Violaine Forissier1, Agnès Tallet2, Monique Cohen3, Jean-Marc Classe4, Fabien Reyal5, Nicolas Chopin6, Chafika Mazouni7, Pierre Gimbergues8, Emile Daraï9, Pierre Emmanuel Colombo10, Pierre Azuar11, Eric Lambaudie12, Gilles Houvenaeghel12. 1. Institut Paoli Calmettes, Department of Radiotherapy, 232 Bd Ste Marguerite, Marseille, France. Electronic address: vioforissier@gmail.com. 2. Institut Paoli Calmettes, Department of Radiotherapy, 232 Bd Ste Marguerite, Marseille, France. 3. Institut Paoli Calmettes, Department of Surgery, 232 Bd Ste Marguerite, Marseille, France. 4. Institut Rene Gauducheau, Site Hospitalier Nord, St Herblain, France. 5. Institut Curie, 26 Rue D'Ulm 75248, Paris, France. 6. Centre Léon Bérard, 28 Rue Laennec, Lyon, France. 7. Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France. 8. Centre Jean Perrin, 58 Rue Montalembert, Clermont Ferrand, France. 9. Hôpital Tenon, 4 Rue de La Chine, Paris, France. 10. ICM Val D'Aurelle, 34298 Montpellier, France. 11. Hôpital de Grasse, Chemin de Clavary, Grasse, France. 12. Institut Paoli Calmettes, Department of Surgery, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Faculté Timone, 25 Boulevard Jean Moulin, Marseille, France.
Abstract
AIM: To assess the value of post-mastectomy radiation therapy (PMRT) to breast cancer (BC) patients with no or minimal lymph node (LN) involvement. MATERIALS AND METHODS: We retrospectively analysed a French multi-centric cohort of 4283 patients treated by mastectomy and axillary dissection, with or without PMRT, between 1980 and 2013. Practices were analysed for three treatment periods (1980-1999, 2000-2005 and 2006-2013). The impact of PMRT on loco-regional recurrence (LRR), disease-free survival (DFS), BC-specific survival and overall survival was assessed in pN0-1mi patients using multivariate analyses (logistic regression and Cox model). It was subsequently assessed based on the number of clinicopathological recurrence-risk factors, generating a prognostic index (French-PMRT index), to isolate a pN0-1mi patients subgroup that might derive a benefit from PMRT. We tested the accuracy of the Cambridge-PMRT (c-PMRT) index to discriminate between patients with significantly different outcomes and the value of PMRT in each c-PMRT prognostic group. RESULTS: More than half of the pN0-1mi patients of our cohort underwent PMRT, which almost significantly improved LRR-free survival and DFS. Matching pN0-1mi patients based on the number of clinicopathologic recurrence-risk factors identified a higher risk subpopulation (≥3 recurrence-risk factors), but PMRT did not improve patient outcomes. Although the c-PMRT index had the potential to predict patient outcomes, its use did not help in making the decision of whether or not to use PMRT. CONCLUSION: We failed to isolate a subgroup of early BC patients without LN involvement suitable for PMRT, despite studying a large cohort.
AIM: To assess the value of post-mastectomy radiation therapy (PMRT) to breast cancer (BC) patients with no or minimal lymph node (LN) involvement. MATERIALS AND METHODS: We retrospectively analysed a French multi-centric cohort of 4283 patients treated by mastectomy and axillary dissection, with or without PMRT, between 1980 and 2013. Practices were analysed for three treatment periods (1980-1999, 2000-2005 and 2006-2013). The impact of PMRT on loco-regional recurrence (LRR), disease-free survival (DFS), BC-specific survival and overall survival was assessed in pN0-1mi patients using multivariate analyses (logistic regression and Cox model). It was subsequently assessed based on the number of clinicopathological recurrence-risk factors, generating a prognostic index (French-PMRT index), to isolate a pN0-1mi patients subgroup that might derive a benefit from PMRT. We tested the accuracy of the Cambridge-PMRT (c-PMRT) index to discriminate between patients with significantly different outcomes and the value of PMRT in each c-PMRT prognostic group. RESULTS: More than half of the pN0-1mi patients of our cohort underwent PMRT, which almost significantly improved LRR-free survival and DFS. Matching pN0-1mi patients based on the number of clinicopathologic recurrence-risk factors identified a higher risk subpopulation (≥3 recurrence-risk factors), but PMRT did not improve patient outcomes. Although the c-PMRT index had the potential to predict patient outcomes, its use did not help in making the decision of whether or not to use PMRT. CONCLUSION: We failed to isolate a subgroup of early BC patients without LN involvement suitable for PMRT, despite studying a large cohort.
Authors: Kyubo Kim; Jinhong Jung; Haeyoung Kim; Wonguen Jung; Kyung Hwan Shin; Ji Hyun Chang; Su Ssan Kim; Won Park; Jee Suk Chang; Yong Bae Kim; Sung Ja Ahn; Ik Jae Lee; Jong Hoon Lee; Hae Jin Park; Jihye Cha; Juree Kim; Jin Hwa Choi; Taeryool Koo; Jeanny Kwon; Jin Hee Kim; Mi Young Kim; Shin-Hyung Park; Yeon-Joo Kim Journal: Cancer Res Treat Date: 2021-08-25 Impact factor: 4.679
Authors: Mausam Patel; Chenghui Li; Julia H Aronson; Cole M Howie; Sanjay Maraboyina; Arpan V Prabhu; Thomas Kim Journal: Breast Date: 2020-03-06 Impact factor: 4.380