Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection

Naoko Fujimoto, Atsushi Amemiya, Makoto Kondo, Atsuya Takeda, Naoyuki Shigematsu

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND. The role of axillary lymph node dissection (AxD) for patients with breast carcinoma who have clinically negative lymph nodes (cN0) and undergo breast-conserving therapy has been controversial. If patients do not undergo AxD, then it is uncertain whether specific lymph node irradiation should be given. The authors compared the results obtained from patients w ho underwent AxD with the results from patients who received axillary irradiation (AxR) using one of two radiotherapy techniques. METHODS. Patients with T1-T2cN0 breast carcinoma were treated from 1983 to 2002 with either AxD (80 patients) or AxR (1134 patients received tangential-field [2-field] irradiation, and 303 patients received 3-field irradiation). The median follow-up was 161 months for the AxD group and 66 months for the AxR group (55 months for patients who received tangential-field irradiation, and 122 months for patients who received 3-field irradiation). RESULTS. One patient in the AxD group and 35 patients in the AxR group had axillary recurrences. The 10-year cumulative axillary recurrence rates were 1.3% and 4.6% for the AxD group and the AxR group, respectively (P = 0.21). For patients with T1 tumors, the 10-year overall survival rates for the two groups were 94.7% and 92.7%, respectively (P = 0.34); and, for patients with T2 tumors, the 10-year overall survival rates were 92.5% and 89.1%, respectively (P = 0.34). In the AxR group, the 5-year axillary recurrence rates were 2.5% for patients who received tangential-field irradiation and 1.7% for patients who received 3-field irradiation (P = 0.18), and the 5-year regional recurrence rates for the two groups were 4.8% and 2.4%, respectively (P = 0.048). On multivariate analysis, positive lymphovascular invasion, outer tumor location, and larger tumor size were significant risk factors for regional failure. CONCLUSIONS. For patients with cN0 breast carcinoma, AxD and AxR yielded the same overall survival rates. Most patients can be treated safely with tangential-field irradiation alone. Patients who are at increased risk of regional failure may benefit from three-field irradiation.

Original languageEnglish
Pages (from-to)2155-2163
Number of pages9
JournalCancer
Volume101
Issue number10
DOIs
Publication statusPublished - 2004 Nov 15

Fingerprint

Dissection
Radiotherapy
Lymph Nodes
Breast Neoplasms
Therapeutics
Recurrence
Survival Rate
Neoplasms
Lymph Node Excision

Keywords

  • Breast-conservation therapy
  • Clinically negative axilla
  • Lymphovascular invasion
  • Tangential-field irradiation
  • Three-field irradiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection. / Fujimoto, Naoko; Amemiya, Atsushi; Kondo, Makoto; Takeda, Atsuya; Shigematsu, Naoyuki.

In: Cancer, Vol. 101, No. 10, 15.11.2004, p. 2155-2163.

Research output: Contribution to journalArticle

Fujimoto, Naoko ; Amemiya, Atsushi ; Kondo, Makoto ; Takeda, Atsuya ; Shigematsu, Naoyuki. / Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection. In: Cancer. 2004 ; Vol. 101, No. 10. pp. 2155-2163.
@article{4461e8c8726d4596ab2fef21252fe019,
title = "Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection",
abstract = "BACKGROUND. The role of axillary lymph node dissection (AxD) for patients with breast carcinoma who have clinically negative lymph nodes (cN0) and undergo breast-conserving therapy has been controversial. If patients do not undergo AxD, then it is uncertain whether specific lymph node irradiation should be given. The authors compared the results obtained from patients w ho underwent AxD with the results from patients who received axillary irradiation (AxR) using one of two radiotherapy techniques. METHODS. Patients with T1-T2cN0 breast carcinoma were treated from 1983 to 2002 with either AxD (80 patients) or AxR (1134 patients received tangential-field [2-field] irradiation, and 303 patients received 3-field irradiation). The median follow-up was 161 months for the AxD group and 66 months for the AxR group (55 months for patients who received tangential-field irradiation, and 122 months for patients who received 3-field irradiation). RESULTS. One patient in the AxD group and 35 patients in the AxR group had axillary recurrences. The 10-year cumulative axillary recurrence rates were 1.3{\%} and 4.6{\%} for the AxD group and the AxR group, respectively (P = 0.21). For patients with T1 tumors, the 10-year overall survival rates for the two groups were 94.7{\%} and 92.7{\%}, respectively (P = 0.34); and, for patients with T2 tumors, the 10-year overall survival rates were 92.5{\%} and 89.1{\%}, respectively (P = 0.34). In the AxR group, the 5-year axillary recurrence rates were 2.5{\%} for patients who received tangential-field irradiation and 1.7{\%} for patients who received 3-field irradiation (P = 0.18), and the 5-year regional recurrence rates for the two groups were 4.8{\%} and 2.4{\%}, respectively (P = 0.048). On multivariate analysis, positive lymphovascular invasion, outer tumor location, and larger tumor size were significant risk factors for regional failure. CONCLUSIONS. For patients with cN0 breast carcinoma, AxD and AxR yielded the same overall survival rates. Most patients can be treated safely with tangential-field irradiation alone. Patients who are at increased risk of regional failure may benefit from three-field irradiation.",
keywords = "Breast-conservation therapy, Clinically negative axilla, Lymphovascular invasion, Tangential-field irradiation, Three-field irradiation",
author = "Naoko Fujimoto and Atsushi Amemiya and Makoto Kondo and Atsuya Takeda and Naoyuki Shigematsu",
year = "2004",
month = "11",
day = "15",
doi = "10.1002/cncr.20650",
language = "English",
volume = "101",
pages = "2155--2163",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "10",

