Breast Cancer pp 637-644 | Cite as
Postmastectomy Radiation Therapy of Early Breast Cancer
Abstract
Postmastectomy radiation therapy (PMRT) in high-risk breast cancer patients reduces the risk of locoregional recurrence and improves disease-free and overall survival. This has been established in randomized trials where patients were also treated with systemic therapy indicating that in radically operated breast cancer patients, both optimal systemic and optimal locoregional therapies are important and contribute to improved prognosis of the patient.
The target of PMRT is the chest wall, and depending on tumour risk parameters, all or part of the lymph node areas draining the glandular breast tissue are included in the irradiated volume. Data pointing to the effect of including the internal mammary lymph nodes are highlighted. The ESTRO consensus for target delineation is presented, and technical issues like dose, fractionation, field arrangements, breathing-adapted respiratory techniques and use of bolus are discussed.
Balancing the gain and risk from PMRT in the individual patient is very important, and future directions in providing more individualized therapy are mentioned.
References
- 1.Halsted WS (1895) The results of operations for cure of cancer of the breast performed at Johns Hopkins Hospital from June 1889 to January 1894. Johns Hopkins Bull 4:297–319Google Scholar
- 2.Halsted WS (1907) The results of radical operations for the cure of carcinoma of the breast. Ann Surg 46:1–6CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Fisher B (1980) Laboratory and clinical research in breast cancer—The David A. Karnofsky memorial lecture. Cancer Res 40:3863–3874PubMedGoogle Scholar
- 4.Koscielny S, Tubiana M, Le MG (1984) Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination. Br J Cancer 49(6):709–715CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Hellman S (1994) Karnofsky memorial lecture: natural history of breast cancers. J Clin Oncol 12:2229–2234CrossRefPubMedGoogle Scholar
- 6.Abe O, Abe R, Enomoto K, Kikuchi K, Koyama H, Masuda H, Nomura Y, Sakai K, Sugimachi K, Tominaga T, Uchino J, Yoshida M, Haybittle JL, Davies C, Harvey VJ, Holdaway TM, Kay RG, Mason BH, Forbes JF, Wilcken N, Gnant M, Jakesz R, Ploner M, Yosef HMA, Focan C et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106CrossRefGoogle Scholar
- 7.Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K (1997) 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(14):949–955CrossRefPubMedGoogle Scholar
- 8.Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, Kamby C, Kjaer M, Gadeberg CC, Rasmussen BB, Blichert-Toft M, Mouridsen HT (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353(9165):1641–1648CrossRefPubMedGoogle Scholar
- 9.Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, Wilson KS, Knowling MA, Coppin CM, Paradis M, Coldman AJ, Olivotto IA (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337(14):956–962CrossRefPubMedGoogle Scholar
- 10.Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J (2006) Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol 24(15):2268–2275CrossRefPubMedGoogle Scholar
- 11.Muss HB, Cooper MR, Brockschmidt JK, Ferree C, Richards F, White DR, Jackson DV, Spurr CL (1991) A randomized trial of chemotherapy (L-PAM vs CMF) and irradiation for node positive breast cancer. Eleven year follow-up of a Piedmont Oncology Association trial. Breast Cancer Res Treat 19(2):77–84CrossRefPubMedGoogle Scholar
- 12.Blomqvist C, Tiusanen K, Elomaa I, Rissanen P, Hietanen T, Heinonen E, Grohn P (1992) The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial. Br J Cancer 66(6):1171–1176CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Griem KL, Henderson IC, Gelman R, Ascoli D, Silver B, Recht A, Goodman RL, Hellman S, Harris JR (1987) The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. J Clin Oncol 5(10):1546–1555CrossRefPubMedGoogle Scholar
