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Postmastectomy Radiotherapy

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Advances in Breast Cancer Management

Part of the book series: Cancer Treatment and Research ((CTAR,volume 103))

Abstract

Postmastectomy radiotherapy (PMRT) clearly reduces the risk of local-regional failure (LRF) for patients with invasive breast cancer. However, for many years it has been controversial whether or not this reduction also results in decreased risks of distant failure and, ultimately, death due to cancer. This was largely because randomized trials employing PMRT without systemic therapy did not show improved survival, compared to surgery alone,1–6 with the exception of one trial.7 However, simultaneous publication in the New England Journal of Medicine in October 1997 of two trials routinely employing chemotherapy suddenly brought this debate renewed life.8,9 These studies showed that giving radiation therapy following modified radical mastectomy not only reduced LRF rates but also yielded clinically-relevant improvements in disease-free and overall survival rates.

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References

  1. Cuzick J, Stewart H, Rutqvist L, et al: Cause-specific mortality in longterm survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 12: 447–453, 1994.

    PubMed  CAS  Google Scholar 

  2. Recht A: The return (?) of postmastectomy radiotherapy (Editorial). J Clin Oncol 13: 2861–2864, 1995.

    PubMed  CAS  Google Scholar 

  3. Harris JR, Morrow M: Local management of invasive breast cancer, in Harris JR, Lippman ME, Morrow M, et al (eds): Diseases of the Breast. Philadelphia, J.B. Lippincott, 1996, pp 485–545.

    Google Scholar 

  4. Early Breast Cancer Trialists’ Collaborative Group: Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Engl J Med 333: 1444–1455, 1995.

    Article  Google Scholar 

  5. Pierce LJ, Lichter AS: Defining the role of post-mastectomy radiotherapy: the new evidence. Oncology (Huntingt) 10: 991–1002, 1996.

    CAS  Google Scholar 

  6. Fowble B: Postmastectomy radiotherapy: then and now. Oncology (Huntingt) 11: 213–239, 1997.

    CAS  Google Scholar 

  7. Arriagada R, Rutqvist LE, Mattsson A, et al: Adequate locoregional treatment for early breast cancer may prevent secondary dissemination. J Clin Oncol 13: 2869–2878, 1995.

    PubMed  CAS  Google Scholar 

  8. Overgaard M, Hansen PS, Overgaard J, et al: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337: 949–955, 1997.

    Article  PubMed  CAS  Google Scholar 

  9. Ragaz J, Jackson SM, Le N, et al: Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337: 956–962, 1997.

    Article  PubMed  CAS  Google Scholar 

  10. Recht A, Bartelink H, Fourquet A, et al: Postmastectomy radiotherapy: questions for the twenty-first century. J Clin Oncol 16: 2886–2889, 1998.

    PubMed  CAS  Google Scholar 

  11. Recht A: Local-regional failure rates in patients with involved axillary nodes following mastectomy and systemic therapy. Semin Radiat Oncol 9: 223–229, 1999.

    Article  PubMed  CAS  Google Scholar 

  12. Recht A: Postmastectomy loco-regional radiotherapy: is it here to stay? Semin Oncol 2000 (in press).

    Google Scholar 

  13. Blomqvist C, Tiusanen K, Elomaa I, et al: The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicinftorafur) and tamoxifen in Stage II breast cancer. Long-term follow-up results of a randomized trial. Br J Cancer 66: 1171–1176, 1992.

    Article  PubMed  CAS  Google Scholar 

  14. Hayat H, Brufman G, Borovik R, et al: Adjuvant chemotherapy and radiation therapy vs. chemotherapy alone for Stage II breast cancer patients (Abstr.). Ann Oncol 1 (suppl.): 21, 1990.

    Google Scholar 

  15. Griem KL, Henderson IC, Gelman R, et al: The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. J Clin Oncol 5: 1546–1555, 1987.

    PubMed  CAS  Google Scholar 

  16. Schulz K-D, Reusch K, Schmidt-Rhode P, et al: Consecutive radiation and chemotherapy in the adjuvant treatment of operable breast cancer, in Salmon SE, Jones SE (eds): Adjuvant Therapy of Cancer III. New York, Grune & Stratton, 1982, pp 411–418.

    Google Scholar 

  17. Muss HB, Cooper MR, Brockschmidt JK, et al: A randomized study of chemotherapy (L-PAM vs CMF) and irradiation for node positive breast cancer: eleven year follow-up of a Piedmont Oncology Association trial. Breast Cancer Res Treat 19: 77–84, 1991.

    Article  PubMed  CAS  Google Scholar 

  18. Klefström P, Gröhn P, Heinonen E, et al: Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in Stage III breast cancer. Cancer 60: 936–942, 1987.

