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Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes.

Publication ,  Journal Article
Moo, TA; McMillan, R; Lee, M; Stempel, M; Patil, S; Ho, A; El-Tamer, M
Published in: Ann Surg Oncol
October 2013

BACKGROUND: Postmastectomy radiotherapy (PMRT) is well established in patients with ≥4 positive axillary lymph nodes (ALN); indications in 1 to 3 positive ALN remains controversial. We examined clinicopathologic criteria used for PMRT selection and compared locoregional recurrence (LRR), recurrence-free survival (RFS), and overall survival (OS) among patients with and without PMRT. METHODS: Between 1995 and 2006, a total of 1,331 patients with T1-T2 tumors and 1 to 3 positive ALN underwent mastectomy. We excluded T3/T4 tumors and neoadjuvant chemotherapy; we analyzed 1,087 patients (924 without PMRT, 163 with PMRT). Chi square testing compared clinicopathologic features between groups. The Kaplan-Meier method and Cox regression analysis examined the association between PMRT and LRR, RFS, and OS. RESULTS: PMRT patients were more likely to be ≤50 years old (p = 0.001) and to have larger tumors (p = 0.01), disease of a higher histologic grade (p = 0.03), lymphovascular invasion (LVI) (p < 0.0001), a greater number of positive ALN (p < 0.0001), extranodal invasion (p < 0.0001), and macroscopic ALN metastases (p < 0.0001). With a median follow-up of 7 years, PMRT and no-PMRT groups were similar in LRR (p = 0.57), RFS (p = 0.70), and OS (p = 0.28). On multivariate analysis of the no-PMRT group, age ≤50 years (p = 0.002) and presence of LVI (p < 0.0001) were associated with LRR. Stratified by age and LVI, patients ≤50 years old and with LVI had the highest 5-year LRR, 10.1 versus 1.1 %, than in patients >50 years old without LVI (p < 0.001). CONCLUSIONS: By using clinicopathologic features, clinicians delivered PMRT to a select group of patients with T1-T2 tumors and 1 to 3 positive ALN, resulting in similarly low rates of 5-year LRR. Among patients not receiving PMRT, age ≤50 years and LVI were associated with increased LRR rates and warrant PMRT consideration.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2013

Volume

20

Issue

10

Start / End Page

3169 / 3174

Location

United States

Related Subject Headings

  • Young Adult
  • Radiotherapy, Adjuvant
  • Prospective Studies
  • Prognosis
  • Patient Selection
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Middle Aged
 

Citation

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Moo, T. A., McMillan, R., Lee, M., Stempel, M., Patil, S., Ho, A., & El-Tamer, M. (2013). Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol, 20(10), 3169–3174. https://doi.org/10.1245/s10434-013-3117-0
Moo, Tracy Ann, Robert McMillan, Michele Lee, Michelle Stempel, Sujata Patil, Alice Ho, and Mahmoud El-Tamer. “Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes.Ann Surg Oncol 20, no. 10 (October 2013): 3169–74. https://doi.org/10.1245/s10434-013-3117-0.
Moo TA, McMillan R, Lee M, Stempel M, Patil S, Ho A, et al. Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol. 2013 Oct;20(10):3169–74.
Moo, Tracy Ann, et al. “Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes.Ann Surg Oncol, vol. 20, no. 10, Oct. 2013, pp. 3169–74. Pubmed, doi:10.1245/s10434-013-3117-0.
Moo TA, McMillan R, Lee M, Stempel M, Patil S, Ho A, El-Tamer M. Selection criteria for postmastectomy radiotherapy in t1-t2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol. 2013 Oct;20(10):3169–3174.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2013

Volume

20

Issue

10

Start / End Page

3169 / 3174

Location

United States

Related Subject Headings

  • Young Adult
  • Radiotherapy, Adjuvant
  • Prospective Studies
  • Prognosis
  • Patient Selection
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Neoplasm Grading
  • Middle Aged