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Title: Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy

Abstract

Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with <10 nodes examined recurred in the low-mid axilla. Seventy-seven patients had a recurrence in the supraclavicular fossa/axillary apex (10-year actuarial rate 8%). Forty-nine were isolated regional recurrences. Significant predictors of failures in this region included {>=}4 involved axillarymore » lymph nodes, >20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p < 0.0005). The extent of axillary dissection and the size of the largest involved node were not predictive of failure within the supraclavicular fossa/axillary apex. Conclusions: These results suggest that failure in the level I-II axilla is an uncommon occurrence after modified radical mastectomy and chemotherapy. Therefore, supplemental radiotherapy to the dissected axilla is not warranted for most patients. However, patients with {>=}4 involved axillary lymph nodes, >20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall.« less

Authors:
 [1];  [2];  [2];  [2];  [2];  [2];  [3];  [4];  [5];  [2]
  1. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States). E-mail: estrom@mdanderson.org
  2. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
  3. Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
  4. Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
  5. Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
20788247
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2005.05.044; PII: S0360-3016(05)00954-5; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; CHEST; CLINICAL TRIALS; DOXORUBICIN; FAILURES; HEALTH HAZARDS; LYMPH NODES; MAMMARY GLANDS; METASTASES; PATHOLOGY; PATIENTS; RADIOTHERAPY

Citation Formats

Strom, Eric A., Woodward, Wendy A., Katz, Angela, Buchholz, Thomas A., Perkins, George H., Jhingran, Anuja, Theriault, Richard, Singletary, Eva, Sahin, Aysegul, and McNeese, Marsha D. Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy. United States: N. p., 2005. Web. doi:10.1016/J.IJROBP.2005.0.
Strom, Eric A., Woodward, Wendy A., Katz, Angela, Buchholz, Thomas A., Perkins, George H., Jhingran, Anuja, Theriault, Richard, Singletary, Eva, Sahin, Aysegul, & McNeese, Marsha D. Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy. United States. doi:10.1016/J.IJROBP.2005.0.
Strom, Eric A., Woodward, Wendy A., Katz, Angela, Buchholz, Thomas A., Perkins, George H., Jhingran, Anuja, Theriault, Richard, Singletary, Eva, Sahin, Aysegul, and McNeese, Marsha D. Thu . "Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788247,
title = {Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy},
author = {Strom, Eric A. and Woodward, Wendy A. and Katz, Angela and Buchholz, Thomas A. and Perkins, George H. and Jhingran, Anuja and Theriault, Richard and Singletary, Eva and Sahin, Aysegul and McNeese, Marsha D.},
abstractNote = {Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with <10 nodes examined recurred in the low-mid axilla. Seventy-seven patients had a recurrence in the supraclavicular fossa/axillary apex (10-year actuarial rate 8%). Forty-nine were isolated regional recurrences. Significant predictors of failures in this region included {>=}4 involved axillary lymph nodes, >20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p < 0.0005). The extent of axillary dissection and the size of the largest involved node were not predictive of failure within the supraclavicular fossa/axillary apex. Conclusions: These results suggest that failure in the level I-II axilla is an uncommon occurrence after modified radical mastectomy and chemotherapy. Therefore, supplemental radiotherapy to the dissected axilla is not warranted for most patients. However, patients with {>=}4 involved axillary lymph nodes, >20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 63,
place = {United States},
year = {Thu Dec 01 00:00:00 EST 2005},
month = {Thu Dec 01 00:00:00 EST 2005}
}