Patterns and risk factors for locoregional failures after mastectomy for breast cancer: an International Breast Cancer Study Group report
P Karlsson, B F Cole, B H Chua, K N Price, J Lindtner, J P Collins, A Kovács, B Thürlimann, D Crivellari, M Castiglione-Gertsch, J F Forbes, R D Gelber, A Goldhirsch, G Gruber, International Breast Cancer Study Group, P Karlsson, B F Cole, B H Chua, K N Price, J Lindtner, J P Collins, A Kovács, B Thürlimann, D Crivellari, M Castiglione-Gertsch, J F Forbes, R D Gelber, A Goldhirsch, G Gruber, International Breast Cancer Study Group
Abstract
Background: Rates and risk factors of local, axillary and supraclavicular recurrences can guide patient selection and target for postmastectomy radiotherapy (PMRT).
Patients and methods: Local, axillary and supraclavicular recurrences were evaluated in 8106 patients enrolled in 13 randomized trials. Patients received chemotherapy and/or endocrine therapy and mastectomy without radiotherapy. Median follow-up was 15.2 years.
Results: Ten-year cumulative incidence for chest wall recurrence of >15% was seen in patients aged <40 years (16.1%), with ≥4 positive nodes (16.5%) or 0-7 uninvolved nodes (15.1%); for supraclavicular failures >10%: ≥4 positive nodes (10.2%); for axillary failures of >5%: aged <40 years (5.1%), unknown primary tumor size (5.2%), 0-7 uninvolved nodes (5.2%). In patients with 1-3 positive nodes, 10-year cumulative incidence for chest wall recurrence of >15% were age <40, peritumoral vessel invasion or 0-7 uninvolved nodes. Age, number of positive nodes and number of uninvolved nodes were significant parameters for each locoregional relapse site.
Conclusion: PMRT to the chest wall and supraclavicular fossa is supported in patients with ≥4 positive nodes. With 1-3 positive nodes, chest wall PMRT may be considered in patients aged <40 years, with 0-7 uninvolved nodes or with vascular invasion. The findings do not support PMRT to the dissected axilla.
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Source: PubMed