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Published in:

01-02-2007

Predicting Patients at Low Probability of Requiring Postmastectomy Radiation Therapy

Authors: Anees B. Chagpar, MD, MSc, Charles R. Scoggins, MD, Robert C. G. Martin 2nd, MD, Earl F. Cook, ScD, Terry McCurry, MD, Nana Mizuguchi, MD, Kristie J. Paris, MD, David J. Carlson, MD, Alison L. Laidley, MD, Souzan E. El-Eid, MD, Terre Q. McGlothin, MD, Kelly M. McMasters, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2007

Abstract

Background

Postmastectomy radiation therapy (PMRT) is recommended for patients with four or more positive lymph nodes (LN+). Given the ramifications of PMRT for immediate reconstruction, we sought to create a model using preoperative and intraoperative factors to predict which patients with a positive sentinel lymph node will have less than four LN+.

Methods

The database from a prospective multicenter study of 4,131 patients was used for this analysis. Patients with one to three positive sentinel lymph nodes (SLN) and tumors < 5 cm (n = 1,133) in size were randomly divided into a training set (n = 580) and a test set (n = 553). Multivariate logistic regression was used on the training set to create a prediction rule that was subsequently validated in the test set.

Results

Median patient age was 57 (range, 27–100) years, and median tumor size was 2.0 (range, 0.2–4.8) cm. In the training set, factors associated with having four or more LN+ on multivariate analysis were: tumor size [odds ratio (OR) = 2.087; 95% confidence interval (CI): 1.307–3.333, P = 0.002), number of positive SLN (P < 0.0005), and proportion of positive SLN (OR = 3.602; 95% CI: 2.100–6.179, P < 0.005). A predictive model was established with a point assigned to each positive SLN, T2 (vs. T1), and if proportion of positive SLN was > 50%, for a maximum of five points. In both the training and test sets, patients with one point had a low probability of having four or more LN+ (3.8% and 3.3%, respectively).

Conclusion

Tumor size, number of positive SLN, and the proportion of positive SLN influence whether patients will have four or more LN+. A simple model can predict the probability of requiring PMRT.

Ragaz J, Olivotto IA, Spinelli JJ, et al. Locoregional radiation therapy in patients with high risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia Randomized Trial. J Natl Cancer Inst 2005; 97:116–36PubMed

Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997; 337:949–55PubMedCrossRef

Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet 1999; 353:1641–8PubMedCrossRef

Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: Guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19:1539–69PubMed

Harris JR, Halpin-Murphy P, McNeese M, et al. Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 1999; 44:989–90PubMed

Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 2004; 114:950–60PubMedCrossRef

Tran NV, Chang DW, Gupta A, et al. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001; 108:78–82PubMedCrossRef

Tran NV, Evans GR, Kroll SS, et al. Postoperative adjuvant irradiation: effects on transverse rectus abdominis muscle flap breast reconstruction. Plast Reconstr Surg 2000; 106:313–7PubMedCrossRef

Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109:1919–24PubMedCrossRef

10.

Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 2000; 105:930–42PubMedCrossRef

11.

Vandeweyer E, Deraemaecker R. Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg 2000; 106:56–8PubMedCrossRef

12.

von Smitten K, Sundell B. The impact of adjuvant radiotherapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy for breast cancer. Eur J Surg Oncol 1992; 18:119–23

13.

Contant CME, van Geel AN, van der Holt, et al. Morbidity of immediate breast reconstruction after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol 2000; 26:344–50

14.

Buchholz TA, Strom EA, Perkins GH, McNeese MD. Controversies regarding the use of radiation after mastectomy in breast cancer. The Oncologist 2002; 7:539–46PubMedCrossRef

15.

van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 2003; 10:1140–51PubMedCrossRef

16.

Hanks SH, Lyons JA, Crowe J, et al. The acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous flap used in immediate breast reconstruction. Int J Radiation Oncology Biol Phys 2000; 47:1185–90

17.

Foster RD, Hansen SL, Esserman LJ, et al. Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease. Arch Surg 2005; 140:196–200PubMedCrossRef

18.

Styblo TM, Lewis MM, Carlson GW, et al. Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous flap. Ann Surg Oncol 1996; 3:375–80PubMedCrossRef

19.

Behnam AB, Nguyen D, Moran SL, Serletti JM. TRAM flap breast reconstruction for patients with advanced breast disease. Ann Plast Surg 2003; 50:567–71PubMedCrossRef

20.

Zimmerman RP, Mark RJ, Kim AI, et al. Radiation tolerance of transverse rectus abdominis myocutaneous free flaps used in immediate breast reconstruction. Am J Clin Oncol 1998; 21:381–5PubMedCrossRef

21.

Soong IS, Yau TK, Ho CM, et al. Postmastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of breast cancers. Clinical Oncology 2004; 16:283–9PubMedCrossRef

22.

Kronowitz SJ, Hunt KK, Kuerer HM, et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg 2004; 113:1617–28PubMedCrossRef

23.

Shahar KH, Hunt KK, Thames HD, et al. Factors predictive of having four or more positive axillary lymph nodes in patients with positive sentinel lymph nodes: implications for selection of radiation fields. Int J Radiation Oncology Biol Phys 2004; 59:1074–9CrossRef

24.

McMasters KM, Wong SL, Tuttle TM, et al. Preoperative lymphoscintigraphy for breast caner does not improve the ability to identify axillary sentinel lymph nodes. Ann Surg 2000; 231:724–31PubMedCrossRef

25.

Rivers AK, Griffith KA, Hunt KK, et al. Clinicopathologic features associated with having four or more metastatic axillary nodes in breast cancer patients with a positive sentinel lymph node. Ann Surg Oncol 2006; 13:36–44PubMedCrossRef

26.

Fisher BJ, Perera FE, Cooke AL, et al. Extracapsular axillary node extension in patients receiving adjuvant systemic therapy: an indication for radiotherapy? Int J Radiat Oncol Biol Phys 1997; 38:551–9PubMed

27.

Truong PT, Olivotto IA, Kader HA, et al. Selecting breast cancer patients with T1-T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy. Int J Radiation Oncol Biol Phys 2005; 61:1337–47

28.

Whelan T, Levine M. More evidence that locoregional radiation therapy improves survival: what should we do? J Natl Cancer Inst 2005; 97:82–4PubMedCrossRef

29.

Ceilly E, Jagsi R, Goldberg S, et al. Radiotherapy for invasive breast cancer in North America and Europe: Results of a survey. Int J Radiation Oncology Biol Phys 2005; 61:365–73

Title: Predicting Patients at Low Probability of Requiring Postmastectomy Radiation Therapy
Authors: Anees B. Chagpar, MD, MSc
Charles R. Scoggins, MD
Robert C. G. Martin 2nd, MD
Earl F. Cook, ScD
Terry McCurry, MD
Nana Mizuguchi, MD
Kristie J. Paris, MD
David J. Carlson, MD
Alison L. Laidley, MD
Souzan E. El-Eid, MD
Terre Q. McGlothin, MD
Kelly M. McMasters, MD, PhD
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9107-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predicting Patients at Low Probability of Requiring Postmastectomy Radiation Therapy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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