Mastectomy Scar Boost Results in Low Risk of Locoregional Recurrence in the Setting of Close or Involved Surgical Margins

Laura Johnson, Natalie Lichter, Mamie Hextall, Patricia L. Watkins, Tarek A. Dufan, John M. Watkins

c/o Bismarck Cancer Center, School of Medicine, University of North Dakota (Southwest Campus), Bismarck, USA.

DOI: 10.4236/jct.2014.52020                

Abstract

Background: Several Phase III randomized trials have demonstrated improved local control and survival for post-mastectomy radiotherapy in patients with high-risk pathologic features. Close or involved surgical margins were not included as high-risk in these protocols, but have been associated with increased risk of local failure; however, the impact of a boost dose following chestwall radiotherapy in this setting remains to be determined. Methods: Retrospective single-institution outcomes analysis for patients with close or involved surgical margins treated with post-operative radiotherapy is followed by a boost. Results: Between 2003 and 2011, 34 patients were identified for inclusion in the present study. The median chestwall dose was 5040 cGy (range 5000 - 5040) and median boost dose was 1080 cGy (900 - 1620). At a median follow-up of 38.4 months (10.2 - 115.6; with 29% more than 5 years), 28 patients were alive without evidence of recurrence, 3 were alive with recurrent disease (1 chestwall), and 3 had died (none with recurrent disease). The 3-year local control, disease-free survival, and overall survivals were 96.9%, 93.9%, and 93.1%, respectively. Conclusion: Chestwall radiotherapy plus boost results in low risk of early locoregional recurrence for women with close or involved surgical margin(s) at mastectomy. Further investigation of PMRT with or without boost in this setting is warranted.

