Systematic review of postmastectomy radiotherapy for breast cancer patients with one to three positive lymph nodes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUMiao ¹ , CHENJin ² , DONGWei ³ , QINWenzhe ² ,  LÜQing ⁴

1. Department of Breast, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R.China;
2. Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
3. Department of Intensive Care Unit, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R.China;
4. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding author：

LÜQing, Email: lqlq1963@163.com

Keywords：

systematic review; breast cancer; postmastectomy radiotherapy; 1-3 positive lymph nodes

DOI：

10.7507/1007-9424.201605075

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Objective To evaluate the effect of postmastectomy radiotherapy(PMRT)on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio (HR) was 0.23, 95%CI (0.15, 0.37), the result showed statistical difference (P＜0.000 01), and the heterogeneity was existed (P=0.09,I²=59%). One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI (0.71, 0.93), the result showed statistical difference (P=0.002 ), and there did not existed heterogeneity (P=0.65,I²=0%). Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI (0.56, 0.90), the result showed statistical difference (P=0.005), and there did not existed heterogeneity (P=0.63,I²=0%). Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI (0.66, 0.85), the result showed statistical difference (P＜0.000 01), and there did not existed heterogeneity (P=0.49,I²=0%). Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.

Citation： YUMiao, CHENJin, DONGWei, QINWenzhe, LÜQing. Systematic review of postmastectomy radiotherapy for breast cancer patients with one to three positive lymph nodes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(1): 85-91. doi: 10.7507/1007-9424.201605075 Copy

1.	National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. www.NCCN.org/patientsVersion3.2008.
2.	Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med, 1997, 337(14): 949-955.
3.	Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol, 2007, 82(3): 247-253.
4.	Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol, 2001, 19(5): 1539-1569.
5.	Early Breast Cancer Trialists, Collaborative Group. Effects of radiotherapy and surgery in early breast cancer——An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1456.
6.	National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. www.NCCN.org/patientsVersion3.2015.
7.	Higgins JPT, Altman DG. Assessing risk of bias in included studies//Higgins JPT, Green S. Cochrane handbook for systematic reviews of intervention. Version 5.3.0 http://www.cochrane-hand book.org.
8.	Killander F, Anderson H, Rydén S, et al. Radiotherapy and tamoxifen after mastectomy in postmenopausal women——20 year follow-up of the South Sweden Breast Cancer group randomised trial SSBCG Ⅱ: Ⅰ. Eur J Cancer, 2007, 43(14): 2100-2108.
9.	Killander F, Anderson H, Rydén S, et al. Efficient reduction of loco-regional recurrences but no effect on mortality twenty years after postmastectomy radiation in premenopausal women with stage Ⅱ breast cancer-a randomized trial from the South Sweden Breast Cancer Group. Breast, 2009, 18(5): 309-315.
10.	Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet, 1999, 353(9165): 1641-1648.
11.	Ragaz J, Olivotto IA, Spinelli JJ, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst, 2005, 97(2): 116-126.
12.	唐金海. 乳腺癌综合治疗. 南京: 江苏科学技术出版社, 2008: 363.
13.	Nielsen HM, Overgaard M, Grau C, et al. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol, 2006, 24(15): 2268-2275.
14.	van der Hage JA, Putter H, Bonnema J, et al. Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer, 2003, 39(15): 2192-2199.
15.	Chitapanarux I, Tharavichitkul E, Jakrabhandu S, et al. Real-world outcomes of postmastectomy radiotherapy in breast cancer patients with 1-3 positive lymph nodes: a retrospective study. J Radiat Res, 2014, 55(1): 121-128.
16.	Fodor J, Polgár C, Major T, et al. Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size. Strahlenther Onkol, 2003, 179(3): 197-202.
17.	Macdonald SM, Abi-Raad RF, Alm El-Din MA, et al. Chest wall radiotherapy: middle ground for treatment of patients with one to three positive lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys, 2009, 75(5): 1297-1303.
18.	Whelan TJ, Olivotto I, Ackerman I, et al. NCIC-CTG MA. 20: An intergroup trial of regional nodalirradiation in early breast cancer. 2011 ASCO Annual Meeting. J Clin Oncol, 2011, 29(Suppl): abstr LBA1003.
19.	Cortazar P, Zhang JJ, Sridhara R, et al. Relationship between OS and PFS in metastatic breast cancer (MBC): Review of FDA submission data. J Clin Oncol, 2011, 29(15 Suppl): 1035.
20.	Yildirim E, Berberoglu U. Postmastectomy locoregional recurrence and distant metastasis in breast carcinoma patients. Breast, 2008, 17(4): 367-371.
21.	EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
22.	Chen X, Yu X, Chen J, et al. Radiotherapy can improve the disease-free survival rate in triple-negative breast cancer patients with T1-T2 disease and one to three positive lymph nodes after mastectomy. Oncologist, 2013, 18(2): 141-147.
23.	Yang PS, Chen CM, Liu MC, et al. Radiotherapy can decrease locoregional recurrence and increase survival in mastectomy patients with T1 to T2 breast cancer and one to three positive nodes with negative estrogen receptor and positive lymphovascular invasion status. Int J Radiat Oncol, 2010, 77(2): 516-522.
24.	Matsunuma R, Oguchi M, Fujikane T, et al. Influence of lymphatic invasion on locoregional recurrence following mastectomy: indication for postmastectomy radiotherapy for breast cancer patients with one to three positive nodes. Int J Radiat Oncol, 2012, 83(3): 845-852.
25.	Moo TA, McMillan R, Lee M, et al. Selection criteria for postmastectomy radiotherapy in T1-T2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol, 2013, 20(10): 3169-3174.

