Comprehensive Locoregional Treatment and Systemic Therapy for Postmastectomy Isolated Locoregional Recurrence
Journal
International Journal of Radiation Oncology Biology Physics
Journal Volume
72
Journal Issue
5
Pages
1456-1464
Date Issued
2008
Abstract
Purpose: To assess the impact of comprehensive locoregional therapy and systemic therapy on disease control and survival for postmastectomy patients with isolated locoregional recurrence (ILRR). Methods and Materials: A total of 115 postmastectomy breast cancer patients treated for ILRR were included. Of the patients, 98 underwent comprehensive locoregional treatment (local tumor excision plus postoperative radiotherapy), and 17 received definitive radiotherapy alone. Involved-field radiotherapy was given to 69 patients, whereas entire-field radiotherapy (both involved-field and elective-field, involving the chest wall and regional lymphatics) was given to 46 patients. Systemic therapy consisting of hormone therapy, chemotherapy, or both was given to 69% of patients. Results: Patients treated with comprehensive locoregional treatment had a significantly better 5-year invasive disease-free survival (IDFS) and overall survival (OS) after ILRR than patients treated with definitive radiotherapy alone (IDFS rate, 51% vs. 16%, p = 0.006; OS rate, 62% vs. 37%, p = 0.017). Patients with the most comprehensive locoregional treatment (recurrent tumor excision and entire-field radiotherapy) and systemic therapy had a significantly better 5-year IDFS and OS than patients given either treatment or neither treatment (IDFS rate, 52% vs. 39%, p = 0.011; OS rate, 63% vs. 50%, p = 0.026). Multivariate analysis revealed that positive axillary lymph nodes, Grade III tumor, negative estrogen and progesterone receptor status at primary diagnosis, disease-free interval of less than 2 years, and less comprehensive locoregional treatment were significantly associated with worse IDFS and OS. Conclusions: Use of comprehensive locoregional therapy and systemic therapy can achieve good survival outcome in a substantial proportion of postmastectomy patients with ILRR. ? 2008 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
Chemotherapy; Computer operating systems; Decision making; Disease control; Multivariant analysis; Patient monitoring; Shelters (from attack); Tumors; Axillary lymph nodes; Breast cancer; Breast cancers; Chest walls; Definitive radiotherapies; Hormone therapies; Locoregional recurrence; Locoregional recurrences; Metastasis; Multivariate analyses; Os rates; Overall survivals; Postoperative radiotherapies; Progesterone receptors; Recurrent tumors; Survival; Systemic therapies; Radiotherapy; anastrozole; anthracycline derivative; goserelin; letrozole; navelbine; tamoxifen; taxane derivative; adult; aged; article; breast cancer; cancer chemotherapy; cancer control; cancer localization; cancer survival; controlled study; hormonal therapy; human; major clinical study; mastectomy; priority journal; prognosis; radiation dose; treatment outcome; tumor recurrence; Adult; Aged; Breast Neoplasms; Cobalt Radioisotopes; Combined Modality Therapy; Disease-Free Survival; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Mastectomy, Modified Radical; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Particle Accelerators; Prognosis; Radiotherapy, Adjuvant; Survival Rate
Type
journal article