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Section 2
Postmastectomy Radiation Therapy

This is a very interesting question that challenges the concept we’ve had for so many years that breast cancer is a systemic disease. While one can quibble with aspects of the Danish and British Columbia trials, it is important that the subset that seemed to benefit the most in terms of survival — small tumors with a limited number of positive nodes — is consistent with everything else we believe about aggressive local-regional therapy. 

The ongoing Intergroup trial of patients with one to three positive nodes is very important. This study is using modern radiotherapy techniques, and one would hope that the incidence of late cardiac morbidity is going to be very low. In a nonprotocol setting, we evaluate these one to three node-positive cases individually and discuss radiation therapy in patients with large nodal metastases, extracapsulary extension and large primary tumors, particularly with lots of lymphatic invasion in the breast. We also discuss this option in a woman who is very anxious to minimize her risk of failure and wants to opt for treatments that may give very little benefit. Everything we know about node-positive disease says it’s a continuum. I suspect that this will be also be true in terms of the benefits of postmastectomy radiation therapy.

—Monica Morrow, MD

SWOG-S9927: Phase III Randomized Study of Postmastectomy Radiotherapy in Women with Stage II Breast Cancer with One to Three Positive Nodes Protocol 

Eligibility  Stage II breast cancer, 1-3 nodes +

ARM 1 5 weeks XRT 
ARM 2 Observation


SELECT PUBLICATIONS

Cuzick J. Overview: Postmastectomy radiotherapy. NIH Consensus Conference on Early Breast Cancer, 2000. Abstract

Hojris I et al. Late treatment-related morbidity in breast cancer patients randomized to postmastectomy radiotherapy and systemic treatment versus systemic treatment alone. Acta Oncol 2000;39(3):355-72. Abstract

Katz A et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: Implications for postoperative irradiation. J Clin Oncol 2000;18(15):2817-27. Abstract

Lee JH. A decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy for high-risk breast cancer. Proc. ASCO 1998; Abstract 1621 

Liao Z et al. Locoregional irradiation for inflammatory breast cancer: Effectiveness of dose escalation in decreasing recurrence. Int J Radiat Oncol Biol Phys 2000;47(5):1191-200. Abstract

Metz JM et al. Analysis of outcomes for high-risk breast cancer based on interval from surgery to postmastectomy radiation therapy. Cancer J 2000;6(5):324-30. Abstract

Metz JM et al. Long-term outcome after postmastectomy radiation therapy for breast cancer patients at high risk for local-regional recurrence. Proc. ASCO 1998; Abstract 462

Pierce L. Adjuvant postmastectomy radiotherapy: Review of treatment guidelines and techniques. NIH Consensus Conference on Early Breast Cancer, 2000. Abstract

Ragaz J et al. Postmastectomy radiation (RT) outcome in node (N)-positive breast cancer patients among N 1-3 versus N4+ subset: Impact of extracapsular spread (ES). Update of the British Columbia randomized trial. Proc. ASCO 1999; Abstract 274

Recht A et al. Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001;19:1539-69. Abstract

2000 NIH Consensus Development Conference on Early Breast Cancer, Final Statement Full Text

There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy will benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary tumor…

…At this time, the role of post- mastectomy radiotherapy for women with one to three positive lymph nodes remains uncertain and is being examined in a randomized clinical trial.


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Editor’s Note

Sentinel Node Dissection:
Implications to Medical Oncology

Postmastectomy Radiation
Therapy

Ductal Carcinoma In Situ

ER/PR Results and Endocrine
Therapy

Adjuvant Therapy for Low-risk
Invasive Tumors

ATAC Trial: Arimidex vs
Tamoxifen vs Combination

Bisphosphonates in Primary
Breast Cancer 

Adjuvant Taxanes: Surgical
Oncology Perspective

Proposed IBIS 2 Prevention Trial:
Arimidex vs Tamoxifen vs Placebo

Predictions of Future Trends
in Breast Cancer Research

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