TY - JOUR
T1 - Locoregional recurrence after doxorubicin-based chemotherapy and postmastectomy
T2 - Implications for breast cancer patients with early-stage disease and predictors for recurrence after postmastectomy radiation
AU - Woodward, Wendy A.
AU - Strom, Eric A.
AU - Tucker, Susan L.
AU - Katz, Angela
AU - McNeese, Marsha D.
AU - Perkins, George H.
AU - Buzdar, Aman U.
AU - Hortobagyi, Gabriel N.
AU - Hunt, Kelly K.
AU - Sahin, Aysegul
AU - Meric, Funda
AU - Sneige, Nour
AU - Buchholz, Thomas A.
N1 - Funding Information:
Supported in part by grants CA16672 and T32CA77050 from the National Cancer Institute and a grant from the Stanford and Joan Alexander Foundation, Houston, Texas. Dr. Buchholz is supported by Department of Defense Breast Cancer Research Program Career Development Award, BC980154.
PY - 2003/10/1
Y1 - 2003/10/1
N2 - Purpose: To compare rates of locoregional recurrence (LRR) after mastectomy, doxorubicin-based chemotherapy, and radiation with those of patients receiving mastectomy and doxorubicin-based chemotherapy without radiation and to determine predictors of LRR after postmastectomy radiation. Methods: Kaplan-Meier freedom-from-LRR rates were calculated for 470 patients treated with mastectomy, doxorubicin-based chemotherapy, and postmastectomy radiation in five single-institution clinical trials. The LRR rates in these patients were compared to previously reported rates in 1031 patients treated without radiation in the same trials. Results: Median follow-up was 14 years. Irradiated patients had significantly less favorable prognostic factors for LRR than did unirradiated patients. Despite this, in all subsets of node-positive patients, postmastectomy radiation led to lower rates of LRR. This included patients with T1 or T2 tumors and one to three positive nodes (10-year LRR rates of 3% vs. 13%, p = 0.003). Multivariate analysis of LRR for patients with this stage of disease revealed that no radiation, close/positive margins, gross extracapsular extension, and dissection of <10 nodes predicted for increased LRR (hazard ratios 6.25, 4.61, 3.27, and 2.66, respectively). Significant predictors of LRR for patients treated with postmastectomy radiation were higher number and ≥20% positive nodes, larger tumor size, lymphovascular space invasion, and estrogen receptor (ER)-negative disease. Recursive partitioning analysis revealed ER-negative status to be the most powerful discriminator of LRR in irradiated patients. Conclusions: Postmastectomy radiation decreases LRR for patients with breast cancer, including those with Stage II breast cancer and one to three positive lymph nodes.
AB - Purpose: To compare rates of locoregional recurrence (LRR) after mastectomy, doxorubicin-based chemotherapy, and radiation with those of patients receiving mastectomy and doxorubicin-based chemotherapy without radiation and to determine predictors of LRR after postmastectomy radiation. Methods: Kaplan-Meier freedom-from-LRR rates were calculated for 470 patients treated with mastectomy, doxorubicin-based chemotherapy, and postmastectomy radiation in five single-institution clinical trials. The LRR rates in these patients were compared to previously reported rates in 1031 patients treated without radiation in the same trials. Results: Median follow-up was 14 years. Irradiated patients had significantly less favorable prognostic factors for LRR than did unirradiated patients. Despite this, in all subsets of node-positive patients, postmastectomy radiation led to lower rates of LRR. This included patients with T1 or T2 tumors and one to three positive nodes (10-year LRR rates of 3% vs. 13%, p = 0.003). Multivariate analysis of LRR for patients with this stage of disease revealed that no radiation, close/positive margins, gross extracapsular extension, and dissection of <10 nodes predicted for increased LRR (hazard ratios 6.25, 4.61, 3.27, and 2.66, respectively). Significant predictors of LRR for patients treated with postmastectomy radiation were higher number and ≥20% positive nodes, larger tumor size, lymphovascular space invasion, and estrogen receptor (ER)-negative disease. Recursive partitioning analysis revealed ER-negative status to be the most powerful discriminator of LRR in irradiated patients. Conclusions: Postmastectomy radiation decreases LRR for patients with breast cancer, including those with Stage II breast cancer and one to three positive lymph nodes.
KW - Breast
KW - Locoregional recurrence
KW - Postmastectomy
KW - Radiation
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U2 - 10.1016/S0360-3016(03)00593-5
DO - 10.1016/S0360-3016(03)00593-5
M3 - Article
C2 - 12957243
AN - SCOPUS:0041328350
SN - 0360-3016
VL - 57
SP - 336
EP - 344
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -