Abstract
Background and purpose
International consensus reports recommend postmastectomy radiotherapy only to patients
at high risk of a local recurrence (LR).
Materials and methods
The present analysis included 1000 out of 3083 high-risk breast cancer patients randomly
assigned to postmastectomy radiotherapy in the DBCG82 b&c trials. Tissue microarrays
had been constructed and sections stained for estrogen, progesterone and HER2 receptors.
Median potential follow-up time was 17 years. Endpoints were LR as isolated first event, breast cancer mortality and overall
mortality.
Results
Among patients randomly assigned to not receive radiotherapy, three prognostic subgroups
of LR risk were found. “The good” defined by at least four out of five favorable criteria
(⩽3 positive nodes, tumor size <2 cm, Grade 1 malignancy, estrogen or progesterone receptor positive, HER2 negative),
“the Poor” defined by at least two out of three un-favorable criteria (>3 positive
nodes, tumor size >5 cm, Grade 3 malignancy) and finally “the Intermediate” the group in between. The smallest
absolute reduction in 5-year LR probability (11%) after radiotherapy was seen for
the good prognosis group. A similar absolute reduction in 15-year breast cancer mortality
after radiotherapy (11%) was seen. The largest absolute reduction in 5-year LR probability
after radiotherapy was seen for the poor prognosis group (36%). However, this large
LR reduction did not translate into any reduction in 15-year breast cancer mortality
(0%).
Conclusion
Translation of LR reduction into breast cancer mortality reduction after postmastectomy
radiotherapy to high-risk breast cancer patients seems to be heterogeneous, with the
largest translation occurring within the good prognosis group.
Abbreviations:
CMF (cyclophosphamide methotrexate fluorouracil), CT (computer tomography), DBCG (Danish Breast Cancer Cooperative Group), DM (distant metastases), EBCTCG (Early Breast Cancer Trialists Collaborative Group), ER (estrogen receptor), PgR (progesterone receptor), LR (local recurrence), PMRT (Postmastectomy radiotherapy), TNM (tumor node metastasis)Keywords
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Article info
Publication history
Published online: May 09, 2008
Accepted:
April 28,
2008
Received in revised form:
April 28,
2008
Received:
April 26,
2008
Footnotes
☆The study was conducted on behalf of the DBCG (Danish Breast Cancer Cooperative Group).
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
