Matthew J Abrams1, Paul P Koffer2, David E Wazer3, Jaroslaw T Hepel4. 1. Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts. Electronic address: mabrams@tuftsmedicalcenter.org. 2. Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts. 3. Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts; Department of Radiation Oncology, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island. 4. Department of Radiation Oncology, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
Abstract
PURPOSE: Because of its rarity, there are no randomized trials investigating postmastectomy radiation therapy (PMRT) in male breast cancer. This study retrospectively examines the impact of PMRT in male breast cancer patients in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. METHODS AND MATERIALS: The SEER database 8.3.2 was queried for men ages 20+ with a diagnosis of localized or regional nonmetastatic invasive ductal/lobular carcinoma from 1998 to 2013. Included patients were treated by modified radical mastectomy (MRM), with or without adjuvant external beam radiation. Univariate and multivariate analyses evaluated predictors for PMRT use after MRM. Kaplan-Meier overall survival (OS) curves of the entire cohort and a case-matched cohort were calculated and compared by the log-rank test. Cox regression was used for multivariate survival analyses. RESULTS: A total of 1933 patients were included in the unmatched cohort. There was no difference in 5-year OS between those who received PMRT and those who did not (78% vs 77%, respectively, P=.371); however, in the case-matched analysis, PMRT was associated with improved OS at 5 years (83% vs 54%, P<.001). On subset analysis of the unmatched cohort, PMRT was associated with improved OS in men with 1 to 3 positive nodes (5-year OS 79% vs 72% P=.05) and those with 4+ positive nodes (5-year OS 73% vs 53% P<.001). On multivariate analysis of the unmatched cohort, independent predictors for improved OS were use of PMRT: HR=0.551 (0.412-0.737) and estrogen receptor-positive disease: HR=0.577 (0.339-0.983). Predictors for a survival detriment were higher grade 3/4: HR=1.825 (1.105-3.015), larger tumor T2: HR=1.783 (1.357-2.342), T3/T4: HR=2.683 (1.809-3.978), higher N-stage: N1 HR=1.574 (1.184-2.091), N2/N3: HR=2.328 (1.684-3.218), black race: HR=1.689 (1.222-2.336), and older age 81+: HR=4.164 (1.497-11.582). CONCLUSIONS: There may be a survival benefit with the addition of PMRT for male breast cancer with node-positive disease.
PURPOSE: Because of its rarity, there are no randomized trials investigating postmastectomy radiation therapy (PMRT) in male breast cancer. This study retrospectively examines the impact of PMRT in male breast cancerpatients in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. METHODS AND MATERIALS: The SEER database 8.3.2 was queried for men ages 20+ with a diagnosis of localized or regional nonmetastatic invasive ductal/lobular carcinoma from 1998 to 2013. Included patients were treated by modified radical mastectomy (MRM), with or without adjuvant external beam radiation. Univariate and multivariate analyses evaluated predictors for PMRT use after MRM. Kaplan-Meier overall survival (OS) curves of the entire cohort and a case-matched cohort were calculated and compared by the log-rank test. Cox regression was used for multivariate survival analyses. RESULTS: A total of 1933 patients were included in the unmatched cohort. There was no difference in 5-year OS between those who received PMRT and those who did not (78% vs 77%, respectively, P=.371); however, in the case-matched analysis, PMRT was associated with improved OS at 5 years (83% vs 54%, P<.001). On subset analysis of the unmatched cohort, PMRT was associated with improved OS in men with 1 to 3 positive nodes (5-year OS 79% vs 72% P=.05) and those with 4+ positive nodes (5-year OS 73% vs 53% P<.001). On multivariate analysis of the unmatched cohort, independent predictors for improved OS were use of PMRT: HR=0.551 (0.412-0.737) and estrogen receptor-positive disease: HR=0.577 (0.339-0.983). Predictors for a survival detriment were higher grade 3/4: HR=1.825 (1.105-3.015), larger tumor T2: HR=1.783 (1.357-2.342), T3/T4: HR=2.683 (1.809-3.978), higher N-stage: N1 HR=1.574 (1.184-2.091), N2/N3: HR=2.328 (1.684-3.218), black race: HR=1.689 (1.222-2.336), and older age 81+: HR=4.164 (1.497-11.582). CONCLUSIONS: There may be a survival benefit with the addition of PMRT for male breast cancer with node-positive disease.
Authors: Sarah B Bateni; Anders J Davidson; Mili Arora; Megan E Daly; Susan L Stewart; Richard J Bold; Robert J Canter; Candice A M Sauder Journal: Ann Surg Oncol Date: 2019-02-13 Impact factor: 5.344
Authors: Siddhartha Yadav; Dhauna Karam; Irbaz Bin Riaz; Hao Xie; Urshila Durani; Narjust Duma; Karthik V Giridhar; Tina J Hieken; Judy C Boughey; Robert W Mutter; John R Hawse; Rafael E Jimenez; Fergus J Couch; Roberto A Leon-Ferre; Kathryn J Ruddy Journal: Cancer Date: 2019-10-07 Impact factor: 6.860
Authors: Daniel Rolf; Khaled Elsayad; Mohamed A M Meheissen; Yasser Elkerm; Carl Opitz; Isabel Radke; Anne Bremer; Anne Hülskamp; Rasha Elsaka; Horeya M Ismail; Essam Elfaham; Abdelsalam Attia Ismail; Hazem Elmansy; Eva Wardelmann; Amr Abdelaziz Elsaid; Barbara Krause-Bergmann; Joke Tio; Hans Theodor Eich; Oliver Micke Journal: Adv Radiat Oncol Date: 2020-02-20