Radiotherapy and prognostic analysis of breast cancer patients with isolated regional recurrence after mastectomy
10.3760/cma.j.cn113030-20201127-00573
- VernacularTitle:乳腺癌全乳房切除术后单纯区域复发的放疗和预后分析
- Author:
Xuran ZHAO
1
;
Liang XUAN
;
Jun YIN
;
Yu TANG
;
Huiru SUN
;
Shikai WU
;
Hao JING
;
Hui FANG
;
Yongwen SONG
;
Jing JIN
;
Yueping LIU
;
Hua REN
;
Bo CHEN
;
Shunan QI
;
Ning LI
;
Yuan TANG
;
Ningning LU
;
Yong YANG
;
Yexiong LI
;
Bing SUN
;
Shulian WANG
Author Information
1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021
- Keywords:
Neoplasm recurrence, breast/radiotherapy;
Subsequent locoregional recurrence;
Prognosis
- From:
Chinese Journal of Radiation Oncology
2021;30(10):1030-1035
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes.Methods:Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS).Results:With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR ( P<0.001) and PFS ( P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest ( P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions ( P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%( P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions:Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.
