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2001 Longterm follow-up of axillary node positive breast cancer patients receiving adjuvant systemic therapy alone: Patterns of recurrence
I. J. Radiation Oncology 0 Biology l Physics
278
Volume 36, Number 1, Supplement, 1996
1068 A STUDY OF AXILLARY METASTASIS IN INVASIVE BREAST CANCER LESS THAN 1 CM IN DIAMETER Michael H. Hayman. M.D. East Jefferson General Hospital To determine if there is a correlation between Bloom/Richardson grading and axillary nodal status in patients with invasive PumdOblwy& breast carcinomas less than 1 cm in the greatest dimension. Materials & Methods: 130 patients with TlA/TlB invasive breast carcinoma were treated between 1988 and 19%. The axillary dissection records were retrospectively reviewed and correlated with Bloom/Richardson grading. All casesof noninvasive in situ and microinvasive cancer were excluded from the review. Patients with multifocal disease(i.e., more than one breast mass)were also excluded. 124 patients were diagnosed by mammogram alone. The remainder of the patients were diagnosed by breast self examination or physician examination of the breast. Results: There was a strong correlation between grade and axillary node statusin well, moderately, and poorly differentiated carcinoma of the breast less than 1 cm in size. In well differentiated carcinomas, the axillary metastasisrate was approximately 2.2%. in moderately differentiated carcinomas, the axillary metastasisrate was approximately 4% and in poorly differentiated carcinomas, the metastasisrate was approximately 10%. conclusion; Axillary node metastasishas a strong correlation with differentiation of tumor. The axillary node metastasisrate Seen in this modern series of mammographically diagnosed patients is much lower than many previously reported series which gave an axillary nodal metastasisrate of approximately 20%. This may be related to the high percentageof mammographically diagnosed tumors in this series. The question of whether or not axillary dissection is necessaryin this entire group of patients will be discussed.
2001 LONGTERM THERAPY
FOLLOW-UP OF AXILLARY NODE ALONE: PATTERNS OF RECURRENCE
POSITIVE
BREAST
CANCER
PATIENTS
RECEIVING
ADJUVANT
SYSTEMIC
B.J. Fisher, MD’, F.E. Perem, MD’, A.L. Cooke, MD?, A. Opeitum, MD3 ‘Department of Radiition Oncology, London Regional Cancer Centre, University of Western Ontario, London, Ontario, Canada, ‘Department of Radiition Oncology, Winnipeg Regional Cancer Centre, Wiipeg, Manitoba, Canada, ‘Department of Biostatistics, University of Western Ontario and London Regional Cancer Centre, London, Ontario, Canada Purpose: The purpose of this retrospective review is to examine the patterns of failure of 320 patients with Stage II or III axillary node positive breast cancer who received adjuvant chemothempy without locoregional radiion. Materials and Methods: The records of 735 patients who were referred to the London Regional Cancer Centre between 1980-1989 with a diagnosis of StageI1 or III breast cancer were reviewed. Three hundred and twenty patients were identified who underwent segmentalmastectomy with axillary dissectionor modified radical mastectomyand adjuvant chemotherapywithout adjuvant IocoregionaI radiation. Seventy-onepercent of thesepatients had undergone a modified radical mastectomy,40% had Tl tumors, 49% T2 and 11% T3. Resection margins were positive in 13 patients. Fifty-four percent had l-3 positive axillary nodes, 27% had 4-7 positive nodes and 19% had in excessof sevenpositive axillary nodes. Results: Median follow-up for the 320 patients was 77 months. One hundred and fourteen patients developed a l-regional recurrence as the ste of first relapse (31 in the intact breast, 29 on the chest wail, 21 in the axilla, 22 in the supmclavicular fossa, 1 in the internal mammarychain and 10 in the multiple sites)Thirty-three percent of segmental mastectomypatients and 12% of modified radical mastectomypatients developed lccal recurrence. Seven percent of patients recurred in axillary or supraclavicular nodes respectively. Factors which on univariate analysis were significant for Iocoregional recurrence.included: type of mastectomy(ie. segmental versus modified radical), size of the primary tumor, positive resection margins, and percent of ideal chemotherapy dose intensity (C66% vs > =66%). Afkr multivariate analysis, only type of mastectomy, size of the primary tumor and percent of ideal chemotherapy dose intensity retained significance. Number of positive axillary nodes was not a significant factor. Number of positive axillary nodes plus the above four clinical factors significant for IocoregionaI recurrence were analyzed in terms of regional recurrence specifically. By univariate and multivariate analysis only size of the primary tumor retained significance. Again, number of axillary nodes was not a relevant factor. Conclusions: Patients receiving adjuvant chemotherapy who are at high risk of locoregional recurrence include those who undergo segmental mastectomy, those with larger tumors (greater than 5 cm in dieter), those with positive resection margins and those who have repeated or prolonged delays in the administration of their chemotherapy. Breast or chest wall radiion is recommended for these groups. Axillary and supraclavicular recurrenceswere relatively infrequent in patients who had undergone an adequateaxilbuy dissection and therefore routine regional radiation in thesepatients was not recommended except in patients with tumors larger than 5 cm in dieter irregardless of number of positive rccilhy nodes.