- 14.Velez-Garcia E, Carpenter JT Jr, Moore M, Vogel CL, Marcial V, Ketcham A, Singh KP, Bass D, Bartolucci AA, Smalley R (1992) Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a South-Eastern Cancer Study Group (SEG) Trial. Eur J Cancer 28A(11):1833–1837CrossRefPubMedGoogle Scholar
- 15.McArdle CS, Crawford D, Dykes EH, Calman KC, Hole D, Russell AR, Smith DC (1986) Adjuvant radiotherapy and chemotherapy in breast cancer. Br J Surg 73(4):264–266CrossRefPubMedGoogle Scholar
- 16.Olson JE, Neuberg D, Pandya KJ, Richter MP, Solin LJ, Gilchrist KW, Tormey DC, Veeder M, Falkson G (1997) The role of radiotherapy in the management of operable locally advanced breast carcinoma: results of a randomized trial by the Eastern Cooperative Oncology Group. Cancer 79(6):1138–1149CrossRefPubMedGoogle Scholar
- 17.Tennvall-Nittby L, Tengrup I, Landberg T (1993) The total incidence of loco-regional recurrence in a randomized trial of breast cancer TNM stage II. The South Sweden Breast Cancer Trial. Acta Oncol 32(6):641–646CrossRefPubMedGoogle Scholar
- 18.Ryden S, Ferno M, Moller T, Aspegren K, Bergljung L, Killander D, Landberg T (1992) Long-term effects of adjuvant tamoxifen and/or radiotherapy. The South Sweden Breast Cancer Trial. Acta Oncol 31(2):271–274CrossRefPubMedGoogle Scholar
- 19.Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, Peto R, Baum M, Fisher B, Host H (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 12(3):447–453CrossRefPubMedGoogle Scholar
- 20.Hojris I, Overgaard M, Christensen JJ, Overgaard J (1999) Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet 354(9188):1425–1430CrossRefPubMedGoogle Scholar
- 21.McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, Fornander T, Gigante B, Jensen MB, Peto R, Rahimi K, Taylor CW, Ewertz M (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100(2):167–175CrossRefPubMedGoogle Scholar
- 22.Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, Senn HJ (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann Oncol 24(9):2206–2223CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, Fleming GF, Formenti S, Hudis C, Kirshner JJ, Krause DA, Kuske RR, Langer AS, Sledge GW Jr, Whelan TJ, Pfister DG (2001) Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19(5):1539–1569CrossRefPubMedGoogle Scholar
- 24.Taylor ME, Haffty BG, Rabinovitch R, Arthur DW, Halberg FE, Strom EA, White JR, Cobleigh MA, Edge SB (2009) ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast. Int J Radiat Oncol Biol Phys 73(4):997–1002CrossRefPubMedGoogle Scholar
- 25.Truong PT, Olivotto IA, Whelan TJ, Levine M (2004) Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ 170(8):1263–1273CrossRefPubMedPubMedCentralGoogle Scholar
- 26.McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, Gray R, Mannu G, Peto R, Whelan T, Wang Y, Wang Z, Darby S (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383(9935):2127–2135CrossRefPubMedGoogle Scholar
- 27.Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, Zackrisson S, Cardoso F (2015) Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v8–30CrossRefPubMedGoogle Scholar
- 28.Wenz F, Sperk E, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Fussl C, Sauer R (2014) DEGRO practical guidelines for radiotherapy of breast cancer IV: radiotherapy following mastectomy for invasive breast cancer. Strahlenther Onkol 190(8):705–714CrossRefPubMedGoogle Scholar
- 29.Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete SA, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P (2015) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 114(1):3–10CrossRefPubMedGoogle Scholar