}

TY - JOUR

T1 - Treatment of breast carcinoma in patients with clinically negative axillary lymph nodes using radiotherapy versus axillary dissection

AU - Fujimoto, Naoko

AU - Amemiya, Atsushi

AU - Kondo, Makoto

AU - Takeda, Atsuya

AU - Shigematsu, Naoyuki

PY - 2004/11/15

Y1 - 2004/11/15

N2 - BACKGROUND. The role of axillary lymph node dissection (AxD) for patients with breast carcinoma who have clinically negative lymph nodes (cN0) and undergo breast-conserving therapy has been controversial. If patients do not undergo AxD, then it is uncertain whether specific lymph node irradiation should be given. The authors compared the results obtained from patients w ho underwent AxD with the results from patients who received axillary irradiation (AxR) using one of two radiotherapy techniques. METHODS. Patients with T1-T2cN0 breast carcinoma were treated from 1983 to 2002 with either AxD (80 patients) or AxR (1134 patients received tangential-field [2-field] irradiation, and 303 patients received 3-field irradiation). The median follow-up was 161 months for the AxD group and 66 months for the AxR group (55 months for patients who received tangential-field irradiation, and 122 months for patients who received 3-field irradiation). RESULTS. One patient in the AxD group and 35 patients in the AxR group had axillary recurrences. The 10-year cumulative axillary recurrence rates were 1.3% and 4.6% for the AxD group and the AxR group, respectively (P = 0.21). For patients with T1 tumors, the 10-year overall survival rates for the two groups were 94.7% and 92.7%, respectively (P = 0.34); and, for patients with T2 tumors, the 10-year overall survival rates were 92.5% and 89.1%, respectively (P = 0.34). In the AxR group, the 5-year axillary recurrence rates were 2.5% for patients who received tangential-field irradiation and 1.7% for patients who received 3-field irradiation (P = 0.18), and the 5-year regional recurrence rates for the two groups were 4.8% and 2.4%, respectively (P = 0.048). On multivariate analysis, positive lymphovascular invasion, outer tumor location, and larger tumor size were significant risk factors for regional failure. CONCLUSIONS. For patients with cN0 breast carcinoma, AxD and AxR yielded the same overall survival rates. Most patients can be treated safely with tangential-field irradiation alone. Patients who are at increased risk of regional failure may benefit from three-field irradiation.

AB - BACKGROUND. The role of axillary lymph node dissection (AxD) for patients with breast carcinoma who have clinically negative lymph nodes (cN0) and undergo breast-conserving therapy has been controversial. If patients do not undergo AxD, then it is uncertain whether specific lymph node irradiation should be given. The authors compared the results obtained from patients w ho underwent AxD with the results from patients who received axillary irradiation (AxR) using one of two radiotherapy techniques. METHODS. Patients with T1-T2cN0 breast carcinoma were treated from 1983 to 2002 with either AxD (80 patients) or AxR (1134 patients received tangential-field [2-field] irradiation, and 303 patients received 3-field irradiation). The median follow-up was 161 months for the AxD group and 66 months for the AxR group (55 months for patients who received tangential-field irradiation, and 122 months for patients who received 3-field irradiation). RESULTS. One patient in the AxD group and 35 patients in the AxR group had axillary recurrences. The 10-year cumulative axillary recurrence rates were 1.3% and 4.6% for the AxD group and the AxR group, respectively (P = 0.21). For patients with T1 tumors, the 10-year overall survival rates for the two groups were 94.7% and 92.7%, respectively (P = 0.34); and, for patients with T2 tumors, the 10-year overall survival rates were 92.5% and 89.1%, respectively (P = 0.34). In the AxR group, the 5-year axillary recurrence rates were 2.5% for patients who received tangential-field irradiation and 1.7% for patients who received 3-field irradiation (P = 0.18), and the 5-year regional recurrence rates for the two groups were 4.8% and 2.4%, respectively (P = 0.048). On multivariate analysis, positive lymphovascular invasion, outer tumor location, and larger tumor size were significant risk factors for regional failure. CONCLUSIONS. For patients with cN0 breast carcinoma, AxD and AxR yielded the same overall survival rates. Most patients can be treated safely with tangential-field irradiation alone. Patients who are at increased risk of regional failure may benefit from three-field irradiation.

KW - Breast-conservation therapy

KW - Clinically negative axilla

KW - Lymphovascular invasion

KW - Tangential-field irradiation

KW - Three-field irradiation

UR - http://www.scopus.com/inward/record.url?scp=7644228346&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=7644228346&partnerID=8YFLogxK

U2 - 10.1002/cncr.20650

DO - 10.1002/cncr.20650

M3 - Article

VL - 101

SP - 2155

EP - 2163

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 10

ER -