    Article  PubMed  Google Scholar 

  19. Gervâsio H, Alves H, Rito A, et al: Phase III study: adjuvant chemotherapy versus adjuvant radiotherapy plus chemotherapy in women with node-positive breast cancer (Abstr.). Breast J 4 (suppl. 1): S88, 1998.

    Google Scholar 

  20. Ahmann DL, O’Fallon JR, Scanlon PW, et al: A preliminary assessment of factors associated with recurrent disease in a surgical adjuvant clinical trial for patients with breast cancer with special emphasis on the aggressiveness of therapy. Am J Clin Oncol 5: 371–381, 1982.

    Article  PubMed  CAS  Google Scholar 

  21. McArdle CS, Crawford D, Dykes EH, et al: Adjuvant radiotherapy and chemotherapy in breast cancer. Br J Surg 73: 264–266, 1986.

    Article  PubMed  CAS  Google Scholar 

  22. Vélez-Garcia E, Carpenter JT, Moore M, et al: Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a South-Eastern Cancer Study Group (SEG) trial. Eur J Cancer 28A: 1833–1837, 1992.

    Article  Google Scholar 

  23. Tennvall-Nittby L, Tenegrup I, Landberg T: The total incidence of loco-regional recurrence in a randomized trial of breast cancer TNM Stage II: the South Sweden Breast Cancer Trial. Acta Oncol 32: 641–646, 1993.

    Article  PubMed  CAS  Google Scholar 

  24. Overgaard M, Hansen PS, Overgaard J, et al: Randomized trial evaluating postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen. Results from the DBCG 82c trial (Abstr.). Radiother Oncol 48 (suppl. 1): S78, 1998.

    Google Scholar 

  25. Olson JE, Neuberg D, Pandya KJ, et al: The role of radiotherapy in the managment of operable locally advanced breast cancer: results of a randomized trial by the Eastern Cooperative Oncology Group. Cancer 79: 1138–1149, 1997.

    Article  PubMed  CAS  Google Scholar 

  26. Whelan T, Wright J, Julian J, et al: Does radiation therapy post-mastectomy improve survival? A meta-analysis (Abstr.). Breast Cancer Res Treat 50: 286, 1998.

    Google Scholar 

  27. Recht A, Hayes DF, Eberlein TJ, et al: Local-regional recurrence after mastectomy or breast-conserving therapy, in Harris JR, Lippman M, Morrow M, et al (eds): Diseases of the Breast. Philadelphia, J.B. Lippincott, 1996, pp 649–667.

    Google Scholar 

  28. Goldhirsch A, Gelber RD, Castiglione M: Relapse of breast cancer after adjuvant treatment in premenopausal and perimenopausal women: patterns and prognoses. J Clin Oncol 6: 89–97, 1988.

    PubMed  CAS  Google Scholar 

  29. Buzdar A, McNeese MD, Hortobagyi GN, et al: Is chemotherapy effective in reducing the local failure rate in patients with operable breast cancer? Cancer 65: 394–399, 1990.

    Article  PubMed  CAS  Google Scholar 

  30. Kaufmann M, Jonat W, Abel U, et al: Adjuvant randomized trials of doxorubicin/cyclophosphamide versus doxorubicin/cyclophosphamide/ tamoxifen and CMF chemotherapy versus tamoxifen in women with node-positive breast cancer. J Clin Oncol 11: 454–460, 1993.

    PubMed  CAS  Google Scholar 

  31. Chu AM, Kiel K: Comparison of adjuvant postoperative radiotherapy and multiple-drug chemotherapy (CMF-VP) in operable breast cancer patients with more than four positive axillary lymph nodes. Cancer 50: 212–218, 1982.

    Article  PubMed  CAS  Google Scholar 

  32. O’Rourke S, Galea MH, Morgan D, et al: Local recurrence after simple mastectomy. Br J Surg 81: 386–389, 1994.

    Article  PubMed  Google Scholar 

  33. Pisansky TM, Ingle JN, Schaid DJ, et al: Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Cancer 72: 1247–1260, 1993.

    Article  PubMed  CAS  Google Scholar 

  34. Bijker N, Rutgers EJT, Peters JL, et al: Modified radical mastectomy or how to achieve optimal loco-regional control in larger breast cancers (Abstr.). Eur J Surg Onco120: 258, 1994.

    Google Scholar 

  35. Stal O, Sullivan S, Wingren S, et al: c-erbB-2 expression and benefit from adjuvant chemotherapy and radiotherapy of breast cancer. Eur J Cancer 31A: 2185–2190, 1995.

