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Research Paper | Radiological Sciences | Egypt | Volume 5 Issue 8, August 2016
Evaluation of the Role of Postmastectomy Radiotherapy in Women with One to Three Positive Auxillary Nodes with Extracapsular Invasion
Nabila Hezi. MD | Nadia Ali. MD [2]
Abstract: Background There is insufficient evidence to suggest the routine use of postmastectomy radiotherapy (PMRT) in women with T1-T2 breast carcinoma and 1-3 positive lymph nodes with extracapsular invasion (ECI). PURPOSE To determine whether PMRT after adjuvant chemotherapy will reduce the risk of loco-regional recurrence (LRR) and thus improve survival, in this group of patients. Patients and methods Between May 2010 and December 2015, 64 women with pathologic T1-T2 breast carcinoma and 1-3 positive nodes with ECI, and who had undergone modified radical mastectomy and received adjuvant chemotherapy, were randomized to PMRT (group A, n=32) or no adjuvant radiotherapy (group B, n=32). Loco-regional radiotherapy schedule was 50 Gy in 25 fractions over 5 weeks. The median Follow-up period was 50 months (range, 35-66). Results The two treatment groups were well balanced with respect to the known prognostic factors. Out of 64 patients, 53 % were < 45 years, 75 % had more than one positive node with ECI 56 % had stage T2, 61 % had lymphovascular invasion, 31 % were negative estrogen receptor and 23 % had histologic grade 3. LRR rates were 12.5 % and 25 % of patients in group A and group B, respectively (P < 0.05). The estimated 5-year disease free survival rates were 81 % and 68 % of patients in group A and group B, respectively (P > 0.05). The 5-year overall survival rates were 96 % and 93 % of patients in group A and group B, respectively (P > 0.05). Univariate analysis failed to show any impact of prognostic factors on local recurrence free survival, distant metastasis free survival or overall survival. Three patients in group A and one in group B developed grade-3 lymphedema. None of the patients have developed radiation pneumonitis, brachial plexopathy or cardiac events. Conclusion In women with T1-T2 breast carcinoma and 1-3 positive lymph nodes with ECI, significantly lower LRR was observed with PMRT than without adjuvant radiotherapy. Further trials with a larger number of patients and longer follow-up periods are needed to optimize loco-regional control and potentially improve survival in this group of patients.
Keywords: Breast cancer, Post-mastectomy radiotherapy, 1-3 positive nodes, Extracapsular invasion
Edition: Volume 5 Issue 8, August 2016,
Pages: 1309 - 1313