Mastectomy without radiotherapy

Outcome analysis after 10 years of follow-up in a single institution

E. Botteri, O. Gentilini, N. Rotmensz, P. Veronesi, S. Ratini, C. Fraga-Guedes, A. Toesca, C. Sangalli, A. Del Castillo, M. Rietjens, G. Viale, R. Orecchia, A. Goldhirsch, U. Veronesi

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The aim of this study was to identify the prognostic factors associated with the risk of loco-regional recurrence (LRR) of women undergoing mastectomy and complete axillary dissection without radiotherapy. We analyzed data from 650 women operated between 1997 and 2001 in a single institution. Median follow-up was 10 years. Overall survival was 89.8 % at 5 years and 76.6 % at 10 years. The 10-year cumulative incidence of LRRs was 10.0 % (5.0, 10.5, 15.8, and 18.5 % in patients with 0, 1-3, 4-9, and ≥10 positive lymph nodes (LNs), respectively). Sixty-two (9.5 %) LRRs were observed, 5 (0.8 %) of which occurred in the axillary LNs. Supraclavicular LNs recurrences (n = 16, 2.5 %) occurred more frequently in patients with four or more positive LNs, Ki-67 ≥ 20 % or extensive peritumoral vascular invasion (PVI). At multivariable analysis, nodal status was the only prognostic factor for local events, while nodal status, Ki-67 and PVI were significant prognostic factors for recurrences in the regional LNs. Moreover, within each category of positive LNs, high values of Ki-67 and extensive PVI were associated with the highest risk of LRR while low values of Ki-67 and absence of extensive PVI were associated with the lowest risk of LRR. Women with node-negative tumors have the lowest risk of LRR and represent the group of patients that might benefit the least from radiotherapy. PVI and Ki-67 might help tailoring PMRT indications among patients with positive LNs. Finally, the very low incidence of recurrences in the axillary LNs raises questions about the inclusion of the axilla in the radiation field.

Original languageEnglish
Pages (from-to)1221-1228
Number of pages8
JournalBreast Cancer Research and Treatment
Volume134
Issue number3
DOIs
Publication statusPublished - Aug 2012

Fingerprint

Mastectomy
Radiotherapy
Lymph Nodes
Recurrence
Blood Vessels
Axilla
Incidence
Dissection
Radiation
Survival

Keywords

  • Breast cancer
  • Mastectomy
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{4603c7410531434ca2cf897129540ffa,
title = "Mastectomy without radiotherapy: Outcome analysis after 10 years of follow-up in a single institution",
abstract = "The aim of this study was to identify the prognostic factors associated with the risk of loco-regional recurrence (LRR) of women undergoing mastectomy and complete axillary dissection without radiotherapy. We analyzed data from 650 women operated between 1997 and 2001 in a single institution. Median follow-up was 10 years. Overall survival was 89.8 {\%} at 5 years and 76.6 {\%} at 10 years. The 10-year cumulative incidence of LRRs was 10.0 {\%} (5.0, 10.5, 15.8, and 18.5 {\%} in patients with 0, 1-3, 4-9, and ≥10 positive lymph nodes (LNs), respectively). Sixty-two (9.5 {\%}) LRRs were observed, 5 (0.8 {\%}) of which occurred in the axillary LNs. Supraclavicular LNs recurrences (n = 16, 2.5 {\%}) occurred more frequently in patients with four or more positive LNs, Ki-67 ≥ 20 {\%} or extensive peritumoral vascular invasion (PVI). At multivariable analysis, nodal status was the only prognostic factor for local events, while nodal status, Ki-67 and PVI were significant prognostic factors for recurrences in the regional LNs. Moreover, within each category of positive LNs, high values of Ki-67 and extensive PVI were associated with the highest risk of LRR while low values of Ki-67 and absence of extensive PVI were associated with the lowest risk of LRR. Women with node-negative tumors have the lowest risk of LRR and represent the group of patients that might benefit the least from radiotherapy. PVI and Ki-67 might help tailoring PMRT indications among patients with positive LNs. Finally, the very low incidence of recurrences in the axillary LNs raises questions about the inclusion of the axilla in the radiation field.",
keywords = "Breast cancer, Mastectomy, Radiotherapy",
author = "E. Botteri and O. Gentilini and N. Rotmensz and P. Veronesi and S. Ratini and C. Fraga-Guedes and A. Toesca and C. Sangalli and {Del Castillo}, A. and M. Rietjens and G. Viale and R. Orecchia and A. Goldhirsch and U. Veronesi",
year = "2012",
month = "8",
doi = "10.1007/s10549-012-2044-2",
language = "English",
volume = "134",
pages = "1221--1228",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York LLC",
number = "3",

}

TY - JOUR

T1 - Mastectomy without radiotherapy

T2 - Outcome analysis after 10 years of follow-up in a single institution

AU - Botteri, E.

