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Wu SG, Wang J, Lei J, Lian CL, Hua L, Zhou J, He ZY. Prognostic validation and therapeutic decision-making of the AJCC eighth pathological prognostic staging for T3N0 breast cancer after mastectomy. Clin Transl Med 2020; 10:125-136. [PMID: 32508053 PMCID: PMC7240839 DOI: 10.1002/ctm2.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND T3N0 breast cancer might be a distinct clinical and biological entity, with higher heterogeneity and presenting diverse responses to locoregional and systemic therapy. The aim of the current study was to validate the prognostic effect and assess the treatment decision-making of the American Joint Committee on Cancer (AJCC) eighth pathological prognostic staging in T3N0 breast cancer after mastectomy. METHODS We retrospectively included 2465 patients with stage T3N0 breast cancer who had undergone mastectomy between 2010 and 2014 using the data from Surveillance, Epidemiology, and End Results program. The primary endpoint of this study was breast cancer-specific survival (BCSS). RESULTS Of the entire cohort, 76.0% of patients in the seventh AJCC staging system were restaged to the eighth AJCC pathological prognostic staging system. A total of 1431 (58.1%) and 1175 (47.7%) of them received chemotherapy and postmastectomy radiotherapy (PMRT), respectively. Pathological staging was an independent prognostic factor for BCSS. Using pathological prognostic stage IA as the reference, BCSS gradually became worse with increased hazard ratios. The 5-years BCSS was 96.9%, 95.5%, 91.1%, 85.6%, and 75.5% in pathological prognostic stage IA, IB, IIA, IIB, and IIIA breast cancers, respectively (P < .001). In pathological prognostic stage IA, IB, and IIA breast cancers, the receipt of PMRT or chemotherapy was not correlated with better BCSS. However, PMRT was correlated with better BCSS in pathological prognostic stage IIB disease (P = .006), but not in pathological prognostic IIIA disease. Moreover, chemotherapy was correlated with better BCSS in pathological prognostic stage IIIA disease (P = .006), but not in pathological prognostic stage IIB disease. CONCLUSIONS The eighth AJCC pathological prognostic staging system provides more risk stratification of T3N0 breast cancers after mastectomy and might affect individualized decision-making for chemotherapy and PMRT in this patient subset.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
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Barrientos R, Samtani S, Frelinghuysen M, Sotomayor C, Gormaz JG, Burotto M. Clinical decision making in postmastectomy radiotherapy in node negative breast cancer. Ecancermedicalscience 2018; 12:874. [PMID: 30483354 PMCID: PMC6214678 DOI: 10.3332/ecancer.2018.874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/29/2022] Open
Abstract
For decades, postmastectomy radiotherapy (PMRT) has been recommended for node positive [N(+)] breast cancer patients; nevertheless, the beneficial effect of PMRT for treatment of node negative [N(−)] disease remains under discussion. Nowadays, the biology of breast cancer and the risk factors (RFs) for locoregional failure (LRF) must be included in the decision on whether or not to carry out PMRT. For these reasons, the present review aims to evaluate the rationale use of PMRT in N(−) patients and discuss which subgroups may further benefit from the treatment in present times where the decision must be personalised, according to the RFs of locoregional recurrence (LRR). To perform the analysis, we ponder that LRR of over 10% should be considered unacceptable due to the fact that LRRs generate great morbidity in patients. For this purpose, we consider that routine RT in these patients is not recommended, although there are subgroups of patients with high LRR, in which PMRT could be beneficial.