- 30.Poortmans PM, Collette S, Kirkove C, Van LE, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M, De WK, Marnitz S, Barillot I, Scandolaro L, Vonk E, Rodenhuis C, Marsiglia H, Weidner N, Van TG, Glanzmann C, Kuten A, Arriagada R, Bartelink H, Van Den BW (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373(4):317–327CrossRefPubMedGoogle Scholar
- 31.Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, Vallis KA, White JR, Rousseau P, Fortin A, Pierce LJ, Manchul L, Chafe S, Nolan MC, Craighead P, Bowen J, McCready DR, Pritchard KI, Gelmon K, Murray Y, Chapman JA, Chen BE, Levine MN (2015) Regional nodal irradiation in early-stage breast cancer. N Engl J Med 373(4):307–316CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Thorsen LB, Offersen BV, Dano H, Berg M, Jensen I, Pedersen AN, Zimmermann SJ, Brodersen HJ, Overgaard M, Overgaard J (2016) DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 34:314–320Google Scholar
- 33.Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513–520CrossRefPubMedGoogle Scholar
- 34.Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, Dobbs HJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Simmons S, Sydenham MA, Venables K, Bliss JM, Yarnold JR (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14(11):1086–1094CrossRefPubMedGoogle Scholar
- 35.Feigenberg SJ, Price MN, Benda RK, Morris CG (2003) Postmastectomy radiotherapy: patterns of recurrence and long-term disease control using electrons. Int J Radiat Oncol Biol Phys 56(3):716–725CrossRefPubMedGoogle Scholar
- 36.Overgaard M, Christensen JJ (2008) Postoperative radiotherapy in DBCG during 30 years. Techniques, indications and clinical radiobiological experience. Acta Oncol 47(4):639–653CrossRefPubMedGoogle Scholar
- 37.Kirova YM, Campana F, Fournier-Bidoz N, Stilhart A, Dendale R, Bollet MA, Fourquet A (2007) Postmastectomy electron beam chest wall irradiation in women with breast cancer: a clinical step toward conformal electron therapy. Int J Radiat Oncol Biol Phys 69(4):1139–1144CrossRefPubMedGoogle Scholar
- 38.Spierer MM, Hong LX, Wagman RT, Katz MS, Spierer RL, McCormick B (2004) Postmastectomy CT-based electron beam radiotherapy: dosimetry, efficacy, and toxicity in 118 patients. Int J Radiat Oncol Biol Phys 60(4):1182–1189CrossRefPubMedGoogle Scholar
- 39.Gaffney DK, Leavitt DD, Tsodikov A, Smith L, Watson G, Patton G, Gibbs FA, Stewart JR (2001) Electron arc irradiation of the postmastectomy chest wall with CT treatment planning: 20-year experience. Int J Radiat Oncol Biol Phys 51(4):994–1001CrossRefPubMedGoogle Scholar
- 40.Pierce LJ, Butler JB, Martel MK, Normolle DP, Koelling T, Marsh RB, Lichter AS, Fraass BA (2002) Postmastectomy radiotherapy of the chest wall: dosimetric comparison of common techniques. Int J Radiat Oncol Biol Phys 52(5):1220–1230CrossRefPubMedGoogle Scholar
- 41.Thomsen MS, Berg M, Nielsen HM, Pedersen AN, Overgaard M, Ewertz M, Block T, Brodersen HJ, Caldera C, Jakobsen E, Kamby C, Kjaer-Kristoffersen F, Klitgaard D, Nielsen MM, Stenbygaard L, Zimmermann SJ, Grau C (2008) Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group. Acta Oncol 47(4):654–661CrossRefPubMedGoogle Scholar
- 42.Korreman SS, Pedersen AN, Aarup LR, Nottrup TJ, Specht L, Nystrom H (2006) Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys 65(5):1375–1380CrossRefPubMedGoogle Scholar
- 43.Nissen HD, Appelt AL (2013) Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol 106(1):28–32CrossRefPubMedGoogle Scholar
- 44.Hjelstuen MH, Mjaaland I, Vikstrom J, Dybvik KI (2012) Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular- and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk. Acta Oncol 51(3):333–344CrossRefPubMedGoogle Scholar
- 45.Lutz CM, Poulsen PR, Fledelius W, Offersen BV, Thomsen MS (2015) Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging. Acta Oncol 18:1–8Google Scholar
