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Survival Benefit with Radiation Therapy in Node-Positive Breast Carcinoma Patients

Überlebensvorteil bei postoperativer Strahlentherapie bei Patientinnen mit Mammakarzinom und Lymphknotenbefall

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Background and Purpose:

Postoperative radiation therapy (RT) has been the subject of discussion, especially in patients with one to three positive lymph nodes (≤ 3 pN+) in the axillary dissection. The authors investigated whether postoperative RT provides a survival benefit for pT1–2 pN+ breast cancer patients.

Patients and Methods:

Patients included were selected from the SEER database (NCI – Surveillance, Epidemiology and End Results, release 2000; n = 24,410) and the UZ Brussel database (1984–2002; n = 1,011) according to the following criteria: women aged 25–95, no previous cancer, unilateral pT1–pT2 breast tumors, total mastectomy (ME) or breast-conserving surgery (BCS), postoperative RT, and an axillary dissection showing at least one pathologic lymph node.

Results:

The overall survival (OS) of patients in the SEER and UZ Brussel databases who received postoperative RT was identical. However, patients in the SEER database who did not receive RT had a significantly worse outcome (p < 0.0001). After ME or BCS, all patients (SEER and UZ Brussel) who had ≥ 4 pN+ and received RT had comparable outcomes after 15 years. The 15-year OS in the subgroup with ME and ≤ 3 pN+ nodes was 57.0% and 46.6% (p = 0.0004) with RT (UZ Brussel) and without RT (SEER), respectively. For BCS and ≤ 3 pN+, the same significant difference in OS at 15 years was seen: 63.8% after RT (UZ Brussel) and 60.4% without RT (SEER; p = 0.0029).

Conclusion:

RT provides a survival benefit in patients with ≤ 3 or ≥ 4 pN+; the indication for postoperative RT should therefore be adapted in future consensus meetings.

Hintergrund und Ziel:

Der Nutzen einer postoperativen Strahlentherapie (RT) wird diskutiert, insbesondere bei Patientinnen mit einem bis drei befallenen Lymphknoten (≤ 3 pN+). In der vorliegenden Studie wird untersucht, ob die postoperative RT fur Patientinnen mit Mammakarzinom im Stadium pT1–2 pN+ einen Überlebensvorteil bietet.

Patienten und Methodik:

Die Patientinnen wurden aus der SEER-Datenbank (NCI – Surveillance, Epidemiology and End Results, Ausgabe 2000; n = 24 410) und der Datenbank des UZ Brussel (1984–2002; n = 1 011) ausgewahlt. Berücksichtigt wurden folgende Kriterien: Frauen im Alter von 25–95 Jahren, keine Krebserkrankung in der Vorgeschichte, unilaterale Mammakarzinome Stadium pT1–pT2, Mastektomie (ME) oder brusterhaltende Operation (BCS [„breast-conserving surgery“]), postoperative RT und Axilladissektion mit mindestens einem befallenen Lymphknoten.

Ergebnisse:

Das Gesamtüberleben (OS [„overall survival“]) der Patientinnen aus der SEER-Datenbank und der Datenbank des UZ Brussel, die postoperativ bestrahlt worden waren, war identisch. Demgegenüber fand sich bei Patientinnen aus der SEER-Datenbank, die keine postoperative RT erhalten hatten, ein schlechteres Ergebnis (p < 0,0001). Unabhangig von der Art des operativen Eingriffs (ME oder BCS) zeigten alle Patientinnen (SEER und UZ Brussel), die ≥ 4 pN+ aufwiesen und eine RT erhalten hatten, vergleichbare Resultate nach 15 Jahren. Das 15-Jahres-OS in der Untergruppe mit ME und ≤ 3 pN+ betrug 57,0% und 46,6% (p = 0,0004) mit RT (UZ Brussel) bzw. ohne RT (SEER). Bei Patientinnen nach BCS und ≤ 3 pN+ zeigte sich der gleiche signifikante Unterschied im OS nach 15 Jahren: 63,8% nach RT (UZ Brussel) und 60,4% ohne RT (SEER; p = 0,0029).

Schlussfolgerung:

Die RT bietet sowohl fur Patientinnen mit ≤ 3 als auch mit ≥ 4 pN+ einen Uberlebensvorteil; deshalb sollte in künftigen Konsensuskonferenzen die Indikationsstellung für eine postoperative RT angepasst werden.

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Authors and Affiliations

  1. Department of Radiotherapy, Oncologic Center UZ Brussel, Brussels, Belgium

    Mia Voordeckers, Vincent Vinh-Hung & Guy Storme

  2. Department of Oncologic Surgery, Oncologic Center UZ Brussel, Brussels, Belgium

    Jan Lamote

  3. Department of Radiotherapy, Centre Hospitalier “Peltzer-La Tourelle”, Verviers, Belgium

    Annette Bretz

  4. Radiotherapy Department, UZ Brussel, Laarbeeklaan 101, 1090, Jette, Belgium

    Mia Voordeckers

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  1. Mia Voordeckers
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  2. Vincent Vinh-Hung
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  4. Annette Bretz
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  5. Guy Storme
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Correspondence to Mia Voordeckers.

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Voordeckers, M., Vinh-Hung, V., Lamote, J. et al. Survival Benefit with Radiation Therapy in Node-Positive Breast Carcinoma Patients. Strahlenther Onkol 185, 656–662 (2009). https://doi.org/10.1007/s00066-009-2047-z

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  • DOI: https://doi.org/10.1007/s00066-009-2047-z

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