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Affiliation(s)
- Rodrigo Barrientos
- Department of Radiation Oncology, Instituto de Radiomedicina IRAM, Santiago, Chile
| | - Suraj Samtani
- Department of Medical Oncology, Clinica Alemana Santiago, Vitacura, Chile
| | | | - Camilo Sotomayor
- Radiation Oncology Unit, Hospital Clinico Regional de Concepción, Concepción, Chile
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Chen J, Wu X, Christos P, Yan W, Ravi A. Adjuvant Radiation Therapy for T3N0 Breast Cancer Patients Older Than 75 Years After Mastectomy: A SEER Analysis. Clin Breast Cancer 2018; 18:e967-73. [PMID: 29914691 DOI: 10.1016/j.clbc.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/28/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Breast cancer patients with tumors > 5 cm but without nodal disease who undergo mastectomy present a clinical challenge regarding the appropriate adjuvant treatment. Traditionally, postmastectomy radiation therapy (PMRT) was the standard of care. However, recent studies have suggested local failure rates without PMRT might be low enough to omit RT. This might be especially true in the elderly. PATIENTS AND METHODS Women aged ≥ 75 years with a diagnosis of T3N0 breast cancer who had undergone mastectomy were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 database. The study period was limited to 2006 to 2009 for more modern sampling. Multivariable proportional hazards modeling was used to examine the association of treatment and mortality, adjusting for demographic and clinicopathologic factors. RESULTS A total of 635 patients were identified. The median follow-up period was 43 months. PMRT was given to 31.2% of the patients aged 75 to 79 years, 21.5% of those aged 80 to 84 years, and 11.7% of the patients aged ≥ 85 years (P < .001). The receipt of PMRT showed a trend toward improved overall survival on bivariable analysis (hazard ratio [HR], 0.58; P < .001) and multivariable analysis (HR, 0.78; P = .14). The 5-year overall survival was 64.2% for those who had received PMRT and 44.8% for those who had not. A nonsignificant trend was seen toward improved breast cancer-specific survival at 5 years on bivariable analysis (HR, 0.63; P = .09) but not on multivariable analysis. The interaction of age and PMRT receipt could have confounded the results. Patient age and tumor grade were significant indicators of the survival prognosis in these patients. CONCLUSION The results of the present analysis of the SEER database suggest that PMRT might still be beneficial in women aged > 75 years with T3N0 disease but also supports continuing efforts to confirm whether it could be safe to omit. It is likely that efforts to subdivide this population using other factors (eg, comorbidity) will be important. The search for refined inclusion and exclusion criteria for adjuvant RT remains an important field of research both clinically and economically.
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Cassidy RJ, Liu Y, Kahn ST, Jegadeesh NK, Liu X, Subhedar PD, Arciero CA, Gillespie TW, Torres MA. The role of postmastectomy radiotherapy in women with pathologic T3N0M0 breast cancer: PMRT in Patients With pT3N0M0 Breast Cancer. Cancer 2017; 123:2829-39. [DOI: 10.1002/cncr.30675] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/26/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022]
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Johnson ME, Handorf EA, Martin JM, Hayes SB. Postmastectomy radiation therapy for T3N0: a SEER analysis. Cancer 2014; 120:3569-74. [PMID: 24985911 DOI: 10.1002/cncr.28865] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/24/2014] [Accepted: 05/09/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the benefit of postmastectomy radiation therapy (PMRT) for pathologic stage T3N0M0 breast cancers. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database to investigate the benefit of PMRT in this patient population. METHODS We queried the SEER database for T3N0M0 breast cancer patients diagnosed from 2000 to 2010 who underwent modified radical mastectomy. We excluded males, patients with unknown radiation timing/type, other primary tumors, and survival <6 months. A total of 2525 patients were included in the analysis. We performed univariate and multivariate statistical analysis using chi-square tests, log-rank tests, and Cox proportional hazards regression. The primary endpoints were overall survival (OS) and cancer-specific survival (CSS). RESULTS Of the 2525 patients identified, 1063 received PMRT. The median follow-up was 56 months (range, 6-131 months). On univariate analysis, PMRT improved OS (76.5% vs 61.8%, P<.01) and CSS (85.0% vs 82.4%, P<.01) at 8 years. The use of PMRT remained significant on multivariate analysis: PMRT improved OS (hazard ratio 0.63, P<.001) and CSS (hazard ratio 0.77, P = .045). Low tumor grade (P<.01) and marital status of "married" (P = .01) also was a predictor of improved CSS on multivariate analysis. CONCLUSIONS PMRT was associated with significant improvements in both CSS and OS in patients with T3N0M0 breast cancers treated with modified radical mastectomy from 2000 to 2010. PMRT should be strongly considered in T3N0M0 patients. Postmastectomy radiation therapy is associated with significant improvements in overall and cause-specific survival in patients with T3N0M0 breast cancers treated with modified radical mastectomy from 2000 to 2010 in the SEER database. Postmastectomy radiation therapy should be strongly considered for patients who have T3N0M0 tumors.
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Affiliation(s)
- Matthew E Johnson
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Jagsi R. Postmastectomy radiation therapy: an overview for the practicing surgeon. ISRN Surg 2013; 2013:212979. [PMID: 24109522 DOI: 10.1155/2013/212979] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Abstract
Locoregional control of breast cancer is the shared domain and responsibility of surgeons and radiation oncologists. Because surgeons are often the first providers to discuss locoregional control and recurrence risks with patients and because they serve in a key gatekeeping role as referring providers for radiation therapy, a sophisticated understanding of the evidence regarding radiotherapy in breast cancer management is essential for the practicing surgeon. This paper synthesizes the complex and evolving evidence regarding the role of radiation therapy after mastectomy. Although substantial evidence indicates that radiation therapy can reduce the risk of locoregional failure after mastectomy (with a relative reduction of risk of approximately two-thirds), debate persists regarding the specific subgroups who have sufficient risks of residual microscopic locoregional disease after mastectomy to warrant treatment with radiation. This paper reviews the evidence available to guide appropriate referral and patient decision making, with special attention to areas of controversy, including patients with limited nodal disease, those with large tumors but negative nodes, node-negative patients with high risk features, patients who have received systemic chemotherapy in the neoadjuvant setting, and patients who may wish to integrate radiation therapy with breast reconstruction surgery.
