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Impact of postmastectomy radiotherapy on the outcomes of breast cancer patients with T1–2 N1 disease

An individual patient data analysis of three clinical trials
  • Omar Abdel-RahmanEmail author
Original Article
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Abstract

Purpose

To assess the impact of postmastectomy radiotherapy (PMRT) on overall survival and relapse-free survival among breast cancer patients with T1–T2 N1 disease who received standard adjuvant systemic therapy.

Methods

This is an individual patient data pooled analysis of 1053 breast cancer patients referred for adjuvant therapy in three clinical trials (BIG 02/98, BCIRG001, and BCIRG005). Overall survival was assessed according to whether or not patients received adjuvant radiotherapy through Kaplan–Meier analysis. Univariate and multivariate analyses of predictors of overall and relapse-free survival were conducted through Cox regression analysis.

Results

Locoregional relapse rates (after a median follow up of 116 months) were 5.6% among patients who received adjuvant radiotherapy vs. 6.6% among patients who did not receive adjuvant radiotherapy. Actuarial 5‑ and 10-year locoregional relapse-free survival rates were 94 and 93%, respectively, among patients who did not receive adjuvant radiotherapy versus 95 and 92% among patients who received adjuvant radiotherapy. The following factors were associated with worse overall survival in multivariate Cox regression analysis: age < 40 years (P < 0.0001), T2 stage (P = 0.004), higher lymph node ratio (P < 0.0001), and negative hormone receptor status (P < 0.0001). Likewise, the following factors were predictive of shorter locoregional relapse-free survival: age ≤ 40 (P < 0.0001), no PMRT (P = 0.034), fluorouracil/adriamycin/cyclophosphamide (FAC) chemotherapy (P = 0.001), and higher T stage (P = 0.002).

Conclusion

The current analysis does not show a beneficial impact of PMRT on overall or relapse-free survival among patients with T1–T2 N1 disease who received standard adjuvant systemic therapy. There is, however, evidence of improvement in locoregional relapse-free survival with PMRT. These findings need to be prospectively validated.

Keywords

Locoregional control Survival Prognosis Evidence-based medicine Relapse 

Auswirkungen der Strahlentherapie nach Mastektomie auf die Ergebnisse von Mammakarzinompatientinnen im Stadium T1–2 N1

Eine individuelle Patientendatenanalyse aus 3 klinischen Studien

Zusammenfassung

Ziel

Untersuchung der Auswirkungen der Postmastektomie-Strahlentherapie (PMRT) auf das Gesamtüberleben und das rezidivfreie Überleben von Mammakarzinompatientinnen im Stadium T1–2 N1, die anschließend eine systemische adjuvante Standardtherapie erhielten.

Methoden

Gepoolte individuelle Patientendatenanalyse von 1053 Mammakarzinompatientinnen mit einer adjuvanten Systemtherapie im Rahmen von drei klinischen Studien (BIG 02/98; BCIRG001, BCIRG005). Das Gesamtüberleben von Patientinnen mit und ohne adjuvante Strahlentherapie wurde mittels Kaplan-Meier-Analyse verglichen. Zur univariaten und multivariaten Analyse von unabhängigen Prädiktoren für das Gesamt- und rezidivfreie Überleben wurde eine Cox-Regression durchgeführt.

Ergebnisse

In einem medianen Follow-up-Zeitraum von 116 Monaten kam es in 5,1 % aller Patientinnen mit adjuvanter Strahlentherapie zum lokoregionären Rezidiv im Vergleich zu 6,4 % der nichtbestrahlten Patientinnen. Die rezidivfreien 5‑Jahres- und 10-Jahres-Überlebensraten betrugen 94 und 93 % bei Patientinnen ohne bzw. 95 und 92 % mit adjuvanter Strahlentherapie. Die folgenden Faktoren waren mit einem schlechteren Gesamtüberleben in der multivariaten Cox-Regression assoziiert: Alter < 40 Jahre (P < 0,0001), T2-Stadium (P = 0,004), höheres Lymphknotenverhältnis (P < 0,0001) und negativer Hormonrezeptorstatus (P < 0,0001). Zudem waren die folgenden Faktoren prädiktiv für ein kürzeres lokoregionäres rezidivfreies Überleben: Alter < 40 (P < 0,0001), kein PMRT (P = 0,034), „Fluorouracil/Adriamycin/Cyclophosphamide“(FAC)-Chemotherapie (P = 0,001) und höheres T‑Stadium (P = 0,002).

Fazit

Die aktuelle Analyse zeigt keinen positiven Einfluss der PMRT auf das Gesamt- oder rezidivfreie Überleben bei Patientinnen mit Mammakarzinom im Stadium T1–2 N1, die eine standardmäßige adjuvante Systemtherapie erhielten. Es gibt aber Hinweise auf eine Verbesserung des lokoregionalen rezidivfreien Überlebens mit PMRT. Diese Ergebnisse bedürfen jedoch einer prospektiven Evaluierung.

Schlüsselwörter

Locoregionale Kontrolle Überleben Prognose Rückfälle Medizin basierend auf Fakten 
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Notes

Acknowledgements

This publication is based on research using information obtained from www.projectdatasphere.org, which is maintained by Project Data Sphere, LLC. Neither Project Data Sphere, LLC, nor the owner(s) of any information from the website have contributed to, approved, or are in any way responsible for the contents of this publication. The datasets were downloaded from the project data sphere platform after obtaining all appropriate relevant approvals.

Compliance with ethical guidelines

Conflict of interest

O. Abdel-Rahman declares that he has no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada

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