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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 2  |  Page : 279-283

Post-mastectomy radiation beyond chest wall in patients with N1 breast cancer: Is there a benefit?


Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Budhi Singh Yadav
Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.136560

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Introduction: Nodal stage is the most important prognostic factor and one of the indicators for loco-regional radiation in patients with breast cancer. N1 (patients with 1-3 lymph node metastases in axilla) nodal stage is a controversial area as far as axillary and supraclavicular fossa (SCF) irradiation is concerned. We conducted a retrospective analysis at our institute to assess the impact of post-mastectomy radiotherapy (PMRT) beyond chest wall (CW) in N1- nodal stage breast cancer patients. Materials and Methods: Since January 2004 to December 2007, 293 post-mastectomy patients with N1 nodal stage breast cancer were analyzed for patient-related characteristics such as age, menopausal status, pathological stage/tumour size, tumour location, histology, oestrogen/progesterone receptor status, histological grade, extra capsular extension, lymph vascular invasion and treatment-related factors, PMRT and systemic therapy. Outcome studied were locoregional recurrence rate (LRR), disease free survival (DFS) and overall survival (OS). Results: At a median follow up of 55m, 260 patients received radiotherapy; 212 to CW+SCF, 48 to the CW only; and 33 patients did not receive radiotherapy. LRR was 5% in patients who received radiotherapy to CW+SCF and 8% in CW only (P = 0.34). There was no difference in the DFS between the two groups. OS at 5 year was 88% in CW+SCF group and 76% in CW only group respectively (P < 0.001). Conclusion: In N1 nodal stage patients with breast cancer LRR was not significantly different after radiation to CW+SCF or to the CW only but OS was significantly better.

Abstract in Chinese

N1乳腺癌患者行扩大胸壁范围的术后放疗是否有获益? 摘要 背景:淋巴结分期是影响预后的重要因素之一,也是乳腺癌患者的局部区域放疗的指征。N1(1到3个淋巴结转移的腋窝淋巴结分期患者)的腋窝和锁骨上窝(SCF)照射是一个有争议的地区。我们对在我院术后放疗(PMRT)的范围超过胸壁(CW)的N1淋巴结分期的乳腺癌患者进行了一项回顾性分析。 材料与方法:自2004年1月至2007年12月共293术后患者N1淋巴结分期的乳腺癌患者,分析临床病理因素如年龄,绝经状态,病理分期/肿瘤的大小,肿瘤位置,组织学,雌激素/孕激素受体状态,组织学分级,包膜外侵犯,淋巴血管侵犯,术后放疗和全身治疗等与预后的关系。研究结果为局部复发率(LRR),无病生存率(DFS)和总生存期(OS)。 结果:平均随访55个月,260例病人接受了放疗:212例 CW + SCF(胸壁+锁骨上窝),48例只进行胸壁放疗。另外33例未接受放疗。局部复发率LRR :胸壁+锁骨上窝组为5%,单纯胸壁组 8%(P = 0.34)。两组之间在DFS无显着差异。5年生存率为88%(胸壁+锁骨上窝组)和 76%(单纯胸壁组)(P<0.001)。 结论:胸壁+锁骨上窝照射较单纯胸壁放疗在N1淋巴结分期乳腺癌患者中的局部复发率无显著差异,但前者 OS明显高于后者。 关键词:乳腺癌,胸壁,局部复发率,总生存率,术后放疗



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