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Sun JY, Wu SG, Li S, Li FY, Chen WF, Lin Q, He ZY. Locoregional recurrence of pT3N0M0 breast cancer after mastectomy is not higher than that of pT1-2N0M0: an analysis for radiotherapy. Cancer Sci 2013; 104:599-603. [PMID: 23421381 DOI: 10.1111/cas.12130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/12/2013] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to investigate the value of post-operative radiotherapy in the treatment of pT3N0M0 breast cancer after mastectomy. We analyzed the clinical data of 1390 patients with pT1-3N0M0 breast cancer who were admitted and treated from 1998 to 2007 at the Sun Yat-sen University Cancer Center. All patients underwent mastectomy and did not receive radiotherapy. The locoregional recurrence-free survival, distant metastasis-free survival and overall survival of different T stages of breast cancer were compared. The median follow-up duration was 72 months. The 10-year locoregional recurrence-free survival patients with pT1N0, pT2N0 and pT3N0 breast cancers were 95.3, 91.9 and 93.6%, respectively (χ(2) = 2.550, P = 0.279). The 10-year distant metastasis-free survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 88.1%, 81.0% and 78.4%, respectively (χ(2) = 8.254, P = 0.016). The 10-year overall survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 91.9%, 83.5% and 73.0%, respectively (χ(2) = 12.403, P = 0.002). Univariate analyses failed to identify any prognostic factors for locoregional recurrence in pT3N0 patients. Multivariate analysis showed that the T stage had no effect on locoregional recurrence. The locoregional recurrence rate in patients with pT3N0M0 breast cancer who underwent mastectomy and did not receive postoperative radiotherapy was not higher than that in patients with pT1-2N0M0 breast cancer who received the same treatment, suggesting that routine adjuvant post-operative radiotherapy should not be recommended in this patient population.
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Affiliation(s)
- Jia-Yuan Sun
- State Key Laboratory of Oncology in Southern China, China
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Clerc J, Sunyach MP, Duruisseaux M, Mignotte H, Bajard A, Tredan O, Arnaud A. [Regional recurrence of triple-negative breast cancer: interest of systematic adjuvant lymph node irradiation?]. Gynecol Obstet Fertil 2013; 41:90-95. [PMID: 22771170 DOI: 10.1016/j.gyobfe.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/03/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the percentage of regional recurrence (RR) in patients with triple-negative (TN) N0 breast cancer in order to consider the interests of a systematic adjuvant nodal irradiation. PATIENTS AND METHODS Between February 1996 and June 2009, 249 patients were treated for TN breast cancer in Léon-Bérard center (Lyon, France). All patients received first surgical treatment followed or not by chemotherapy or radiotherapy. We excluded patients with metastasis at diagnosis, patients who were initially irradiated regional lymph node, patients which ER, PR and/or HER2 status was not known and patients who didn't have standard treatment. Ultimately, 100 patients were included. RESULTS Two patients (2%) developed regional recurrence (1 sub and supraclavicular recurrence and 1 supraclavicular recurrence). The median follow-up was 34 months (95% CI: 29,2 to 37,4). The survival rate at 3 years was 98% (95% CI: 90-99). Our study showed no differences in terms of RR between TN cancers and not TN cancers for a median followed up of 34 months. CONCLUSION The results of our study do not suggest that patients with TN breast cancer should receive systematic nodal adjuvant radiotherapy.
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Affiliation(s)
- J Clerc
- Département de radiothérapie et d'oncologie, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Hamamoto Y, Ohsumi S, Aogi K, Takashima S, Shinohara S, Nakajima N, Kataoka M. Identification of candidates for postmastectomy radiotherapy in patients with pT3N0M0 breast cancer. Breast Cancer 2013; 20:218-22. [DOI: 10.1007/s12282-011-0331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
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Nagar H, Mittendorf EA, Strom EA, Perkins GH, Oh JL, Tereffe W, Woodward WA, Gonzalez-Angulo AM, Hunt KK, Buchholz TA, Yu TK. Local-regional recurrence with and without radiation therapy after neoadjuvant chemotherapy and mastectomy for clinically staged T3N0 breast cancer. Int J Radiat Oncol Biol Phys 2011; 81:782-7. [PMID: 21885207 DOI: 10.1016/j.ijrobp.2010.06.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 06/07/2010] [Accepted: 06/17/2010] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. METHODS AND MATERIALS Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were ≤40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. CONCLUSIONS Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.
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Goulart J, Truong P, Woods R, Speers CH, Kennecke H, Nichol A. Outcomes of Node-Negative Breast Cancer 5 Centimeters and Larger Treated With and Without Postmastectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 80:758-64. [DOI: 10.1016/j.ijrobp.2010.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 02/15/2010] [Accepted: 02/17/2010] [Indexed: 11/15/2022]
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Taras AR, Thorpe JD, Morris AD, Atwood M, Lowe KA, Beatty JD. Irradiation effect after mastectomy on breast cancer recurrence in patients presenting with locally advanced disease. Am J Surg 2011; 201:605-10. [DOI: 10.1016/j.amjsurg.2011.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 11/19/2022]
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Boutrus R, Taghian AG; Association of Radiotherapy and Oncology of the Mediterranean arEa (AROME). Post mastectomy radiation for large node negative breast cancer: time for a second look. Crit Rev Oncol Hematol 2012; 84 Suppl 1:e75-8. [PMID: 21115360 DOI: 10.1016/j.critrevonc.2010.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/03/2010] [Accepted: 10/01/2010] [Indexed: 11/21/2022] Open
Abstract
Patients with node negative and large primary tumors ≥5cm comprise a rare entity of breast cancer patients for which clear management guidelines are not available. Data about the rates of loco-regional failures (LRF) in this patient population are scarce and reporting widely varying observations. Post Mastectomy Radiation Therapy (PMRT) for this group of patients is controversial. In this review we examined the available literature discussing the LRF rates in this clinical setting and the value of adding PMRT in their management.
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Clavel S, Roy I, Carrier JF, Rousseau P, Fortin MA. Adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer: a survey of canadian radiation oncologists. Clin Oncol (R Coll Radiol) 2009; 22:39-45. [PMID: 19945833 DOI: 10.1016/j.clon.2009.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 09/10/2009] [Accepted: 09/14/2009] [Indexed: 11/29/2022]
Abstract
AIMS To document the use of adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer by Canadian radiation oncologists and to identify the factors influencing their clinical decisions. MATERIALS AND METHODS We conducted a survey to assess the above aims. In April 2008, a questionnaire was sent to 167 members of the Canadian and Quebec Associations of Radiation Oncologists with interest in breast cancer management. The answers were obtained through a dedicated website, which collected the raw data collected for analysis. RESULTS In total, 67 radiation oncologists completed the survey, corresponding to a 40% response rate. Most respondents were experienced and high-volume providers. We identified several areas of variation in the decision-making regarding regional lymph node irradiation after breast-conserving therapy. Regarding the decision to combine regional nodal irradiation with irradiation of the breast, the number of positive nodes after axillary dissection (1-3 vs > or =4) was a crucial determinant. For patients with between one and three positive nodes and a nodal ratio of 50%, most respondents added regional irradiation. Similarly, the same nodal ratio of 50% was the main factor for inclusion of the axillary nodal region in the radiation field. However, few radiation oncologists have chosen to include the internal mammary chain in their treatment plan. The number of positive lymph nodes, the nodal ratio, the number of lymph nodes removed and the presence of extracapsular extension were the primary self-reported factors that directed the decision to offer regional radiotherapy. CONCLUSIONS This survey showed that there is a wide variation of practices among radiation oncologists in Canada. These results support the need for treatment guidelines and provide guidance on which factors should be included in a decision-making algorithm.
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Affiliation(s)
- S Clavel
- Department of Radiation Oncology, Centre hospitalier de l'université de montréal (CHUM), Montréal, Québec, Canada.
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Floyd SR, Taghian AG. Post-mastectomy radiation in large node-negative breast tumors: does size really matter? Radiother Oncol 2009; 91:33-7. [PMID: 19201501 DOI: 10.1016/j.radonc.2008.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 09/15/2008] [Accepted: 09/19/2008] [Indexed: 11/29/2022]
Abstract
Treatment decisions regarding local control can be particularly challenging for T3N0 breast tumors because of difficulty in estimating rates of local failure after mastectomy. Reports in the literature detailing the rates of local failure vary widely, likely owing to the uncommon incidence of this clinical situation. The literature regarding this clinical scenario is reviewed, including recent reports that specifically address the issue of local failure rates after mastectomy in the absence of radiation for large node-negative breast tumors.
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Affiliation(s)
- Scott R Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
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McCammon R, Finlayson C, Schwer A, Rabinovitch R. Impact of postmastectomy radiotherapy in T3N0 invasive carcinoma of the breast. Cancer 2008; 113:683-9. [DOI: 10.1002/cncr.23611] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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