Keywords

Breast Neoplasms; Mastectomy; Adjuvant Therapy; Radiotherapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. Zellars, “Post-Mastectomy Radiotherapy,” Clinical Advances in Hematology and Oncology, Vol. 7, 2009, pp. 533-543.
[2]	M. Overgaard, P. S. Hensen, J. Overgaard, et al., “Postoperative Radiotherapy in High-Risk Premenopausal Women with Breast Cancer Who Receive Adjuvant Chemotherapy,” The New England Journal of Medicine, Vol. 337, 1997, pp. 949-955. http://dx.doi.org/10.1056/NEJM 199710023371401
[3]	M. Overgaard, M. B. Jensen, J. Overgaard, et al., “Postoperative Radiotherapy in High-Risk Postmenopausal Breast-Cancer Patients Given Adjuvant Tamoxifen: Danish Breast Cancer Cooperative Group Dbcg 82c Randomised Trial,” Lancet, Vol. 353, No. 9165, 1999, pp. 1641-1648. http://dx.doi.org/10.1016/S0140-6736(98)09201-0
[4]	J. Ragaz, S. M. Jackson, N. Le, et al., “Adjuvant Radiotherapy and Chemotherapy in Node-Positive Premenopausal Women with Breast Cancer,” The New England Journal of Medicine, Vol. 337, 1997, pp. 956-962. http://dx.doi.org/10.1056/NEJM199710023371402
[5]	R. Jagsi, R. A. Raad, S. Goldberg, et al., “Locoregional Recurrence Rates and Prognostic Factors for Failure in Node-Negative Patients Treated with Mastectomy: Implications for Postmastectomy Radiation,” International Journal of Radiation Oncology * Biology * Physics, Vol. 62, No. 4, 2005, pp. 1035-1039. http://dx.doi.org/10.1016/j.ijrobp.2004.12.014
[6]	G. M. Freedman, B. L. Fowble, A. L. Hanlon, et al., “A Close or Positive Margin Is Not an Indication for Chest Wall Irradiation Except in Women Aged Fifty or Younger,” International Journal of Radiation Oncology * Biology * Physics, Vol. 41, No. 3, 1998, pp. 599-605. http://dx.doi.org/10.1016/S0360-3016(98)00103-5
[7]	P. T. Truong, I. A. Olivotto, C. H. Speers, et al., “A Positive Margin Is Not Always an Indication for Radiotherapy after Mastectomy in Early Breast Cancer,” International Journal of Radiation Oncology * Biology * Physics, Vol. 58, No. 3, 2004, pp. 797-804. http://dx.doi.org/10.1016/S0360-3016(03) 01626-2
[8]	P. T. Truong, M. Lesperance, A. Culhaci, et al., “Patient Subsets with T1-T2, Node-Negative Breast Cancer at High Locoregional Recurrence Risk after Mastectomy,” International Journal of Radiation Oncology * Biology * Physics, Vol. 62, No. 1, 2005, pp. 175-182. http://dx.doi.org/10.1016/j.ijrobp. 2004.09.013
[9]	H. Bartelink, J. C. Horiot, P. Poortmans, et al., “Recurrence Rates after Treatment of Breast Cancer with Standard Radiotherapy with or without Additional Radiation,” The New England Journal of Medicine, Vol. 345, 2001, pp. 1378-1387. http://dx.doi.org/10.1056/NEJMoa010874
[10]	H. Bartelink, J. C. Horiot, P. M. Poortmans, et al., “Impact of Higher Radiation Dose on Local Control and Survival in Breast-Conserving Therapy of Early Breast Cancer: 10-Year Results of the Randomized Boost versus No Boost EORTC 22881-10882 Trial,” Journal of Clinical Oncology, Vol. 25, No. 22, 2007, pp. 3259-3265. http://dx.doi.org/10.1200/JCO.2007.11.4991
[11]	P. Romestaing, Y. Lehingue, C. Carrie, et al., “Role of a 10-Gy Boost in the Conservative Treatment of Early Breast Cancer: Results of a Randomized Clinical Trial in Lyon, France,” Journal of Clinical Oncology, Vol. 15, 1997, pp. 963-968.
[12]	S. J. Feigenberg, N. P. Mendenhall, R. K. Benda and C. G. Morris, “Postmastectomy Radiotherapy: Patterns of Recurrence and Long-Term Disease Control Using Electrons,” International Journal of Radiation Oncology * Biology * Physics, Vol. 56, No. 3, 2003, pp. 716-725. http://dx.doi.org/10.1016/S0360-3016(03)00112-3
[13]	J. E. Panoff, C. Takita, J. Hurley, et al., “Higher Chest Wall Dose Results in imProved Locoregional Outcome in Patients Receiving Postmastectomy Radiation,” International Journal of Radiation Oncology * Biology * Physics, Vol. 82, No. 3, 2012, pp. 1192-1199. http://dx.doi.org/10.1016/j. ijrobp.2011.02.045
[14]	A. Chagpar, K. M. Kuerer, K. K. Hunt, E. A. Strom and T. A. Buchholz, “Outcome of Treatment for Breast Cancer Patients with Chestwall Recurrence According to Initial Stage: Implications for Post-Mastectomy Radiation Therapy,” International Journal of Radiation Oncology * Biology * Physics, Vol. 57, No. 1, 2003, pp. 128-135. http://dx.doi.org/10.1016/S0360-3016(03)00431-0
[15]	A. Rashtian, S. Iganej, I. A. Liu, et al., “Close or Positive Margins after Mastectomy for DCIS: Pattern of Relapse and Potential Indications for Radiotherapy,” International Journal of Radiation Oncology * Biology * Physics, Vol. 72, No. 4, 2008, pp. 1016-1020. http://dx.doi.org/10.1016/j.ijrobp.2008.06. 1954
[16]	S. M. Eulau and J. D. Beatty, “The Role of Adjuvant Radiotherapy after Mastectomy in Ductal Carcinoma in Situ, Breast,” International Journal of Radiation Oncology * Biology * Physics, Suppl.69, 2007
[17]	L. W. Chan, J. Rabban, S. Hwang, et al., “Is Radiation Indicated in Patients with Ductal Carcinoma in Situ and Close or Positive Mastectomy Margins?” International Journal of Radiation Oncology * Biology * Physics, Vol. 80, No. 1, 2011, pp. 25-30. http://dx.doi.org/10.1016/j.ijrobp.2008.06.1954