278
Volume 36, Number 1, Supplement, 1996
1068 A STUDY OF AXILLARY METASTASIS IN INVASIVE BREAST CANCER LESS THAN 1 CM IN DIAMETER Michael H. Hayman. M.D. East Jefferson General Hospital To determine if there is a correlation between Bloom/Richardson grading and axillary nodal status in patients with invasive PumdOblwy& breast carcinomas less than 1 cm in the greatest dimension. Materials & Methods: 130 patients with TlA/TlB invasive breast carcinoma were treated between 1988 and 19%. The axillary dissection records were retrospectively reviewed and correlated with Bloom/Richardson grading. All casesof noninvasive in situ and microinvasive cancer were excluded from the review. Patients with multifocal disease(i.e., more than one breast mass)were also excluded. 124 patients were diagnosed by mammogram alone. The remainder of the patients were diagnosed by breast self examination or physician examination of the breast. Results: There was a strong correlation between grade and axillary node statusin well, moderately, and poorly differentiated carcinoma of the breast less than 1 cm in size. In well differentiated carcinomas, the axillary metastasisrate was approximately 2.2%. in moderately differentiated carcinomas, the axillary metastasisrate was approximately 4% and in poorly differentiated carcinomas, the metastasisrate was approximately 10%. conclusion; Axillary node metastasishas a strong correlation with differentiation of tumor. The axillary node metastasisrate Seen in this modern series of mammographically diagnosed patients is much lower than many previously reported series which gave an axillary nodal metastasisrate of approximately 20%. This may be related to the high percentageof mammographically diagnosed tumors in this series. The question of whether or not axillary dissection is necessaryin this entire group of patients will be discussed.
2001 LONGTERM THERAPY
FOLLOW-UP OF AXILLARY NODE ALONE: PATTERNS OF RECURRENCE
POSITIVE
BREAST
CANCER
PATIENTS
RECEIVING
ADJUVANT
SYSTEMIC
B.J. Fisher, MD’, F.E. Perem, MD’, A.L. Cooke, MD?, A. Opeitum, MD3 ‘Department of Radiition Oncology, London Regional Cancer Centre, University of Western Ontario, London, Ontario, Canada, ‘Department of Radiition Oncology, Winnipeg Regional Cancer Centre, Wiipeg, Manitoba, Canada, ‘Department of Biostatistics, University of Western Ontario and London Regional Cancer Centre, London, Ontario, Canada Purpose: The purpose of this retrospective review is to examine the patterns of failure of 320 patients with Stage II or III axillary node positive breast cancer who received adjuvant chemothempy without locoregional radiion. Materials and Methods: The records of 735 patients who were referred to the London Regional Cancer Centre between 1980-1989 with a diagnosis of StageI1 or III breast cancer were reviewed. Three hundred and twenty patients were identified who underwent segmentalmastectomy with axillary dissectionor modified radical mastectomyand adjuvant chemotherapywithout adjuvant IocoregionaI radiation. Seventy-onepercent of thesepatients had undergone a modified radical mastectomy,40% had Tl tumors, 49% T2 and 11% T3. Resection margins were positive in 13 patients. Fifty-four percent had l-3 positive axillary nodes, 27% had 4-7 positive nodes and 19% had in excessof sevenpositive axillary nodes. Results: Median follow-up for the 320 patients was 77 months. One hundred and fourteen patients developed a l-regional recurrence as the ste of first relapse (31 in the intact breast, 29 on the chest wail, 21 in the axilla, 22 in the supmclavicular fossa, 1 in the internal mammarychain and 10 in the multiple sites)Thirty-three percent of segmental mastectomypatients and 12% of modified radical mastectomypatients developed lccal recurrence. Seven percent of patients recurred in axillary or supraclavicular nodes respectively. Factors which on univariate analysis were significant for Iocoregional recurrence.included: type of mastectomy(ie. segmental versus modified radical), size of the primary tumor, positive resection margins, and percent of ideal chemotherapy dose intensity (C66% vs > =66%). Afkr multivariate analysis, only type of mastectomy, size of the primary tumor and percent of ideal chemotherapy dose intensity retained significance. Number of positive axillary nodes was not a significant factor. Number of positive axillary nodes plus the above four clinical factors significant for IocoregionaI recurrence were analyzed in terms of regional recurrence specifically. By univariate and multivariate analysis only size of the primary tumor retained significance. Again, number of axillary nodes was not a relevant factor. Conclusions: Patients receiving adjuvant chemotherapy who are at high risk of locoregional recurrence include those who undergo segmental mastectomy, those with larger tumors (greater than 5 cm in dieter), those with positive resection margins and those who have repeated or prolonged delays in the administration of their chemotherapy. Breast or chest wall radiion is recommended for these groups. Axillary and supraclavicular recurrenceswere relatively infrequent in patients who had undergone an adequateaxilbuy dissection and therefore routine regional radiation in thesepatients was not recommended except in patients with tumors larger than 5 cm in dieter irregardless of number of positive rccilhy nodes.