Low locoregional recurrence rates in patients treated after 2000 with doxorubicin based chemotherapy, modified radical mastectomy, and post-mastectomy radiation

Greenbaum, Michael P.; Strom, Eric A.; Allen, Pamela K.; Perkins, George H.; Oh, Julia L.; Tereffe, Welela; Yu, Tse-Kuan; Buchholz, Thomas A.; Woodward, Wendy. A.

doi:10.1016/j.radonc.2010.02.013

« Previous Next »Radiotherapy & Oncology
Volume 95, Issue 3 , Pages 312-316, June 2010

Low locoregional recurrence rates in patients treated after 2000 with doxorubicin based chemotherapy, modified radical mastectomy, and post-mastectomy radiation

Michael P. Greenbaum
- The Methodist Hospital, Houston, TX, USA
Eric A. Strom
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Pamela K. Allen
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
George H. Perkins
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Julia L. Oh
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Welela Tereffe
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Tse-Kuan Yu
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Thomas A. Buchholz
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Wendy. A. Woodward
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
- Corresponding author. Address: The University of Texas M. D. Anderson Cancer Center Department of Radiation Oncology, Unit 1202, 1515 Holcombe Blvd, Houston, TX 77005, United States.

Received 16 March 2009; received in revised form 15 February 2010; accepted 17 February 2010. published online 15 March 2010.

Abstract

Purpose

To determine the rate of locoregional recurrence (LRR) associated with modern tri-modality therapy.

Methods

We retrospectively reviewed data from 291 consecutive PMRT patients treated from 1999 to 2001. These patients were compared to an historical group of 313 patients treated from 1979 to 1988 who had fluoroscopic simulation and contour-generated 2D planning. 1999–2001 spans the adoption of CT simulators for breast radiation therapy and a comparison was made between patients simulated before and after the implementation of CT simulation. Five-year actuarial rates for LRR, distal metastasis (DM), and overall survival (OS) between the pre and post CT simulation cohorts were compared as well.

Results

Compared to a 2D planned historic control, the combined contemporary patients had improved outcomes at 5years for all endpoints studied; LRR 3.0% vs. 11.5%, DM 29.2% vs. 39.2%, and OS 79.2% vs. 70.6% (p=0.0004, 0.0052, 0.0012, respectively). Significant factors in a multivariate analysis for LRR were: advanced T-stage (RR=2.14, CI=1.11–4.11, p=0.023), and percent positive nodes (RR=1.01, CI=1.00–1.02, p=0.012). The comparison of the pre and post CT-simulated PMRT patients (1999–2001) found no significant difference in any endpoint.

Conclusions

The rate of locoregional control for PMRT patients treated with modern radiotherapy is outstanding and has improved significantly compared to historical controls.

Keywords: PMRT, Post-mastectomy radiation therapy, Locoregional control, Locoregional recurrence, 3D treatment planning