Locoregional failure 10 years after post mastectomy radiotherapy with or without adjuvant chemo-hormonal treatment

The objective of this study is to do a retrospective analysis of patterns of locoregional failure [LRF] and influential prognostic factors after post mastectomy locoregional radiotherapy [PMLRT] in breast cancer patients. From 1980 until 1995, 241 evaluable patients [their median age was 45 years with a range of 23-84 years] who underwent mastectomy and postoperative radiotherapy for T1-4, NO-2, MO breast cancer with or without adjuvant chemo-hormonal treatment were included in this study. One hundred and ninety four patients had simple mastectomy and axillary sampling, 39 modified radical mastectomy and 6 radical mastectomy. Total doses of radiotherapy ranged from 40 Gy-50 GyI16-25 fractions/4-5 weeks. Locoregional radiotherapy field [chest wall and peripheral lymphatics] excluded chest wall [CW] in 102 patients and internal mammary chain [IMC] in 84 patients. One hundred and twenty three patients received adjuvant chemo-hormonal therapy [CHT]; 76 hormonal therapy, 14 chemotherapy and 28 no CHT. The results revealed that chest wall recurrence was the commonest in 43/49 LRF patients. The 10 year locoregional progression free survival was 70.4%, while the 10 year overall survival was 60.57%. One hundred and ten patients developed recurrence; 15 LRF, 61 distant failure [DF] and 34 simultaneous LRF and DF. Cox regression analysis showed that T3 or T4 tumors, positive lymphovascular invasion, grade 3 [G3] tumors and four or more positive axillary nodes had increased the risk of LRF; while positive estrogen receptors or combined CW and peripheral lymphatics RT with or without IMC had reduced such risk. Distant failure, G3 tumors, T3 or more stage and 4 or more positive axillary nodes had increased the risk of death at 10 years; while adjuvant chemotherapy reduced such risk. Long term side effects included moderate lymphedema 25 [10.4%], second cancer 10 [4.1%] and cardiac failure 2 [0.8%]. The study concluded that post mastectomy locoregional radiotherapy [chest wall and ipsilateral peripheral lymphatics] is indicated in any T3 or T4 stage, grade 3 histology, positive lymphovascular invasion or 4 or more positive axillary nodes breast cancer patients. Indications for internal mammary chain and whole axillary radiation fields are still to be defined in prospective trials

Risk factors for locoregional failure post breast conserving therapy in stage I and II breast cancer with or without systemic adjuvant therapy: 15 years follow-up

Fifty-one evaluable patients who underwent lumpectomy and axillary dissection with postoperative radiotherapy for stage I and II breast cancer with or without adjuvant chemohormonal treatment were included in this study. Forty-seven patients had lumpectomy and axillary sampling or dissection and four patients had lumpectomy without axillary sampling. Total doses radiotherapy to tumor bed equaled 60-66 Gy/30-33 fractions/6-7 weeks. Twenty patients received adjuvant chemohormonal therapy [CHT], 18 received hormonal therapy, 2 patients received chemotherapy and 11 cases had no CHT. The study concluded that in spite of the large number of the patients in this study, large tumor size [more than 3 cm] and extensive intraductal component [EIC] association played an important role in predicting locoregional failure [LRF] following post breast conserving therapy [BCT], which requires adequate margins that in some instances requires mastectomy to preserve a cosmetically accepted breast which might be difficult with large volumes of resected breast tissue