    Article  Google Scholar 

  36. Zellars RC, Clark GM, Allred DC, et al: Prognostic value of p53 for local failure in mastectomy treated breast cancer patients (Abstr.). Proc Am Soc Clin Oncol 17: 104a, 1998.

    Google Scholar 

  37. Ahlborn TN, Gump FE, Bodian C, et al: Tumor to fascia margin as a factor in local recurrence after modified radical mastectomy. Surg Gynecol Obstet 166: 523–526, 1988.

    PubMed  CAS  Google Scholar 

  38. Mentzer SJ, Osteen RT, Wilson RE: Local recurrence and the deep resection margin in carcinoma of the breast. Surg Gynecol Obstet 163: 513–517, 1986.

    PubMed  CAS  Google Scholar 

  39. Freedman GM, Fowble L, Hanlon AL, et al: A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger. Int J Radiat Oncol Biol Phys 41: 599–605, 1998.

    Article  PubMed  CAS  Google Scholar 

  40. Fowble B, Gray R, Gilchrist K, et al: Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy. J Clin Oncol 6: 1107–1117, 1988.

    PubMed  CAS  Google Scholar 

  41. Sykes HF, Sim DA, Wong CJ, et al: Local-regional recurrence in breast cancer after mastectomy and adriamycin-based adjuvant chemotherapy: evaluation of the role of postoperative radiotherapy. Int J Radiat Oncol Biol Phys 16: 641–647, 1989.

    Article  PubMed  CAS  Google Scholar 

  42. Diab SG, Hilsenbeck SG, deMoor CA, et al: Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy. J Clin Oncol 16: 1655–1660, 1998.

    PubMed  CAS  Google Scholar 

  43. Recht A, Gray R, Davidson NE, et al: Local-regional failure ten years following mastectomy in patients with histologically involved axillary lymph nodes receiving adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. Submitted for publication.

    Google Scholar 

  44. Fisher B, Brown AM, Dimitrov NV, et al: Two months of doxorubicincyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B15. J Clin Oncol 8: 1483–1496, 1990.

    PubMed  CAS  Google Scholar 

  45. Budd GT, Green S, O’Bryan RM, et al: Short-course FAC-M versus 1 year of CMFVP in node-positive, hormone receptor-negative breast cancer: an Intergroup study. J Clin Oncol 13: 831–839, 1995.

    PubMed  CAS  Google Scholar 

  46. Moliterni A, Bonadonna G, Valagussa P, et al: Cyclophosphamide, methotrexate, and fluorouracil with and without doxorubicin in the adjuvant treatment of resectable breast cancer with one to three positive axillary nodes. J Clin Oncol 9: 1124–1130, 1991.

    PubMed  CAS  Google Scholar 

  47. Fisher B, Anderson S, Wickerham DL, et al: Increased intensification and total dose of cyclophosphamide in a doxorubicin-cyclophosphamide regimen for the treatment of primary breast cancer: findings from the National Surgical Adjuvant Breast and Bowel Project B-22. J Clin Oncol 15: 1858–1869, 1997.

    PubMed  CAS  Google Scholar 

  48. Castiglione M, Gelber RD, Goldhirsch A: Adjuvant systemic therapy for breast cancer in the elderly: competing causes of mortality. J Clin Oncol 8: 519–526, 1990.

    PubMed  CAS  Google Scholar 

  49. Falkson HC, Gray R, Wolberg WH, et al: Adjuvant trial of 12 cycles of CMFPT followed by observation or continuous tamoxifen versus four cycles of CMFPT in postmenopausal women with breast cancer: an Eastern Cooperative Oncology Group phase III study. J Clin Oncol 8: 599–607, 1990.

    PubMed  CAS  Google Scholar 

  50. Tormey DC, Gray R, Falkson HC: Postchemotherapy adjuvant tamoxifen beyond five years in patients with lymph node-positive breast cancer. J Natl Cancer Inst 88: 1828–1833, 1996.

    Article  PubMed  CAS  Google Scholar 

  51. Current Trials Working Party of the Cancer Research Campaign Breast Cancer Trials Group: Preliminary results from the Cancer Research Campaign trial evaluating tamoxifen duration in women aged fifty years or older with breast cancer. J Natl Cancer Inst 88: 1834–1839, 1996.

    Article  Google Scholar 

  52. Swedish Breast Cancer Cooperative Group: Randomized trial of two years versus five years of adjuvant tamoxifen for postmenopausal early stage breast cancer. J Natl Cancer Inst 88: 1543–1549, 1996.