1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. www.NCCN.org/patientsVersion3.2008.
2. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med, 1997, 337(14): 949-955.
3. Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Radiother Oncol, 2007, 82(3): 247-253.
4. Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol, 2001, 19(5): 1539-1569.
5. Early Breast Cancer Trialists, Collaborative Group. Effects of radiotherapy and surgery in early breast cancer——An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1456.
6. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. www.NCCN.org/patientsVersion3.2015.
7. Higgins JPT, Altman DG. Assessing risk of bias in included studies//Higgins JPT, Green S. Cochrane handbook for systematic reviews of intervention. Version 5.3.0 http://www.cochrane-hand book.org.
8. Killander F, Anderson H, Rydén S, et al. Radiotherapy and tamoxifen after mastectomy in postmenopausal women——20 year follow-up of the South Sweden Breast Cancer group randomised trial SSBCG Ⅱ: Ⅰ. Eur J Cancer, 2007, 43(14): 2100-2108.
9. Killander F, Anderson H, Rydén S, et al. Efficient reduction of loco-regional recurrences but no effect on mortality twenty years after postmastectomy radiation in premenopausal women with stage Ⅱ breast cancer-a randomized trial from the South Sweden Breast Cancer Group. Breast, 2009, 18(5): 309-315.
10. Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet, 1999, 353(9165): 1641-1648.
11. Ragaz J, Olivotto IA, Spinelli JJ, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst, 2005, 97(2): 116-126.
12. 唐金海. 乳腺癌综合治疗. 南京: 江苏科学技术出版社, 2008: 363.
13. Nielsen HM, Overgaard M, Grau C, et al. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol, 2006, 24(15): 2268-2275.
14. van der Hage JA, Putter H, Bonnema J, et al. Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer, 2003, 39(15): 2192-2199.
15. Chitapanarux I, Tharavichitkul E, Jakrabhandu S, et al. Real-world outcomes of postmastectomy radiotherapy in breast cancer patients with 1-3 positive lymph nodes: a retrospective study. J Radiat Res, 2014, 55(1): 121-128.
16. Fodor J, Polgár C, Major T, et al. Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size. Strahlenther Onkol, 2003, 179(3): 197-202.
17. Macdonald SM, Abi-Raad RF, Alm El-Din MA, et al. Chest wall radiotherapy: middle ground for treatment of patients with one to three positive lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys, 2009, 75(5): 1297-1303.
18. Whelan TJ, Olivotto I, Ackerman I, et al. NCIC-CTG MA. 20: An intergroup trial of regional nodalirradiation in early breast cancer. 2011 ASCO Annual Meeting. J Clin Oncol, 2011, 29(Suppl): abstr LBA1003.
19. Cortazar P, Zhang JJ, Sridhara R, et al. Relationship between OS and PFS in metastatic breast cancer (MBC): Review of FDA submission data. J Clin Oncol, 2011, 29(15 Suppl): 1035.
20. Yildirim E, Berberoglu U. Postmastectomy locoregional recurrence and distant metastasis in breast carcinoma patients. Breast, 2008, 17(4): 367-371.
21. EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8 135 women in 22 randomised trials. Lancet, 2014, 383(9935): 2127-2135.
22. Chen X, Yu X, Chen J, et al. Radiotherapy can improve the disease-free survival rate in triple-negative breast cancer patients with T1-T2 disease and one to three positive lymph nodes after mastectomy. Oncologist, 2013, 18(2): 141-147.
23. Yang PS, Chen CM, Liu MC, et al. Radiotherapy can decrease locoregional recurrence and increase survival in mastectomy patients with T1 to T2 breast cancer and one to three positive nodes with negative estrogen receptor and positive lymphovascular invasion status. Int J Radiat Oncol, 2010, 77(2): 516-522.
24. Matsunuma R, Oguchi M, Fujikane T, et al. Influence of lymphatic invasion on locoregional recurrence following mastectomy: indication for postmastectomy radiotherapy for breast cancer patients with one to three positive nodes. Int J Radiat Oncol, 2012, 83(3): 845-852.
25. Moo TA, McMillan R, Lee M, et al. Selection criteria for postmastectomy radiotherapy in T1-T2 tumors with 1 to 3 positive lymph nodes. Ann Surg Oncol, 2013, 20(10): 3169-3174.

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Systematic review of postmastectomy radiotherapy for breast cancer patients with one to three positive lymph nodes

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