Abstract
Background
The applicability of modern prospective data on adjuvant radiotherapy (RT) fields
in patients with micrometastases is limited because many trials occurred prior to
routine measurement of nodal metastasis size and modern sentinel lymph node evaluation
techniques. We aimed to determine prognostic factors for patients with micrometastases
and evaluate the impact of adjuvant RT on disease outcomes.
Patients and Methods
Patients diagnosed with pathologic T1-T3 N1mi breast cancers between 2004-2015 were
identified. Cox proportional hazards methods were used to determine characteristics
predictive of locoregional recurrence (LRR). Tumor and treatment-specific factors
were further evaluated using log-rank statistics to compare rates of LRR-free survival.
Results
This analysis included 156 patients. On multivariable analysis, grade 3 histology
(HR 10.84, 95% CI 2.72-43.21) and adjuvant RT (HR 0.22, 95% CI 0.06-0.81) were independent
predictors of LRR. Among patients with grade 1-2 histology, 5-year LRR-free survival
was 98.8% in patients who received adjuvant RT versus 100% in patients who did not
receive adjuvant RT (P = .82). Among patients with grade 3 histology, 5-year LRR-free survival was 90.1%
in patients who received adjuvant RT versus 53.0% in patients who did not receive
adjuvant RT (P = .025), and 100% in patients receiving comprehensive nodal irradiation versus 76.7%
in patients receiving whole breast irradiation or no RT (P = .045).
Conclusion
Patients with grade 3 micrometastases are at substantial risk for LRR. Adjuvant RT,
including comprehensive nodal irradiation, should be strongly considered in these
women.
Keywords
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Article Info
Publication History
Published online: January 12, 2022
Accepted:
January 7,
2022
Received in revised form:
January 4,
2022
Received:
November 11,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
