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  • Title: Prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy.
    Author: Kim K, Chie EK, Han W, Noh DY, Oh DY, Im SA, Kim TY, Bang YJ, Ha SW.
    Journal: Am J Clin Oncol; 2010 Feb; 33(1):23-7. PubMed ID: 19704369.
    Abstract:
    OBJECTIVES: To evaluate the prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy. METHODS: Between May 1988 and April 2002, 65 breast cancer patients underwent radiotherapy as a component of salvage treatment for isolated locoregional recurrence after mastectomy. The sites of failure were as follows: chest wall in 37 patients, regional lymph nodes (LNs) in 23 patients, and combined chest wall and LNs in 5 patients. None of the patients had previously been treated with radiation. Thirty-nine patients had surgical resection, and 55 patients received systemic chemotherapy and/or hormonal therapy for recurrent disease. In 51 cases (78.5%), the chest wall and ipsilateral regional lymphatics including supraclavicular, axillary, and internal mammary LNs were irradiated. Median dose was 50.4 Gy (range: 50-71.5). Median duration of follow-up was 52 months (range: 2-206). RESULTS: The 5-year overall survival rate was 48.1%. On multivariate analysis, patients without initial nodal involvement had better overall survival (P = 0.0118). The 5-year locoregional progression-free survival rate was 69.8%, and time to recurrence (>36 months vs. < or =36 months) had an influence on the outcome with borderline significance (P = 0.0775). The 5-year distant metastasis-free survival rate was 42.1%. Lack of systemic therapy after recurrence (P = 0.0089) and age <50 years at recurrence (P = 0.0145) were significant prognostic factors predicting poor distant metastasis-free survival. CONCLUSIONS: Radiotherapy for isolated locoregional relapse after mastectomy achieved locoregional control in about two-thirds of patients. Major pattern of failure was distant relapse, and systemic therapy is warranted to prevent secondary dissemination.
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