AU - Gentilini, O.

AU - Rotmensz, N.

AU - Veronesi, P.

AU - Ratini, S.

AU - Fraga-Guedes, C.

AU - Toesca, A.

AU - Sangalli, C.

AU - Del Castillo, A.

AU - Rietjens, M.

AU - Viale, G.

AU - Orecchia, R.

AU - Goldhirsch, A.

AU - Veronesi, U.

PY - 2012/8

Y1 - 2012/8

N2 - The aim of this study was to identify the prognostic factors associated with the risk of loco-regional recurrence (LRR) of women undergoing mastectomy and complete axillary dissection without radiotherapy. We analyzed data from 650 women operated between 1997 and 2001 in a single institution. Median follow-up was 10 years. Overall survival was 89.8 % at 5 years and 76.6 % at 10 years. The 10-year cumulative incidence of LRRs was 10.0 % (5.0, 10.5, 15.8, and 18.5 % in patients with 0, 1-3, 4-9, and ≥10 positive lymph nodes (LNs), respectively). Sixty-two (9.5 %) LRRs were observed, 5 (0.8 %) of which occurred in the axillary LNs. Supraclavicular LNs recurrences (n = 16, 2.5 %) occurred more frequently in patients with four or more positive LNs, Ki-67 ≥ 20 % or extensive peritumoral vascular invasion (PVI). At multivariable analysis, nodal status was the only prognostic factor for local events, while nodal status, Ki-67 and PVI were significant prognostic factors for recurrences in the regional LNs. Moreover, within each category of positive LNs, high values of Ki-67 and extensive PVI were associated with the highest risk of LRR while low values of Ki-67 and absence of extensive PVI were associated with the lowest risk of LRR. Women with node-negative tumors have the lowest risk of LRR and represent the group of patients that might benefit the least from radiotherapy. PVI and Ki-67 might help tailoring PMRT indications among patients with positive LNs. Finally, the very low incidence of recurrences in the axillary LNs raises questions about the inclusion of the axilla in the radiation field.

AB - The aim of this study was to identify the prognostic factors associated with the risk of loco-regional recurrence (LRR) of women undergoing mastectomy and complete axillary dissection without radiotherapy. We analyzed data from 650 women operated between 1997 and 2001 in a single institution. Median follow-up was 10 years. Overall survival was 89.8 % at 5 years and 76.6 % at 10 years. The 10-year cumulative incidence of LRRs was 10.0 % (5.0, 10.5, 15.8, and 18.5 % in patients with 0, 1-3, 4-9, and ≥10 positive lymph nodes (LNs), respectively). Sixty-two (9.5 %) LRRs were observed, 5 (0.8 %) of which occurred in the axillary LNs. Supraclavicular LNs recurrences (n = 16, 2.5 %) occurred more frequently in patients with four or more positive LNs, Ki-67 ≥ 20 % or extensive peritumoral vascular invasion (PVI). At multivariable analysis, nodal status was the only prognostic factor for local events, while nodal status, Ki-67 and PVI were significant prognostic factors for recurrences in the regional LNs. Moreover, within each category of positive LNs, high values of Ki-67 and extensive PVI were associated with the highest risk of LRR while low values of Ki-67 and absence of extensive PVI were associated with the lowest risk of LRR. Women with node-negative tumors have the lowest risk of LRR and represent the group of patients that might benefit the least from radiotherapy. PVI and Ki-67 might help tailoring PMRT indications among patients with positive LNs. Finally, the very low incidence of recurrences in the axillary LNs raises questions about the inclusion of the axilla in the radiation field.

KW - Breast cancer

KW - Mastectomy

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=84868200443&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868200443&partnerID=8YFLogxK

U2 - 10.1007/s10549-012-2044-2

DO - 10.1007/s10549-012-2044-2

M3 - Article

VL - 134

SP - 1221

EP - 1228

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 3

ER -