<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2018-0012_s_006_w2aab2b8c43b1b7b1aab1c16b1Aa"><h3>Background</h3><p>Postmastectomy radiotherapy (PMRT) improves survival by eliminating potential occult lesions in the chest wall and lymphatic drainage area. Meta-analysis has shown that PMRT reduces mortality and local recurrence of patients with node positive breast cancer, but there is no specific data about the effectiveness of PMRT in a subgroup of patients with a high number of positive axillary lymph nodes (PALN). The aim of the study was to analyse the impact of the number of PALN on local and distant metastasis occurrence, overall survival (OS) and distant metastases free survival (DMFS) in patients treated with PMRT.</p></sec><sec id="j_raon-2018-0012_s_007_w2aab2b8c43b1b7b1aab1c16b2Aa"><h3>Patients and methods</h3><p>We reviewed medical records of 129 consecutive breast cancer patients with PALN, treated at Institute of Oncology Ljubljana with PMRT between January 2003 and December 2004. We grouped patients according to the number of PALN as follows: Group 1 (less than 15 PALN) and Group 2 with more than 15 PALN. All patients received adjuvant systemic therapy according to the clinical guidelines. We analysed number of locoregional (LR) recurrences, distant metastasis, overall survival (OS), progression free survival (PFS) and DMFS.</p></sec><sec id="j_raon-2018-0012_s_008_w2aab2b8c43b1b7b1aab1c16b3Aa"><h3>Results</h3><p>After the median follow-up time of 11.5 years, the Kaplan-Meier survival analysis of PALN showed significantly shorter OS (p = 0.006), shorter PFS (p = 0.002) and shorter DMFS (p &lt; 0.001) in the group of > 15 PALN. Only one LR was found in the group of patients with more than 15 PALN. In multivariate analysis more than 15 PALN and treatment with anthracycline chemotherapy statistically significantly influenced OS and DMFS. For PFS presence of more than 15 PALN were the only independent factor of shorter survival.</p></sec><sec id="j_raon-2018-0012_s_009_w2aab2b8c43b1b7b1aab1c16b4Aa"><h3>Conclusions</h3><p>Patients with more than 15 PALN have shorter DMFS, PFS and OS as compared to patients with less than 15 PALN, though they receive the same LR treatment. More studies with higher number of patients included are needed to further evaluate our findings.</p></sec></abstract>

BackgroundPostmastectomy radiotherapy (PMRT) improves survival by eliminating potential occult lesions in the chest wall and lymphatic drainage area. Meta-analysis has shown that PMRT reduces mortality and local recurrence of patients with node positive breast cancer, but there is no specific data about the effectiveness of PMRT in a subgroup of patients with a high number of positive axillary lymph nodes (PALN). The aim of the study was to analyse the impact of the number of PALN on local and distant metastasis occurrence, overall survival (OS) and distant metastases free survival (DMFS) in patients treated with PMRT.Patients and methodsWe reviewed medical records of 129 consecutive breast cancer patients with PALN, treated at Institute of Oncology Ljubljana with PMRT between January 2003 and December 2004. We grouped patients according to the number of PALN as follows: Group 1 (less than 15 PALN) and Group 2 with more than 15 PALN. All patients received adjuvant systemic therapy according to the clinical guidelines. We analysed number of locoregional (LR) recurrences, distant metastasis, overall survival (OS), progression free survival (PFS) and DMFS.ResultsAfter the median follow-up time of 11.5 years, the Kaplan-Meier survival analysis of PALN showed significantly shorter OS (p = 0.006), shorter PFS (p = 0.002) and shorter DMFS (p < 0.001) in the group of > 15 PALN. Only one LR was found in the group of patients with more than 15 PALN. In multivariate analysis more than 15 PALN and treatment with anthracycline chemotherapy statistically significantly influenced OS and DMFS. For PFS presence of more than 15 PALN were the only independent factor of shorter survival.ConclusionsPatients with more than 15 PALN have shorter DMFS, PFS and OS as compared to patients with less than 15 PALN, though they receive the same LR treatment. More studies with higher number of patients included are needed to further evaluate our findings.

