after prophylactic postoperative radiotherapy for breast cancer.Clin Exp Metastasis 2:235–239, 1984.
Tough IC: Massive chest wall recurrence after simple mastectomy and radiotherapy for breast cancer.J R Coll Surg Edinb 15:45–48, 1970.
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Mitsumori, M., Hiraoka, M. & Kodama, H. Long-term results of postoperative prophylactic nodal irradiation for node-positive, high-risk Breast Cancer patients. Breast Cancer 6, 193–200 (1999). https://doi.org/10.1007/BF02967167