Patients With T1 to T2 Breast Cancer With One to Three Positive Nodes Have Higher Local and Regional Recurrence Risks Compared With Node-Negative Patients After Breast-Conserving Surgery and Whole-Breast Radiotherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 73; no. 2; pp. 357 - 364
• Main Authors: Truong, Pauline T., Jones, Stuart O., Kader, Hosam A., Wai, Elaine S., Speers, Caroline H., Alexander, Abraham S., Olivotto, Ivo A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2009
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast radiotherapy; CARCINOMAS; Combined Modality Therapy; ESTROGENS; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Locoregional recurrence; Lymph Node Excision; Lymphatic Irradiation; Lymphatic Metastasis - pathology; Lymphatic Metastasis - radiotherapy; MAMMARY GLANDS; Mastectomy, Segmental; Middle Aged; MULTIVARIATE ANALYSIS; Neoplasm Recurrence, Local; Neoplasm Staging; Node-negative; Node-positive; PATIENTS; RADIATION HAZARDS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Adjuvant; RECEPTORS; Regional nodal radiotherapy; Risk; SURGERY; Young Adult; Node-negative; Node-positive; Breast cancer; Breast radiotherapy; Regional nodal radiotherapy; Locoregional recurrence
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.04.034

To evaluate locoregional recurrence according to nodal status in women with T1 to T2 breast cancer and zero to three positive nodes (0–3N+) treated with breast-conserving surgery (BCS). The study subjects comprised 5,688 women referred to the British Columbia Cancer Agency between 1989 and 1999 with pT1 to T2, 0–3N+, M0 breast cancer, who underwent breast-conserving surgery with clear margins and radiotherapy (RT) of the whole breast. The 10-year Kaplan-Meier local, regional, and locoregional recurrence (LR, RR, and LRR, respectively) were compared between the N0 ( n = 4,433) and 1–3N+ ( n = 1,255) cohorts. The LRR was also examined in patients with one to three positive nodes (1–3N+) treated with and without nodal RT. Multivariate analysis was performed using Cox regression modeling. Median follow-up was 8.6 years. Systemic therapy was used in 97% of 1–3N+ and 41% of N0 patients. Nodal RT was used in 35% of 1–3N+ patients. The 10-year recurrence rates in N0 and 1–3N+ cohorts were as follows: LR 5.1% vs. 5.8% ( p = 0.04); RR 2.3% vs. 6.1% ( p < 0.001), and LRR 6.7% vs. 10.1% ( p < 0.001). Among 817 1–3N+ patients treated without nodal RT, 10-year LRR were 13.8% with age <50 years, 20.3% with Grade III, and 23.4% with estrogen receptor (ER)–negative disease. On multivariate analysis, 1–3N+ status was associated with significantly higher LRR (hazard ratio [HR], 1.85; 95% confidence interval, 1.34–2.55, p < 0.001), whereas nodal RT significantly reduced LRR (HR, 0.59; 95% confidence interval, 0.38–0.92, p = 0.02). Patients with 1–3N+ and young age, Grade III, or ER-negative disease have high LRR risks approximating 15% to 20% despite BCS, whole-breast RT and systemic therapy. These patients may benefit with more comprehensive RT volume encompassing the regional nodes.