Is postmastectomy radiotherapy really needed in breast cancer patients with many positive axillary lymph nodes?

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundPostmastectomy radiotherapy (PMRT) improves survival by eliminating potential occult lesions in the chest wall and lymphatic drainage area. Meta-analysis has shown that PMRT reduces mortality and local recurrence of patients with node positive breast cancer, but there is no specific data about the effectiveness of PMRT in a subgroup of patients with a high number of positive axillary lymph nodes (PALN). The aim of the study was to analyse the impact of the number of PALN on local and distant metastasis occurrence, overall survival (OS) and distant metastases free survival (DMFS) in patients treated with PMRT.Patients and methodsWe reviewed medical records of 129 consecutive breast cancer patients with PALN, treated at Institute of Oncology Ljubljana with PMRT between January 2003 and December 2004. We grouped patients according to the number of PALN as follows: Group 1 (less than 15 PALN) and Group 2 with more than 15 PALN. All patients received adjuvant systemic therapy according to the clinical guidelines. We analysed number of locoregional (LR) recurrences, distant metastasis, overall survival (OS), progression free survival (PFS) and DMFS.ResultsAfter the median follow-up time of 11.5 years, the Kaplan-Meier survival analysis of PALN showed significantly shorter OS (p = 0.006), shorter PFS (p = 0.002) and shorter DMFS (p  15 PALN. Only one LR was found in the group of patients with more than 15 PALN. In multivariate analysis more than 15 PALN and treatment with anthracycline chemotherapy statistically significantly influenced OS and DMFS. For PFS presence of more than 15 PALN were the only independent factor of shorter survival.ConclusionsPatients with more than 15 PALN have shorter DMFS, PFS and OS as compared to patients with less than 15 PALN, though they receive the same LR treatment. More studies with higher number of patients included are needed to further evaluate our findings.

BackgroundPostmastectomy radiotherapy (PMRT) improves survival by eliminating potential occult lesions in the chest wall and lymphatic drainage area....

Patients characteristics	No patients	%
	129	100
Age (years)
Median	56
Q1-Q3	48-64
Histology
IDC	104	80.7
ILC	25	19.3
Tumour size
T1	29	9.3
T2	79	45.7
T3	21	45.0
Histological grade
G1	12	9.3
G2	59	45.7
G3	58	45.0
Lymphovascular invasion
Yes	54	41.9
No	64	49.6
N/A	11	8.5
Perineural invasion
Yes	20	15.5
No	83	64.3
N/A	26	20.2
No. of positive axillary lymph nodes (PALN)
1-3	29	22.5
4-15	70	54.3
>15	30	23.2
No. of PALN according to N category
N1	29	22.5
N2	47	36.5
N3	53	41.0
Estrogen receptor
Positive	100	77.5
Negative	29	22.5
Progesteron receptor
Positive	85	65.9
Negative	44	34.1
HER-2 overexpression
Positive	37	28.7
Negative	92	71.3
Adjuvant hormone therapy
Yes	101	78.3
No	28	21.7
Adjuvant chemotherapy
Yes	108	83.7
No	21	16.3
Adjuvant chemotherapy with anthracycline:
Yes	99	76.7
No	30	23.2
Breast cancer subtype
Luminal A	61	47.3
Luminal B	40	31.0
Her2-overexpression	12	12.4
Triple negative breast cancer (TNBC)	16	9.3

Is postmastectomy radiotherapy really needed in breast cancer patients with many positive axillary lymph nodes?

Article Category: Research Article

Published Online: Mar 08, 2018

Page range: 275 - 280

Received: Dec 13, 2017

Accepted: Dec 21, 2017

DOI: https://doi.org/10.2478/raon-2018-0012

© 2018 Tanja Marinko, Karmen Stanic, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Patients’ characteristics