Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy
Background and PurposeOptimal radiation target volumes for breast cancer patients with their first isolated chest wall recurrence (ICWR) after mastectomy are controversial. We aimed to analyze the regional failure patterns and to investigate the role of prophylactic regional nodal irradiation (RNI)...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-02-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2020.600525/full |
| _version_ | 1819160297585246208 |
|---|---|
| author | Xu-Ran Zhao Liang Xuan Jun Yin Yu Tang Hui-Ru Sun Hao Jing Yong-Wen Song Jing Jin Yue-Ping Liu Hui Fang Hua Ren Bo Chen Yuan Tang Ning Li Shu-Nan Qi Ning-Ning Lu Yong Yang Ye-Xiong Li Bing Sun Shi-Kai Wu Shi-Kai Wu Shu-Lian Wang |
| author_facet | Xu-Ran Zhao Liang Xuan Jun Yin Yu Tang Hui-Ru Sun Hao Jing Yong-Wen Song Jing Jin Yue-Ping Liu Hui Fang Hua Ren Bo Chen Yuan Tang Ning Li Shu-Nan Qi Ning-Ning Lu Yong Yang Ye-Xiong Li Bing Sun Shi-Kai Wu Shi-Kai Wu Shu-Lian Wang |
| author_sort | Xu-Ran Zhao |
| collection | DOAJ |
| description | Background and PurposeOptimal radiation target volumes for breast cancer patients with their first isolated chest wall recurrence (ICWR) after mastectomy are controversial. We aimed to analyze the regional failure patterns and to investigate the role of prophylactic regional nodal irradiation (RNI) for ICWR.Materials and MethodsAltogether 205 patients with ICWR after mastectomy were retrospectively analyzed. Post-recurrence progression-free survival (PFS) and overall survival (OS) rates were calculated by Kaplan-Meier method and the differences were compared with Log-rank test. Competing risk model was used to estimate the subsequent regional recurrence (sRR) and locoregional recurrence (sLRR) rates, and the differences were compared with Gray test.ResultsThe 5-year sRR rate was 25.2% with median follow-up of 88.6 months. Of the 52 patients with sRR, 30 (57.7%) recurred in the axilla, 29 (55.8%) in supraclavicular fossa (SC), and five (9.6%) in internal mammary nodes. Surgery plus radiotherapy was independently associated with better sLRR and PFS rates (p<0.001). The ICWR interval of ≤ 4 years was associated with unfavorable sRR (p=0.062), sLRR (p=0.014), PFS (p=0.001), and OS (p=0.005). Among the 157 patients who received radiotherapy after ICWR, chest wall plus RNI significantly improved PFS (p=0.004) and OS (p=0.021) compared with chest wall irradiation alone. In the 166 patients whose ICWR interval was ≤ 4 years, chest wall plus RNI provided the best PFS (p<0.001) and OS (p=0.022) compared with chest wall irradiation alone or no radiotherapy.ConclusionPatients with ICWR have a high-risk of sRR in SC and axilla. Chest wall plus RNI is recommended. |
| first_indexed | 2024-12-22T16:54:13Z |
| format | Article |
| id | doaj.art-5d69ee1b0f9d4f3e94225610614d7651 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-22T16:54:13Z |
| publishDate | 2021-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5d69ee1b0f9d4f3e94225610614d76512022-12-21T18:19:30ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-02-011010.3389/fonc.2020.600525600525Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After MastectomyXu-Ran Zhao0Liang Xuan1Jun Yin2Yu Tang3Hui-Ru Sun4Hao Jing5Yong-Wen Song6Jing Jin7Yue-Ping Liu8Hui Fang9Hua Ren10Bo Chen11Yuan Tang12Ning Li13Shu-Nan Qi14Ning-Ning Lu15Yong Yang16Ye-Xiong Li17Bing Sun18Shi-Kai Wu19Shi-Kai Wu20Shu-Lian Wang21Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, The Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, The Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiation Oncology, The Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaDepartment of Radiation Oncology, The Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaDepartment of Medical Oncology, Peking University First Hospital, Beijing, ChinaDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBackground and PurposeOptimal radiation target volumes for breast cancer patients with their first isolated chest wall recurrence (ICWR) after mastectomy are controversial. We aimed to analyze the regional failure patterns and to investigate the role of prophylactic regional nodal irradiation (RNI) for ICWR.Materials and MethodsAltogether 205 patients with ICWR after mastectomy were retrospectively analyzed. Post-recurrence progression-free survival (PFS) and overall survival (OS) rates were calculated by Kaplan-Meier method and the differences were compared with Log-rank test. Competing risk model was used to estimate the subsequent regional recurrence (sRR) and locoregional recurrence (sLRR) rates, and the differences were compared with Gray test.ResultsThe 5-year sRR rate was 25.2% with median follow-up of 88.6 months. Of the 52 patients with sRR, 30 (57.7%) recurred in the axilla, 29 (55.8%) in supraclavicular fossa (SC), and five (9.6%) in internal mammary nodes. Surgery plus radiotherapy was independently associated with better sLRR and PFS rates (p<0.001). The ICWR interval of ≤ 4 years was associated with unfavorable sRR (p=0.062), sLRR (p=0.014), PFS (p=0.001), and OS (p=0.005). Among the 157 patients who received radiotherapy after ICWR, chest wall plus RNI significantly improved PFS (p=0.004) and OS (p=0.021) compared with chest wall irradiation alone. In the 166 patients whose ICWR interval was ≤ 4 years, chest wall plus RNI provided the best PFS (p<0.001) and OS (p=0.022) compared with chest wall irradiation alone or no radiotherapy.ConclusionPatients with ICWR have a high-risk of sRR in SC and axilla. Chest wall plus RNI is recommended.https://www.frontiersin.org/articles/10.3389/fonc.2020.600525/fullbreast neoplasmchest wall recurrenceregional failure patternsradiotherapyregional nodal irradiation |
| spellingShingle | Xu-Ran Zhao Liang Xuan Jun Yin Yu Tang Hui-Ru Sun Hao Jing Yong-Wen Song Jing Jin Yue-Ping Liu Hui Fang Hua Ren Bo Chen Yuan Tang Ning Li Shu-Nan Qi Ning-Ning Lu Yong Yang Ye-Xiong Li Bing Sun Shi-Kai Wu Shi-Kai Wu Shu-Lian Wang Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy Frontiers in Oncology breast neoplasm chest wall recurrence regional failure patterns radiotherapy regional nodal irradiation |
| title | Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy |
| title_full | Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy |
| title_fullStr | Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy |
| title_full_unstemmed | Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy |
| title_short | Prognosis and Prophylactic Regional Nodal Irradiation in Breast Cancer Patients With the First Isolated Chest Wall Recurrence After Mastectomy |
| title_sort | prognosis and prophylactic regional nodal irradiation in breast cancer patients with the first isolated chest wall recurrence after mastectomy |
| topic | breast neoplasm chest wall recurrence regional failure patterns radiotherapy regional nodal irradiation |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2020.600525/full |
| work_keys_str_mv | AT xuranzhao prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT liangxuan prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT junyin prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yutang prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT huirusun prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT haojing prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yongwensong prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT jingjin prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yuepingliu prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT huifang prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT huaren prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT bochen prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yuantang prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT ningli prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT shunanqi prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT ningninglu prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yongyang prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT yexiongli prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT bingsun prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT shikaiwu prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT shikaiwu prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy AT shulianwang prognosisandprophylacticregionalnodalirradiationinbreastcancerpatientswiththefirstisolatedchestwallrecurrenceaftermastectomy |