- 46.Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ (2010) Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys 78(5):1594–1603CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Nichols GP, Fontenot JD, Gibbons JP, Sanders ME (2014) Evaluation of volumetric modulated arc therapy for postmastectomy treatment. Radiat Oncol 9:66CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Popescu CC, Olivotto IA, Beckham WA, Ansbacher W, Zavgorodni S, Shaffer R, Wai ES, Otto K (2010) Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys 76(1):287–295CrossRefPubMedGoogle Scholar
- 49.Stovall M, Smith SA, Langholz BM, Boice JD Jr, Shore RE, Andersson M, Buchholz TA, Capanu M, Bernstein L, Lynch CF, Malone KE, Anton-Culver H, Haile RW, Rosenstein BS, Reiner AS, Thomas DC, Bernstein JL (2008) Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. Int J Radiat Oncol Biol Phys 72(4):1021–1030CrossRefPubMedPubMedCentralGoogle Scholar
- 50.bo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, Giordano FA, Herskind C, Steil V, Wenz F, Glatting G (2014) Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol 110(3):471–476CrossRefGoogle Scholar
- 51.Grantzau T, Thomsen MS, Vaeth M, Overgaard J (2014) Risk of second primary lung cancer in women after radiotherapy for breast cancer. Radiother Oncol 111(3):366–373CrossRefPubMedGoogle Scholar
- 52.Depauw N, Batin E, Daartz J, Rosenfeld A, Adams J, Kooy H, Macdonald S, Lu HM (2015) A novel approach to postmastectomy radiation therapy using scanned proton beams. Int J Radiat Oncol Biol Phys 91(2):427–434CrossRefPubMedGoogle Scholar
- 53.Shiau AC, Chiu MC, Chen TH, Chiou JF, Shueng PW, Chen SW, Chen WL, Kuan WP (2012) Surface and superficial dose dosimetric verification for postmastectomy radiotherapy. Med Dosim 37(4):417–424CrossRefPubMedGoogle Scholar
- 54.Vu TT, Pignol JP, Rakovitch E, Spayne J, Paszat L (2007) Variability in radiation oncologists' opinion on the indication of a bolus in post-mastectomy radiotherapy: an international survey. Clin Oncol (R Coll Radiol) 19(2):115–119CrossRefGoogle Scholar
- 55.Tieu MT, Graham P, Browne L, Chin YS (2011) The effect of adjuvant postmastectomy radiotherapy bolus technique on local recurrence. Int J Radiat Oncol Biol Phys 81(3):e165–e171CrossRefPubMedGoogle Scholar
- 56.Kronowitz SJ (2012) Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 130(4):513e–523eCrossRefPubMedPubMedCentralGoogle Scholar
- 57.Ribuffo D, Lo TF, Giannitelli SM, Urbini M, Tortora L, Mozetic P, Trombetta M, Basoli F, Licoccia S, Tombolini V, Cassese R, Scuderi N, Rainer A (2015) The effect of post-mastectomy radiation therapy on breast implants: unveiling biomaterial alterations with potential implications on capsular contracture. Mater Sci Eng C Mater Biol Appl 57:338–343CrossRefPubMedGoogle Scholar
- 58.Kyndi M, Sorensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J (2008) Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol 26(9):1419–1426CrossRefPubMedGoogle Scholar
- 59.Tramm T, Mohammed H, Myhre S, Kyndi M, Alsner J, Borresen-Dale AL, Sorlie T, Frigessi A, Overgaard J (2014) Development and validation of a gene profile predicting benefit of postmastectomy radiotherapy in patients with high-risk breast cancer: a study of gene expression in the DBCG82bc cohort. Clin Cancer Res 20(20):5272–5280CrossRefPubMedGoogle Scholar
- 60.Tramm T, Kyndi M, Myhre S, Nord S, Alsner J, Sorensen FB, Sorlie T, Overgaard J (2014) Relationship between the prognostic and predictive value of the intrinsic subtypes and a validated gene profile predictive of loco-regional control and benefit from post-mastectomy radiotherapy in patients with high-risk breast cancer. Acta Oncol 53(10):1337–1346CrossRefPubMedGoogle Scholar