Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy
Xuan Liang1, Zhao Xuran2, Sun Huiru1, Yin Jun2, Tang Yu2, Jing Hao2, Fang Hui2, Song Yongwen2, Jin Jing2, Liu Yueping2, Ren Hua2, Chen Bo2, Qi Shunan2, Li Ning2, Tang Yuan2, Lu Ningning2, Yang Yong2, Wu Shikai3, Li Yexiong2, Wang Shulian2, Sun Bing1
1Department of Radiation Oncology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China; 2Department 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 100021, China; 3Department of Medical Oncology, Peking University First Hospital, Beijing 100034, China
Abstract：Objective To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence. Methods Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval oF>12 months had a lower sLR rate. Patients with recurrence interval oF>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60Gy vs.>60Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%(P=0.061) with tumor bed dose ≤60Gy and>60Gy, respectively. Conclusions Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60Gy, and it should be above 60Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
Xuan Liang,Zhao Xuran,Sun Huiru et al. Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy[J]. Chinese Journal of Radiation Oncology, 2021, 30(9): 898-902.
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