    Article  Google Scholar 

  53. Boccardo F, Rubagotti A, Amoroso D, et al: Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, oestrogen-receptor positive breast cancer patients. An update at 7 years of the 1st GROCTA (Breast Cancer Adjuvant Chemo-hormone Therapy Cooperative Group) Trial. Eur J Cancer 28: 673–680, 1992.

    Article  PubMed  CAS  Google Scholar 

  54. Fisher B, Redmond C, Legault-Poisson S, et al: Postoperative chemotherapy and tamoxifen compared with tamoxifen alone in the treatment of positive-node breast cancer patients aged 50 years and older with tumors responsive to tamoxifen: results from the National Surgical Adjuvant Breast and Bowel Project B-16. J Clin Oncol 8: 1005–1018, 1990.

    PubMed  CAS  Google Scholar 

  55. Pritchard KI, Paterson AHG, Fine S, et al: Randomized trial of cyclophosphamide, methotrexate, and fluorouracil chemotherapy added to tamoxifen as adjuvant therapy in postmenopausal women with node-positive estrogen and/or progesterone receptor-positive breast cancer: a report of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 15: 2302–2311, 1997.

    PubMed  CAS  Google Scholar 

  56. International Breast Cancer Study Group: Late effects of adjuvant oophorectomy and chemotherapy upon premenopausal breast cancer patient. Ann Oncol 1: 30–35, 1990.

    Google Scholar 

  57. Stevin ML, Stubbs L, Plant HJ, et al: Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. Br Med J 300: 1458–1460, 1990.

    Article  Google Scholar 

  58. McQuellon R, Muss H, Hoffman S, et al: The influence of toxicity on treatment preferences of women with breast cancer (Abstr.). Proc Am Soc Clin Oncol 13: 76, 1994.

    Google Scholar 

  59. Whelan TJ, Levine MN, Gafni A, et al: Breast irradiation postlumpectomy: development and evaluation of a decision instrument. J Clin Oncol 13: 847853, 1995.

    Google Scholar 

  60. Palda VA, Llewellyn-Thomas HA, Mackenzie RG, et al: Breast cancer patients’ attitudes about rationing postlumpectomy radiation therapy: applicability of trade-off methods to policy-making. J Clin Oncol 15: 31923200, 1997.

    Google Scholar 

  61. Hayman JA, Fairclough DL, Harris JR, et al: Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer. J Clin Oncol 15: 1252–1260, 1997.

    PubMed  CAS  Google Scholar 

  62. Shapiro CL, Recht A: Late effects of adjuvant therapy for breast cancer. J Natl Cancer Inst Monogr 16: 101–112, 1994.

    PubMed  Google Scholar 

  63. Non-small Cell Lung Cancer Collaborative Group: Chemotherapy in non-small cell lung cancer: a meta-analysis of updated data on individual patients from 52 randomized clinical trials. BMJ 311: 899–909, 1995.

    Article  Google Scholar 

  64. Early Breast Cancer Trialists’ Collaborative Group: Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 351: 1451–1467, 1998.

    Article  Google Scholar 

  65. Early Breast Cancer Trialists’ Collaborative Group: Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 352: 930–942, 1998.

    Article  Google Scholar 

  66. Martinez A, Ahmann D, O’Fallon J, et al: An interim analysis of the randomized surgical adjuvant trial for patients with unfavorable breast cancer (Abstr.). Int J Radiat Oncol Biol Phys 10 (suppl. 2): 106, 1984.

    Article  Google Scholar 

  67. Schmoor C, Bastert G, Bojar H, et al: Effect of radiotherapy in addition to 6 cycles CMF in node positive breast cancer patients (Abstr.). Eur J Cancer 34 (suppl. 5): S59, 1998.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Harvard Medical School Beth Israel Deaconess Medical Center, USA

    Abram Recht MD (Associate Professor of Medicine)

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  1. Abram Recht MD
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Editors and Affiliations

  1. Breast Medical Oncology, Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical School, 676 North St. Clair Street, Suite 850, 60611-2927, Chicago, IL, USA

    William J. Gradishar M.D. (Associate Professor of Medicine, Director) (Associate Professor of Medicine, Director)

  2. Cancer Center, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road, N.E., Suite B206, 30322-1104, Atlanta, GA, USA

    William C. Wood M.D. (Joseph Brown Whitehead Professor and Chairman, Clinical Director) (Joseph Brown Whitehead Professor and Chairman, Clinical Director)

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Recht, A. (2000). Postmastectomy Radiotherapy. In: Gradishar, W.J., Wood, W.C. (eds) Advances in Breast Cancer Management. Cancer Treatment and Research, vol 103. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-3147-7_3

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  • DOI: https://doi.org/10.1007/978-1-4757-3147-7_3

  • Publisher Name: Springer, Boston, MA

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